Search

Aim Households are a significant venue for the transmission of SARS-CoV-2. We conducted a study to characterise the transmission dynamics and identify risk factors for household transmission of SARS-CoV-2 in Negeri Sembilan, Malaysia. Methods This retrospective observational study included 185 families of paediatric COVID-19 cases from 1 February 2020 to 31 December 2020. We identified the index case for each household and gathered the socio-demographic, epidemiological investigation results and risk factors for household transmission from medical case records. The secondary attack rate was calculated, and logistic regression analyses were used to identify risk factors associated with secondary household transmission of SARS-CoV-2. Results Of the 848 household contacts, 466 acquired secondary infections, resulting in a secondary attack rate of 55%. The median age of the secondary cases was 12 years. Female household contacts and household contacts who slept in the same room with the index case were significantly associated with increased risk for COVID-19. Other independent risk factors associated with higher transmission risk in the household included an index case who was symptomatic, a household index case aged greater than 18 years and a male household index case. Conclusions High rates of household transmission of COVID-19 were found, indicating households were a major setting of transmission of SARS-CoV-2. Our data provide insight into the risk factors for household transmission of SARS-CoV-2 in Malaysia.

When incentives are offered to parents and their children to partake in research, there are concerns that parents may be unduly influenced by the incentives, and the children may be exploited. We present a case from a low- and middle-income country and consider the ethical issues that arise when the children are asked to participate in a multinational, double-blind, randomized, placebo-controlled trial of the effects of a nutritional supplement on growth. The first commenter, from Malaysia, notes that their residents might not share Americans’ expectations regarding children’s role in the consent process from a cultural perspective, which may alter the analysis of the concerns. The authors of the second commentary emphasize the use of incentives that benefit the child participant rather than their parent or are provided directly to the child participant to address the concerns. The third commentator discusses the importance of minimizing the study’s risks and balancing the benefits and the risks, which attenuates the concerns.

There is a continuing concern about how graduate work readiness (WR) reflects on the success of universities meeting the requirements of employment. This study is to establish a valid and reliable instrument measuring WR in health professions (HP) graduates of medicine, pharmacy and dentistry.The study from March 2016 to April 2017 was conducted to validate the 'Work Readiness Scale' (WRS; Deakin University) using Principal Component Analysis and Cronbach - α for internal consistency. It was modified to a four-item even-point scale and distributed as an online survey to 335 final year students of the three programs.A reduction from 64 to 53 items provided good internal consistency in all factors: WC 0.85, OA 0.88, SI 0.88 and PC 0.71. The PC domain had the greatest item reduction from 22 to 6, whilst the SI domain increased in items from 8 to 19. These changes may be associated with difference in understanding or interpretation of the items in the SI domain.The modified WRS can be used to evaluate job readiness in HP graduates. However, it needs further refinement and validation in specific educational and employment contexts.

We are reporting the results of implementing Learning from Observation and Discussions at Clinical Campus International Medical University, Kuala Lumpur, Neonatal Intensive Care Unit (NICU). This initiative was conceived and successfully implemented with the aim to identify medical student’s learning perception from self-reported learning experiences. A total of 80 Semester eight medical students were invited to participate in the study. A structured, validated and reliable instrument developed from a work skill development framework was used to assess student’s perception of learning through discussions and observations (Total D&O), input from their experience providing future ideas (Total Ideas) and guided ward rounds as a new learning format (Total Visit). Informed consent was obtained from 42 students who participated over the ten months’ period of the study. Data was analysed with ANOVA and structural regression equation modelling. The study showed that both Total Visit and Total Discussion & Observation can predict Total Perception of Learning. According to student evaluations, the Total Visits rating was the best single predictor summarising positive perception of rounds at the neonatal intensive care unit based on the significance values, partial eta squared and power. Students ranked the process of guided rounds at the neonatal intensive care unit as valuable in providing educational experiences and integral to their learning perception.

Clinical ethics consultation service remains undeveloped in developing countries. It is recognised that its introduction poses challenges. Malaysia, a multicultural society with diverse religions, values and perceptions further complicate the introduction of formal clinical ethics consultation service. Clinicians attending a national congress workshop completed a Strengths–Weaknesses–Opportunities–Threats analysis. The aim was to gain insight into clinician’s expectations and promote initiatives leading to the introduction of clinical ethics consultation service. Clinicians agree that clinical ethics consultation service can improve quality of care, reduce healthcare costs and advocate for patients and providers. The analysis highlighted constraints in sufficient critical mass of relevant expertise and restricted opportunities for training. The opportunities lie in education, curriculum development and availability of dedicated proponents. Cultural barriers, limited resources, lack of awareness, differences in opinions, fear of litigation and destructive influence of social media are seen as threats to the introduction of clinical ethics consultation service. This study illustrates the value of involving stakeholders when introducing clinical ethics consultation service formally. The issues identified will inform the strategic directions for the delivery of clinical ethics consultation service at a national level.

