Introduction Anxiety and depression were known to bring detrimental outcome in patients
with ischemic heart disease (IHD). Notwithstanding their high prevalence
and catastrophic impact, anxiety and depression were unrecognized and
untreated. The aim of this study was to determine the prevalence of anxiety
and depression among IHD patients and the association of this condition with
clinical and selected demographic factors.
Methods This was a cross-sectional study on 100 IHD patients admitted to medical
ward in UKMMC. Patients diagnosed to have IHD were randomly assessed
using Hospital Anxiety and Depression Scale (HADS) and Perceived Social
Support (PSS) Questionnaire. Socio-demographic data were obtained by
direct interview. Fifteen percent of IHD patients in this sample were noted to
have anxiety, fourteen percent noted to have depression while thirty two
percent was noted to have both anxiety and depression. Patients’ age group
and the duration of illness were found to have significant association with
anxiety. Socio-demographic data were obtained by direct interview.
Results Fifteen percent of IHD patients in this sample were noted to have anxiety,
fourteen percent noted to have depression while thirty two percent was noted
to have both anxiety and depression. Patients’ age group and the duration of
illness were found to have significant association with anxiety. The other
clinical and selected demographic factors such as gender, race, marital status,
education level, occupation, co-existing medical illness and social support
were not found to be significantly associated with anxiety or depression
among the IHD patients.
Conclusions In conclusion, proper assessment of anxiety and depression in IHD patients,
with special attention to patients’ age and duration of illness should be
carried out routinely to help avert detrimental consequences.
Limited studies on prevalence and risk factors of Premature Coronary Artery Disease (PCAD) were done in Malaysia, primarily on lipid profile. This cross sectional study aims to identify any changing patterns in prevalence and risk factors of Premature CAD between 2000 and 2012. From 2000 to 2012 we included 21862 patients who underwent the first Percutaneous Coronary Intervention (PCI). Analysis of risk factors was done to 1660 and 2098 patients from year 2007 and 2012 respectively. Age of less than 45 years was taken as PCAD. Data was collected from PCI database of National Heart Institute (NHI), NHI TrakCare System, and patients’ medical records. PCAD significantly decreased from 18.8% (2000) to 11.6% (2012). Malay ethnicity showed increasing trend over the years from 55.1% to 66.9%. Multiple logistic regression analysis in 2007 showed that smoking had the higher risk (AOR=2.52), followed by male gender (AOR=2.06), family history of PCAD (AOR=1.96), Indian ethnicity, (AOR=1.65), triglycerides level (AOR=1.20) and BMI (AOR=1.06). In 2012, family history of PCAD had the highest risk (AOR=2.00) followed by smoking (AOR=1.91) and BMI (AOR=1.11). There are changes in risk factors patterns of premature CAD between 2007 and 2012. Most of them are preventable at earlier stage.
There is a large volume of published studies describing the adverse relationship between treatment non-adherence with tuberculosis treatment outcome. Non-adherence could result in increased risks of prolonged infectiousness, drug resistance, relapse cases and poor survival among tuberculosis patients. Nevertheless, few studies are to be found providing detailed on the reason of defaulting treatment among tuberculosis patients in Malaysia. Hence the goal of this paper is to find out the barriers and motivations factors that affect patients’ treatment compliance among our local tuberculosis patients. This is a qualitative study which included 12 in-depth interviews with tuberculosis non-compliance patients who were treated at Institute of Respiratory Medicine, Kuala Lumpur. All the conversations were recorded, transcribed and analysed by using thematic analysis. It was found that low knowledge, self-negative attitudes, traditional believes, negative perceptions towards health caregiver, drug side effects, stigma, financial problems, less family support and work commitments are the barriers that prevent the patients from religiously taking their anti-tuberculosis treatment. Meanwhile, factors that encourage them to continue their treatment were the believes of bad effects of the disease onto their lives and health, good relationship between patient and health caregiver and social support from people around them. In conclusion, non-adherence involved a dynamic influence of individual, socio-economic and treatment-related factors on the patients. The results presented here may facilitate improvement in the activities in promoting compliance among tuberculosis patients in the future which tailored to the patients’ specific needs.
