Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

CONTENTS Scientific Committee

2

Program

3

List of Topics and Presenters

7

Pre-Conference

13

Plenary

16

Symposium

20

Oral Presentation

32

Poster Presentation

38

1

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

ORGANISING COMMITTEE OF 13th FAMILY MEDICINE SCIENTIFIC CONFERENCE 2009 CHAIRMAN:

Dr Mohd Faudzi Abdullah

DEPUTY CHAIRMAN:

Dr Mohd Fozi Kamaruddin

SECRETARY:

Dr Kow Fei Ping

DEPUTY SECRETARY:

Dr Arfah Ahmad

TREASURER:

Dr Siti Aishah Johari

SCIENTIFIC COMMITTEE:

Dr Baizury Bashah Dr Rosli Omar Dr Abdul Jamil Ahmad Dr Yusmawati Mohd Yusoff

INVITATION, PROTOCOL & TECHNICAL / AUDIO-VISUAL: Dr Adlina Bakar Dr Yusnita Yusoff EXHIBITION, FINANCE & EVENTS SECRETARIATS: Dr Sri Wahyu Taher Dr Nor Azah Mohamad Nawi Dr Shakirah Ismail ACCOMODATION & HOSPITALITY:

Dr Habshoh Hat Dr Siti Khamariah Ahmad

PUBLICITY & MEDIA:

Dr Zamri Mansor Dr Mohd Hafidin Basir

SOUVENIERS & REGISTRATION:

Dr Norsiah Md Nor Dr Jamilah Abdullah Dr Fatimah Abu Bakar

SOCIAL FUNCTIONS / EVENTS CO-ORDINATORS: Dr Suzaini Mat Daud Dr Azlina Shuaib Dr Nor Hashimah Ismail TRANSPORTATIONS:

Dr Abdul Jalil Ahmad Dr Rohaizan Rodzi Dr Tang Wei Shoung

AWANA HOTEL REPRESENTATIVE:

Cik Azizah Aziz

2

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

PROGRAM Date : 6th August 2009 (Thursday) Day 1 : Pre-Conference: Best Practices in Family Medicine Registration time: 1300 - 1400 Time

Topics

States

1400 - 1415

Integrated Diabetes Centre

Negeri Sembilan

1415 - 1430

Electronic Medical Records

Wilayah Persekutuan

1430 - 1445

Cervical Cancer Screening

Kedah

1445 - 1500

Primary Care Infectious Disease Clinic

Selangor

1500 - 1515

Retinopathy Screening At Health Clinic

Terengganu

1515 - 1530

Obesity Program

Pahang

1530 - 1545

Phototherapy For NNJ At Health Clinic

Perlis

1545 - 1615

Q&A

1615 - 1630

Tea Break

1630 - 1945

Relax Social Event – ‘Jom Shopping’

1945 - 2230

Sponsored Dinner Symposium (1) – CCM

3

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

Date : 7th August 2009 (Friday) Day 2 : Conference: Primary Care – Now More Than Ever Registration time: 0730 - 0800 Time

Topics

0800 - 0900

Plenary 1 : World Health Report 2008 – Malaysian Adoption

0900 - 1000

Opening Ceremony VVIP – Booth

1000 - 1015

Tea Break

1015 - 1200

Concurrent Session: Symposium 1: WOMEN HEALTH

Symposium 2: MEN HEALTH

1a. Domestic Violence: Managing It in Your Clinic

2a. Global Disparities in Men’s Health

1b. Women Health and Gender Bias Issues

2b. Organizing Preventive Healthcare in Men

1c. Pre-Pregnancy Care

2c. The Shrinking Willies

Qs & As

Qs & As

1200 - 1430

Sponsored Lunch Symposium 1 – Boehringer Ingelhein (BI) (Friday’s Prayers)

1430 - 1530

Plenary 2 : Financing Models For Primary Health Care

1530 - 1700

Concurrent Event : Symposium 3: CHILD HEALTH

Symposium 4: GERIATRIC HEALTH

3a. Thalassaemia Update

4a. Healthy, Active and Productive Ageing

3b. Failure To Thrive – Management in Primary Care

4b. Living With Osteoporosis

3c. The Slow Learner

4c. Elderly Quality of Life Issues Qs & As

Qs & As

4

1700 - 1945

Relax Social Event – ‘Joy Ride and Eagle Feed at Sea’

1945 - 2200

Sponsored Dinner Symposium 2 – GSK

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

Date : 8th August 2009 (Saturday) Day 3 : Conference: Primary Care – Now More Than Ever Registration time: 0730 - 0800 Time

Topics

0800 - 0900

Plenary 3 : Primary Care Services In Malaysia… The Way Forward

0900 - 1000

Plenary 4 : 30 Years of Primary Care Movement: How Far Did We Achieve?

1000 - 1030

Tea Break

1030 - 1230

Concurrent Session: Symposium 5: MENTAL HEALTH

Symposium 6: REHABILITATION – PALLIATIVE CARE

5a. School Refusal

6a. Palliative Care: Management Option in Primary Care

5b. Adolescent with Depression

6b. Cardiac Rehabilitation in Primary Care

5c. Living Dangerously: Managing Adolescent High Risk Behaviors

6c. Pain Management: Approach in Primary Care Qs & As

Qs & As 1230 - 1430

Sponsored Lunch Symposium 2 – Eli Lilly

1430 - 1700

Free Papers Presentation

1700 - 1715

Tea Break

1715 - 1900

FMSA AGM

1945 - 2200

Sponsored Gala Dinner 3 – Boehringer Ingelhein (BI)

5

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

Date : 9th August 2009 (Sunday) Day 4 : Conference: Primary Care – Now More Than Ever Registration time: 0730 - 0800 Time

Topics

0800 - 0900

Sponsored Breakfast Symposium (1) – Pfizer

0900 - 1000

Plenary 5 : Role Of Family Medicine Specialist In Evidence Based Clinical Practice Guidelines

1000 - 1030

Tea Break

1030 - 1230

Concurrent Event : Symposium 7: ADDICTION MEDICINE

Symposium 8: EMERGENCY MEDICINE

7a. Methadone: Challenges & Relevance at Primary Care

8a. Obstetric Emergencies

7b. Motivating Behavior Change in Addiction Disorder

8b. Eye Emergencies

7c. Sex Addiction – Does It Exist?

8c. Pre Hospital Care

Qs & As 1230 - 1400

6

Qs & As

Plenary 6 : Family Medicine Specialist Services Last 13 Years

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

LIST OF TOPICS AND PRESENTERS PRE-CONFERENCE No

Pre Conference Topic

Speaker

Special Programme In Family Medicine 1

Integrated Diabetes Centre

Dr Mastura Ismail Family Medicine Specialist Fellow in Chronic Disease Negeri Sembilan Malaysia

2

Electronic Medical Records

Dr Zainal Fitri Zakaria Family Medicine Specialist Putrajaya Federal Territory Malaysia

3

Cervical Cancer Screening

Dr Habshoh Hat Family Medicine Specialist Kedah Malaysia

4

Primary Care Infectious Disease Clinic

Dr Salmiah Md Sharif Family Medicine Consultant Fellow in Infectious Diseases Selangor Malaysia

5

Diabetic Retinopathy Screening

Dr Kamilah Mohamad Family Medicine Specialist Terengganu Malaysia

6

Obesity Programme

Dr Adienur Ahmad Norawi Family Medicine Specialist Pahang Malaysia

7

Phototherapy For NNJ At Health Clinic

Dr Suzaini Mat Daud Family Medicine Specialist Kangar Health Office Perlis Malaysia

7

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

PLENARY

8

No

Plenary Topic

Speaker

P1

World Health Report 2008 - Malaysian Adoption

Yg Bhg Tan Sri Dato’ Seri Dr Hj Mohd Ismail bin Merican Director General of Health Ministry of Health Malaysia

P2

Financing Models For Primary Health Care

Prof Dato’ Dr Syed Mohamed Aljunid Professor of Health Economics & Senior Research Fellow United Nations University - International Institute for Global Health Malaysia

P3

Primary Care Services In Malaysia..... The Way Forward

Dr Hjh Safurah Hj Jaafar Director Family Health and Development Division Ministry of Health Malaysia

P4

30 Years Of Primary Care Movement: How Far Did We Achieve?

Dr Viroj Tangcharoensathien Director of International Health Policy Programme Ministry of Public Health Thailand

P5

Role Of Family Medicine Specialists In Evidence-based Clinical Practice Guidelines

Dr Sheamini Sivasampu Principal Assistant Director Health Technology Assessment Session Medical Development Division Ministry of Health Malaysia

P6

Family Medicine Specialist Services Last 13 Years

Dr Baizury Bashah Family Medicine Consultant Community Mental Health Kedah Malaysia

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

SYMPOSIUM No

Symposium Topic

1

Speaker S1: WOMEN HEALTH

a

Domestic Violence: Managing It In Primary Care

Dr Sajaratulnisah Othman Senior Lecturer Department of Primary Care University of Malaya Malaysia

b

Women Health And Gender Bias Issues

Assoc Prof Dr Harlina Halizah Hj Siraj Obstetrics & Gynaecology Consultant Universiti Kebangsaan Malaysia Malaysia

c

Pre Pregnancy Care

Dr Bavanandan Naidu Obstetrics & Gynaecology Consultant Consultant in Maternal Fetal Medicine Sultanah Bahiyah Hospital Kedah Malaysia

2

S2: MEN’S HEALTH a

Global Disparities In Men’s Health

Prof Dato’ Dr Tan Hui Meng Consultant Urologist Sec Gen of Asia Pacific SSAM & President of Malaysia Society of Andrology Subang Jaya Medical Centre Malaysia

b

Organizing Preventive Healthcare In Men

Assoc Prof Dr Saiful Bahari Ismail Department of Family Medicine Fellow in Male Sexual & Reproductive Health Universiti Sains Malaysia Malaysia

c

The Shrinking Willies

Prof Dato’ Dr Tan Hui Meng

9

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

No

Symposium Topic

3

S3: CHILD HEALTH a

Thalassaemia Update

Dr N Thiyagar Head of Paediatric Department Senior Consultant Paediatrician & Adolescent Medicine Specialist Sultan Abdul Halim Hospital Kedah Malaysia

b

Failure To Thrive, Are We Doing Enough?

Dr Angeline Yeoh Aing Chiee Head of Paediatric Department Senior Consultant Paediatrician Seberang Jaya Hospital Pulau Pinang Malaysia

c

The Slow Learner

Dr Lai Fong Hwa Child and Adolescent Psychiatrist Hospital Pulau Pinang Malaysia

4

10

Speaker

S4: GERIATRIC HEALTH a

Healthy, Active And Productive Ageing

Dr Zaiton Ahmad Senior Lecturer & Family Medicine Specialist Fellow in Community Geriatrics Deputy Director, Institute of Gerontology Universiti Putra Malaysia Malaysia

b

Living With Osteoporosis

Dr Lee Fatt Soon Consultant Physician & Geriatrician Head of Geriatric Unit Kuala Lumpur Hospital Malaysia

c

Elderly Quality Of Life Issues

Dr Esther Ebenezer Old Age Psychiatrist & Consultant Psychogeriatician UniKL - Royal College of Medicine Perak Malaysia

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

No

Symposium Topic

5

Speaker S5: MENTAL HEALTH

a

School Refusal

Dr Lai Fong Hwa Child and Adolescent Psychiatrist Hospital Pulau Pinang Malaysia

b

Adolescent With Depression

Dr Nazrila Hairizan Nasir Family Medicine Specialist Fellow in Adolescent Health Selangor Malaysia

c

Living Dangerously: Managing Adolescent With High Risk Behavior

Dr Iskandar Firzada Osman Family Medicine Specialist Fellow in Adolescent Health Pahang Malaysia

6

S6: REHABILITATION / PALLIATIVE MEDICINE a

Palliative Care: Management Options In Primary Care

Dr Richard Lim Boon Leong Palliative Medicine Consultant Selayang Hospital Selangor Malaysia

b

Cardiac Rehabilitation In Primary Care

Dr Shaari Mohd Yatim Rehabilitative Medicine Consultant Serdang Hospital Selangor Malaysia

c

Pain Management: Approach In Primary Care

Dr Richard Lim Boon Leong

11

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

No

Symposium Topic

7

S7: ADDICTION MEDICINE a

Methadone: Challenges And Relevance At Primary Care

Dr Norsiah Ali Family Medicine Specialist Fellow in Addictive Health Negeri Sembilan Malaysia

b

Motivating Behavioural Change In Addiction Disorder

Dr Salina Abd Aziz Consultant Psychiatrist Hospital Kuala Lumpur Malaysia

c

Sex Addiction - Does It Exist?

Dr Mohd Afandi Yusuf Universiti Sains Malaysia Kelantan Malaysia

8

12

Speaker

S8: EMERGENCY MEDICINE a

Obstetrics Emergencies

Dr Hari Ram Obstetrics & Gynaecology Consultant Hospital Tuanku Fauziah Perlis Malaysia

b

Eye Emergencies

Dr Haslina Md Ali Consultant Opthalmologist Consultant in Vitreoretinal Medicine Hospital Sultanah Bahiyah Kedah Malaysia

c

Pre-Hospital Care

Dr Adi Osman Head of A&E Department Tuanku Bainon Hospital Perak Malaysia

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

PRE-CONFERENCE PRE1: INTEGRATED DIABETES CENTRE Dr Mastura Ismail Ampangan Health Clinic, Negeri Sembilan, Malaysia. Diabetes represents one of the most common and debilitating conditions seen in primary care. Because patients’ care often involves multiple providers and because follow-up requires persistence by patients and clinicians alike, ideal outcomes are often difficult to achieve. Management of diabetes therefore offers an excellent opportunity to practice population management–a systems approach designed to ensure excellent care. Accordingly, through broad staffs’ collaboration, the Non-Communicable Disease (NCD) team developed a comprehensive approach to adult diabetes care: the Integrated Diabetes Centre (IDC). The IDC Program has three elements: an internally audit report, Clinical Practice Guidelines for Adult Diabetes Care; a set of tools for applying population management and patient empowerment concepts; and an outcomes measurement component, i.e. instruments for evaluating IDC Program impact and gathering feedback. We would like to describe the IDC Program and the processes by which it was developed. Included are specific examples of the tools and how they can be used by individual clinicians in caring for patients.

