This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Summary We surveyed primary care physicians in Malaysia for their knowledge, attitude and practice in screening and managing osteoporosis. We found a low level of screening and active management of osteoporosis in the primary care setting despite positive attitudes towards them. We advocate for the active management of osteoporosis at the primary care level. Introduction Prevention of osteoporotic fracture is important in primary healthcare for healthy ageing. Little is known about the knowledge, attitude, practice and barriers in the screening and managing osteoporosis among primary care doctors. Methods A cross-sectional study, using an online pre-tested questionnaire after face and content validation, was conducted for primary care doctors from 1 June to 30 July 2021 across Malaysia. Pearson’s chi-square test and logistic regression were employed. Results A total of 350 primary care doctors in Malaysia, consisting of 113 (32.3%) family medicine specialists (FMS) and 237 (67.7%) medical officers, participated in this study. The mean ± SD score of osteoporosis knowledge was 50.46 ± 15.09 with minimum and maximum values of 0 and 83.64%, respectively. One hundred and ten (31.4%) respondents achieved a satisfactory overall knowledge score of ≥ 60%, 156 (44.6%) were confident in advising patients for initiation of anti-osteoporotic medication, and 243 (69.4%) perceived that bisphosphonate should be made available in health clinics. Only 97 (27.7%) practised osteoporosis screening. Inaccessibility of bone mineral densitometry (BMD) (90.6%), inadequate knowledge (87.7%) and inaccessibility of pharmacotherapy (87.1%) are perceived modifiable barriers to osteoporosis screening and management. Factors associated with a satisfactory knowledge of osteoporosis are designation as a family medicine specialist (AOR 3.034, p = 0.002), attendance at an osteoporosis management update course (AOR 2.095, p = 0.034) and the practice of osteoporosis screening for the elderly (AOR 2.767, p = 0.001). Conclusion Given the insufficient knowledge and low level of osteoporosis screening, there is a need for a national structured health programme to address the knowledge gap, increase screening practices and enhance accessibility to BMD and anti-osteoporosis medication in primary care.

Introduction: Obesity is associated with an increased risk for non-communicable diseases. Local studies have shown that 33.1% of healthcare providers (HCPs) are overweight, while 21.1% are obese. Interventions that consist of diet, physical exercise and cognitive behavioural training have been shown to be successful in reducing weight. Methods: We designed a weight loss programme for our HCPs named the ‘Fit and Trimmed Staff’ programme, which consisted of 3 months of group education on obesity-related health problems led by a doctor, a pharmacist, a nutritionist and an occupational therapist among HCPs. Monthly individual dietary counselling by a nutritionist was also provided for 6 months. We measured the body weight, body mass index, percentage of body fat, visceral fat and percentage of skeletal muscle of the HCPs before and after the intervention. Results: Forty-five (56.25%) HCPs at Simpang Health Clinic were either overweight or obese; the majority of them were drivers and administrative clerks (100%), followed by health attendants (69.2%) and medical assistants (63.6%). At 6 months post-intervention, there was a trend towards a non-significant reduction in the fat percentage (median=-0.8%, P=0.423). Approximately 42% (n=19) of the HCPs lost weight, while 58% gained weight. Weight loss was observed more commonly in the male HCPs (>50%) than in the female HCPs. Conclusion: A weight loss programme solely consisting of health discussion and nutritional advice is inadequate to induce weight reductions. A multimodal approach may be considered in managing weight among HCPs.

(1) Background: The teaching profession has become more challenging due to the increased use of information technology, which potentially increases psychological distress among teachers. This study aimed to determine the prevalence of depression, anxiety, and stress among school teachers in Malaysia during the period of the COVID-19 pandemic and its associated sociodemographic factors. (2) Methods: A cross-sectional study was conducted among primary and secondary school teachers in Malaysia. A validated DASS-21 questionnaire was used for mental health screening, and the study was conducted online during the pandemic period. (3) Results: The percentages of respondents with mild, moderate, severe, and extremely severe depression were 12%, 9.7%, 4.7%, and 3.1%, respectively. Those with mild, moderate, severe, and extremely severe anxiety accounted for 11.5%, 12.3%, 6.3%, and 6%, respectively. Those with mild, moderate, severe, and very severe stress accounted for 12.8%, 12%, 5.3%, and 2.5%, respectively. Perceived overworking was significantly greater during the pandemic compared to before the pandemic. Significant experience in teaching, and less perceived overworking before and during the pandemic were associated with better mental health. (4) Conclusions: Periodic mental health screening for teachers may be beneficial in preventing mental health disorders and improving the quality of student education. A full assessment and innovation of the curriculum and workload should be implemented.

Introduction: Fetal pleural effusion is rarely seen in primary care setting. It is more commonly diagnosed among women with diabetes mellitus in pregnancy. Method: This report illustrates two patients with fetal bilateral pleural effusions, detected at 18-week and 24-week period of amenorrhea (POA) during routine antenatal scans by primary care doctors. Result: These two pregnancies were complicated with hydrops fetalis and resulted in fresh stillbirth and intra-uterine death. Conclusion: Primary healthcare providers play an important role in the early diagnosis of fetal congenital anomaly, counseling regarding the ultrasonography findings, neonatal outcome, and referral to obstetrician for further management and monitoring for maternal complications, such as polyhydramnios, preeclampsia, mirror syndrome, and depression as a result of hydrops fetalis.