Test-retest reliability of multiple true-false questions in preclinical medical subjects

It has been suggested that the 'ideal' measure of reliability of an examination is obtained by test and retest using the one examination on the same group of students. However, because of practical and theoretical arguments, most reported reliabilities for multiple choice examinations in medicine are actually measures of internal consistency. While attempting to minimize the effects of potential interfering factors, we have undertaken a study of true test-retest reliability of multiple true-false type multiple choice questions in preclinical medical subjects. From three end-of-term examinations, 363 items (106 of 449 from term 1, 150 of 499 from term 2, and 107 of 492 from term 3) were repeated in the final examination (out of 999 total items). Between test and retest, there was little overall decrease in the percentage of items answered correctly and a decrease of only 3.4 in the percentage score after correction for guessing. However, there was an inverse relation between test-retest interval and decrease in performance. Between test and retest, performance decreased significantly on 33 items and increased significantly on 11 items. Test-retest correlation coefficients were 0.70 to 0.78 for items from the separate terms and 0.885 for all items that were retested. Thus, overall, these items had a very high degree of reliability, approximately the 0.9 which has been specified as the requirement for being able to distinguish between individuals.     

Medical school entrance and career plans of Malaysian medical students

This study investigates the reasons for entry to medicine and the career perspectives of phase III medical students of the Universiti Sains Malaysia (USM). The majority of the students were Malays from low socio-economic backgrounds who entered medical school after completing a 2–year matriculation course. An interest in medicine and helping people were the two main stated reasons for entry to medical school. A group of students wishing to work in private practice was identified. In comparison to the rest of the study body, students in the group were: not well prepared to enter medical school; dissatisfied with the course; and subject to family influences. A desire for monetary gain motivated their choice of medicine as a career. Overall, 13% of the students wished to change career because they were dissatisfied with their experience of medicine as undergraduates.
The study did not find a significant difference in career intentions between female and male medical students. However, women were less likely to seek entrance into private practice or pursue formal postgraduate education. The choice of surgery as a career was confined to men. About 90% of the students had already decided on their future specialty. Four well-established specialties were their most popular choices. The gender of the students had no significant influences of the decision to continue into postgraduate education. The proportion of female students who wished to marry doctors was significantly higher than for male students.     

The Effects of a 7000-Step Goal and Weekly Group Walking Program for Overweight and Obese Elderly People in Sarawak,Malaysia: A Quasi-experimental Study

Objectives:Physical inactivity is the fourth leading global risk factor for mortality, followed by obesity. The combination of these risk factors is associated with non-communicable diseases, impaired physical function, and declining mental function. The World Health Organization recommends physical activity to reduce the mortality rate. Thus, this study examined the effects on anthropometric measurements of a 12-week walking program for elderly people in Samarahan, Sarawak, Malaysia with a 7000-step goal and weekly group walking activities.Methods:A quasi-experimental study was conducted involving 109 elderly people with a body mass index (BMI) ≥25.0 kg/m². BMI, body composition, and average daily steps were measured at baseline, 6 weeks, and 12 weeks. Data were analyzed using SPSS version 26.0, and repeated-measures analysis of variance with the paired t-test for post-hoc analysis was conducted.Results:In total, 48 participants in the intervention group and 61 participants in the control group completed the study. A significant interaction was found between time and group. The post-hoc analysis showed a significant difference between pre-intervention and post-intervention (within the intervention group). The post-intervention analysis revealed an increase in the mean number of daily steps by 3571.59, with decreases in body weight (-2.20 kg), BMI (-0.94 kg/m²), body fat percentage (-3.52%), visceral fat percentage (-1.29%) and waist circumference (-2.91 cm). Skeletal muscle percentage also showed a significant increase (1.67%). Conclusions:A 12-week walking program combining a 7000-step goals with weekly group walking activities had a significant effect on the anthropometric measurements of previously inactive and overweight/obese elderly people.     