PRE2: ELECTRONIC MEDICAL RECORD IN PRIMARY CARE: STRENGTH, CHALLENGES AND OPPORTUNITY Dr Zainal Fitri Zakaria Putrajaya Health Clinic, Putrajaya, Malaysia. Electronic Medical Record (EMR) has been in use for more than 5 years in the Malaysian primary care setting (Putracare and Teleprimary Care). It started with one clinic, later extended to several pilot sites and is now ready to roll out throughout the whole country. Despite the problems and obstacles faced, the EMR has made a significant debut. It has been a useful learning experience; developing new work process flows, computer and internet skills, dealing with problematic vendors, overcoming bureaucratic hurdles, and other difficulties faced. Despite all these challenges, almost half a million data have been created yearly using EMR. The next step is to carry out data mining and analyze this data to extract meaningful information. The ACG casemix system is one of the tools available where the patient’s biodata and diagnoses can be reclassified to provide morbidity profiling, resource usage and high-risk case detection. However, how good the result strongly depends on quality data entry, which includes data completeness and data accuracy.

PRE3: CERVICAL CANCER SCREENING Dr Habshoh Hat Jeniang Health Clinic, Kedah, Malaysia. Cervical cancer is the only cancer that can be prevented by doing screening. It has a precancerous stage which can be treated and cured. Pap smear has been used world wide as a screening tool for cervical cancer. However it has some barriers in implementing the procedure as it is costly, involved many steps and procedures, involved laboratory services, time consuming, more man-power, patient’s anxiety because of the waiting time and it requires skill in colposcopy in confirming the diagnosis before treatment. Visual inspection with acetic acid (VIA) has been recognized as a screening tool comparable to pap smear. It is tried in district of Sik, Kedah as a Demonstration Project to assess the acceptability of the community to this test. It is a cheap screening test and does not require any laboratory services. It uses a 5 % acetic acid which is applied to the cervix for one minute and can give an instant result to our client while she is on the examination table. An acetowhite epithelium is recognized as a positive test. It can also be treated there and then with a cryotherapy if the facility is available. The benefit is in reducing the cost and can reduce the waiting time as well reducing defaulters and has a very high acceptance rate in the community.

13

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

PRE4: PRIMARY CARE INFECTIOUS DISEASE CLINIC Dr Salmiah Md Sharif Batu 9, Cheras Health Clinic, Selangor, Malaysia.

PRE5: DIABETIC RETINOPATHY SCREENING Dr Kamilah Mohamad Health Clinic, Terengganu, Malaysia.

PRE6: COMMUNITY LIFESTYLE INTERVENTION PROGRAM ON OBESITY CONTROL Dr Adienuar Ahmad Norawi Beserah Health Clinic, Pahang, Malaysia. Obesity has been recognized as a major growing health problem in Malaysia affecting all age groups and races. It is an important cause of ill health and results in multiple complications leading to early death. The objective of the program is to both heighten public awareness on the disease impacts as well as offering services to healthily manage the patients’ weight. This community based program initially started off in January 2005 in the form of a competition-based, weight loss program, whereby 417 selfenrolled participants were given a 6 month intervention program and followed up. The outcomes of the program were assessed for its weight loss efficacy, attitude change and quality of life. The findings from this study has been reported and presented in local journals and it pioneered a potential health management strategy to be implemented at Klinik Kesihatan level. Following this pilot project, further events were carried out on annual basis and this year it has entered its 5th season. The program has since progressed from lifestyle modification to the introduction of approved medications for obesity. More importantly it has provided insights into ways in which a community health program to be carried out focusing on client empowerment and sustainability. This pre-conference workshop on obesity offers sharing of our experience into methods in obesity intervention program to be carried out at other Klinik Kesihatan especially those interested in the areas of non-communicable disease prevention.

14

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

PRE7: NEONATAL PHOTOTHERAPY SERVICE AT ARAU HEALTH CLINIC - FIVE YEARS EXPERIENCE (2002-2006) Dr Suzaini Mat Daud, Sakimah I Arau Health Clinic, Perlis, Malaysia. Introduction: Phototherapy service at health clinic act as an alternative option for neonatal jaundice (NNJ) who meets the criteria to have this treatment other than hospital. The service has been introduced since year 2002 and situated at Alternative Birthing Center, Arau Health Clinic (HC), Perlis. Objective: To provide effective treatment as in hospital by reducing level of bilirubin constantly, to decrease percentage of referral NNJ cases to hospital and to provide a treatment which is safe, without complications and well accepted by the community. Methodology: Any NNJ cases that fulfill the criteria for admission at phototherapy Arau HC will be included. Level of bilirubin will be monitored by Serum Bilirubin Capillary (SBC) method, which was taken pre and four hours after phototherapy instituted. All cases will be reviewed at least once by medical officer and then 4 hourly by on-call nurse. Results: All 444 NNJ cases successfully been managed at Arau HC for the past five years, with the trend of admission was increasing on each year. Majority of patients only required 24 hours and less then 48 hours to bring down their SBC to the level that do not deserve photo treatment. Mean reduction for the SBC was 1.5 mgl/dL. Percentage of referral NNJ cases to hospital was reduced from 11.0 % to 0.8 %. No complications documented in all cases. Discussion: Phototherapy at health clinic is able to provide the effective treatment for low risk cases of NNJ. It also shown to reduce the referral of NNJ cases to hospital which indirectly reduced the burden of admission in pediatric ward. Proper monitoring the babies while receiving phototherapy will ensure the safety and prevent complications. Conclusion: Phototherapy at health center should be instituted at selected HC in order to improve the primary care service in Malaysia especially maternal and child health care.

15

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

PLENARY PL1: THE WORLD HEALTH REPORT 2008 – MALAYSIAN ADOPTION Tan Sri Dato’ Seri Dr Mohd Ismail Merican Director General, Ministry of Health, Malaysia. The World Health Report 2008 entitled ‘Primary Care, Now More Than Ever’ looks into progress, achievements and failures of countries, including Malaysia, in providing health for all. It is in conjunction with the 30th anniversary of Alma-Ata International Conference in Primary Health Care, which enshrined the principles of health equity. However after 30 years, there are still health inequities between and within countries. Malaysia is among the countries that have shown commitment to improve, yielding better results than many others. Recognising areas for further improvements, there are suggested health care reforms that countries including Malaysia can adopt and/or adapt. These health care reforms are in the areas of universal coverage, service delivery, public policy and leadership. In the area of coverage, Malaysia has made it possible with heavily subsidised government health services from primary to tertiary care. In the private sector, a government regulatory body, C-KAPS, helps monitor the charges imposed on the service users. The National Health Financing System has been keenly implied towards future plan. There are variations in the service delivery rendered to the population, to better adapt to the local needs, each with its own strengths and weaknesses. This paper also looks into the policies available and suggested; among others, making primary care financially competitive with equal opportunities as that of specialization. Leadership reform is towards enhancing better engagement with other stakeholders, within and between agencies. Keywords: health equity, health reforms, Malaysian adoption

PL2: FINANCING MODELS FOR PRIMARY HEALTH CARE Prof Dato’ Dr Syed Mohamed Aljunid Professor of Health Economics and Senior Research Fellow, United Nations University-International Institute for Global Health, Malaysia. Universal coverage is a noble goal for healthcare systems of all countries in the world. Primary health care is the minimum health services that should be made accessible and affordable in the context of universal coverage. Despite vigorous efforts by counties to improve access to essential healthcare services, it is estimated that currently at least 1.3 billion people mostly from low income group still do not have access to effective and affordable drugs, surgeries and other necessary health interventions due to weaknesses in health financing. With the recent global economic crisis, financing for health services is likely to be effected adversely. In most developing countries, primary health care are funded through tax-based system. The ability for developing countries to raise adequate resources for healthcare through taxation is quite limited. Over emphasis on indirect tax such as on trade or sales tax, rather than direct taxes such as on income and property tax is a major flaw in taxation system in many developing nations. Capacity to mobilize resources through indirect taxation is affected especially with the reduction in tariff often as a result of bilateral, regional or world trade negotiations with high and middle income countries. Tax avoidance with the use of offshore financial centers further reduces the amount of resources that can be raised for primary healthcare. It is estimated that the value of personal assets in offshore financial centers ranges between US 8 trillion US 11.5 trillion. Annually developing countries loss about US 50 billion in revenue due to this mechanism of tax avoidance. Social insurance scheme is the next common method of financing primary healthcare. However three aspects of social insurance scheme i.e. revenue collections, pooling of risks and purchasing of services should be strengthened. Mechanisms to ensure that the poor are being exempted while those in informal sector who can afford contribute to the pool of resources should be developed and properly implemented. Pooling of resources through cross subsidy to cover the non-insured and risk equalization rules to ensure sustainability of social insurance scheme with high risk groups are among important issues that should be handled with care to ensure viability. Ability to pay and not willingness to pay should be given greater emphasis in running of social insurance scheme so that contributions to the scheme are based on income and not on risk. Capacity for social insurance scheme operators

16

Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/ to use efficient tools to purchase services from public and private providers should be enhanced. Case-payment and global budget which is proven to be more efficient and does not promote moral hazards should be the main methods of reimbursement of providers. In conclusions, primary healthcare is the main pillar in achieving universal coverage and equity in health. Taxation system and social insurance schemes are two main prepayment methods of financing primary health care services. Developing countries should take necessary steps to address the weaknesses and sustain the strong elements in these methods of financing to ensure long term efficiency and sustainability.

PL3: PRIMARY CARE SERVICES IN MALAYSIA.....THE WAY FORWARD Dr Hjh Safurah Hj Jaafar Director, Family Health and Development Division, Ministry of Health, Malaysia. The Malaysian government has made serious commitment towards achieving the Mid Development Goals. This is demonstrated by making some of the indicators in MDG 4, 5 and 6 as corporate performance key indicators for the Secretary General and Director General of Malaysia starting last year, 2008. The continuous improvements of our performance on the immunization coverage, reduction in mortalities and prevalence of HIV have contributed to the 5-star award for the DG of Health together with the other 4, as top-5 institutions for 2008. The situation however now becomes more challenging. How do we maintain and continuously improve those indicators! The greatest challenge in the list is the maternal mortality graph which is not going to show a cliff plunge but remained rippling wave for the last 10 years, our contraceptive prevalence have yet to cover those unmet needs adequately, the feminization of HIV is sending flags of alerts whilst chronic diseases are eating up greater chunk of the primary care budget. How do we move forward? One of the strategies we have embarked on, amongst others is the Reviewed Approach in Primary Health Care, the principle of which, is, moving away from selective to comprehensive in approach that is from silos of activities to greater integration of the various activities within the public primary health care clinics. The idea is to provide more holistic, coordinated individual’s care placing the patient in the centre and not the program or the disease. Universal access is one of the key drivers in PHC and we uphold to that undertaking. All clinics are expected to develop their services more comprehensively, with various programs put together, so that the spread across many clinics with these services can be benefited by the larger good of population. Whilst doing that the “Wellness “approach that has been embedded in the process is looking for risks amongst the various age groups. The idea is to provide preventive strategies that focus on shifting the entire distribution of the risk factor so that we can further prevent more diseases than would the case be if only the high risk groups are targeted. So in short we are starting to look at pre-high risk cases, using clinical, biomedical and social parameters. Service delivery points for primary care continue to be made more accessible by land water or air, but what’s more challenging is to provide and ensure quality and uninterrupted care. The acceptance level of our primary care services in fact is growing and this is demonstrated by the exponential volume of attendance over the last 7 years. Though attempts to increase human resources in particular have been aggressive, it still cannot match the growing expectations of both the people and the moving targets that we want to achieve. Hence the need to optimally use the private general practitioners clinics which are twice the number of public clinics and seven times more the number of doctors, needs to be brought in to similarly provide the key packages of care. We are in the early stage in developing some common standards of care as well as the training curriculum. We hope to witness the greater integration between private and public in primary care paving towards greater universality, equity and solidarity.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

PL4: 30 YEARS OF PRIMARY CARE MOVEMENT: HOW FAR DID WE ACHIEVE? R Jon1, C Simon2, C Mickey3, T Viroj4, B Robert5, AB Zulfiqar6, EL Joy7 1BRAC University, Dhaka, Bangladesh; 2London School of Hygiene and Tropical Med, London, UK; 3Health Systems Research Unit, Cape Town, South Africa; 4IHPP, Ministry of Public Health, Bangkok, Thailand; 5Johns Hopkins Bloomberg School of PH, Baltimore, USA; 6Aga Khan University, Karachi, Pakistan; 7Institute of Child Health, London, United Kingdom. We assessed progress for primary health care in countries since Alma-Ata. First we analysed life expectancy relative to national income and HIV prevalence to identify overachieving and underachieving countries. Then we focused on the 30 low-income and middle-income countries with the highest average yearly reduction of mortality among children less than 5 years of age, describing coverage and equity of primary health care as well as non-health sector actions. These 30 countries have scaled up selective primary health care (e.g. immunisation, family planning), and 14 have progressed to comprehensive primary health care, marked by high coverage of skilled attendance at birth. Good governance and progress in non-health sectors are seen in almost all of the 14 countries identified with a comprehensive primary health care system. However, these 30 countries include those that are making progress despite very low income per person, political instability, and high HIV/AIDS prevalence. Thailand has the highest average yearly reduction in mortality among children less than 5 years of age (8·5%) and has achieved universal coverage of immunisation and skilled birth attendance, with low inequity. Lessons learned from all these countries include the need for a nationally agreed package of prioritised and phased primary health care that all stakeholders are committed to implementing, attention to district management systems, and consistent investment in primary health-care extension workers linked to the health system. More detailed analysis and evaluation within and across countries would be invaluable in guiding investments for primary health care, and expediting progress towards the Millennium Development Goals and “health for all”.