Studies on vitamin D status and its determinants in growing children in countries with ample sunshine such as Malaysia have been limited. The aim of our study was to determine factors associated with serum 25(OH)D concentrations such as lifestyle, dietary intake, anthropometry, and body composition in 243 pre-adolescent Malaysian children from low-income families living in Kuala Lumpur. This cross-sectional study measured bone density and body composition using dual-energy X-ray absorptiometry (DXA), while serum 25(OH)D was measured using LC–MS/MS. Time spent outdoors, body surface area exposed to sunlight, dietary intake, and physical activity level were assessed using questionnaires. Multiple linear regression and stepwise analysis were performed to identify significant predictors for serum 25(OH)D. About 69.4% had 25(OH)D &lt, 50 nmol/L, and 18.9% were vitamin-D-deficient with 25(OH)D &lt, 30 nmol/L. Girls had a nine-fold higher prevalence of vitamin D deficiency than boys. Body surface area exposed to sunlight, Sun Index, and fat mass were significant predictors of 25(OH)D concentrations in this population. Modifiable lifestyle factors such as sun exposure and reducing obesity are important public health guidance to ensure optimal vitamin D status in these children.

Background Recruitment and retention in longitudinal nutrition intervention studies among children is challenging and scarcely reported. This paper describes the strategies and lessons learned from a 1-year randomized double-blind placebo-controlled trial among pre-adolescent children on the effects of soluble corn fiber (SCF) on bone indices (PREBONE-Kids). Methods Participants (9–11 years old) were recruited and randomized into 4 treatment groups (600 mg calcium, 12 g SCF, 12 g SCF plus 600 mg calcium and placebo). Interventions were consumed as a fruit-flavored powdered drink for 1-year. School-based recruitment was effective due to support on study benefits from parents and teachers, peer influence and a 2-weeks study run-in for participants to assess their readiness to commit to the study protocol. Retention strategies focused on building rapport through school-based fun activities, WhatsApp messaging, providing health screening and travel reimbursements for study measurements. Compliance was enhanced by providing direct on-site school feeding and monthly non-cash rewards. Choice of 2 flavors for the intervention drinks were provided to overcome taste fatigue. Satisfaction level on the manner in which the study was conducted was obtained from a voluntary sub-set of participants. Results The study successfully enrolled 243 participants within 6 months and retained 82.7% of the participants at the end of 1 year, yielding a drop-out rate of 17.3%. Compliance to the intervention drink was 85% at the start and remained at 78.7% at the end of 1 year. More than 95% of the participants provided good feedback on intervention drinks, rapport building activities, communication and overall study conduct. Conclusion Successful strategies focused on study benefits, rapport building, frequent communication using social media and non-cash incentives helped improved compliance and retention rate. The lessons learned to maintain a high retention and compliance rate in this study provide valuable insights for future studies in a similar population., Highlights • PREBONE-Kids contributes to evidence on the effect of soluble corn fiber on bone indices in pre-adolescent Asian children. • School-based recruitment, study nature, perceived benefits and study run-in were effective strategies for recruitment. • Rapport building, direct on-site feeding and rewarding protocol adherence were critical for good retention and compliance.

Background In Malaysia, patients are free to choose their own primary care healthcare providers at their own expense. Studies show that patients who choose their own doctor are associated with increased patient satisfaction. Primary care paediatricians realise the need to involve parents as stakeholders in today’s competitive healthcare industry. Objectives This study aimed to identify what factors matter to parents when choosing a paediatric primary care for their children in a free market setting where they have direct access to paediatricians. It also explored if differences in these perceived factors exists between parental education and household income levels. Methods An analytical cross-sectional study was conducted at two paediatric primary care centres in urban Malaysia. Parents who brought their child to seek treatment at the centres were invited to participate. A face and content validated questionnaire that includes respondents’ demographics was devised from the literature and a focus group discussion. A 5-point Likert scale was applied to 25 elements that were organised into five major domains: ‘consultations’ (CO), ‘facilities and services’ (FS), ‘fees and charges’ (FC), ‘social media engagement’ (SM) and ‘doctor’s ‘appearance’ (DA). Elements within each domain were ranked according to a mean ratings score. Internal consistency for each domain was yielded through a Cronbach’s alpha (α) value. Independent t-test was used to determine the associations between outcomes and independent variables. Results 387 parents completed the questionnaires (response rate, 91.3%). The mean age of the parents was 37.7 years. 295 (76.2%) parents attained a tertiary education. 157 (40.6%) parents were bottom tier income earners. Parents rated the provision of FS highest (mean rating score=41.63, α=0.84), followed by ratings on the interaction with healthcare providers during CO (34.73, 0.77). Younger aged parents (p=0.021) and parents from lower household income level (p=0.001) had higher FS rating score compared with older parents and parents of higher income respectively. The top elements in the FS domain were a ‘strategic location of the primary care’ and ‘comfortable and clean waiting room’. The CO ratings have a predilection towards technical quality, interpersonal manners and successful provider-patient communications during clinical encounters. In exchange, for FC (11.80, 0.75), parents appeared to tolerate costlier consultation and treatment, but still appreciate bills that are transparent. While parents with a higher level of education prefer to participate in shared decision-making with the paediatricians (p=0.002), parents from lower household income level rated a significantly higher score in SM (p Conclusions Where parents are free to choose their children’s paediatric primary care service, convenient accessibility and perceived consultation-related proficiency mattered most to parents when deciding. The extent to what makes a difference, appeared to be influenced by parental age, educational and income level. These perceived differences largely confirm the need to invest in the development of individualised support services in a consumer-driven health care system. These preferred elements can provide clue to determine parental satisfaction towards health services provided and predict complex health seeking behaviours.