Introduction: The Health Belief Model has gained widespread popularity and acceptance in the community,
yet little is known about its effectiveness as a basis for health behavior intervention. The purpose of this
study is to systematically review the evidence on the use of the model in health behavior for
Chronic Kidney Disease and the effectiveness of Health Belief Model as a model intervention for
facilitating health-related behavioral changes. Methods: The databases were manually searched
for references and gray literature. Overall, the methodological quality of trials was variable, and there
was limited evidence for the effectiveness of Health Belief Model in improving health
behavior. Results: There are few new trials published that describe the application of
Health Belief Model. Limited evidence supports any benefits of Health Belief Model for improving
health behavior. Conclusion: Studies on the usage of Health Belief Model need to be explored in depth
to assess the importance of Health Belief Model.
The purpose of this study was to determine the prevalence and factors associated with of Premature Ejaculation &Erectile Dysfunctionamong Malaysian men.A cross-sectional study was conducted in urban and rural areas using standardized and validated self-administeredquestionnaires.A total of 319 samples were recruited for PE screening. The overall prevalence of PE was 31.7% with 20.7% and 40.8% for urban and rural arearespectively. Depression, anxiety and frequent masturbation were significantly associated with PE. While For ED, infrequent sexual intercourse was the sole factor significantly associated with ED.PE and ED were highly prevalent in both urban and rural areas; with several significant preventable associated factors.
Objectives: To determine the association of students’ perception of schooling with externalizing/internalizing scores; and to examine the different perceptions related to truancy. Methods:A total of 373 predominantly 16 year-old students attending three high risk schools in Pudu, Kuala Lumpur completed the questionnaires on schooling variables (four items) and externalizing/internalizing syndromes (Youth Self-Report, 112 items). Results: Certain negative perceptions (uncertainty of the schooling purpose, thinking schooling as time wasting) were significantly associated with higher internalizing (p
AIMS: The aim of this study was to evaluate the left ventricular (LV) diastolic dysfunction in rheumatoid arthritis (RA) patients without clinically evident cardiovascular manifestations and to estimate whether there is any correlation between RA disease severity and disability and LV diastolic dysfunction.
METHODS: The study was a cross-sectional study involving 53 patients (47 female and 6 male) with RA without clinically evident heart disease and 53 healthy subjects (47 female and 6 male) who served as a control group. Both groups were matched for age and sex. Echocardiographic and Doppler studies were conducted in all patients with RA and control subjects.
RESULTS: Of 17 cardiac parameters assessed, only two were abnormal. None of the specific cardiac diastolic dysfunction parameters were significantly different in RA patients compared to the control group. There was no significant correlation between diastolic function values in RA patients and value of Disease Activity Score 28 (DAS-28) and value of Health Assessment Questionnaires Disability Index (HAQDI). Atrial (A) wave velocity was greater in RA patients compared to the control group (0.71 [0.58-0.83] vs. 0.61 [0.51-0.71]; P < 0.04). However, interventricular relaxation time (IVRT) ([73.08 ± 9.92 vs. 70.74 ± 9.02], P = 0.207), lower E/A ratio (1.27 [1.02-1.56] vs. 1.42 [1.20-1.68], P = 0.102), diastolic dysfunction parameters according to Redfield Classification (25 [47.2%] vs. 27 [50.9%] P = 0.56), diastolic dysfunction using E/A (P = 0.321) and tissue doppler imaging (E/E') (P = 0.148) were not different.
CONCLUSION: Prevalence of diastolic dysfunction in the rheumatoid arthritis group (47.2%) was not different from controls (50.9%). LV diastolic function had no significant correlation with RA disease severity and duration of disease.