PL5: ROLE OF FAMILY MEDICINE SPECIALIST IN EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES Dr Sheamini Sivasampu Principal Assistant Director, Health Technology Assessment, Medical Development Division, Ministry of Health, Malaysia. Clinical Practice Guidelines (CPG) was introduced to decrease practice variation amongst health care professionals and eliminate inappropriate care aimed at apart from improving quality of care, also at curbing a rise in the health care costs. The other benefit of the CPG is it helps to keep healthcare professionals abreast with the current knowledge and practices in their respective field despite their hectic schedule. While guidelines have been around for about 40 years worldwide, in Malaysia it began to be developed since 1992. Initially there were in the form of consensus statements. These guidelines were drawn by a group of specialist meant for the primary care providers however with no primary care involvement. With the emergence of evidence –based CPG, due emphasis has been placed on the involvement of all relevant stakeholders involved in the management of the condition. The Malaysian Health Technology Assessment Section (MaHTAS) has mandated that all CPG being developed by the Ministry of Health should have at least one family medicine specialist (FMS) representative within the development group. The FMS plays an active role in all aspects of the development process of the CPG. Together with the rest of members, recommendations will be drawn not only based on the evidence but more importantly it must be feasible in the Malaysian health care context. A minimum of 6 CPG are being approved every year. The challenge faced by the FMS is now to implement these guidelines in their work place. In spite of your already existing heavy workload, how do you then find the time to read and train their staff based on these CPG? As most of the CPG are meant for the primary care, it is imperative that the FMS translates the recommendations into practice in their facilities.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

PL6: FAMILY MEDICINE SPECIALIST SERVICES LAST 13 YEARS Dr Baizury Bashah Family Medicine Consultant, Bandar Alor Setar Health Clinic, Kedah, Malaysia. This year celebrates the 13th year of Family Medicine Specialists’ (FMS) existence in the Ministry of Health Malaysia (MoH). From a humble beginning of 6 FMS, scattered sparsely throughout Malaysia, this specialty flourishes by leaps & bounds and to date there are almost 200 FMS all around Malaysia; in MoH, Ministry of Higher Education and in private sector. With it brought a new era of primary care services. FMS, rendering comprehensive, holistic care in the community coupled with the upgrading of equipments, drugs, human resource, transforms basic, conventional care of maternal and child health (MCH), out-patient and school health, into a dynamic, progressive, expanded and extended care made available at first point of contact, to the population near their homes. These services on the one hand, emphasize the importance of primary and secondary prevention, and on the other hand, introduce rehabilitative services, completing the whole spectrum of patient care. With the presence of FMS, many new programmes are introduced. To name a few, child & adolescent health, community mental health, ‘warga emas’, methadone maintenance therapy, needle and syringe exchange, psychosocial rehabilitation and community based rehabilitation. Selected centres with FMS are given the opportunities to pilot specific programmes like Call-recall system for PAP smear and Visual Inspection with Acetic Acid (VIA). Other than highlighting the services rendered by FMS, this paper also takes us on the 13-year-journey of initial struggle, frustration and hardship of gaining recognition and identity, to making an impact on the health status of the community. The vast opportunities that await, alongside old, unresolved and new, trying issues, are challenges to be dealt with.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

SYMPOSIUM Symposium 1: WOMEN HEALTH S1a: DOMESTIC VIOLENCE: MANAGING IT IN YOUR CLINIC Dr Sajaratulnisah Othman Senior Lecturer & Family Medicine Specialist, Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia. Domestic violence or otherwise known as intimate partner violence is no longer accepted as a private matter but as a serious public health problem. It is a systematic pattern of abusive behaviors, occurring over a period of time that may become more frequent and severe. The abusive acts are done for the purpose of control, domination and/or coercion. Victims of domestic violence suffer immediate and long-term consequences of domestic violence; both in physical and psychological forms. These victims have been reported as frequent attendees to health care facilities. Health care providers have an important role to play in the intervention of domestic violence. This presentation will discuss intervention of domestic violence in health care setting, specifically in primary care. There will be discussion on the definition of domestic violence and how it overlaps with other types of interpersonal violence; an overview of domestic violence prevalence and on the burden of the problem. The role of health care providers at various levels will be discussed in greater depth according to recent recommendations for domestic violence intervention.

S1b: WOMEN HEALTH AND GENDER BIAS ISSUES Assoc Prof Dr Harlina Halizah Hj Siraj Obstetrics & Gynaecology Consultant, Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia, Cheras, Malaysia. Around the world, there are significant differences between men’s and women’s health. The interplay of biology and culture, nature and nurture brings about these differences, which should be addressed in order to ensure better healthcare for everyone in the society. In these context, the term ‘sex’ and ‘gender’ are often confused. Sex basically refers to the biological differences between men and women, while gender refers to the socially and culturally prescribed roles of men and women. Both sex and gender play important functions in health. Either acting independently or closely interacting, sex and gender bring about different disease patterns between men and women. Gender bias results in inequalities of health conditions among men and women. Numerous researches found that men’s and women’s biology have more influences on the onset as well as progression of diseases than gender. However, gender differences within the society determines whether men and women recognize their symptoms and act on them, as well as their health-seeking behaviours and compliance to treatment. Women experience morbidity as well as mortality from diseases unique to them, which are always related to reproduction such as maternal mortality, birth – related injuries and incontinence. Women also experience other health problems that have no biological cause but arise entirely from gender bias, such as domestic as well as sexual violence, genital mutilation and honour killing. This paper intends to elaborate on the issues, as well as providing some strategic interventions involving aspects of not only biological, but also cognitive, psychological as well as spiritual approaches to facilitate healthcare providers with appropriate tools in handling gender bias issues in their daily practices.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

S1c: PRE-PREGNANCY CARE Dr Bavanandan Naidu Obstetrics & Gynaecology Consultant, Maternal Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia. Pre pregnancy care is not a new concept – reference to the importance of a mother’s health in improving pregnancy outcomes is found in documents hundreds of years old. In 1825, William Potts Dewees stated that ‘The physical treatment of children should begin as far as may be practicable, with the earliest formation of the embryo; it will, therefore, necessarily involve the conduct of the mother, even before her marriage, as well as during her pregnancy’. In recent years, pre pregnancy care was first described by Chamberlain in1980 as a specialty service for women who had a previous poor reproductive outcome. The goal of pre pregnancy care is to promote the health of women of reproductive age before conception and thereby improve pregnancy-related outcomes. Today, there is ample scientific evidence that an array of interventions before pregnancy can improve pregnancy outcomes. There are several interventions which have scientific evidence for improving pregnancy outcome if implemented before pregnancy or early in pregnancy: • Folic acid supplements - Reduces occurrence of neural tube defects by two thirds. • Rubella vaccination - Provides protection against congenital rubella syndrome. • Diabetes management - Substantially reduces the threefold increase in prevalence of birth defects among infants of diabetic women. • Hypothyroidism management - Adjusting levothyroxine dosage early in pregnancy protects proper neurological development. • Hepatitis B vaccination for at risk women of reproductive age - Prevents transmission of infection to infants and eliminates the risks to the woman of hepatic failure, liver carcinoma, cirrhosis, and death due to HBV infection. • HIV/AIDS screening and treatment - Allows for timely treatment and provides women (or couples) with additional information that can influence the timing of pregnancy and treatment. • STD screening and treatment - Reduces the risk of ectopic pregnancy, infertility, and chronic pelvic pain associated with Chlamydia trachomatis and Neisseria gonorrhoea, and also reduces the possible risk to a fetus of fetal death or physical and developmental disabilities, including mental retardation and blindness. • Oral anticoagulant use management - Switching women off teratogenic anticoagulants (i.e. warfarin) before pregnancy avoids harmful exposure. • Antiepileptic drug use management - Changing to a less teratogenic treatment regimen reduces harmful exposure. • Smoking cessation counseling - Completing smoking cessation before pregnancy can prevent smoking associated preterm birth, low birth weight and other adverse perinatal outcomes. • Eliminating alcohol use - Controlling alcohol binge drinking and/or frequent drinking before pregnancy prevents fetal alcohol syndrome and other alcohol-related birth defects. • Obesity control - Reaching a healthy weight before pregnancy reduces the risks of neural tube defects, preterm delivery, diabetes, Caesarean section, and hypertensive and thrombo-embolic disease that are associated with obesity. Although pre pregnancy care has been recommended for many years, today, most providers do not provide pre pregnancy care. There is substantial evidence that pre pregnancy care should become a standard of care to improve women’s health as well as maternal and infant pregnancy outcomes. The time for a national discussion about how to better incorporate pre pregnancy care into our health systems is long overdue. The need to define the content of pre pregnancy care in the realms of clinical care, public health, and consumer awareness is clear. Equally needed is a national strategy to promote the necessary research, demonstration programs, and community-based implementation that will make this care part of the fabric of healthcare in this country.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

Symposium 2: MEN’S HEALTH S2a: GLOBAL DISPARITIES IN MEN’S HEALTH Prof Dato’ Dr Tan Hui Meng Consultant Urologist Subang Jaya Medical Centre, Subang Jaya; Adjunct Professor, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Despite the enormous progress in public health and the advances of modern treatment approaches, men consistently suffer more serious illness than women and die at an earlier age. Is this mainly due to biological differences? Female life expectancy in Russia is more than 13 years greater than male life expectancies whereas in Japan the difference is only about 4 years. Biology alone cannot account for this. Male life expectancy also varies consistently between countries and regions. Within each country, the differences in life expectancies are also noted among different groups of men and different ethnic origin. Attributable factor include educational and economic status as well as differences in socio-cultural habits, lifestyle and psycho-behavioral attitudes towards health and diseases. These differences in health and disease status of different cohort of men are seen within cities and between regions throughout the world. The facts also underscore that non-biological factors are extremely important determinants of male mortality and morbidity. As non-biological factors are not fixed, external factors and interventions can greatly influence the outcome. Stakeholders and policy makers should address the universal facts and knowledge that men take less effective care of their personal health, men tend to use health services less frequently and men delay in seeking help often till the medical problems are in advanced stage. Men, by and large, are less knowledgeable about personal health than women and they are less likely to seek medical consultations. It is also true that men take more health risk than women both in their work place as well as during their leisure time or lifestyles. Globally, there is an urgent need to improve men’s health to sustain economic development, to control healthcare cost and to meet the high expectation of a ‘good life’ in their graying or preferably called the ‘golden’ years. Strategies to improve men’s health will need input from governmental bodies, NGO’s as well as the health care professionals. Among the many international movements in advocating the urgent need for improvements in men’s health, the “Vienna Declaration on the health of Men and Boys” stands out prominently. There is a need for this declaration to expand and develop into an international body or authorities to have an impact in the progress of men’s health. The world’s including Malaysian governmental organizations, providers of health services and other relevant bodies must be coaxed to take cognisance that men’s health is a distinct and important issue, develop a better understanding of men’s attitudes to health, and disease, promote ‘male sensitive’ approaches to providing healthcare, initiate preventive health and for boys and young men in school and community settings and advocate coordinated health and social policies that promotes men’s health. If these steps are taken, men will have the opportunity to achieve an equitable and high level of health and well-being.

S2b: ORGANIZING PREVENTIVE HEALTHCARE IN MEN Assoc Prof Dr Shaiful Bahari Ismail Deputy Dean (Academic) & Family Medicine Specialist, Department of Family Medicine, Universiti Sains Malaysia, Kelantan, Malaysia. Men are unique creature. They are simple but have high ego. Men are not taking care of themselves and use less health care services as compared to women. They suffered more illnesses and they die younger than women. There are many issues pertaining to the organizing preventive healthcare for men. The first thing is to bring them to the healthcare system. The development of men’s health clinic maybe one of the ways to bring them in with the male doctors and male support staffs attending them and hopefully will bring out even the most sensitive issues in the consultation. A recent Australian qualitative study has shown that the qualities that men values when interacting with the doctors include a direct, ‘matter of fact’ communication style, doctors who were confident and knowledgeable, use humour, able to communicate at the same level with patients and give prompt resolution to their health issues.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/ Cardiovascular and chronic diseases are still the primary issues related to the preventive measures in men. However, sexual dysfunction can be the portal in bringing men to the healthcare system and also can be the cause of many physical, psychological and social illnesses among men. Men’s Health Clinic in HUSM started in March 2007 with the main aim to bring as many ‘healthy’ men as possible to educate, assess and screen them for cardiovascular and other non-communicable diseases. So far, we have overwhelming response from men with various physical, psychological and social illnesses. It’s definitely a challenge for us at the primary care level to get the cooperation of men to improve their health so that it can lead into healthier family, community and nation.

S2c: THE SHRINKING WILLIES Dato’ Prof Dr Tan Hui Meng Consultant Urologist Subang Jaya Medical Centre, Subang Jaya; Adjunct Professor, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. The problem of the shrinking willies affects men all over the world. This is not just a big dent to a men’s ego but has proven to be also threatening to his health and life. Men may be willing to take chances on their life and health but when their manhood is at stake, their everyday life goes into a tail spin. The primary care physicians should be aware that men generally do not like medical consultation except for a ‘quick fix’ medical problem. As such if a male patient complains of nonspecific symptoms like lack of vigour, poor concentration, irritability, sleeps disturbance and declining sexual ‘energy’, please be aware that he is hoping that his GP will inquire about the problem of his ‘shrinking willies’. As most men are concerned of any lingering threat to their ‘macho’ status and feelings, primary care physicians should also be aware of the population of aging men at risk of declining hormone levels. These include men who are obese, diabetic, hypertensive, with coronary artery disease, history of infertility, ex-smokers and men with erectile dysfunction. The possible clinical findings of men with testosterone deficiency syndrome (TDS) include sexual dysfunction, erectile dysfunction, visceral obesity, diminished muscle mass, muscle strength and bone mineral density, alterations in spatial cognition and mood. Physical examination is often unhelpful but decrease in testicular and prostate size, alterations in testicular consistency and hair distribution can be detected. Not all the manifestation need to be present simultaneously and their intensity shows marked interindividual variability. The diagnosis of TDS is to identify compatible symptoms, exclude diseases with similar symptoms like depression, anaemia, hypothyroidism etc., and perform a biochemical confirmation. A total testosterone level of less than 11nmol/ L is suggestive of TDS and level of more than 14nmol/L exclude the condition. Current treatments available in Malaysia include injectable formulation, oral medications and depots. Other preparations like transdermal and buccal formulations are available in other countries. Testosterone therapy in properly indicated men is generally safe and well accepted. It is only contraindicated in men with clinical or histological evidence of prostate cancer and breast cancer. The treating physician should have sufficient knowledge and adequate understanding of TDS, and the treated patients should understand the goal of the treatment and be fully committed to close follow up. Treating men who are devastated with progressively ‘shrinking’ penis allow the primary care physician the golden opportunity to address the men’s dire concern and a chance to advocate preventive healthcare. Best of all, the rewarding outcome of the physician patient interaction often generates excellent goodwill and loyalty.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

Symposium 3: CHILD HEALTH S3a: THALASSEMIA UPDATE Dr N Thiyagar Senior Consultant Paediatrician & Adolescent Medicine Specialist, Pediatric Department, Sultan Abdul Halim Hospital, Kedah, Malaysia. The thalassemias are inherited disorders of hemoglobin where defective synthesis of one or more globin chains leads to abnormal haemoglobin production and anemia. Thalassemias are among the most common genetic disorders in humans. Although it was first recognised in the Mediterranean countries they are encountered among all ethnic groups and in almost every country around the world. Their clinical severity varies widely, ranging from asymptomatic forms to severe or even fatal entities. Several classifications are used. Thalassemia major is defined as a severe and transfusion-dependent form; thalassemia intermedia with less severe symptoms; and thalassemia minor (carrier state or trait), without clinical symptoms, but with hematological abnormalities. Development of screening, antenatal diagnosis and counseling of at risk couples, has reduced the mortality and morbidity of thalassemias. However, the ultimate eradication of thalassemia has a long way to go. Until the goal is achieved we must optimise the management of thalassemia effectively with judicious blood transfusion and newer adjunct treatment with iron chelator and with haematopoietic stem cell transplantation.

