RESEARCH DIGEST

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Research Digest is a selection of original research done by Malaysian authors or conducted in Malaysia. Only articles felt to be of clinical relevance to primary care physicians are selected. This Research Digest is abstracted by CL Teng (tengcl@gmail.com)
Editor’s note: We wish to thank authors for providing full text reprint of their articles.

Three out of seven elderly men in urban Selangor have erectile dysfunction

Khoo EM, Tan HM, Low WY. Erectile dysfunction and comorbidities in aging men: an urban cross-sectional study in Malaysia. J Sex Med 2008; 5(12):2925-34 [PubMed]
Affiliation of primary author: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur
This is a cross-sectional survey of 361 men aged ³50 years from an urban area in, Selangor, Malaysia. Erectile dysfunction (ED) and androgen deficiency in aging men (ADAM) and other variables were evaluated using questionnaires.
Prevalence of ED was 70.1% and 25.4% scored positive on ADAM questionnaire.
Funding: Malaysian Society of Andrology and the Study of the Aging Male, the Ministry of Women Affairs, Family and Development, GlaxoSmithKline Pharmaceutical Sdn Bhd, Pfizer (Malaysia) Sdn Bhd, Schering (Malaysia) Sdn Bhd, Organon (M) Sdn Bhd and Emerging Pharma (M) Sdn Bhd.

The Malaysian Osteoporosis Knowledge Tool is a valid and reliable instrument for measuring osteoporosis knowledge

Lai PS, Chua SS, Chan SP, Low WY. The validity and reliability of the Malaysian Osteoporosis Knowledge Tool in postmenopausal women. Maturitas 2008; 60(2):122-30 [PubMed]
Affiliation of primary author: Pharmacy Unit, University Malaya Medical Centre, Kuala Lumpur
A 40-item English version questionnaire to assess knowledge on osteoporosis was developed. It was reviewed by a panel of health professional and tested on pharmacists and osteoporosis patients. The internal consistency (Cronbach's a=0.82) and test-retest reliability of the instrument was good. Flesch reading ease was 57 (satisfactory), mean difficulty factor was 0.73 (moderately easy). The difference in knowledge scores between the two groups was statistically significant (as expected).
Funding: University of Malaya (postgraduate research fund)

Women who never had Pap smear lack knowledge and have misconceptions about this test

Wong LP, Wong YL, Low WY, et al. Cervical cancer screening attitudes and beliefs of Malaysian women who have never had a Pap smear: a qualitative study. Int J Behav Med. 2008;15(4):289-92 [PubMed]
Affiliation of primary author: Medical Education & Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur
In this qualitative study, in-depth interviews were conducted with 20 Malaysian women (ages 21-56 years) who have never had a Pap smear. Respondents generally showed a lack of knowledge about cervical cancer screening using Pap smear, and the need for early detection for cervical cancer. Many believed the Pap smear was a diagnostic test for cervical cancer, and since they had no symptoms, they did not go for Pap screening. Other main reasons for not doing the screening included lack of awareness of Pap smear indications and benefits, perceived low susceptibility to cervical cancer, and embarrassment. Other reasons for not being screened were related to fear of pain, misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own health needs versus those of the family.
Funding: Ministry of Science, Technology and Environment, Malaysia

“Test and treat” costs less but has less patient satisfaction than endoscopy in dyspeptic adults

Mahadeva S , Chia YC, Vinothini A, et al. Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat" strategy compared with prompt endoscopy in young Asians with dyspepsia. Gut. 2008; 57(9):1214-20 [Link]
Affiliation of primary author: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur.
432 uninvestigated dyspeptic adults were randomised to either a urea breath test or prompt endoscopy and followed up for 12 months. Baseline Helicobacter pylori positivity was 32.6% (no difference between groups). At 12 months, there was no difference in symptom change (measured by the Leeds Dyspepsia Questionnaire) between the two groups, but more patients were very satisfied in the endoscopy group. The median cost of the initial prompt endoscopy approach at 12 months was significantly higher than a "test and treat" strategy.
Funding: Vote F (Medical Faculty, University of Malaya), Fundamental Research Vote (Institute of Postgraduate Studies, University of Malaya), Malaysian Society of Gastroenterology and Hepatology, Abbot Laboratories Malaysia

Two out of three Malaysian ED patients are using traditional and complementary medicine

Wong LP, Tan HM, Low WY, Ng CJ. Traditional and complementary medicine (T/CM) in the treatment of erection difficulties – experience from the Asian Men's Attitudes To Life Events and Sexuality (MALES) study. Journal of Men's Health. 2008;5(4):356-65
Affiliation of primary author: Medical Education & Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur
A total of 10,934 Asian men living in 5 Asian countries (including Malaysia) were interviewed. Use of T/CM for erection difficulties (9.1%) was relatively low compared to conventional medicine (83.5%). 67.4% of Malaysian patients with erectile dysfunction reportedly using T/CM.
Funding: Not reported.