Willingness to use pre‐exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Malaysia: findings from a qualitative study

Background : Men who have sex with men (MSM) continue to be disproportionately affected by HIV in Malaysia. Recent success has been observed within demonstration projects examining the efficacy of HIV pre‐exposure prophylaxis (PrEP), an antiretroviral ‐based medication taken by HIV‐negative men to prevent sero‐conversion. In order for such promising findings to be translated in real‐world settings, it is important to understand the acceptability of PrEP, including perceived barriers to access or uptake. Methods : As part of a larger mixed‐methods study exploring acceptability and willingness to use PrEP among MSM in Malaysia, 19 men took part in audio‐recorded focus group discussions hosted by a community‐based HIV organization and facilitated by a trained researcher. Discussions focussed on awareness and potential information management, general perceptions of PrEP and potential motivations or barriers to the use of PrEP, including those at the personal, social, health system or structural level. Data were transcribed verbatim and underwent a detailed thematic analysis. Results : Rather than perceiving PrEP as a replacement for condoms in terms of having safer sex, many participants viewed it as an additional layer protection, serving as a crucial barrier to infection on occasions where condom use was intended, but did not occur. It was also perceived as more valuable to “at‐risk” men, such as those in HIV sero‐discordant relationships or those with a higher number of sexual partners. Elements of discussion tended to suggest that some men taking PrEP may be subject to stigma from others, on the assumption they may be promiscuous or engage in high‐risk sexual behaviours. Conclusions : This qualitative study indicates that, broadly speaking, PrEP may be acceptable to MSM in Malaysia. However, in order for its potential to be realized, and uptake achieved, educative interventions are required to inform the target population as to the efficacy and potential, positive impact of PrEP. Given concerns for how those taking it may be stigmatized, it is crucial that the use of PrEP is presented as a responsible course of action, and one of a range of strategies that men can use to keep themselves safe from HIV.     

海外中医制度文化之探索马来西亚中医药发展大蓝图(2018—2027)

在马来西亚,中医被纳入传统与辅助医学的范畴。马来西亚卫生部于2018年3月13日推出马来西亚传统与辅助医药发展蓝图2018—2027(医疗篇)本文简称马来西亚中医药发展大蓝图。本文借此契机,以宏观的角度系统地介绍与回顾蓝图中涉及中医药的部分,包括蓝图的宗旨,内容和主要成果并分享现今中医药界所面临的各种挑战以及该蓝图所提出的中期和长期战略回应。该蓝图达成了3项主要成果,1)勾勒出中医药在马来西亚发展的宏观格局。两大特殊国情催生了马来西亚各传统医学以多元为本的4大特点。2)探明中医药在微观层次的现况。该蓝图从临床、教育、科研和药物监管4大微观方向探索中医药界所面临的以发展方向不明确和资源投入不足所引起的各项挑战和其成因后果。3)明确提出未来10年的发展大方向。所提出的六大方针充分反映了该蓝图依据中医自身的发展规律,创造性地提出了加强各政策的合适性,优化资源投入和迈向专业化的三大中心理念。整体上该蓝图在制定落实和监督上都秉承了群策群力集体磋商凝聚共识的马来西亚核心精神。     

Trends in overweight and obese adults in Malaysia (1996–2009): a systematic review

Like other nations experiencing rapid industrialization, urbanization and a nutrition transition, there is concern in Malaysia of a possible escalation in the prevalence of overweight and obesity. In 1996, the National Health and Morbidity Survey reported a 16.6% and 4.4% prevalence of overweight and obesity, respectively. In the following decade, there have been several national and community surveys on overweight and obesity in Malaysia. The objective of this systematic review is to describe the trend from 1996 to 2009 in the prevalence of overweight and obesity in adults in Malaysia nationally and by gender, age and race. Results indicate that there has been a small rise in overweight adults in the years 1996, 2003 and 2006 (20.7%, 26.7% and 29.1%) and a much more dramatic increase in obesity in 1996, 2003, 2004 and 2006 (5.5%, 12.2%, 12.3% and 14.0%). Evidence showed a greater risk for overweight and obesity among women compared with men. Based on the highest‐quality studies, overweight and obesity levels were highest among adults 40–59 years old. Overweight levels were highest among Indians, followed by Malays, Chinese and Aboriginals, with less consistency across studies on the order of risk or obesity by ethnicity.