S3b: FAILURE TO THRIVE – MANAGEMENT IN PRIMARY CARE Dr Angeline Yeoh Aing Chiee Senior Consultant Pediatrician, Pediatric Department, Seberang Jaya Hospital; Senior Honorary Lecturer, Penang Medical College, Pulau Pinang, Malaysia. Failure to thrive is a condition commonly seen in primary care. Failure to thrive is diagnosed when a child’s weight for age falls below the fifth percentile of the standard growth charts or if it crosses two major percentile lines. Many infants with failure to thrive are not identified especially in busy clinical setting unless careful attention is paid to plotting growth parameters accurately at routine checkup. Medical and psychosocial factors often contribute to failure to thrive. Either extreme of parental attention (neglect or hyper vigilance) can lead to failure to thrive. Growth variation in normal infants can confound the diagnosis. About 25 percent of normal infants will shift to a lower growth percentile in the first two years of life and then follow that percentile; this should not be diagnosed as failure to thrive. Infants with Down syndrome, intrauterine growth retardation, specific ethnic (e.g. Asians) or premature birth follow different growth patterns than normal infants and will benefit from modified growth charts. A thorough history and physical examination is the best guide to establish the etiology of the failure to thrive and determine further evaluation and management. All children with failure to thrive need nutrition intervention and additional calories for catch-up growth (typically 150 percent of the caloric requirement for their expected, not actual, weight). Only a few patients need laboratory evaluation initially. Hospitalization is rarely required and is indicated only for severe failure to thrive and for those whose safety is a concern. A multidisciplinary approach is recommended when failure to thrive persists despite intervention or when it is severe. Early childhood is a critical period for growth and development, and prompt diagnosis and early intervention for any child with failure to thrive will reduce the risk of growth, developmental and behavioral sequelae in the long term.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

S3c: THE SLOW LEARNER Dr Lai Fong Hwa Consultant Child and Adolescent Psychiatrist, Psychiatry Department, Pulau Pinang Hospital, Pulau Pinang, Malaysia. The 30 mins paper aims at sharing a practical approach to the assessment, diagnosis and management of child cases presenting as “slow learners”. It begins by looking at the multiple causative factors which could bring about this presentation. An important question to ask is “Who says that this child is a slow learner?” Is it the school/teacher, parents or the child himself or herself? Are the factors intrinsic (e.g. low IQ, dyslexia, depression) or extrinsic (e.g. unhappiness in family or excessively stress school environment?). We will also look briefly at some of the specific learning disorders: reading disorder, mathematical disorder and disorder of written language. Adequate information from various sources such as child, parent and teacher need to be obtained before a treatment plan based on a biopsychosocial approach is agreed upon and implemented with regular reevaluation. The need for special educational intervention and alternative school placement is also discussed.

Symposium 4: GERIATRIC HEALTH S4a: HEALTHY, ACTIVE AND PRODUCTIVE AGEING Dr Zaiton Ahmad Senior Lecturer & Family Medicine Specialist, Deputy Director, Institute of Gerontology, Universiti Putra Malaysia, Selangor. The number of older persons is increasing worldwide. In 2000 there were 600 million older persons aged 60 years and above. By 2025 it is expected to increase to 1.2 billion and 2 billion by the year 2050. Presently two thirds of all the older persons are living in the developing countries. Similar to most countries in the world, Malaysian’s population is also undergoing demographic transition. This transition is due to fertility, mortality and to some extend migration as a result of social and cultural development. With increasing ageing also come the various challenges and issues which will affect the society in the 21st century. Among them are burden of diseases, increase risk of disability, feminization of ageing as well as the care and the economics of the aging population. To overcome these issues of concern, certain programs and policies will have to be introduced in order to attain older persons that are healthy, active as well as productive. This paper will discuss the concept of healthy, active and productive ageing as well as issues that will enable the older persons to be participating actively in an age friendly environment and at the same time maintain their autonomy.

S4b: LIVING WITH OSTEOPOROSIS Dr Lee Fatt Soon Consultant Physician & Geriatrician, Head of Geriatric Unit, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. The World Health Organisation (WHO) working group and consensus conference have defined osteoporosis as “A disease characterised by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk”. Prevalence of osteoporosis increases with age. Those at risk include Orientals, females especially those with premature menopause, slender build and family history of osteoporosis. However modifiable risk factor includes poor calcium intake, sedentary life style, cigarette smoking and excessive alcohol / caffeine intake. One of the most feared complications of osteoporosis is fracture. Studies have quoted that one in three women and one in twelve men over the age of 50 will suffer an osteoporotic fracture. In Malaysia, the incidence of hip fracture 50 years of age is said to be 90 per 100,000 with Chinese women accounting for 44.8% of hip fractures. This results in high cost both in terms of morbidity and financially. A 1997 estimate revealed that RM22 million was incurred as direct hospitalisation cost for hip fractures. However for the patients and their families other cost will be significantly higher as there is major functional impairment and indirect cost incurred in caring for the patient. Management of osteoporosis include excluding secondary causes and non-pharmacological interventions including diet and exercise. In addition, falls prevention should also be targeted as reducing falls will lead to lower risk of fractures. This is especially so in the older individuals as most of the injuries are of low impact injuries.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

S4c: ELDERLY QUALITY OF LIFE ISSUES Dr Esther Ebenezer Old Age Psychiatrist and Senior Lecturer, UniKL Royal College of Medicine and Ipoh Specialist Hospital, Perak, Malaysia. Global population is aging rapidly, it in much more pronounced in developing countries and Malaysia is not exceptional. Physical changes associated with aging would result in decline in efficiency of function but do not qualify as having a disease refers to ‘Usual Ageing’ whereas ‘Successful Ageing’ causes minimal age associated change in a given physiological function. Healthy ageing is the process of optimizing physical, social and mental health to enable older people to take an active part in society to enjoy autonomy, independence and good quality of life. Quality of life is determined by various factors like culture, gender, health and social services, financial securities, personal and behavioral apart from physical, mental and social well being. In the past decade a fast shift from communicable to non-communicable diseases is occurring in developing countries, where chronic illnesses such as heart disease, cancer and depression are becoming the leading causes of morbidity and disability. Encouraging healthy life style can stabilize or even can prevent the onset of many physical conditions. Disease prevention should be promoted through healthy ageing policies. Equity of health for elders explicitly includes nondiscrimination of age. It is never too late to promote health for the elderly Ageing populations will increase demands in health care and social security costs but evidence show that innovation, cooperation from all sectors, and planning ahead culturally-appropriate policy choices will enable the policy makers to manage the economics of an elderly population successfully. Educating young people about ageing and upholding the rights of older people will help to eliminate discrimination and abuse. Families and communities should be supported in efforts to care for their older members.

Symposium 5: MENTAL HEALTH S5a: SCHOOL REFUSAL Dr Lai Fong Hwa Consultant Child and Adolescent Psychiatrist, Psychiatry Department, Pulau Pinang Hospital, Pulau Pinang, Malaysia. Reasons for children and adolescents refusing to attend school can, in general, be grouped into factors which ‘push away’ children from school or factors which ‘pull away’ from school. These categorical divisions can be used in approaching cases of school refusals brought to the clinic. “Repelling factors” or factors which make school unpleasant for children are things like excessively punitive school systems, excessive amount of homework, lack of positive feedback and encouragement by teachers, and problems of bullying in school which are not properly addressed. “Attractive factors” are usually ‘home factors’ where children are allowed by parents to watch TV, play computer games when they complained of headache or abdominal pain usually before the school buses arrive. Other factors such as depressive illness, anxiety disorders as well as learning disorders need to be considered during the assessment process. Management usually requires meeting and working together with parents, and teachers with the aim of returning the child back to school as soon as possible. A number of case vignettes will be shared.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

S5b: ADOLESCENT WITH DEPRESSION Dr Nazrila Hairizan Nasir Family Medicine Specialist, Pandamaran Health Clinic, Selangor, Malaysia. Over the last three decades there are increasing evidence that depression occurs in children and adolescents. Prevalence of mental health problems in adolescents in Malaysia shows increasing trends within 10 years as evidenced by the National Health Morbidity Surveys. Presentation of depression amongst adolescents will be discussed. Low mood that is pervasive is usually the primary complaint including other symptoms that will be presented. Whilst low mood may be a commonly reported by adolescents, this may not equate to depressive illness. On the other hand signs of depressive illness may be wrongly attributed to perceived normal turbulence of adolescence. Irritability, outbursts and hostility could be mistaken as disobedience or conduct problems. Assessment of the adolescents is of profound importance and has to be done carefully and thoroughly. Presentation of the problem is looked at holistically and risk factors for depression in the adolescent are taken into account. In this presentation, the risk factors for depression in adolescents will be explored. Some of these factors include gender, family history, self image and adolescents’ life events. Before concluding treatment modalities for depression in adolescents will be discussed. Some of these modalities would include counseling, effective problem solving techniques, cognitive behavior therapy and the role of medication would also be discussed in line with the guidelines that are available. Finally a case study or two would be presented to demonstrate the problem.

S5c: LIVING DANGEROUSLY; MANAGING ADOLESCENT WITH HIGH RISK BEHAVIOUR Dr Iskandar Firzada Osman Family Medicine Specialist, Jaya Gading Health Clinic, Kuantan, Pahang, Malaysia. High-risk behaviours are those that can have adverse effects on the overall development and well-being of youth. This includes behaviours that cause immediate physical injury (e.g. fighting), as well as behaviours with cumulative negative effects (e.g. substance use). Identifying types of high-risk behaviours helps in planning for intervention. Types of high-risk behaviours are; self-injurious behaviours, violence and suicide; substance use; risky sexual behaviours; and behaviours related to obesity and unhealthy dieting. Risk factors are; low self-esteem, negative peer groups, low school engagement, low educational aspirations, poor parent-child communication, low parental monitoring, lack of family support, parents themselves engage in risky behaviours, negative school climate, poor neighbourhood quality, low socioeconomic status, and poor (or no) relationships with non-parental adults. This presentation looks into the approach and recommendations on dealing with adolescent with high-risk behaviours.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

Symposium 6: REHABILITATION / PALLIATIVE HEALTH S6a: PALLIATIVE CARE MANAGEMENT OPTION IN PRIMARY CARE Dr Richard Lim Boon Leong Consultant Palliative Medicine Physician, Selayang Hospital, Selangor, Malaysia. Palliative care is defined as an approach that improves the quality of life of patients and families facing the problem associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. For many patients who face life-threatening illnesses with limited survival, time spent at home near family members and loved ones is a priority. Many patients who are progressively deteriorating from illnesses such as cancer are increasingly weak and disabled in their last weeks of life and traveling to healthcare facilities to obtain medications and treatment can be very challenging. This is where there is a great need for the development of palliative care services within the primary care setting. Community palliative care has long been recognized as a key component to complete palliative care and to date majority of this is being provided by non-governmental organizations or hospice organizations. It is obvious however that there is still a lot that needs to be done to develop community palliative care especially in the rural areas where NGOs do not exist. In order to develop better palliative care in the primary care setting, it will be necessary to increase awareness and training of primary care doctors and nurses regarding the philosophy and concepts of palliative care and its management. Apart from this, essential drugs required to deliver good palliative care must also be made available at the primary care level especially drugs such as morphine and other narcotic analgesics. Finally, a good network system between hospitals and the primary health care givers must be established in order to ensure constant communication between all parties managing these patients whose conditions will rapidly change with progression of the disease process.

