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.
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
Introduction The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide
and many of these affected individuals remain unidentified. Undiagnosed
T2DM may impose substantial public health implications because these
individuals remain untreated and at risk for complications. The objective of
this study was to determine the national prevalence of undiagnosed T2DM
and to identify the associated risk factors.
Methods A nationwide cross-sectional study was conducted involving 17,783
respondents. Two-stage stratified sampling design was used to select a
representative sample of the Malaysian adult population. Structured
validated questionnaires with face to face interviews were used to obtain
data. Respondents, who claimed that they were not having diabetes, were
then asked to perform a fasting blood glucose finger-prick test by Accutrend
Results The prevalence of undiagnosed T2DM was 8.9% (n=1587). The highest
percentage of undiagnosed T2DM was found among males (10.2%), 55-59
years old (13.4%), highest education attainers of primary school (11.1%),
Indians (10.3%), married (10.3%), working (8.9%) and living in the urban
areas (9.2%). Multivariate analyses showed that factors associated with
undiagnosed T2DM were gender, age group, ethnicity, marital status, obesity
Conclusion This study found an increasing trend of undiagnosed T2DM in Malaysia
compared to 2006. This finding is alarming as risk factors associated with
undiagnosed diabetes were related to most of the socio-demographic factors
studied. Therefore, early diabetic screening is crucial especially among adults
aged 30 and above to prevent more serious complications of this disease.
Introduction Helminthiasis is a common parasitic condition particularly among children in
rural areas in developing countries where poor hygiene standard is practiced.
The study aimed to determine the prevalence of helminthiasis among Indian
preschoolers in urban areas in Penang and its associated factors.
Methods A total of 194 urban Indian preschoolers aged 4 to 6 years old were selected
randomly from 11 kindergartens in the state of Penang for this cross sectional
study. Data collection was carried out in 2 phases. First, microscopic stool
examinations were done to examine the presence of helminths. Second, self
administered questionnaires which inquired about human, environment and
socioeconomic factors were completed by the parents/guardians.
Results The overall prevalence of helminthiasis was 7.2% and the most frequently
encountered infective agent was Ascaris lumbricoides (57.1%) and followed
by the tapeworms (42.86%). The logistic regression indicated that habitual
thumb sucking (AOR= 5.6. 95%CI: 1.73-18.39) and families owning
domestic pets (AOR= 3.2; 95%CI: 1.03-10.14) were the significant
contributing factors to helminthiasis among the Indian pre-schoolers in urban
Penang. Although the prevalence of helminth infection among the urban
Indian preschoolers is lower than rural area, it is still a public health concern.
Children habitual thumb sucking and rearing domestic pets at home were the
significant contributing factors in helminthiasis.
Conclusion Prevention strategy should focus on health education and promotion among
adults and children, awareness on domestic animal hygiene and maintaining
good environmental sanitation. Multi agency collaboration is clearly
essential, especially between state health, education and veterinary
departments in curbing this disease.
Introduction The quality of education is one of the controversial topics and vital issues that
requires more emphases from researchers due to the current challenges in
education at the university level. Involvement and participation from the
studentis essential to implement quality assurance and to reach for academic
accreditation. The aim of this study is to assess knowledge, attitudes, and
practices (KAP) of students towards TQM in education and its influencing
factorsatHigh Institute of Health Sciences (HIHS) in Sana'a, Yemen.
Methods A cross-sectional study using a self-administered questionnaire was
conducted in 2016. A total of 208 students from second and third study levels
in HIHS had participated from 268 students were observed (study
population). Descriptive statistics, chi-square, and one-way ANOVA were
used to determine the association between students’ KAP towards TQM in
education with its influencing factors.
Results Mean age of the students were 22.44(SD±2.027) year old. Majority of HIHS
students were male 135 (64.9%) and 108 (51.9%) were from the third
studying level. The highest students' KAP scores were 53.4%, 65.4%, and
41.3% for good knowledge, good attitudes, and moderate practices
respectively. Education Department was found to be significantly associated
with students' knowledge and practices with p
Introduction Non-specific low back pain is one of the most common physical ailments
affecting millions of people worldwide. This condition constitutes a
significant public health problem and was listed as a prevalent health
complaint in most societies. Even though there are many anecdotal claims
for reflexology in the treatment of various conditions such as a migraine,
arthritis and multiple sclerosis, but very little clinical evidence exists for
reflexology on the management of low back pain per se. This study aims to
evaluate the effects of foot reflexology therapy as an adjunctive treatment to
the Malaysian low back pain standard care in relieving pain and promoting
health-related quality of life among people with non-specific low back pain.
Methods This is a parallel randomized controlled trial with pre and post-treatment
study design. The study setting for the intervention located at Penawar
Reflexology Center, Kuala Terengganu, Malaysia. A total of 100
participants with non-specific low back pain will be allocated to one of two
groups, using a randomization computer program of Research Randomizer.
The control group will receive low back pain standard care, while the
intervention group will receive standard care plus eight sessions of foot
reflexology therapy. The pain intensity and health-related quality of life
scores will be measured using Visual Analogue Scale and Euro-quality of
life scale respectively in both groups. The study was approved by the
Human Research Ethics Committee of University Sultan Zainal Abidin
(UHREC/2016/2/011). The study protocol was registered at
ClinicalTrials.gov, with the ID number of NCT02887430.
Measurements Outcome measures will be undertaken at pre-intervention (week 1), postintervention
(week 6) and follow-up (week 10).
Conclusions This will be the first trial to compare the foot reflexology therapy with
control group among people who medically diagnosed with non-specific low
back pain in Malaysia. The result of this study will contribute to better
management of this population, especially for Malaysia healthcare setting.
