In the cold winter month of January 2012, two post graduate students from the Department of Community Health, Universiti Kebangsaan Malaysia (UKM), went on a two weeks field attachment with the Division of International Health (Public Health), Niigata University Graduate School of Medical & Dental Sciences (NU). This report is an account of our first hand learning experience about the public health system and culture in Niigata, Japan. Famously known as the 'Snow Country', Niigata prefecture is approximately 350 kilometers north of Tokyo, in the middle of the west coast of Honshu island, facing the Sea of Japan. It borders on the east with Fukushima prefecture, which was badly affected by the great tsunami disaster in March 2011. Niigata has a population of two and a half million, of which 21.3% is above the age of 65. Niigata University is located in Niigata City, the capital of Niigata prefecture. This attachment was under the UKM-Global Student Mobility Programme (Outbound) and it was taken as an opportunity to improve the memorandum of understanding between UKM and NU. The objectives were to gain knowledge and experience in various public health issues in a developed nation like Japan. Specifically, we were interested to learn about the local public health programmes, the influenza surveillance system, public health programmes for the elderly population, the Geographical Information System (GIS) and the Japanese culture in general. (Copied from article).
MeSH terms: Aged; Disasters; Humans; Influenza, Human; Japan; Learning; Malaysia; Public Health; Snow; Students; Tokyo; Universities; Developed Countries; Geographic Information Systems; Tsunamis; Islands
The relationship between healthcare services and inequalities is more likely when a group that shares a salient identity faces severe inequalities of various kinds. Such inequalities may be catalyzed by economic, social, political or concern cultural status. The objectives of this review are to identify the issues and challenges involve in healthcare inequalities, to compare factors contributes to healthcare inequalities and to purpose suggestions and recommendations for improvement based on issues and challenges between United States and India. Comparing annual year healthcare report, documentation of healthcare institutional, Ministry of Health's report and circular, official institutional website, scientific healthcare journals, articles and reports published in 1994 until 2011 regarding healthcare inequalities between United States and India. Health inequalities in the healthcare system contributed by the different in socioeconomic status and accessibility to the healthcare facility due to high cost of treatment has been common risk 'Catastrophic' factors to the inequalities in both countries. Health financing system and resource allocation that benefit only the upper class social spectrum of the population. Disparities occur due to the imbalance in distribution of wealth, discrimination and change in the world economy. Adapting healthcare system that provides care to all classes of people need improvement as no healthcare system is perfect. This matter must be tackle urgently as it's a matter of national concern.
MeSH terms: Documentation; Health Services; India; Social Class; Socioeconomic Factors; United States; Resource Allocation; Healthcare Disparities; Healthcare Financing
Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Carpal tunnel syndrome (CTS) is a hand disorder which indicates the presence of symptoms such as pain, numbness, and muscle weakness among the patient. CTS is an occupational related disorder which can occur in any profession. However, it can be prevented and managed. The aims of the research were to determine the prevalence of acquiring CTS among nurses who worked in the wards and occupational risk factors involving the upper limbs during nursing tasks performance. The specific aims were to determine the relationship between the prevalence of acquiring CTS and individual factors (age, gender, race, educational level, duration of work and medical history), relationship between the prevalence of acquiring CTS and occupational risk factors in nursing tasks. Nurses profession was chosen as they are performing multitask involving upper limbs especially the wrist joints. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the level of severity in CTS. Occupational risk factors were assessed by using the Rapid Upper Limb Assessment (RULA). This research was a cross sectional mode which was carried out at a government university medical centre from November through December 2010. Eighty nurses were involved in the research. The respondents were required to fill in the socio-demographic information sheet. Those having CTS were required to fill in the BCTQ. Assessments were performed by observing of the job activity through RULA. The results showed that the prevalence for nurses acquiring CTS is 7.5%. The RULA assessment also indicated that the risk factor was in the highest level with a score of 7. No relationship was shown between the prevalence of CTS and race, gender, educational level and medical history. Significant relationship was indicated by the prevalence of CTS and occupational risk factors. In conclusion, a significant prevalence of CTS related to age of more than 30 years old, Malay races compared to Indian, working experience of more than 10 years and respondents with right hand dominant. Occupational risk factors also indicated among the active nurses. Therefore, it is important for us to modify the work environment, work flow, work methodology and ergonomic factors in order to prevent the nurses from acquiring CTS. Furthermore, education about the condition of CTS should be implemented and reinforced especially among the higher risk nurses.