S6b: CARDIAC REHABILITATION AT PRIMARY CARE Dr Shaari Mohd Yatim Consultant Rehabilitative Medicine Physician, Serdang Hospital, Selangor, Malaysia. Coronary artery disease (CAD) is the second leading cause of death in Malaysia in 2006 despite improvement in health services and facilities. They were accounting for about 15.7% of those who died in government hospitals. They are projected to be the leading cause of death in Malaysia by 2010. Cardiac rehabilitation program that involves medical evaluation, exercise prescription, education and counseling of patients with cardiac disease have been consistently shown to improve objective measures of exercise tolerance and psychological well being without increasing the risk of significant complications. Cardiac rehabilitation has to be comprehensive and at the same time, individualized, with goals orientated program which involve multidisciplinary team approach. There are three recognized phases in cardiac rehabilitation, and phase III is a maintenance phase which include the community cardiac rehabilitation program. Primary health caregiver plays an important role in secondary prevention and during the maintenance phase. The majority of CAD are preventable and controllable, public education and consistent exercise program is extremely important to address the reduction of risk factors of major CAD. Multidisciplinary team members include Family Medicine Physician, nurses, therapist, dietician and pharmacist should be actively involved in this program. The transdisciplinary approach should be used in condition that there are limited human resources. Knowledge about patient selection criteria, risk stratification, CAD, basic and advanced life support should be equipped to all the medical directors and the program coordinators even though there is no evidence that stable patients are harmed by the exercise component of cardiac rehabilitation. All of these improvements enable the patient to enquire and maintain functional independence and return to satisfactory and appropriate activity that benefits the patient and society.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

S6c: PAIN MANAGEMENT APPROACH IN PRIMARY CARE Dr Richard Lim Boon Leong Consultant Palliative Medicine Physician, Selayang Hospital, Selangor, Malaysia. Cancer pain is a common and many a time most feared symptom in patients with advanced cancer. The field of palliative medicine has become the forerunner in the area of cancer pain management. Specialised palliative care units are now fast becoming the norm all over the world however regardless of these units, majority of patients still spend most of their remaining life span at home or in the community. Primary care physicians therefore should be familiar with basic cancer pain management and should be confident in using medications such as opioid analgesics in order to ensure that patients presenting to primary care services will be relieved of their pain without any delay. They should also be able to maintain and adjust pain relief medications as required hence avoiding unnecessary admissions or troublesome follow ups with tertiary centres. Primary care physicians should be familiar with pain assessments in cancer pain and be able to recognize the different types of pain syndromes encountered by cancer patients. They should also be familiar with the WHO cancer pain guideline and understand the basic pharmacology of opioid analgesia as well as the management of side effects of opioids. Recognition of neuropathic pain and being alert to warning signs where specialist review may be warranted especially in cases such as spinal cord compression is also important in managing cancer pain.

Symposium 7: ADDICTIONS MEDICINE S7a: METHADONE: CHALLENGES & RELEVANCE AT PRIMARY CARE Dr Norsiah Ali Family Medicine Specialist, Tampin Health Clinic, Negri Sembilan, Malaysia. Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. One of the greatest challenges faced by Malaysia nowadays is the threat of HIV infection that is contributed largely by sharing infected needles among intravenous drug users. Harm reduction approach that took place in the country since 2005 has started to show some positive impact. However scaling up was still far beyond the national target. The main challenges are accessibility to the harm reduction components as the drug users are scattered all over the countries. The Non Government Organization that runs Needle Syringe Exchange Program such as AARG, Intan Life Zone and Ikhlas are mainly located in urban areas. Methadone Maintenance Therapy (MMT) is currently not just available in government hospital or primary care clinic, but is already introduced in the prison. The National Anti Drug Agency (NADA / AADK) had started similar service since about a year ago. Retention rate in primary care clinic setting was better than in hospital setting. There are various advantages of providing the service at primary care clinic and was proven to be so in various countries worldwide. Apart from minimizing the stigma, primary care clinic will be a suitable place to deliver comprehensive care to the so called ‘marginalized population’ and an opportunity to empower the community to contribute in sharing the burden. However the challenges that is faced in many clinics are lack in counseling support by AADK, failure to differentiate the concept of harm reduction versus treatment for opiate addiction, prolonged transition period especially when dealing with police, difficulty / lack in skill to handle underlying behavior issues / personality disorder, limited MMT facilities, existing drug law, difficulty of the community and internal client to accept the fact that addiction is a chronic relapsing illness that had caused some neurotransmitter changes in the brain and issues of lack / difficulty to optimize functions & coordination in human recourses. The process of linking up their needs to various related agencies in the community is also quite slow. We must not give up hope as if harm reduction fail, by 2015, Malaysia might be having 300 000 citizen with HIV infection that will definitely affect the country’s socioeconomic status.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

S7b: MOTIVATING BEHAVIOUR CHANGE IN ADDICTION DISORDER Dr Salina Abd Aziz Consultant Psychiatric, Department of Psychiatry, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. Helping patients change behavior is an important role for family physicians. A change in patient lifestyle is necessary for successful management of long-term illness, and relapse can often be attributed to lapses in healthy behavior by the patient. Motivational interviewing is a client-centered counseling style that elicits behavior change by helping clients explore and resolve ambivalence regarding their substance abuse. Understanding patient readiness to make change, appreciating barriers to change and helping patients anticipate relapse can improve patient satisfaction and lower physician frustration during the change process. Instead of trying to fix the patient’s health problem by forceful instruction, therapists need to use warmth and respect, to persuade the patient to want to change. Motivational interviewing helps patient resolve their ambivalence about changing addictive behaviors. It create a conducive atmosphere for change by expressing empathy, helping patients explore the gaps between their current behaviors and the lives they would like to lead, avoiding argument, rolling with resistance, and using encouragement.

S7c: SEX ADDICTION – DOES IT EXIST? Dr Mohd Affandi Yusuf Sexologist, Universiti Sains Malaysia, Kelantan, Malaysia.

Symposium 8: EMERGENCY MEDICINE S8a: OBSTETRIC EMERGENCIES Dr Hari Ram Ramayya Consultant Obstetrician & Gynaecologist, Tuanku Fauziah Hospital, Perlis, Malaysia. Maternal mortality claims nearly 536,000 women’s lives each year. Nearly all these lives could be saved if affordable, good-quality obstetric care were available 24 hours a day, 7 days a week. Most of the deaths are caused by haemorrhage, obstructed labour, infection (sepsis), unsafe abortion and eclampsia (pregnancy induced hypertension). Indirect causes like malaria, HIV and anaemia also contribute to maternal deaths. For every woman who dies, an estimated 15 to 30 women suffer from chronic illnesses or injuries as a result of their pregnancies. MMR is as high as 2100 in Sierra Leonne and as low as 1 in Ireland (per 100,000 live births) according to WHO World Health Statistics 2008. Thus it is essential for us as care givers to equip ourselves with the knowledge and skills to manage obstetric emergencies. APH, PPH, cord prolapse, eclampsia, shoulder dystocia, uterine inversion and uterine rupture are few of the emergencies that we must know how to diagnose, treat and prevent. Let us equip ourselves to be a better caregiver and help the newborns to be with their mothers.....

S8b: EYE EMERGENCIES Dr Haslina Mohd Ali Consultant Ophthalmologist, The Vitreoretinal Centre, Ophthalmology Department, Sultanah Bahiyah Hospital, Kedah, Malaysia. Ocular/eye emergencies can be divided into those presenting with red eye, sudden onset of decreased vision and ocular trauma. Decreased vision may be further divided into media opacity and conduction defect whilst red eye can be painful or painless. This presentation shall go into the causes and primary care management of these patients.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

S8c: PRE-HOSPITAL TRAUMA CARE: INITIAL ASSESSMENT, TRIAGE AND ACUTE INTERVENTION Dr Adi Osman Emergency Medicine Consultant, Head of A&E Department, Raja Permaisuri Bainon Hospital; Honorary Senior Lecturer, Royal Perak College of Medicine, Perak, Malaysia. Email: [email protected] Trauma is not a generic disease. Hence, therapy will differ according to the anatomical disruption and physiological consequences of the injury. Each case presents the clinical challenges and treatment modalities of the different injuries to encounter our practice. The first hour of trauma care has been described as the ‘‘golden hour’’ and many severely injured patients spend almost threequarters of this hour in the pre hospital phase. This golden hour concept has more recently been augmented by the idea of the ‘‘platinum ten minutes’’, which is the pivotal time for airway care and prevention of traumatic exsanguination. During these first few minutes the basic essentials of airway (with cervical immobilization), breathing, and circulation with hemorrhage control must be rapidly assessed and optimized. It has been suggested that the main aim of the pre hospital process is to ensure that the lungs are working effectively, which will allow the ultimate goal of adequate tissue oxygenation. Patient assessment commences during the initial emergency call and before the provider sees the patient. Key information in the call and during scene assessment may hold clues from witnesses to indicate mechanisms of injury and therefore develop an idea of suspected injuries. Triage has become a key area of pre hospital care: getting the right patient to the right facility at the right time. The examination of the patient should commence with the primary survey. This A, B, C,D, E survey looks systematically for lifethreatening injuries that should be treated as they are found and before processing to further examination. The entire primary survey should be completed within a very few minutes and will dictate whether the patient needs rapid transport to hospital (load and go) or whether the patient is more stable and can receive initial treatment at the scene (treat then transfer). The extent of any further examination will depend upon the situation and is often inappropriate in the pre hospital stage of treatment. Basic techniques in pre hospital care cannot be overemphasized, but the application of more advanced techniques should be considered cautiously with attention to the latest evidence base. Two treatment strategies have been suggested. They have become known as scoop and run and treat then transfer. Clinical evidence now suggests that life threatening airway and breathing problems must be diagnosed and treated on the scene, whereas circulation is best treated by surgical haemostasis in the hospital. Some patients would therefore benefit from very rapid transfer with minimal on-scene intervention, while others may be fully stabilized at the scene.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

ORAL PRESENTATION F1: PATIENTS RATING DOCTORS – A REVIEW M Omar Kelana Jaya Health Centre, Selangor, Malaysia. Beginning this year, Family Medicine Specialists are assigned several Key Performance Indicators (KPI). One of these KPIs involved assessment by their patients. This paper aims to determine the types of assessments that have been carried out worldwide by patients to evaluate doctors and the findings of these studies. There are several ways for patients to assess their doctors; including self administered questionnaires, interviews, surveys, focus group discussions, using standardized patients and through internet sites. Factors influencing patients’ assessments are discussed. Doctors are rated on certain aspects of communicative behavior. Findings suggest that competence in communication may be perceived as medical competence by patients. Some of these studies also include patient outcomes. Although feedbacks are provided to doctors to improve the quality of interpersonal care, it is interesting that feedbacks do not necessarily result in improvement of care. Websites for patients’ feedback is the latest instrument to appraise doctors. However, whether doctor rating sites can improve standards of care remain debatable.

F2: PREVALENCE AND DETERMINANCE OF DEPRESSION AMONG DIABETES MELLITUS PATIENTS IN AN URBAN PRIMARY CARE CLINIC Maizatullifah Miskan1, Anis Safura Ramli1, Ambigga Devi1, Nafiza Mat Nasir1, Ng Kien Keat1, Mohazmi Mohammad2, Ahmad Hatim Sulaiman2, Amylia Zainal3 1Primary Care Medicine Discipline, Universiti Teknologi MARA, Shah Alam, Malaysia. 2University of Malaya, Petaling Jaya, Malaysia. 3Universiti Putra Malaysia, Serdang, Selangor, Malaysia. Background: Affective disorders are common amongst Type 2 Diabetes Mellitus patients, where 11-15% meets the criteria for major depression according to the Diagnostic and Statistical Manual of Mental Disorders (IVth edition). These problems are often under diagnosed; and therefore, there is a need to do rigorous screening at the primary care level. Objective: To determine the prevalence and determinants of depression in diabetes patients attending an urban Primary Care Clinic. Materials and Methods: A cross sectional study of Type 2 Diabetes Mellitus patients attending an urban primary care clinic was conducted over a period of 2 months. Self-filled HADS-D questionnaire was used as a tool to screen for depression. Data were analysed with Statistical Package for the Social Sciences (SPSS) version 16.0. Results: A total of 358 diabetic patients were included in the study. Prevalence of depression amongst the study population was 26% (n=93). Patients earning a total income of less than RM500 per month were found to be significantly more depressed than those earning more than RM500 per month [31.0 % versus 14.5 % respectively, p=0.025, OR=2.65 (95 % CI 1.29-5.43)]. Patients who were never exposed to any formal education were also found to be significantly more depressed than those who had primary and secondary school education [52.6% versus 43.9% versus 9.8% respectively, p=0.025, OR 2.65 (95 % CI 1.29 – 5.43)]. Conclusions: This study found a high prevalence of depression among diabetes mellitus patients attending an urban primary care clinic. Low monthly income and low education level were noted to be significantly related to developing depression. Affective disorders should be rigorously screened in patients with chronic illnesses such as diabetes, especially in the high risk groups, so that they can be managed accordingly.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

F3: PROBLEMS OF THE ANTI-SMOKING PROGRAMS FOR ADOLESCENTS IN MALAYSIA IN THE PERCEPTION OF DOCTORS AND TEACHERS Hizlinda Tohid1, Khairani Omar1, Noor Azimah Muhammad1, Noriah Mohd Ishak (PhD)2 1Department of Family Medicine, Universiti Kebangsaan Malaysia. 2Department of Education, Universiti Kebangsaan Malaysia. Background: The smoking prevalence among adolescents in Malaysia has increased despite many anti-smoking programs organised by the government. Objective: To identify problems of the anti-smoking programs for adolescents in Malaysia from the perception of doctors and teachers. Methods: Semi-structured qualitative interviews with 8 doctors and 8 teachers (2 focus group interviews and 2 in-depth interviews) were held. Transcription of the interviews were analysed using Nvivo7 and themes were identified. Results: All participants had almost similar perceptions relating to the problems of current anti-smoking programs. There are 10 themes of problems that were identified; (1) Poor planning and execution of programs, (2) Poor enforcement of law and regulation, (3) Poor inter-agencies cooperation, (4) Poor public exposure to programs, (5) Low tobacco duty, (6) Problems with audits and researches relating to smoking, (7) Government’s conflict of economic interest, (8) Deficient regulations on tobacco, (9) Poor resources and (10) Uninteresting activities. Both groups thought that the efforts were non-focused, non-continuous, noncomprehensive, non-holistic, insufficient, non-standardised and not accessible to all adolescents. The anti-smoking strategies at school were felt more for smoking prevention; and the school’s disciplinary actions might result in more deleterious consequences to the teenagers. The image of cigarette on anti-smoking posters was also believed to give cues for smoking instead. Conclusion: Identifying problems of available programs are crucial for their improvement. Multiple strategies to overcome these problems must be made to ensure the programs’ effectiveness to reduce smoking prevalence among adolescents.

F4: RETROSPECTIVE STUDY OF ACUTE STROKE PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT OF A UNIVERSITY HOSPITAL WITHIN THE THERAPEUTIC WINDOW FOR THROMBOLYSIS Kamarul S1, Azhari Z1, SH Saw1, Nazirah Z1, Syahidah Z1, Zuraidah CM3, Husyairi H3, Sobri Muda2 of Medicine, Universiti Kebangsaan Malaysia. 2Endovascular and Interventional Radiology, Universiti Kebangsaan Malaysia. 3Centre for Research in Emergency Medicine, Universiti Kebangsaan Malaysia.