The accuracy of the (13)C-methacetin breath test ((13)C-MBT) in differentiating between various stages of liver disease is not clear. A cross-sectional study of Asian patients was conducted to examine the predictive value of the (13)C-MBT in various stages of chronic liver diseases. Diagnostic accuracy of the breath test was determined by sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve analysis. Seventy-seven patients (47 men/30 women, mean age 50 ± 16 years) were recruited. Forty-seven patients had liver cirrhosis (Child Pugh A = 11, Child Pugh B = 15, and Child Pugh C = 21), 21 had fibrosis, and 9 had chronic inflammation. The sensitivity and positive predictive value for liver fibrosis, cirrhosis (all stages), Child-Pugh A, Child-Pugh B, and Child-Pugh C were 65% and 56%, 89% and 89%, 67% and 42%, 40% and 40%, and 50% and 77%, respectively. Area under curve values for fibrosis was 0.62 (0.39-0.86), whilst that for cirrhosis (all stages) was 0.95 (0.91-0.99). The (13)C-methacetin breath test has a poor predictive value for liver fibrosis but accurately determines advanced cirrhosis.
Our study aimed to examine the interplay between clinical and social predictors of future suicide attempt and the transition from suicidal ideation to suicide attempt in depressive disorders. Sixty-six Malaysian inpatients with a depressive disorder were assessed at index admission and within 1 year for suicide attempt, suicidal ideation, depression severity, life event changes, treatment history and relevant clinical and socio-demographic factors. One-fifth of suicidal ideators transitioned to a future suicide attempt. All future attempters (12/66) had prior ideation and 83% of attempters had a prior attempt. The highest risk for transitioning from ideation to attempt was 5 months post-discharge. Single predictor models showed that previous psychiatric hospitalization and ideation severity were shared predictors of future attempt and ideation to attempt transition. Substance use disorders (especially alcohol) predicted future attempt and approached significance for the transition process. Low socio-economic status predicted the transition process while major personal injury/illness predicted future suicide attempt. Past suicide attempt, subjective depression severity and medication compliance predicted only future suicide attempt. The absence of prior suicide attempt did not eliminate the risk of future attempt. Given the limited sample, future larger studies on mechanisms underlying the interactions of such predictors are needed.
Accepted 21 July 2011.
Introduction The extensive and intensive use of pesticides in agricultural practices has exposed farmers to various hazards resulting in varying degrees of health
outcomes.
Methods We conducted a cross-sectional study among paddy farmers in Sabak Bernam district, Malaysia. The objective of this study was to gather baseline information on chlorpyrifos blood level and its relationship with pesticides exposure symptoms.
Results We detected chlorpyrifos in farmers’ blood in 7 percent of the respondents, with mean 7.29 nanogram per millilitre blood (sd 5.84 nanogram per millilitre). The percentage of farmers who experienced at least one pesticide exposure symptoms was 75 percent. However, we found no significant association between chlorpyrifos blood level and its exposure symptoms. The farmers had low scores on safe practice of pesticide use even though they have high marks on knowledge and attitude. We found no significant association between the scores on knowledge, attitude and practice on pesticide use and the chlorpyrifos blood level.
Conclusions The presence of pesticide exposure symptoms proved that most of the farmers were exposed to hazardous effects of pesticides. Specific trainings on safe use and handling of pesticides should be given on regular basis to these farmers to ensure they are protected from hazardous effects of pesticides exposure.