Introduction Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. A physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. This paper presents some information regarding medical ethics, including the values and principles of ethical conduct. Later the requirements of consent form is presented to guide the researchers before conducting a study.
MeSH terms: Ethics, Medical; Humans; Judgment; Morals; Physicians; Research Personnel; Moral Obligations; Theology; Consent Forms
In July 2010 Universiti Kebangsaan Malaysia (UKM) and Niigata University (NU) signed a memorandum of agreement to continue collaboration in joint planning and implementation of education, research and practice services in the field of medicine.This collaboration is also a good opportunity for Doctor of Public Health (DRPH) postgraduate candidates to gain experience on the practice of public health in handling public health issues, planning the healthcare facilities, delivering a quality public health services, enforcing public health policies/regulations and finally learn about the health systems in general at other countries especially from developed country like Japan. Experiencing Health Care and Culture in Niigata, Japan.
MeSH terms: Cooperative Behavior; Delivery of Health Care; Government Programs; Health Policy; Japan; Malaysia; Public Health; Research; United States; United States Public Health Service; Universities; Developed Countries
Accepted 8 February 2012.
Introduction Social norms, though an important contributing factor of adolescent smoking in developed countries, has not been extensively studied in Malaysia. The objective of this study was to determine the association between certain perceived norms regarding smoking with smoking status among Malaysian secondary school students in Kota Tinggi, Johor.
Methods Data were collected from 2311 respondents consisting of 1379 male and 923 female secondary school students in Kota Tinggi district via a self administered questionnaire. Five perceived norms regarding smoking were assessed, namely: perceived peer smoking prevalence, perceived parental reaction towards adolescent smoking, perceived public perception of adolescent smoking, ever noticed peers smoking inside and outside school and perceived enforcement of anti-smoking policy in school and their association with smoking status. Multiple logistic regressions controlling for gender, peer smoking and family smoking was performed.
Results Of the five perceived norms, four were associated with smoking status, (perceived peer smoking prevalence (p
MeSH terms: Adolescent; Female; Humans; Malaysia; Male; Parents; Peer Group; Surveys and Questionnaires; Schools; Smoking; Students; Prevalence; Logistic Models; Developed Countries; Social Norms
Accepted 13 January 2012.
Introduction The purpose of this study is to explore the reasons of Shisha smoking among teenagers in Ipoh, Perak.
Methods Data was collected using in-depth face to face interview. Purposive convenient sampling was used to select volunteer respondents from one of the Shisha restaurant located at Ipoh. The interviews were conducted for 15-20 minutes, recorded using video tape. The data obtained was transcribed and coded for the purpose of thematic analysis.
Results All respondents were influenced by peers in their first attempt in Shisha smoking. Other reasons attracting them to continue smoking Shisha include appealing smell and the flavoured taste of Shisha, easy to access, perceived that Shisha was not addictive and its’ cheaper price. In terms of perception on health risk, all respondents believed that Shisha was less harmful compared to cigarette smoking.
Conclusions More educational programme, health talk about risk of Shisha should be developed and conducted to rectify the misconception about health risk of Shisha smoking. The target population should be focus on male teenagers who smoke Shisha in order to control the widespread Shisha smoking in Malaysia.
MeSH terms: Adolescent; Flavoring Agents; Health Services Needs and Demand; Humans; Malaysia; Male; Surveys and Questionnaires; Restaurants; Smell; Smoke; Smoking; Taste; Tobacco; Volunteers; Taste Perception
OBJECTIVE. Chronic obstructive pulmonary disease (COPD) is a one of the major cause of death and disability worldwide. This study aimed to compare the quality of life (QOL), Activity of Daily Living (ADL), Pulmonary Function Test (PFT) and general health symptoms pre and after hospital-based respiratory physiotherapy program among COPD patients. METHODS. Pre and post intervention study was conducted between January and July 2010. A total of 54 subjects aged between 30 to 40 years old were recruited for this study using universal sampling method from Alzawia Teaching Hospital, Libya. Data collected were socio-demographic data, QOL (before and after the intervention) using the Short Form-36 (SF-36) questionnaire, ADL using the Barthel Index and the General Health Symptoms.