1Faculty

Stroke is a heterogeneous syndrome resulting from the disruption of normal cerebral blood flow that causes infarction and cerebral dysfunction. Delay in seeking early medical help worsens outcome. This is a retrospective study of patients presented to the Emergency Department in a university hospital with signs and symptoms of acute stroke within the first twelve hour after onset of the symptoms. This study aimed to describe the demography of the sample population with a view to determine the proportion who presented within the therapeutic window. The resulting data will provide an estimate of current standard of acute stroke care in Malaysia. There were 267 patients presented to Emergency Department UKMMC from June 2008 until mid April 2009 with signs and symptoms of stroke within 12 hours. All had neuroimaging done in the form of a non-enhanced CT brain. The mean age was 63.03 years consisting 53.2% male individuals. Patients of Chinese ethnicity represent the greatest number of patients with acute stroke symptoms totaling 143 cases (53.6%), followed by Malays with 106 (39.7%) of cases. The majority of patients (75 patients or 28.1%) in the sample presented within the therapeutic window of 1-3 hours from onset to the emergency department. None had thrombolysis.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/ In conclusion, there were a significant proportion of patients who present within the therapeutic window for thrombolysis as well the extended therapeutic window of 6 hours for invasive endovascular therapy in the population. This is in contrast to the current opinion that the majority of acute stroke patients in Malaysia present well beyond the therapeutic window to allow any active intervention. There is a need to promote the application of early interventional therapies that potentially can reverse the devastating effects of stroke to the quality of life of stroke sufferers.

F5: UNDER FIVE NON HOSPITAL DEATHS IN MALAYSIA Norsiah A1, Wong SL2, Hussain I3 Health Clinic, Negeri Sembilan, Malaysia 2Hospital Tuanku Jaafar, Seremban, Negeri.Sembilan, Malaysia. 3Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.

1Tampin

Introduction: Malaysia has been in several eras of development in term of health since it gained independence. Part of the indicators of success in service is mortality statistic. There had been no such extensive data collection or study on non hospital death among children aged 28 days to five years in Malaysia. Information in this area would help to select and target a cause or causes of death for intervention and to plan services for this age group. Methodology: A prospective study that evaluates all under five non hospital deaths in Malaysia in 2006 using verbal autopsy and a specific death investigation form. Result: There were 396 (23.3% of total under five death) non hospital deaths, highest among < 1 years old (49.2%, n=197), the Malays (n=199, 50.3%) followed by aborigines (n=147, 37.1%). The five highest number of non hospital death reported was in the state of Kelantan (16.7%) followed by Sarawak (15.4%), Pahang (13.4%), Perak (9.3%) and Sabah (9.1%). Two third (67.2%,n=264)) of non hospital deaths occurred at home, 51.5% (n=202) certified by non medical person, mainly by police (44.6%, n=177). Fever was the commonest symptoms prior to death (43.4%) followed by shortness of breath (22.2%), cough (21.5%), diarrhoea (15.9%) and not able to drink / feed (14.9%) but 37.1% (n=147) who fell sick did not received any treatment. Non availability of transport was the most important reason for not seeking treatment (36.7%,n= 146). Diseases of the respiratory system were the commonest causes of death (18.2%, n=72). 63.4% (n=251) of non hospital death were preventable and due to patient and family factors (64.1%) that was unaware about the severity of illness (49.1%, n= 195). Discussion & Conclusion: The trend of non hospital death was decreasing (1993-2003, 2006). High death rate observed among the Malays and aborigines, occurred in certain states, due to respiratory causes and mainly preventable. There is a need to expand the implementation of Integrated Management of Childhood Illnesses (IMCI) to other states especially Kelantan, Perak and Kedah so that health care provider can be aware of the warning signs hence can provide better patient care and advice.

F6: WORKING WITH ADOLESCENT DEPRESSION AND SUICIDAL BEHAVIOUR Prof Sami Timimi Faculty of Health and Social Sciences, University of Lincoln, United Kingdom. The literature on outcome in treatment for adolescent depression shows two important features: early intervention can help reduce suicide rates and that the quality of the relationship between client and doctor/therapist, as rated by the client, is by far the most important factor (of those that relate directly to treatment) that contributes to a positive outcome. Therefore two key skills for doctors, particularly primary care physicians, are those of being able to elucidate if there is suicidal ideation and behavior and being able to develop empathic relationships with young people and their families. Formulating pragmatic ways of developing empathy with young people and their families, means appreciating that our understanding of adolescence and its problems are socially constructed. Professionally generated models (such as found in mainstream Western medical model psychiatry) can suffer from being culturally insensitive and inflexible. Remedies to these limitations will be discussed. Understanding a little about how different cultures construct emotions and the philosophical basis behind different systems of traditional medicine, helps thinking about this cultural context. This is not as challenging as it may sound and primary care physicians can do much to develop their skills in this direction. Saving lives may depend it. As well as providing an introduction to the empirical and theoretical foundation for this perspective, I will also use this as a basis for giving some simple pointers for physicians to keep in mind when working with troubled adolescents and their families.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

F7: AUDIT ON APPROPRIATE USE OF ANTIBIOTICS FOR UPPER RESPIRATORY TRACT INFECTION IN PRIMARY CARE CLINICS Nafiza Mat Nasir¹, Maizatullifah Miskan1, Anis Safura Ramli1, Ng Kien Keat1, Ambigga Devi1, Nor Ain Bahar¹, Siti Radiah Ahmad1, Norhaniza Kamaludin1, Siti Nordalila Saad1, Norhafizah Anuar1, Jemah Sajari2, Rozlan Ishak2 1Primary Care Medicine Discipline, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia. 2Pejabat Kesihatan Daerah Gombak, Bandar Baru Selayang, Selangor, Malaysia. Background: The largest volumes of antibiotics are prescribed in primary care¹, and they are frequently given inappropriately for uncomplicated viral infections of upper respiratory tract². The overuse of antibiotic is a risk factor for the development of antimicrobial resistance which can increase morbidity, mortality and health care cost. The aim of this clinical audit is to assess the appropriateness of antibiotic prescription for upper respiratory tract infection in 2 urban primary care clinics based on Mc. Isaac Score. Materials and Methods: Cross sectional audit on patient age > 15 years with diagnosis of upper respiratory tract infection, attending 2 urban primary care clinics was carried out in March to April 2009. Data were collected using a structured questionnaire and physical examination was done. Mc Isaac Score was used in order to decide appropriateness of antibiotic prescribing. Data were analysed with Statistical Package for the Social Sciences (SPSS) version 16.0. Results: A total of 200 patients were audited. The mean age was 36.5 years (SD + 15), of which 53% (106) were males and 47% (94) were females. 55.5% (111) of the subjects were Malays, 22% (44) were Indians, 19.5% (39) were Chinese and 3.5% (7) other races. Overall, 68.5% (137) of patients were prescribed antibiotics and out of this, 98.5% (135) were prescribed inappropriately (Mc Isaac score 0-3). Only 1.5% (2) were prescribed antibiotic appropriately (Mc Isaac score of 4). From the patients’ perception, 58% (118) expected to be given antibiotics for their upper respiratory tract infection. Conclusions: The audit highlights that based on Mc Isaac score, antibiotic prescriptions in these 2 urban primary care clinics were given inappropriately. Strategies need to be taken including education of both healthcare professionals and the public in order to improve the appropriateness of antibiotic prescriptions in the community.

F8: MANAGEMENT OF UNCOMPLICATED HYPERTENSION BY MEDICAL OFFICERS IN HEALTH CLINICS Chew Boon How Klinik Kesihatan Tapah, Perak, Malaysia. Background: Management of blood pressure (BP) alone in hypertension is no longer acceptable. Screening for target organ damage and cardiovascular risk factors are fundamentals to the proper therapy of hypertensive patients. Objective: To examine the management of uncomplicated hypertension in health clinics in 2007. Materials and Methods: This was a cross-sectional survey done in March 2008. Three government health clinics with medical officers were chosen. Patients’ records were sampled if hypertension was the only noted diagnosis and was seen at least once by medical officers throughout 2007. The latest two systolic (SBP) and diastolic (DBP) blood pressure (BP) readings were taken as the measure of control. Screening of any target organs damages and cardiovascular risk factors were scrutinized. Sequences of anti-hypertensives prescribed were traced. Data analyses were done with SPSS version 16. Results: 60 cards were audited. 62.7% were female and the mean age was 59.3 years (SD 9.03). The mean SBP was 145.8 mmHg (SD 20.2, n= 113), the means SBP of the two visits were significantly correlated (r=0.513, n= 53, p < 0.0001). The mean DBP was 83.7 mmHg (SD 10.1, n= 113), the means DBP of the two visits were also significantly correlated (r=0.379, n= 53, p = 0.005). 32.6% had BP < 140/90 mmHg. The mean duration of appointment given were 3.2 months (SD 1.05, n= 113). 57.1% and 54.3% of stage 2 SBP and DBP respectively was given > 3 months of follow-up. 6.7% had an ECG done, 1.7% had limbs pulses felt, 48.3% had serum creatinine tested, 11.7% and 5% had their urine albumin and microalbuminuria tested respectively. 48.3% was screened with fasting blood glucose. Less than 4% was screened for cardiovascular risk factors (body mass index, smoking, exercise, diet and alcohol consumption). Beta-blockers were the favourite anti-hypertensives (30.8% of total prescription) and 34.2% were as first choice, followed by short-acting Nifedipine (27.8%).

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/ Conclusions: About one third of uncomplicated hypertensive patients achieved target blood pressure. There were signs of physician inertia in BP control and thoughtless issuing of appointment. Majority were not screened for target organs damage, cardiovascular risk factors and treated with either beta-blockers or a short-acting Nifedipine. The findings could be limited by incomplete documentation.

F9: COUGHS AND COLDS: REASONS FOR CONSULTING PRIMARY CARE DOCTORS Nik Sherina Hanafi National Primary Care Research and Development Centre, University of Manchester, UK; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Malaysia. Introduction: Minor ailment consultations constitute a significant burden to primary care workload in Malaysia, despite being common symptoms which can be self-managed. This study, using coughs and colds as exemplars, was undertaken to explore why working adults consult primary care doctors for acute symptoms of coughs and colds. Methods: A mixed methods research was conducted among patients who consulted primary care doctors in four public health centres and 28 private clinics in Selangor with symptoms of coughs and colds. The quantitative study was a cross-sectional study on working adults between the ages of 15 to 64 years. Data were analysed using bivariate and multivariate statistical analyses. In the embedded qualitative study, 50 respondents were purposively sampled for in-depth interviews. The interviews were recorded, transcribed and analysed using thematic analyses. Results: Patients with coughs and colds constituted 16.1% of the overall patient load, with the proportion being higher in the private clinics (21.5%) compared to public health centres (15.1%). A total of 1453 patients responded to the cross-sectional study (response rate 93.4%). The majority of the respondents was Malays (56.0%), had up to secondary level education (55.4%), were employed in the private sector (74.2%) and presented within two days of symptom onset (38.8%). The commonest reason for consulting with coughs and colds was because of the need for medicine (97.7%) followed by the need for information (63.7%) and medical certificates (56.7%). Qualitative analyses revealed a general belief that prescribed medicines were more effective compared to over-the-counter medicines. Discussion: This study revealed that among working adults visiting primary care doctors in Malaysia, the commonest reason for consulting primary care doctors was for the need of prescribed medicines. This finding highlights the need for patient education on coughs and colds and promotion of self-management of minor ailments.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

F10: ANAEMIA IN HIV-INFECTED PATIENTS: PREVALENCE AND ITS ASSOCIATED RISK FACTORS Nik Norashikin Nik Ab Rahman1, Juwita Shaaban¹, Mahiran Mustafa², Amaluddin Ahmad3 1Department of Family Medicine, Universiti Sains Malaysia, Kelantan, Malaysia. 2Department of Medicine, Hospital Raja Perempuan Zainab 2, Malaysia. 3Department of Paediatric, Cyberjaya Hospital, Malaysia. Introduction: Anaemia is a common manifestation of infection by HIV, occurring in approximately 30% of patients with asymptomatic HIV and up to 80% of those with clinical AIDS. It has also been associated with a poorer quality of life. Objectives: To determine the prevalence of anaemia among HIV infected patients and its associated factors. Methods: A cross sectional study was conducted from December 2007 to November 2008 on 248 HIV-infected patients aged > 18 years attending HIV clinic in a tertiary centre. Pregnant women and patients already on HAART were excluded. The sociodemographic, risk factor behavior, duration of HIV, history of blood transfusions, current medical illness and medications were collected. Case notes were reviewed for the latest FBC and CD4 counts. Data were analysed using SPSS version 12.0. The significant factors were calculated using multiple logistic regressions. Results: 114 (46%) patients were anaemic (Hb < 12 g/dl and 1 year who attended the clinics within the study period of 6 weeks were randomly selected. Data were obtained from patients’ medical records based on the criteria as recommended by the Malaysian CPG. Data were analysed using the SPSS software version 16.0. Results: 262 hypertensive patients on treatment were included. Mean age was 58.9 years (SD + 10.9, range 31 to 87 years), of which 54.2% were females and 45.8% were males. Blood pressure was recorded every 3 months in 96.6%; but only 46.9% achieved the average target BP of 3 agents. The commonest monotherapy agents being prescribed were the short-acting calcium channel blocker (nifedipine), followed by beta-blockers (atenolol or propranolol). The commonest combinations of 2-drug therapy prescribed were beta blockers and short-acting calcium channel blocker followed by beta blockers and thiazide diuretics. There was no significant difference in the achievement of BP targets among patients treated with monotherapy versus those treated with combination of > 2 antihypertensive agents. Lipid lowering agents were prescribed in 33.6% of the patients. Conclusion: This study shows that pharmacological management of hypertension in the two primary care clinics was not in accordance with current evidence and guidelines. Ongoing clinical audits and remedial measures to improve the standard of hypertension management in both health clinics should be carried out as a matter of great priority.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

P4: PRIMARY HEALTHCARE SERVICES IN THE DISTRICT OF BATANG PADANG, PERAKPERSPECTIVE OF THE HEALTHCARE PROVIDERS Chew Boon How Klinik Kesihatan Tapah, Perak, Malaysia. Background: Primary health care has been shown to be significantly associated with better health indicators both in developed and developing countries. It is one of the most value-for-money investments among existing healthcare systems. World Health Organization had called for urgent adoption and appreciation of primary healthcare in her 2008 annual report. Objective: To determine health care provider’s perspective on primary healthcare. Materials and Methods: A cross sectional survey was carried out from February to April 2009 using opportunistic sampling. Health clinics staffs attending district Continue Medical Education (CME) sessions were invited to participate. A questionnaire was developed in Malay language to capture the essential data and was self-administered. Confidentiality was ascertained throughout. Data analyses were done with SPSS version 16. Results: 69 participated. The mean age was 34 years (SD 10.3). 50 (72.5%) were female and 84.1% were Malay, 8.7% Indian, 5.8% Orang Asli and 1.4% Chinese. 63.3% were nurses, 17.6% and 11.6% were medical assistants and Medical officers respectively. The mean years in primary healthcare were 7.8 years (SD 8.8). 13 (19.1%) were unsatisfied with team-working and most cited unfair duty distribution (15.9%) and colleagues who neglected assigned duties (15.9%) as their reasons; 10 (14.5%) said contrasting and inconsistent orders was the reason. 82.6% said primary healthcare should focus on maternal and child health (MCH) while 92.4% put high emphasis on infectious diseases. 10 (14.5%) disagreed that primary healthcare was cheap and easy to run. Not all opined that primary healthcare should coordinate patient’s medical care and treatment (88.4%) and to do health screening and early identification of serious illnesses (95.7%). 98.6% welcomed further training however, only 33.3% agreed to attend classes on Saturday. Conclusions: Primary healthcare in this district needs credible leaders to improve team-working and to rectify distorted perspective of over-emphasis on MCH and infectious diseases. Training and CME classes on weekdays are preferred.