Tuberculosis (TB) is known as a disease that prone to spatial clustering. Recent development has seen a sharp rise in the number of epidemiologic studies employing Geographical Information System (GIS), particularly in identifying TB clusters and evidences of etiologic factors. The aim of this systematic review is to determine evidence of TB clustering, type of spatial analysis commonly used and the application of GIS in TB surveillance and control. A literature search of articles published in English language between 2000 and November 2015 was performed using MEDLINE and Science Direct using relevant search terms related to spatial analysis in studies of TB cluster. The search strategy was adapted and developed for each database using appropriate subject headings and keywords. The literature reviewed showed strong evidence of TB clustering occurred in high risk areas in both developed and developing countries. Spatial scan statistics were the most commonly used analysis and proved useful in TB surveillance through detection of outbreak, early warning and identifying area of increased TB transmission. Among others are targeted screening and assessment of TB program using GIS technology. However there were limitations on suitability of utilizing aggregated data such as national cencus that were pre-collected in explaining the present spatial distribution among population at risk. Spatial boundaries determined by zip code may be too large for metropolitan area or too small for country. Nevertheless, GIS is a powerful tool in aiding TB control and prevention in developing countries and should be used for real-time surveillance and decision making.
As air travelling now becomes cheaper and available to almost all people of any walk of life, travelling across international borders is fast becoming a lifestyle of many. Having travel health service as part of health care services is important to address the issues of travel related illnesses among travellers. However, lacks of published guidelines pertaining to travel health service rendering many countries to overlook its importance. The aim of this paper is to review published literatures and authoritative websites on the components needed to develop guideline to establish travel health services. A systematic literature search was done using pre-specified keywords for literatures published between years 2000 – 2016. Literatures written in English and fully accessible were all included. No exclusion criteria was set before the search. Online authoritative websites pertaining to travel health were also referred. A total of six literatures ranging from expert opinion, review paper and original study, together with three authoritative websites related to travel health were reviewed. Among the important components needed to be considered for developing the guideline for establishing travel health services are to prioritise pre-travel health service, to set up specialised travel health clinic, to produce travel health/medicine specialist, to emphasize on continuous education and training of the practitioners and to apply multiagency and multidisciplinary approach with adequate fund for research in travel health. As a conclusion, policy makers should prioritise and select the most important components in developing guideline for travel health service.
As air travelling now becomes cheaper and available to almost all people of any walk of life, travelling across international borders is fast becoming a lifestyle of many. Having travel health service as part of health care services is important to address the issues of travel related illnesses among travellers. However, lacks of published guidelines pertaining to travel health service rendering many countries to overlook its importance. The aim of this paper is to review published literatures and authoritative websites on the components needed to develop guideline to establish travel health services. A systematic literature search was done using pre-specified keywords for literatures published between years 2000 – 2016. Literatures written in English and fully accessible were all included. No exclusion criteria was set before the search. Online authoritative websites pertaining to travel health were also referred. A total of six literatures ranging from expert opinion, review paper and original study, together with three authoritative websites related to travel health were reviewed. Among the important components needed to be considered for developing the guideline for establishing travel health services are to prioritise pre-travel health service, to set up specialised travel health clinic, to produce travel health/medicine specialist, to emphasize on continuous education and training of the practitioners and to apply multiagency and multidisciplinary approach with adequate fund for research in travel health. As a conclusion, policy makers should prioritise and select the most important components in developing guideline for travel health service.
Introduction: Cholera epidemics can produce devastating public health outcomes. Cholera distribution is influenced by temperature, precipitation, elevation, distance to the coastline and oceanic environmental factors such as sea surface temperature, sea surface height and ocean chlorophyll concentration. The purpose of this study is to describe the spatial epidemiology of cholera in the four districts of Sabah. Methods: This is a retrospective review of 4 years (2011 to 2014) data from the districts of Kota Kinabalu, Penampang, Putatan and Papar, Sabah. All reported cases of cholera from those areas are included. Coordinates for locations of the cases are based on home addresses. SPSS v20, ArcGIS v10 and CrimeStat IV were used for data analysis and mapping. Results: Cholera showed several clustering of cases, such as in 2011 and 2014 in Kota Kinabalu. In the year 2011 and 2013, Penampang and Papar districts had the nearest neighbour index of less than 1, but p value was not significant, meaning the pattern did not appear to be significant. Nearest neighbour hierarchical clustering analysis further revealed cholera had 7 clusters, of those 6 were first order and 1 was a second order cluster. Conclusion: Cholera shows disease clustering which could mean it is due to its common point source or localised human to human transmission. Using GIS as a tool may help in surveillance and control of cholera infections.