RESULTS.. The mean SF-36 score for QOL is 30.13 (SD = 8.06) and 63.46 (SD = 13.53) before and after the physiotherapy respectively (with the p <0.0001). Patients’ Activity of Daily Living mean scores are 70.18, (SD = 16.50) and mean = 88.89 (SD = 13.28) before and after program (p< 0.0001). The general medical condition mean score after respiratory physiotherapy is 3.72 as compared to 4.96 before the respiratory physiotherapy (p< 0.0001). Pulmonary Function Test shows improvement in actual/predicted FEV1 ratio in all 54 cases with mean improvement from 55.85 before to 81.67 after the pulmonary physiotherapy (with the p <0.0001).
CONCLUSION. Hospital based respiratory physiotherapy program had significantly improved QOL, pulmonary function and activities of daily living among the subjects.
MeSH terms: Activities of Daily Living; Cause of Death; Hospitals, Teaching; Humans; Libya; Quality of Life; Surveys and Questionnaires; Respiratory Function Tests; Physical Therapy Modalities; Pulmonary Disease, Chronic Obstructive
This case report highlights Koro-like symptoms with erectile dysfunction.
Methods: We report a case of a Rohingya refugee who presented with Koro-like symptoms associated with erectile dysfunction and severe religious guilt.
Results: Sexual dysfunction, i.e. erectile dysfunction may be a predisposing factor for a Koro incidence. Religious issues complicated by superstitious beliefs pose a treatment challenge.
Conclusion: Treating patient with sexual dysfunction should involve exploring and addressing patient's conflicts to avoid worsening of symptoms. As this case illustrates, severe anxiety can present with Koro-like symptoms.
encountered particularly in mental health issues and to additionally analyze the methodologies used in studies involving HIV/AIDS informal caregivers.
Methods: Four electronic databases; Science Direct, EBSCOhost, Ovid and Springer Link were searched for articles published in the past 10 years (2002 - 2012). Only full-text English articles related to research on care giving of HIV-infected adult patients were selected.
Results: Twenty two out of 293 articles (7.5%) were reviewed, involving 2,765 caregivers in the USA (n=1,610), Africa (n=253), Asia (n=838) and Oceania (n=64) regions. A variety of age categories was involved in care giving with the youngest carer being 12 years old and the oldest, 60 years on average. Females and whites appeared to be dominant and 603 caregivers themselves were HIV positive. The main outcomes measured were care giving burden, challenges and coping. Stress and depression, stigma and discrimination, insufficient support, role overload and extreme poverty were the main challenges experienced in care giving. Both qualitative (n=11) and quantitative (n=9) were the equally preferred types of study. Purposive sampling emerged as the most preferred sampling technique. Various instruments were utilized, but the Beck Depression Inventory (BDI) was the most popular particularly in quantitative studies.
Conclusion: A variety of life aspects were negatively affected in the process of care giving for HIV/AIDS patients and studies of such nature commonly focused on caregivers' psychosocial burden.
Objective: The MINI International Neuropsychiatric Interview (MINI) is a short, structured diagnostic interview compatible with the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). It was designed for clinical practice, research in psychiatric, primary care settings and epidemiological surveys. This preliminary study aims to evaluate the reliability and validity of the Malaysian Version of MINI for Major Depressive Disorder and Generalized Anxiety Disorder symptoms criteria only.
Methods: Six hours of MINI training was given as part of a National Health Morbidity Survey training program for layman interviewers (n=229) and three videos were prepared by an expert psychiatrist for inter-rater reliability purposes. Meanwhile, for validity purposes, the MINI was administered to patients with Major Depressive Disorder (n=30), Generalized Anxiety Disorder (n=20) and to a normal population (n=60), to conform against the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) that was administered by psychiatrists.
Results: Overall the inter-rater reliability was satisfactory (0.67 to 0.85) and the concordance between the MINI’s and expert diagnoses was good, with kappa values of greater than 0.88.
Conclusions: The Malay version of the MINI is adjusted to the clinical setting and for the assessment of positive cases in a community setting. Modifications were highlighted to correct any identified problems and to improve the reliability of the MINI for future research and clinical use.