P5: AN AUDIT OF ADULT ASTHMA MANAGEMENT IN PUBLIC PRIMARY CARE CLINICS Ng Kien Keat1, Anis Safura Ramli1, Ambigga Devi1, Nafiza Mat Nasir1, Maizatullifah Miskan1, Mazapuspavina Md Yasin1, Siti Radiah Ahmad1, Norhaniza Kamaludin1, Siti Nordalila Saad1, Norhafizah Anuar1, Jemah Sajari2, Rozlan Ishak3 1Primary Care Medicine Discipline,, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia. 2Klinik Kesihatan Taman Ehsan, Selangor, Malaysia. 3Pejabat Kesihatan Daerah Gombak, Selangor, Malaysia. Background: The National Health Morbidity Survey III (NHMS III 2006) showed that the prevalence of adult asthma in Malaysia was 4.53%. Asthma management has been found to be inadequate despite the presence of well-developed clinical practice guidelines. Objective: To evaluate the management of adult asthma in two public primary care clinics in Selangor with reference to the standard care recommended by Global Initiative for Asthma (GINA) Guideline, 2006. Materials and Method: A clinical audit of adult asthma management (age > 18 years old) was carried out in two public primary care clinics in Selangor from January to February 2009. Data were obtained by interviewing patients and from the medical records, using a modified questionnaire based on GINA Guideline, 2006. Statistical Package for the Social Sciences (SPSS) version 16.0 was used to analyze the data.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/ Results: 113 patients were included in the audit. The mean age was 50.4 years (SD+15.1) with male/female ratio of 1:1.33 (49:64). The distribution of ACT scores for uncontrolled, well controlled and total controlled asthmatics were 52.2% (59), 44.3% (50) and 3.5% (4) respectively. The distribution of asthmatics in step1 to step 5 treatment groups before consultation were 38.9% (44), 40.7% (46), 15.0% (17), 2.7% (3) and 2.7% (3) respectively. In step 1 treatment group, 50.0% (22/44) were classified as uncontrolled but only 13.6% (3/22) had their treatment stepped up by the clinic doctors. In step 2 treatment group, 50.0% (23/46) were classified as uncontrolled but none had their treatment stepped up and 4.3% (1/23) had received step-down treatment. Conclusion: The management of adult asthmatics in these clinics was not done in accordance with the guidelines. Remedial measures and ongoing clinical audit are needed to improve the quality of care for asthmatic patients.

P6: ADEQUACY OF ASTHMA MONITORING IN ADULT PATIENTS ATTENDING PUBLIC PRIMARY CARE CLINICS Mazapuspavina Md Yasin¹, Ng Kien Keat¹, Anis Safura Ramli¹, Ambigga Devi¹, Nafiza Mat Nasir¹, Maizatullifah Miskan¹, Siti Radiah Ahmad¹, Norhaniza Kamaludin¹, Siti Nordalila Saad¹, Nohafizah Anuar¹, Jemah Sajari², Rozlan Ishak³ ¹Primary Care Medicine Discipline, Universiti Teknologi MARA, Shah Alam, Sealngor, Malaysia. ²Klinik Kesihatan Taman Ehsan, Selangor, Malaysia. ³Pejabat Kesihatan Daerah Gombak, Selangor, Malaysia. Background: The National Health Morbidity Survey III, 2006 reported poor asthma control rate where 68.1% of the patients had exacerbations in the last 12 months. This is often caused by inadequate monitoring of asthma, both during clinic visits and selfmonitoring at home. Objective: To evaluate the adequacy of adult asthma monitoring in two public primary care clinics in Selangor with reference to the standard care recommended by Global Initiative for Asthma (GINA) Guideline, 2006. Materials and Method: A clinical audit of adult asthma management (age > 18 years old) was carried out in two public primary care clinics in Selangor from January to February 2009. Adequacy of asthma monitoring was measured using the following criteria:- i) measurement of peak expiratory flow rate (PEFR) ii) assessment of inhalation technique iii) recording of home symptoms in asthma diary iv) knowledge of asthma action plan v) appropriate use of prophylactic inhaler. Data were obtained by interviewing patients and from the medical records, using a modified questionnaire based on GINA Guideline, 2006. Statistical Package for the Social Sciences (SPSS) version 16.0 was used to analyse the data. Results: 113 patients were included in the audit. The mean age was 50.4 years (SD+15.1) with male/female ratio of 1:1.33 (49:64). Majority of the patients (93.8%) did not have their PEFR measured during routine follow-up visits and 62.7% demonstrated correct inhalation technique. Majority of the patients (96.3%) did not record home symptoms in asthma diary, but 66.3% said that they were aware of the action plan if asthmatic attack occurred at home. Out of the 64 patients on inhaled prophylaxis (corticosteroid), 59.4% used the inhaler appropriately. Conclusion: The adequacy of adult asthma monitoring in these clinics needs to be improved in many areas. Remedial measures such as to involve patients in self-monitoring is pivotal to improve asthma control at primary care level.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

P7: PREVALENCE OF METABOLIC SYNDROME IN HEALTHY ADULT IN KUCHING, SARAWAK Syed Alwi SAR Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia. Objective: The objective of the study was to estimate the prevalence of metabolic syndrome among healthy Sarawakian adults attending primary health care centers in Kuching, Sarawak. Methods: 312 Sarawakian aged from 20-45 years who were healthy and attending the health centers for routine checkup were invited for the study. The National Cholesterol Education Program - Adult Treatment Panel III criteria of metabolic syndrome were used. Body mass index, waist circumference, fasting blood glucose and fasting plasma lipids and blood pressure were measured. Results: Total number of metabolic syndrome was 78 (18.9%); 57.8% were males. The prevalence of overweight and obesity were 31% and 38.3%. Low HDL-C was found in 50.7% (49.4% of males and 52.1% of females), central obesity was prevalent among 37.7% and was significantly more common among females than males (41.7% versus 26.9% respectively). High TG was prevalent among 21% where males rated significantly higher, double that of females (29.8% versus 15.1% respectively). About 21% of the sample was suffering from either high blood pressure (197.0% of males and 17.8% of females) and/or impaired fasting blood glucose (19.9% of males and 16.0 of females). Conclusion: The prevalence of metabolic syndrome is high among healthy adults attending primary health care centers in Kuching, Sarawak.

P8: HEART HEALTH IN SCHOOLS: TEACHING CHILDREN ABOUT KEEPING THEIR HEARTS HEALTHY Fatima M H Ali,1 Muttib H Ali 2 College London, United Kingdom. 2Princess Alexandra Hospital, Harlow, United Kingdom.

1King’s

Background: Ischaemic heart disease (IHD) is the top cause of mortality in Malaysia; it is widely understood that one can reduce the risk of IHD through modifiable risk factors: diet, exercise and smoking. Patients can control these factors and family medicine practitioners are vital for health promotion and education. Most patients present when they become symptomatic, yet healthy behavior, such as a balanced diet, are lifelong habits best formed in childhood. The scheme: The King’s College London Cardiology Society with support from the British Heart Foundation developed a “Heart Health in Schools” community programme to address health promotion in school aged children. Over 3 months, 8 interactive sessions were delivered in schools for children aged 9-11 years old. The sessions lasted 2 hours each. Children were taught basic science about the heart and the circulatory system. They were also taught good “heart health” through: a mini-presentation, a group game about the heart and 4 small group activities. Medical and nursing students volunteering for the programme underwent a training session. Feedback: Feedback from schools was encouraging with many schools wishing to sign up for future sessions. Medical students who participated in the programme enjoyed it and aided understanding health promotion in the community. Children who participated gave positive feedback to the volunteers; teachers felt the programme was educational as well as enjoyable. Conclusion: Health promotion in childhood has a role in future adult behaviours; programs like this could potentially be run by family medicine practitioners as they have excellent links in the community and would be complementary to current health promotional activities in Malaysia.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

P9: WHAT FACTORS INFLUENCE WOMEN’S DECISION MAKING FOR IMMEDIATE OR DELAYED POST-MASTECTOMY BREAST RECONSTRUCTION Shelima Begum1, Elizabeth A Grunfeld1, Mark Ho-Asjoe2, Jian Farhadi2 1Psychology Department, Institute of Psychiatry, King’s College London, United Kingdom. 2 Department of Plastic Surgery, St Thomas’ Hospital, London, United Kingdom. Objective: The aim of this study was to examine patients’ experiences of the decision to undergo breast reconstructive surgery following mastectomy. Method: 21 women, who had undergone reconstruction, took part in a semi-structured qualitative interview, which examined the participants’ experience of the decision-making process. Results: The immediate and delayed groups had different reasons for the decision to undergo breast reconstructive surgery and also differed in their reasons, whether to undergo immediate or delayed breast reconstruction. However both groups shared similar influential factors and received and used similar informational content and informational sources in order to make their decision. Conclusion: This study has highlighted the important role of a credible information sources, the need for clear information about the outcomes of reconstructive surgery and also the need for novel methods of presenting information to patients. Practice implications: Future patients who are considering breast reconstruction should be provided with the relevant information to make a well informed decision and may benefit from different methods of information delivery that could include decision aids such as informational booklets, photographs, and videos.

P10: ACUPUNCTURE AND DEPRESSION Shamima Nahar King’s College London, United Kingdom. Depression is a major public health issue and has a huge impact on both individuals and to society. The Global Burden of Disease ranked depression as 4th in 1990 and this could rise to 2nd by 2020 (Smith, Hay 2004). Majority is treated in the primary care setting and it is a huge strain on the health service. Therefore any method of treatment that is beneficial for the patients and cost effective should be welcomed. A number of risk factors for developing depression have been identified. These include a stressful life event, family history, postnatal, isolated from society and substance abuse. Depression is managed using the Biopsychosocial model. A combination of psychological interventions, drug therapy (SSRI and TCAs) and social support is used in the West. Traditional Chinese Medicine views depression in a slightly different light, depression is thought to occur due to imbalance in the body. Emotional suppression causes internal injury, leading to liver chi stagnation. This has an impact on the rest of the organs as they are all connected, producing the variety of symptoms that are evident in depression. The treatment approach would be to treat the root as opposed to the symptoms. This is achieved using acupuncture. By needling different points in the meridians, it enables the flow of Chi and to regain a balance in the body. Studies have been conducted to assess the effectiveness of acupuncture. The general findings of the studies conducted, are similar to Han’s Study in 1986. He showed that acupuncture speeds up the synthesis and release of serotonin. Although there were no significant difference in the outcome between acupuncture and anti-depressants, fewer side-effects are seen with acupuncture. This factor alone is of considerable clinical use and has aided the adoption of acupuncture in the West, although there is definitely more room for further integration.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

P11: VALIDATION OF THE COMPREHENSIVE ICF CORE SETS FOR DIABETES MELLITUS: A MALAYSIAN PERSPECTIVE AM Faudzi1, MN Norsiah2, MA Siti Zubaidah3, IB Norizzati B4, A Azlin5, AL Lydia6, H Nazirah6, O Zaliha7 Serai Health Clinic, Kulim, Kedah, Malaysia. 2Kepala Batas Health Clinic, Jitra, Kedah, Malaysia. 3Jelebu Health Clinic, Jelebu, Negeri Sembilan, Malaysia. 4Bandar Baru Bangi Health Clinic, Selangor, Malaysia. 5Kuala Trengganu Health Clinic, Terengganu, Malaysia. 6University of Malaya Medical Centre, Kuala Lumpur, Malaysia. 7Sunway Medical Centre, Petaling Jaya, Selangor, Malaysia.

1Padang

Objective: The objective is to study the content validity of the Comprehensive ICF Core Set for DM from the Malaysian perspective. Methods & Design: This is a multicentre, cross-sectional study involving 5 Health Clinics conducted by Family Medicine Specialists in Malaysia. Subjects: Convenience sampling of 100 respondents with DM. The ICF based measures were collected using the Comprehensive Core Set for DM. SF 36 and SCQ were also used. Results: 97% had Type 2 DM and 3% had Type 1 DM. The mean years of having DM was 6 years. Body functions related to physical health including exercise tolerance (b455), general physical endurance (b4550), aerobic capacity (b4551) and fatiguability (b4552) were the most affected). For body structures, the structure of pancreas (s550) was the most affected. In the ICF component of activities and participation, limitation in sports (d9201) was the highest most affected followed by driving (d475), intimate relationships (d770), handling stress and other psychological demands (d240) and moving around (d455). Only 7% (e355 and e450) in the environmental category were documented as being a relevant factor by more than 90% of the patients. Conclusion: The content validity of the comprehensive ICF Core set DM for Malaysian population were identified and the results show that Physical and Mental functioning were impaired in contrast to what the respondents perceived as leading a healthy lifestyles.