Young women are in favour of HPV vaccine but do not perceive themselves to be at risk for HPV infection

Wong LP. Young multiethnic women's attitudes toward the HPV vaccine and HPV vaccination. Int J Gynaecol Obstet. 2008;103(2):131-5 [PubMed]
Affiliation of primary author: Medical Education & Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur
This is a focus group discussion involving 40 young women (ages 13-27 years). Although participants were in favour of the vaccine, the majority preferred to delay vaccination because it is newly introduced, they did not perceive themselves to be at risk of HPV infection, or because of cost factors. Concerns were raised regarding the vaccine's safety, the potential to be perceived as promiscuous and sexually active, and whether the vaccine was halal.
Funding: University of Malaya

Significant proportion of healthcare staff lack positive attitude toward domestic violence identification

Sajaratulnisah O, Mat Adenan NA. Domestic violence management in Malaysia: A survey on the primary health care providers. Asia Pacific Family Medicine. 2008; 7(1):2 [PubMed] [Full text]
Affiliation of primary author: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur
This is a survey of 108 clinicians and nurses of the outpatient, casualty and antenatal clinics in University Malaya Medical Centre using a self-administered questionnaire. Two-thirds of the healthcare staff perceived the prevalence of domestic violence to be very rare or rare. Victim-blaming attitude exists in 28% of the clinicians and 51.1% of the nursing staff.
Funding: Research and Development Unit, University of Malaya (Vote F).

GPs in Penang are somewhat positive about the increasing role of pharmacist but many are still guarded

Hassali MA, Akmal Shafie A, Saeed M. A pilot study on the perceptions of general medical practitioners in the state of Penang, Malaysia, towards the professional training and roles of community pharmacists. International Journal of Pharmacy Practice. 2008; Suppl 2:B24-B25
Affiliation of primary author: Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang.
This is a survey of 80GPs in Penang (response rate 50%). The respondents agreed that: GPs should listen to the community pharmacists’ recommendations if there is any problem with prescribed medication (46.3%), community pharmacists are the best healthcare professionals to educate patients about the safe and appropriate use of their medications (52.5%), pharmacists should refer patients to them for further medical evaluation (76.3%), the pharmacy profession has undergone major changes from just drug dispensing to being more patient-oriented (61.3%) and if separation of dispensing is implemented they will work closely to monitor patients’ outcome of drug therapy with the community pharmacist (77.5%). The GPs believe that the pharmacists were not well educated in: clinical therapeutics (42.5%), performing minor diagnosis (52.5%) and selected screening tests (52%). The respondents were not comfortable with community pharmacists: maintaining a complete medication profile of
patients (40%), being given the right to make changes to a prescription that can harm a patient without consulting with the
prescriber (71.3%) and being the person to advise GPs on rational use of medicines (58.8%).
Funding: Not reported

One in nine pregnant women is possibly susceptible to rubella

Cheong AT, Khoo EM. Prevalence of rubella susceptibility among pregnant mothers in a community-based antenatal clinic in Malaysia: a cross-sectional study. Asia Pac J Public Health. 2008; 20(4):340-6 [PubMed]
Affiliation of primary author: Department of Community Health, Faculty of Medicine & Health Sciences, University Putra Malaysia, Selangor.
500 pregnant mothers from Petaling District were interviewed rubella IgG tests were performed. The prevalence of rubella susceptibility among pregnant mothers was 11.4%. A history of not having received rubella vaccination or having unknown rubella vaccination status was found to be a significant predictor for mothers to be rubella susceptible.
Funding: Medical Faculty, University of Malaya (Vote F)

Patients hospitalised for osteoporotic fractures have modifiable risk factors

Loh KY, King HS, Soo NL, Lo WY, Shu YW. Risk factors for fragility fracture in Seremban District, Malaysia: a comparison of patients with fragility fracture in the orthopedic ward versus those in the outpatient department. Asia Pac J Public Health. 2008;20(3):251-7 [PubMed]
Affiliation of primary author: Department of Family Medicine, International Medical University, Seremban
Risk factors were compared between 75 patients hospitalised for osteoporotic fracture and 75 controls from primary care clinic. Abstract:  Posible risk factors identified aret advancing age, low body weight, smoking, lack of regular exercise, low consumption of calcium containing foods, and using bone depleting drugs (steroids, thyroid hormone, and frusemides).
Funding: Not reported