MeSH terms: Ambulatory Care Facilities; Anxiety Disorders; Depressive Disorder, Major; Humans; Malaysia; Primary Health Care; Psychometrics; Psychotic Disorders; Surveys and Questionnaires; Sensitivity and Specificity; Reproducibility of Results; Validation Studies; Diagnostic and Statistical Manual of Mental Disorders
Objectives: The aim of this study is to validate the Malay version of the Aggression Questionnaire (AQ) for the purpose of the future study related to aggression. Furthermore, the study seeks to identify types of aggression hold by the female inmates.
Methods: A cross-sectional study was designed involving 90 Malaysian female prisoners. The analyses include descriptive analysis, confirmatory factor analysis, and reliability testing. After one-week interval, a test-retest was conducted.
Results: The preliminary analysis confirmed that factor analysis was appropriate for the Malay-translated version of the AQ. The four factors structure was assessed but the factor loadings are remarkable different from the original versions. The total Cronbach's alpha coefficients is very high (α= 0.91). The Pearson's correlation however is low (r = 0.48) but acceptable for the instrument. Reliability of the subscales and the factors were also found satisfactory. Consequently, anger and hostility were identified as the most common types of aggression among the participants, followed by verbal aggression. In contrast, physical aggression was the least scored type of aggression.
Conclusion: The Malay-translated version of the AQ was found to be valid and reliable to be used in future studies.
MeSH terms: Aggression; Anger; Cross-Sectional Studies; Factor Analysis, Statistical; Female; Hostility; Prisoners; Surveys and Questionnaires; Translating; Reproducibility of Results
This article highlights the issues pertaining to psychiatry and smoking as reported in a symposium on smoking cessation in Malaysia. Methods: A report on a meeting outcome of a symposium on “Making smoking free agenda for psychiatrists in Malaysia.” Results: Smoking is still the number one public health problem and those with mental illness were at a high risk. Despite that, they are often under served in service provision by those caring for them. These shortcoming are seen more and more in Malaysia, where smoking and psychiatry is under researched. Conclusion: More research are needed on the why and how psychiatrist can play a major role in ensuring that those with mental illness in Malaysia are provided equal opportunities to quit smoking.
Objective: The aim of this paper is to examine medical students’ views on the usefulness of a community project as a venue to train professionalism. Methods:Medical students at Cyberjaya University College of Medical Sciences (CUCMS) were surveyed following psychiatry community projects organized during year 4 undergraduate attachments in psychiatry. Results: A total of 176 students returned the survey forms. A majority of medical students thought that the psychiatry community project promotes teamwork and leadership skills. About a quarter thought that it helped foster their communication ability and encouraged them to be more reflective in their daily lives. These findings were translated into the potential of the community project to train “collaborative” and “managerial” affective domain learning outcomes of the university. Conclusions: The findings indicate that psychiatry community project or similar programmes may be useful tools to train several elements of medical professionalism. Future research however should utilise specific measurements to confirm this finding.
MeSH terms: Professionalism; Community Psychiatry; Leadership; Surveys and Questionnaires; Research; Students, Medical; Universities
Objectives: This review aims to compile and evaluate all available randomised controlled trials (RCTs) of auricular acupuncture (AA) treatment in drug addiction population with emphasis on the length of treatment course, needle-points, outcome measures, reported side-effects and overall outcomes.
Methods: Science Direct, Medline and EBSCOhost databases were searched. From the year 1990 until 2010, only full-length English articles incorporating RCTs related to AA studies (needle-based only) in drug addiction such as heroin, morphine, methamphetamine and cocaine were included. Studies involving the usage of various methods of electroacupuncture and investigations relating to cigarette-smoking or alcohol addiction were excluded.
Results: Eight RCTs met all inclusion criteria comprising of 1,594 respondents (age = 19 - 46 years; male = 57% - 76%). Most were involved in cocaine addiction. Overall, trials were designed with brief periods of treatment course and utilised three to five standard National Acupuncture Detoxification Association (NADA) points (Sympathetic, Lung, Liver, Kidney and Shen men), but inconsistent sham points. All trials included urine toxicology test as the main outcome measure while data on side-effects incidence was insufficient. Conclusions: Overall, four of the RCTs reported positive outcomes although at this point, AA’s effectiveness and safety could not be substantially confirmed. For the future, high-quality RCTs of AA are urgently required to provide a clearer understanding on the usefulness of this complementary therapy in drug addiction treatment.