Background Modifiable lifestyle factors and body composition can affect the attainment of peak bone mass during childhood. This study performed a cross-sectional analysis of the determinants of bone health among pre-adolescent (N = 243) Malaysian children with habitually low calcium intakes and vitamin D status in Kuala Lumpur (PREBONE-Kids Study). Methods Body composition, bone mineral density (BMD), and bone mineral content (BMC) at the lumbar spine (LS) and total body (TB) were assessed using dual-energy X-ray absorptiometry (DXA). Calcium intake was assessed using 1-week diet history, MET (metabolic equivalent of task) score using cPAQ physical activity questionnaire, and serum 25(OH) vitamin D using LC-MS/MS. Results The mean calcium intake was 349 ± 180 mg/day and mean serum 25(OH)D level was 43.9 ± 14.5 nmol/L. In boys, lean mass (LM) was a significant predictor of LSBMC (β = 0.539, p p p p p p p = 0.034) and physical activity measured as MET scores (β = 0.163, p = 0.026) were significant predictors of TBBMD in boys. Among girls, LM was also a significant predictor of LSBMC (β = 0.620, p p p p p = 0.034), TBBMC (β = 0.122, p p = 0.002) in girls. Conclusions LM was the major determinant of BMC and BMD among pre-adolescent Malaysian children alongside other modifiable lifestyle factors such as physical activity and calcium intake.

BACKGROUND Bedside teaching (BST) in a hospital setting can play an important role during medical students' clinical placements in paediatrics. Parents often feel obliged to allow their child to participate, even if they are reluctant. The aim of this study was to examine the perceptions of parents who, with their children, were involved in medical students' BST. METHODS Consenting parents participated in a semi-structured interview assessing their experience of having their child involved in BST. The qualitative data were analysed using thematic analysis. Parents were assured that their children's treatment would not be negatively affected in the case of withdrawal from the study. RESULTS A total of 54 parents responded and discussed their experience of their children's participation in clinical teaching. The majority of parents were keen to support medical students' learning, and felt that they could develop better insight into their child's health in association with the teaching session. Some parents found the sessions tiring; their interest increased when they were more actively involved in planning the BST sessions. DISCUSSION This study emphasises children's and adolescents' autonomy as a main principle in making decisions about involving them in BST. Clinical teachers often face problems attempting to properly plan and conduct BST sessions. Parents appreciate having an active role in planning the sessions and are supportive of medical student education. Clinical teachers must ensure that they protect the best interests of paediatric patients and their parents. At the same time, they should advocate for the obvious benefits of BST.

The Neonatal Resuscitation Programme is a good example of an effective educational intervention that has improved perinatal mortality rates in many countries. This paper shares our experience of planning an undergraduate Neonatal Resuscitation Programme using basic principles of education theory of spiral curriculum, Bloom's taxonomy in planning learning outcomes, Kolb's learning model and Miller's model of clinical assessment. Engaging clinicians in pedagogical theories may not be well aligned with how clinicians traditionally thought they learnt best, yet it is key to improving learning concept and educational intervention outcomes in the healthcare professions. This article aims to illustrate the application of such educational theories into one example of practice. We structured this paper in the scope of content, delivery and assessment when planning a psychomotor learning activity.El programa de reanimación neonatal es un buen ejemplo de una intervención educativa eficaz que ha mejorado las tasas de mortalidad perinatal en muchos países. En este artículo, compartimos nuestra experiencia con la planificación de un programa de reanimación neonatal para estudiantes universitarios con fundamento en los principios básicos de las teorías de la educación del currículo en espiral, la taxonomía de Bloom para planificar los resultados del aprendizaje, el modelo de estilos de aprendizaje de Kolb y el marco para la evaluación clínica de Miller. La participación de los médicos clínicos en las teorías pedagógicas podría no estar en línea con la manera en que estos consideraban que aprendían mejor tradicionalmente; aun así, es clave para mejorar el concepto del aprendizaje y los resultados de las intervenciones educativas en el campo de las profesiones relacionadas con la atención médica. Este artículo apunta a ilustrar la aplicación de estas teorías de la educación con un ejemplo de la práctica. Estructuramos este artículo en el marco del contenido, la presentación y la evaluación de la planificación de una actividad de aprendizaje psicomotor.