Dengue fever is an illness by arthropod-borne viral disease that become known pandemic to the most tropical countries. In 2014, Malaysia reported 108 698 cases of dengue fever with 215 deaths which increased tremendously compared to 49 335 cases with 112 deaths in 2008 and 30 110 cases with 69 deaths in 2009. This study aimed to identify the best method in determining dengue outbreak threshold for Negeri Sembilan and hopefully these methods can be standardized as it can help to send uniform messages to inform the general public and make the outbreak analysis comparable within and between countries. Methodology : Using retrospective Negeri Sembilan country dataset from 1st epid week of 2011 till the 52nd epid week of 2016. The data were split into two periods: 1) a 3-year historic period (2011–2013), used to calibrate and parameterise the model, and a 1-year evaluation period (2014); 2) a 2-year historic period (2014–2016), used to calibrate and parameterise the model, and a 1-year evaluation period (2016), used to test the model. E-dengue is a registration system for confirm case dengue by Ministry of Health. Data include details of cases, district locality, records on the outbreak and epidemiological week (Sunday to Saturday). The variables were captured using the Excel spreadsheet. Analysis method included endemic channel method, moving average or deviation bar chart and recent mean. Result: Seremban as big district and facing with heavy dengue cases, all three methods (endemic curve, current mean and moving mean) showed promising results. Meanwhile comparing with small district of Port Dickson and Tampin with fewer dengue cases and outbreak recorded, the suitable method is by using endemic channel for epidemic threshold. Conclusion: Simpler methods such as the endemic channel, recent mean and moving mean may be more appropriate in urban district. Whereas in rural or district with minimal dengue cases, Endemic Channel would be the most suitable method for epidemic threshold. However, both methods require a consistent updated graph threshold as time progress.
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in chronic kidney disease (CKD) patients. This study aimed to determine the roles of CVD biomarkers in CKD patients. This was a case-control study which recruited consecutive patients with stage 2-4 CKD patients with and without CVD. Serum levels of highly-sensitive C reactive protein (hs-CRP), cystatin C (CysC), asymmetrical dimetylarginine (ADMA) and symmetrical dimethylarginine (SDMA) were measured. Sixty two stage 2-4 CKD patients with a mean age of 60.3 ± 10.4 years were recruited. Twenty three (37.1%) of them had CVD. Those CKD patients with CVD were older (64.1±8.0 vs 58.1± 1.1, p<0.05) and had significantly higher systolic blood pressure (139.4 ± 16.2 vs 129.4 ± 14.8 mmHg, p<0.05). Diabetic patients had 8 times (95% CI 1.25-51.77, p< 0.05) higher risk to develop CVD. CKD patients with CVD had a higher serum creatinine (185.0 ± 54.1 vs 154.1 ± 54.4 μmol/L, p<0.05), a lower estimated glomerular filtration rate (33.7 ± 12.2 vs 42.2 ± 14.5 mL/min/1.73m2 p<0.05) and a lower triglyceride levels (1.3 (1.1-1.7) vs 1.8 (1.4-2.3) mmol/L, p<0.05), compared to those without CVD. Fasting blood sugar was 7.1 ± 2.7 mmol/L in CVD group and 6.3 ± 1.6 mmol/L in non CVD group (p>0.05). There were no differences in their mean serum levels of hs-CRP, CysC, ADMA and SDMA. Risk factors including age, diabetes mellitus, hypertension and renal functions were still the most important CVD risk factors in CKD patients.