One in five female students from private colleges in Klang Valley is smoking

Rosliza AM, Shamsuddin K. Smoking among young urban Malaysian women and its risk factors. Asia Pac J Public Health. 2008;20(3):204-13 [PubMed]
Affiliation of primary author: Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur
408 young women (age 18-25 years) from three private higher learning institutions in Kuala Lumpur and Selangor were surveyed using self-administered questionnaire. The prevalence rate of current smoking was 18.6%. Adjusted analyses showed significant association between smoking and individual factors, which are the importance of slim image, average monthly allowance, and car ownership.
Funding: Universiti Kebangsaan Malaysia

Women with pregnancy-induced hypertension are five times more likely to have low birth weight babies.

Latifah AR, Hairi NN, Salleh N. Association between pregnancy induced hypertension and low birth weight; a population based case-control study. Asia Pac J Public Health. 2008;20(2):152-8 [PubMed]
Affiliation of primary author: Kedah State Health Office, Kedah
This is a population-based case control study among antenatal mothers who attended the government health centres in Kedah. Cases were 312 mothers who delivered low birth weight babies, and controls were 312 mothers who delivered normal birth weight babies. After controlling for important confounders, pregnancy-induced hypertension was found to be an independent risk factor (adjusted odds ratio = 5.06; 95% confidence interval: 2.63, 9.71) for low birth weight.
Funding: Not reported

One in two women attending a primary care clinic has orgasmic dysfunction

Sidi H, Midin M, Sharifah Ezat WP, Abdullah N. Orgasmic dysfunction among women at a primary care setting in Malaysia. Asia Pac J Public Health. 2008;20(4):298-306 [PubMed]
Affiliation of primary author: Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan, Kuala Lumpur
230 married women (aged 18-70 years) attending a health centre in Kuala Lumpur were evaluated using The Malay Version Female Sexual Function Index (MVFSFI). The prevalence of orgasmic dysfunction was 51.9% (MVFSFI£4). Women with orgasmic dysfunction were found to be significantly higher in the following groups: age >45 years, being non-Malay, having lower academic status, married longer, having more children, married to an older husband, and being at menopausal state.
Funding: Self-funded.

One in twenty women attending primary care clinics reported domestic violence

Wong YL, Sajaratulnisah O. Early detection and prevention of domestic violence using the Women Abuse Screening Tool (WAST) in primary health care clinics in Malaysia. Asia Pac J Public Health. 2008;20(2):102-16 [PubMed]
Affiliation of primary author: Medical Education & Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur
Face-to-face interviews were conducted with 710 female adult patients from 8 health centres in Selangor using the Women Abuse Screening Tool (WAST). Forty women (5.6%) were positive for domestic violence (WAST ³13). Indian ethnicity, lower education among the husband and husband who habitually consume alcohol/drug were associated with domestic violence.
Funding: Centre for Economic Development and Ethnic Relations (CEDER), University of Malaya

Higher blood lead level is associated with lower cognitive score in children

Zailina H, Junidah R, Josephine Y, Jamal H. The influence of low blood lead concentrations on the cognitive and physical development of primary school children in Malaysia. Asia Pac J Public Health. 2008;20(4):317-26 [PubMed]
Affiliation of primary author:  Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor.
The IQ of 269 Malay children (age 6.5-8.5 years) were assessed by McCarthy Scales of Children’s Abilities (MSCA); 8.9% had weak to very weak IQ level (General Cognitive Index <80). Only 5 children had blood lead level exceeding 10 mg/dL.
There was significant inverse correlation between blood lead level and cognitive scores for all children.
Funding: Ministry of Science, Technology and Environment, Malaysia, and Universiti Putra Malaysia under the Short-Term Fund and Graduate Fellowship Award.

One in two middle-aged women is possibly depressed

Nor Zuraida Z. Depressive symptoms in middle-aged women in Peninsular Malaysia. Asia Pac J Public Health. 2008; 20(4):360-9 [PubMed]
Affiliation of primary author: Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur
3934 women (mean age 51 years, range: 45-60 years) in Peninsular Malaysia were evaluated using Center for Epidemiological Studies for Depression (CES-D) Scale. The prevalence rate of depressive symptoms (CES-D>16) was 54.2%.Of the married women, 38.4% had poor to very severe problems in their marriage. Depressive symptoms were correlated with marital dissatisfaction scores.
Funding: Ministry of Women and Family Development, Malaysia,