P12: IMPROVING MEDICATION COMPLIANCE AMONGST DIABETIC PATIENTS B Mohd Hafidin, MY Rosnita, A Hasbullah, S Sharifah, O Fauziah Klinik Kesihatan Bandar Baharu, Kedah, Malaysia Level of medical non-compliance amongst diabetics are high with many possible causes such as poor management of cases, poor Knowledge, Attitudes and Practices (KAP) of staffs and patients, no supervision, short consultation time and incomplete prescription. This topic was chosen as poor medication compliance is one of the contributing factors of poor diabetic control. There are a large number of diabetics in the population (14.9%) in the latest National Health Morbidity Survey 2006; hence it can bring a big impact to the management of these diabetics. Key measures for improvement in this study is “Level of good medication compliance among Diabetic patients”, set at 70%. A cross-sectional study was done in Serdang Health Centre, from April 2007 until March 2008. Study population involved type 2 diabetic patients with baseline HBA1c done. A study to elicit the level of knowledge, attitude and practice (KAP) on diabetes among patients (N = 50; systematic sampling) and health staffs (N = 20, universal sampling), and an audit on the management and the control of diabetes were done. Only 38% of these diabetics have good compliance with an average HBA1c of 9.04. 36% of the management is considered good (following CPG). 74% of the diabetic patients involved had satisfactory level of knowledge and amongst the staff, only 67% achieved satisfactory level of knowledge. A model of good care for the management of poorly controlled diabetics was introduced. There was addition of 3 staffs - 2 community health nurses and 1 trained nurse with the development of a diabetic team with an increase role of diabetic educator. Counseling aids such as flip chart and medication information pamphlets were introduced with easy access to information and more active participation from family members.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/ Training of staff was also done. Two big campaigns involving Persatuan Diabetes Malaysia and all the diabetic patients and families were done as well; one was targeting on complications of diabetes and the other one was on controlling diabetes. A similar survey was conducted (March 2008) to assess the effectiveness of the intervention. The level of medication compliance increased to 64% and the management of diabetes that was following CPG improved to 48%. The diabetics with satisfactory KAP have also increased from 74% to 86% and amongst the staff, 91.7% achieved satisfactory level of KAP. The average HBA1c falls to 8.69 and the good diabetic control group (HBA1c < 7) has increased to 32% from 28%.

P13: BREASTFEEDING EXPERIENCES AMONG NURSES IN BACHOK, KELANTAN: A QUALITATIVE APPROACH Tengku Alina Tengku Ismail1, Zaharah Sulaiman2, Rohana Abd Jalil1, Nik Normanieza Nik Man1 1Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia. 2Women’s Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia. Introduction: In 2006, only 14.5% babies in Malaysia were exclusively breastfed below six months. Since nurses have a major role in disseminating health education to the community, it is therefore important to explore their own experiences in breastfeeding. Objective: The aim of this study was to provide insight into breastfeeding experiences among nurses in Bachok, Kelantan with regards to exclusive and non-exclusive breastfeeding Methodology: A case study qualitative research design was used to explore breastfeeding experiences among six nurses, in which three of them practiced exclusive breastfeeding and the rest not. A purposive sampling was conducted among nurses working at health clinics in the district of Bachok, Kelantan. In-depth interviews were conducted from December 2008 to March 2009. All the interviews were audio-recorded and transcribed verbatim. Data analysis involved the constant comparative method. Results: Five key themes revealed the reasons why some of the nurses were able to practice exclusive breastfeeding while the others failed. The themes were “Delivery Experiences”, “Support from Husbands, Family Members and Peers”, “Appreciation of Breastfeeding Benefits”, “Working Factor” and “Self-determination and Reproductive Role”. Even though they were under the same working condition, the exclusive breastfeeding nurses negotiated with their managers to avoid attending some courses and were able to breastfeed their babies in between home visits while the non-exclusive nurses did not. Conclusion: Working condition was not a barrier for exclusive breastfeeding in this study. Other factors such as strong determination, early initiation of breastfeeding, not using analgesics during labour, ability to appreciate the benefits and the support received explained the difference in breastfeeding practice among the nurses.

P14: A STUDY ON DRUG COMPLIANCE AMONG EPILEPSY PATIENTS ATTENDING NEUROLOGY CLINIC HUSM Hazlina Ishak, Juwita Shaaban, Adibah Hanim Ismail Department of Family Medicine, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Background: Epilepsy is a chronic disorder and treatment of epilepsy is often life long and non compliance with medication is a wide spread problem. Between 30 to 40% of epilepsy patients appear to be non compliant with their drug regime. Low compliant to prescribed medication is considered the major cause of unsuccessful drug treatment in epilepsy. Uncontrolled seizures is associated with both increased in both direct and indirect cost. Objectives: The study was conducted to examine the percentage of drug non compliance and its associated factors among epilepsy patients. Method: This is a cross sectional study. In this survey a set of questionnaire was completed by 297 epilepsy patients attended Neurology Clinic, HUSM from January 2008 until November 2008. The questionnaires consist of 3 parts, questionnaire on compliance assessment which have 10 items, questionnaire on satisfaction with health care that consist of 23 items and psychosocial questionnaire that contained 39 items. Patients were also given a form on demographic and clinical characteristics data to be filled out.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/ Result: The results showed that the percentage of drug non compliant was 52.2% and the factors that contribute to non compliant were duration of epilepsy, patients’ understanding about their illness and medication barrier. Medication barrier that were significantly related with drug compliance includes the complexity of the drug regime and cost and physical of the medication. There were no associations between socio-demographic, patient satisfaction with health care and other psychosocial factors: motivation, attitude, communication, perception of severity and susceptibility with drug compliance Conclusion: In conclusion, poor drug compliant is high in epilepsy patients attending Neurology Clinic, HUSM. This study found that 52.2% of epilepsy patients were not complies with their drug regime. Factors associated with drug compliance include duration of epilepsy, patient understanding about the illness, complexity of the drug regime and cost and physical of the medication.

P15: A STUDY OF PREMATURE CORONARY ARTERY DISEASE AMONG ANGIOGRAPHICALLY PROVEN ATHEROSCLEROTIC CAD IN HOSPITAL UNIVERSITY SAINS MALAYSIA Zahrni Muda1, Zurkurnai Yusof2, Azidah Abdul Kadir1 of Family Medicine, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. 2Department of Medicine, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

1Department

Introduction: Premature Coronary Artery Disease defined as cardiac events occurring before the age of 55 in men and 65 in women. Differences were observed in the clinical presentation, risk factors profile and angiographic study of young patients compared with older age. Objectives: To determine the proportion of premature coronary artery disease among angiogram positive CAD patient in HUSM and to identify its risk factors. Material and Methods: We compared clinical and angiographic characteristic in 165 among CAD cases who had undergoing coronary angiogram in a tertiary centre. All cases undergoing coronary angiogram due to CAD from 2002, their records were reviewed. The two patients group was compared in term of sociodemographic, associated risk factors, and angiographic findings and was recorded in a data questionnaire. Results: 165 cases were included, of which 55% (n =91) were Premature CAD and 45% (n=74) were Old CAD. The mean age of Premature CAD was 49.7 of male and 51.4 for female and male gender was predominant by 80%. The significant factors associated with Premature CAD were family history of heart disease 38.5% (p=0.02) and low HDL level 1.2 ± 0.30 (p=0.008). Compared with older patients, younger patient had less preponderance of multiple vessel disease (40% vs. 58 %; p 0.03). Conclusion: There was a high prevalence of Premature CAD patients referred to coronary angiogram. Family history of heart disease and Low HDL level are associated with premature coronary artery disease. Thus early cardiovascular screening in family member of patient with heart disease and aggressive treatment to increase HDL level are the first step for prevention of coronary artery disease in young age.

P16: PREVALANCE AND RISK FACTORS OF HEPATITIS B AMONG ANTENATAL MOTHERS IN IPOH Dr Lili Zuryani Marmuji Pegawai Kesihatan Keluarga, Jabatan Kesihatan Negeri, Perak, Malaysia. Introduction: Hepatitis B virus (HBV) infection is a serious global health problem and strategies have been developed to reduce its prevalence. These include antenatal screening, universal immunization and immunoglobulin therapy. The study aims to investigate the prevalence and risk factors of HBV infection among antenatal mothers. Methodology: This was a cross-sectional study conducted among antenatal mothers attending government health clinics in Ipoh between 1st July and 31st October 2008. Mothers were asked to complete a self-administered questionnaire and to undergo a blood test to ascertain their HBsAg status. We compared differences in prevalence according to mothers’ demographic and reproductive factors, family and medical history, and their high-risk behaviours using non-weighted and ethnicity-weighted analysis.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/ Results: The weighted analysis on 7172 mothers gave a better estimate of the magnitude of HBV infection among antenatal mothers since it reflected the actual usage of government health services in Ipoh. Ninety-seven of the 7172 mothers were HBV carriers giving a prevalence of 1.35%. The prevalence was 1.8% in Malays, 1.2% in Chinese, 0.5% in Indians and 1.7% in mothers of other ethnic groups. Prevalence of HBV infection was significantly higher among mothers who were less than 35 years of age, Malays, had 2 or more pregnancies and confirmed HBV carriers. It is also significantly higher among mothers who had positive family history, history of jaundice, contact with a jaundiced patient and history of blood transfusion. Conclusion: Our study showed ethnicity-weighted prevalence of HBV infection among antenatal mothers in Ipoh is low at 1.35%. This information may be useful for planning HBV screening programme in government health facilities in the future. Keywords: Hepatitis B, antenatal screening, prevalence and risk factors.

P17: PRE-PREGNANCY CARE CLINIC – A NEW SERVICE INITIATIVE TOWARDS SAFE MOTHERHOOD: KERIAN, PERAK EXPERIENCE Dr Faridah Abu Bakar1, Nawal Amini Samsuri2 1Pegawai Kesihatan Keluarga, Jabatan Kesihatan Negeri, Perak, Malaysia. 2Ketua Jururawat Kesihatan, Pejabat Kesihatan Kerian, Perak, Malaysia. Introduction: The idea to introduce pre-pregnancy care integrated into the current Maternal Child Health Services came about as the outcome of antenatal card auditing which was part of the activity in several Safe Motherhood Initiative Courses lead by the Family Health Unit, State Health Department. Pre-pregnancy care is a comprehensive care of a woman who is planning to get pregnant and begins before conception. Safe motherhood Initiative depicts that family planning is one of its four pillars. Much is mentioned about other care such as antenatal, safe delivery and essential obstetric care however, only family planning was focused in the pre-conception period. Methodology: Several meetings and training were held at state and district level to plan the implementation. Colour tagging system is used as means to identify clients who were in the service. The flow process and registration format was created. Modified screening tool (combination of screening format as in Perinatal Care Manual – MOH 2002 and Reviewed Approach Programme - Adult Woman – MOH 2007) was used as a screening tool to identify risk factors. Results: From Mac 2007 till December 2008, a total of 2425 clients have received this care. Of which, 92.6% were Malays and 34.6% were in the 20-24 age groups. About 25% - 30% of cases screened had risk factors. Among those with risk factors, 61.5% practiced effective family planning method. In 2008, 36.3% were detected to have anemia, of which 94.8% of them recovered. Among those who came for pre-marital screening and later became pregnant, 84.6% came early for booking and 21.15% of them developed anemia at 36 weeks POA. No women with risk factors of GDM / DM became pregnant during that period. Conclusion: Pre-pregnancy care services in Kerian have been successful in identifying mothers at risk and initiating interventions steps towards a more comprehensive Safe-motherhood Initiative. Keywords: Pre-pregnancy care, safe motherhood initiative.

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Abstracts of 13th Malaysian Family Medicine Specialists Scientific Conference 6th-9th August 2009. Awana Porto Malai, Langkawi, Kedah, Malaysia Malaysian Family Physician 2009; Volume 4, Supplement 1 ISSN: 1985-207X (print), 1985-2274 (electronic) Online version: http://www.ejournal.afpm.org.my/

P18. THE QUALITY OF LIFE AMONG A GROUP OF MALAYSIAN ABORIGINES Muhammad Mazeni, Norjaudah Y, Noor Mastura OK, Fatin Hazirah M, Nik Fah Aisah NS, Than Winn, Aqil MD, Ambigga D, Anis SR Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia Background: The Orang Asli consists of various groups of indigenous people that are found in Peninsular Malaysia. There are approximately 147,000 Orang Asli people reside in various rural and suburban localities in Malaysia. Much of their culture and lifestyle are poorly studied as they are often isolated from the mainstream population. There is also no published literature found on the Quality of Life (QoL) of Orang Asli. Objective: To evaluate the Orang Asli’s perceptions on their QoL in terms of their physical health, psychological, social relationships and environmental domains. Methods: This was a cross sectional study carried out in Kuala Lipis, Pahang involving two villages of Orang Asli Semai. Study sample included adults of age 25 years and above. Participants were interviewed using a previously validated WHOQOL-BREF questionnaire followed by physical examinations. Data analysis was carried out using SPSS ver16. Results: From 149 potential Orang Asli adults, 101 participated in the study giving a response rate of 67.8%. In rating their QoL, 75.3% rated it as either good or very good, 18.8% rated it as neither poor nor good, while only 5.9 rated it as poor. As for health satisfaction, 79.2% were either satisfied or very satisfied with their health, 10.9% were neither satisfied nor were dissatisfied, and only 9.9% were either dissatisfied or very dissatisfied. Out of the four domains which were assessed, the domain of social relationships were rated the highest with a mean total transformed score of 76.9, followed by psychological domain with a mean score of 75.5, physical health domain with a of mean score 75.2, and finally, the environmental domain with a mean score 69.4. Conclusions: The overall perceptions of the studied Orang Asli community towards their QoL were good. This may be associated with their low expectations of living standards, lack of exposure to other communities, low education status and ignorance towards current developments in the country. Orang Asli is a closely knit community where they have a strong network of support, which explains why they were most satisfied with their social and psychological domains. Environmental domain was the area that they were least satisfied and this could be explained by the lack of basic amenities such as electricity, water supply and permanent health care facilities.

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