Objective: The study aims to determine pattern of verbal memory and learning impairment and its associated factors among patients with bipolar I disorder in a psychiatric clinic of a university hospital. Methods: A case control study comparing verbal memory test
performance in 40 patients with bipolar I disorder to that of 40 healthy normal subjects using Rey Auditory Verbal Learning Test (RAVLT). The association between demographic, clinical
characteristics and poor verbal memory performance were examined. Results: Up to 92% of patients with bipolar I disorder have impaired short term working memory in this hospital-based study. They also recalled fewer words in all the RAVLT trials and had difficulties
learning the word list in comparison to that of normal healthy individuals. Verbal memory and learning impairment are observed in bipolar illness in the absence of active mood symptoms while duration and severity of illness are not found to have any effect on verbal memory and learning. Conclusion: There is consistent verbal memory and learning problems in individuals with bipolar I disorder and their presence in the absence of mania, depression and mixed symptoms during the course of the illness suggests a trait related deficit.
Study site: Psychiatric Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Objective: Truancy is a disciplinary problem, which frequently occurs among school students and it has many contributory as well as inter-related factors. It is a growing problem in this country and it often becomes a prelude to other delinquent behaviours. The study objective is to determine the prevalence of truancy as well as factors related to it including psycho-behavioural factors. Methods: A cross-sectional study involving 556 Malay student’s selected using multi-stage sampling was conducted. Results: The overall prevalence of truancy is 30.2%. The predictors to truancy are age, students who frequenting entertainment centre, students who have not completed Quran recital, coping strategies using problems solving methods and time spent watching television/video. There is a significant association between truancy and psycho-behaviour such as watching video/internet pornography, frequenting entertainment centre, smoking, motorcycle racing and dating a special friend. Conclusion: Truancy is a social issue, which must be given serious attention by all concerned components of the society.
The purpose of this study was to compare the serum interleukin (IL)-23 levels between rheumatoid arthritis (RA) patients and healthy controls and to determine the correlation of IL-23 levels with disease activity, joint damage and functional disability in RA. Serum samples were obtained from 45 patients with RA and 45 healthy controls. The enzyme-linked immunosorbent assay method was used for quantitative analysis of IL-23. All the RA patients were assessed for disease activity based on the 28-joint disease activity score, joint damage based on modified Sharp score, and functional ability using the Health Assessment Questionnaire-Disability Index. The mean serum IL-23 level was much higher among the RA patients (24.50 ± 13.98 pg/mL) compared to the controls (5.98 ± 3.40 pg/mL; p < 0.01). There was a significant positive relationship between IL-23 levels and disease activity and questionnaire scores (p = 0.003 and 0.020, respectively). On logistic regression analysis, IL-23 levels were significantly higher in patients with moderate to high disease activity (p = 0.008, odds ratio = 1.073, 95% confidence interval = 1.019-1.130) and patients with significant functional disability (p = 0.008, odds ratio = 1.085, 95% confidence interval = 1.021-1.153). RA patients have significantly higher levels of serum IL-23. The IL-23 levels correlate well with disease activity and functional disability but not with radiographic joint damage.
Study site: Rheumatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
The determination of the high-risk area and clusters of typhoid cases is critical in typhoid control. The purpose of this study was to identify and describe the epidemiology and spatial distribution of typhoid in four selected districts in Kelantan using GIS (geographical information system). A total of 1215 (99%) of the cases were coordinated with GPS (global positioning system) and mapping was done using ArcGIS 9.2. Spatial analysis was performed to determine the cluster and high-risk area of typhoid. Results showed that typhoid incidence was not associated with race and sex. Most affected were from the age group of 5-14 followed by 15-24 year olds. Nine sub-districts were categorized as highly endemic. In addition typhoid has shown a significant tendency to cluster and a total of 22 hotspots were found in Kota Bharu, Bachok and Tumpat with a few sub districts identified as high risk for typhoid. No significant relationships between the treated water ratio and flood risk area were found with the cluster of cases. The cluster of typhoid cases in the endemic area did not appear to be related to environmental risk factors. Understanding the characteristics of these clusters would enable the prevention of typhoid disease in the future.