Objective: This case report highlights on the challenges in the management of people with bipolar disorder. Method: We report a case of 36 year-old lady living with this disorder and her journey in a search for a meaningful life. Result: Adherence to treatment is a major determinant of outcome in bipolar patient like Ms WMY. Poor insight, negative attitudes towards treatment and poor understanding of medications and the illness can all lead to reduced adherence. Conclusion: This case demonstrates on how poverty of insight, poor social support, on-going stressors with significant life events and poor compliance to treatment create a series of stumbling blocks in recovery from bipolar disorder.
MeSH terms: Attitude; Bipolar Disorder; Female; Health Services; Humans; Problem Solving; Social Support; Biological Processes; Physiological Processes
Objective: The objective of the present study was to determine the prevalence and factors contributing to psychological morbidity among doctors in Sana’a city, Yemen. Methods: A cross sectional study was conducted among 442 Yemeni doctors. The (GHQ12) was used as a measure of psychological morbidity. Sources of job stress were determined using a 37-item scale questionnaire. Results: The prevalence of psychological morbidity was 68.1 %. Gender, age range of 30 – 39 years old, chewing Khat, type of residence and income were significantly associated with psychological morbidity (p
Objective: Emotional Intelligence (EI) is described as the ability to perceive, express,
understand, motivate, control and regulate emotion. The USM Emotional Quotient Inventory (USMEQ-i) was designed to measure EI and it was found to be a reliable and valid tool in a sample of prospective medical students. The objective of this study is to determine stability of the USMEQ-i to measure EI at different time and occasions. Methods: A prospective cohort study was done on 196 first year medical students. It was administered to the medical students at four different intervals. The Cronbach’s alpha and intra-class correlation analysis were applied to measure the internal consistency and agreement level across the intervals. The analysis was done using Statistical Package for Social Sciences (SPSS) version 18. Results: A total of 196 first year medical students participated in this study. Its overall Cronbach’s alpha value across intervals ranged between 0.94 and 0.97. The Cronbach’s alpha values of emotional control, emotional maturity, emotional conscientiousness, emotional awareness, emotional commitment, emotional fortitude, and emotional expression scale ranged between 0.59 and 0.91. The Cronbach’s alpha value for the faking index scale ranged from 0.76 to 0.89. The ICC coefficient values for EI total score was 0.83, EI domain score ranged between 0.62 and 0.76 and the faking index score was 0.76. Conclusion: The USMEQ-i has demonstrated a good level of stability and internal consistency to measure EI at different time and occasions. It is a promising psychometric instrument that can be used to measure EI.
Objective: Despite the availability of modern anti-emetics, chemotherapy-induced nausea and vomiting (CINV) symptoms remain distressing to a high number of cancer patients. This study intended to (1) describe the incidence of CINV and antiemetic usage; (2) assess the health-related quality of life (HRQoL) and correlate its components with Global Health Status; (3) evaluate HRQoL status in relation to CINV among breast cancer patients receiving chemotherapy. Methods: A cross sectional study was conducted in two government hospitals located in the East Coast of Peninsular Malaysia (Terengganu, Kelantan). The Morrow Assessment of Nausea and Emesis Follow-up (MANE-FU) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were administered. Descriptive statistics and non-parametric tests were employed (SPSS 16). Results: Respondents included 41 female patients (age = 49 ± 9.6 years; Malay = 92.7%; no family history of breast cancer = 68.3% and on moderately emetogenic chemotherapy = 97.6%). Majority of patients experienced nausea during or after chemotherapy (90.2%) and rated it as ‘severe’. Most patients had taken anti-emetic
(87.8%) and considered it ‘somewhat useful’. The median score for Global Health Status was 50 (IqR= 16.7). Emotional Functioning, Fatigue and Pain correlated fairly with HRQoL (rs= +0.435; -0.417; -0.387 respectively). Patients with ‘a lot’ and ‘moderate’ nausea displayed significantly more fatigue compared to those with little nausea (p=0.029). Those who experienced vomiting reported worse HRQoL profile compared to those who did not (p=0.011). Conclusion: These findings generally ascertained that CINV remains poorly controlled and significantly interferes with HRQoL, providing rooms for improvements in therapeutic intervention.
MeSH terms: Antiemetics; Breast Neoplasms; Cross-Sectional Studies; Emetics; Female; Follow-Up Studies; Government; Health Status; Humans; Malaysia; Nausea; Pain; Quality of Life; Surveys and Questionnaires; Vomiting; Global Health; Incidence