Emotional exhaustion is an important component of burnout. Burnout is common among doctors. It affects the physical and mental health of doctors, their performance and the quality of care they provide. This study aimed to investigate the level and factors associated with emotional exhaustion among doctors in pediatric practice in Malaysia.A self-administered questionnaire was used in this multicenter cross-sectional study. It included questions on the socio-demographics, work characteristics, Emotional Exhaustion, Perceived Stress Scale and sources of job stress. Descriptive, univariate and multivariate analysis were conducted using the SPSS software.A total of 197 doctors working in the Pediatric department in eight hospitals returned complete questionnaire. High and moderate emotional exhaustion was reported by 25.4% and 24.4% doctors, respectively. In bivariate analysis, 29 out of the 38 items of sources of stress showed significant association with emotional exhaustion (p0.05).The significant predictors of emotional exhaustion in the multivariate analysis were: scoring higher on the Perceived Stress Score, dealing with patient's psychosocial problems, disrespectful interactions with colleagues/ subordinates, lack of appreciation from supervisors, lack of incentives and promotions, time pressures and deadlines to meet, and setting unrealistic goals of having them imposed on oneself (p0.05). The most common source of stress was dealing with difficult parents (80.2%).Emotional exhaustion is associated with sources of stress in the workplace but not with socio-demographic factors.El agotamiento emocional es un componente importante del síndrome de burnout (desgaste profesional). El burnout es común entre los médicos. Afecta su salud física y mental, su rendimiento y la calidad de la atención que brindan. Este estudio tuvo como propósito investigar el nivel y los factores asociados con el agotamiento emocional en los médicos pediatras, en Malasia.Eneste estudiomulticéntrico y transversal se utilizó un cuestionario autoadministrado, que incluía preguntas acerca de las características sociodemográficas y laborales, el agotamiento emocional, la escala de estrés percibido y las fuentes laborales de estrés. Con el software SPSS, se llevaron a cabo análisis descriptivos, univariantes y multivariantes.Un total de 197 médicos de los departamentos de pediatría de ocho hospitales respondieron el cuestionario. El 25,4% y el 24,4% de los médicos informaron, respectivamente, agotamiento emocional alto y moderado. En el análisis bivariante, 29 de las 38 opciones correspondientes a fuentes de estrés mostraron una asociación importante con el agotamiento emocional (p0,05). En el análisis multivariante, los predictores importantes de agotamiento emocional fueron: puntajes más altos en la escala del estrés percibido, abordaje de problemas psicosociales de los pacientes, falta de cortesía en las interacciones con colegas/subordinados, falta de reconocimiento de parte de los superiores, falta de incentivos y promociones, trabajo bajo presión del tiempo y necesidad de cumplir con los plazos, y establecimiento de metas inaccesibles o autoimposición de ese tipo de metas (p0,05). La fuente de estrés mencionada con mayor frecuencia fue el trato con padres difíciles (80,2%).El agotamiento emocional está asociado con fuentes de estrés en el entorno laboral pero no con factores sociodemográficos.

When minors are asked to assist medical educators by acting as standardized patients (SPs), there is a potential for the minors to be exploited. Minors deserve protection from exploitation. Such protection has been written into regulations governing medical research and into child labor laws. But there are no similar guidelines for minors’ work in medical education. This article addresses the question of whether there should be rules. Should minors be required to give their informed consent or assent? Are there certain practices that could cause harm for the children who become SPs? We present a controversial case and ask a number of experts to consider the ethical issues that arise when minors are asked to act as SPs in medical education.

A previously healthy 11-year-old Chinese girl presented to the accident and emergency department with a 4-month history of persistent rashes over her palms and soles, and a 1-week history of malaise and low-grade fever. Her general practitioner had suggested that the rash could have been caused by hand, foot and mouth disease. On examination, she had non-blanching erythematous macular lesions with few palpable crusted purpura over …