Introduction There is an increasing trend of obesity in children and adolescent globally.
The objectives of this study were to identify the prevalence of overweight
and obesity among students from secondary schools and to determine the
mean random blood sugar (RBS) for the overweight and obese students.
Methods This was a cross sectional study. Two secondary schools that were scheduled
for visit by the School Health Team, Taiping in July 2016 were included. A
standardized data collection sheet was used to collect the data. Overweight
and obesity were defined based on WHO 2007 reference for BMI-for-age
criteria. Random blood glucose was checked for overweight and obese
Results A total of 184 school students consented and participated. 128 (69.6%) were
female and 90 (48.9%) were Malays. The mean weight and height were 56.21
kg and 1.61 m respectively with BMI of 21.49 kg/m2
. Overall, the prevalence
of obese and overweight were 12.5% and 10.9% respectively. Among the 4
BMI groups, there were no significant difference found in sex (p=0.849) and
races (p=0.536). However, there was significant difference (p=0.042) in
mean RBS for obese and overweight students between races. RBS readings
among overweight and obese students were within normal range with mean
of 5.95 (0.67) mmol/l (range between 4.60 – 7.70 mmol/l).
Conclusions The overall prevalence of overweight and obesity were comparable with
other studies done in Malaysia. Nevertheless, there was no prevalence of
Type II diabetes mellitus among them.
Introduction Special Olympics (SO) Inc. is an organization for people with intellectual disability (ID) to actively engaging in Olympic-type sport and participating in competition. Special Olympic Inc. provides Healthy Athletes Programme (HAP®) in screening and providing health education to Special Olympic Athletes. Objective To study the body mass index (BMI), blood pressure (BP), visual acuity and hearing status of children and young adult with ID in Special Olympics Sarawak. Methods Health data were collected by trained health professionals under HAP®held in conjunction with Special Olympics Sarawak State Games on 17th and 18th April 2010 in Sibu. Health data collected were athletes' weight, BMI, BP, ear canal screen and hearing status (oto-acoustic emission, pure tone audiometry), as well as eye health and visual acuity, using guidelines set by HAP®. Results 195 athletes attended the State Games in 2010 of which 138 were screened. Significant number of athletes was considered overweight / obese (31.5% for children and 36.9% for adult). More than 20% of the adult athletes were hypertensive or at risk of hypertension. Sixteen percent of the adult athletes had hearing loss. More than half of the adult and children athletes never had eye checks, and a significant numbers of them had abnormal eye tests results. Conclusions Health screening conducted during the HAP® is a useful screening program in this population. Health data collected can bring awareness to athletes and their family, and corrective measures in hearing and visual impairment can be taken immediately.
Introduction During haze, at what level should Air Pollutant Index (API) showed, public
or private school be closed is not without controversy and is very much
debated. Therefore, the aim of this paper is to objectively quantify the
potential inhaled dose of PM10 associated with exposure at school and home
microenvironments during haze. The result of the health risk assessment will
be used to propose the API level for closing the school during haze episode.
Methods A hypothetical haze exposure scenario was created using the breakpoints of
PM10 concentration for calculation of API and respective inhaled dose during
haze. To determine the potential inhaled dose, we have considered many
factors that include time spent for specific physical intensity at school and
home microenvironments, age-specific and physical intensity-specific
inhalation rate (m3/min), and the indoor/outdoor ratio of PM10. To calculate
risk quotient (RQ), the inhaled dose was compared with the health reference
dose computed based on the concentration of PM10 in the Malaysian
Ambient Air Quality Standard.
Results When considering the specific exposure at each microenvironment (school
and home), the potential inhaled dose of PM10 was substantially lower when
school is closed for both primary and secondary school. The calculated risk
quotient (RQ) indicates that primary school children are likely to be affected
at slightly lower PM10 concentration (equivalent to API of 197) as compared
to secondary school children. Short duration of high physical activity
intensity during school breaks has contributed to a large proportion of inhaled
dose among school children indicating the important to avoid physical
activities during haze.
Conclusion Based on the assessment, taking into account the uncertainty of risk
assessment methodology, we proposed school to be closed when API reach
190 for both primary and secondary schools. These findings and
recommendations are only valid for naturally ventilated school and applicable
in the context of the current API calculation system and the existing
Recommended Air Quality Guideline values in Malaysia.
Introduction This paper aims to investigate the potential pesticide dermal contamination
among the agricultural community by observing the microenvironmental and
macroactivity interaction between farm children and adult farmer.
Methods A 24 hours timeline activity was observed and recorded in the agricultural
farming village, Kuala Selangor. In this study, 2 homes were monitored for 2
days following a pesticide application. A total of 2 adult farmers and 5
children (7-10 year old) were recruited to participate in this study. Twentyfour
hour videotape segments and time-activity diaries were collected during
Results The microenvironment and macroactivity interaction were modelled in this
study. By considering only the potential dermal exposure pathway, the
different biological vulnerability and exposure pattern to pesticides were
observed. Finding showed a greater extent of interaction between human and
its environment, where adult farmers are the main contributor of
environmental contaminants, and children is one of the vulnerable receivers
of the contaminants’ residuals from the environment.
Conclusion The daily activities and behaviors practiced by the agricultural community
were among the contributing factors which help to highlight the pesticide
dermal contamination pathway in the farming village. This study
recommends the necessary to consider the microenvironment and
macroactivity of the target community when assess their exposure levels to
the environment contaminants.
Accepted 11 August 2011.
Introduction Despite of its importance for preventing fatal and severe injuries in an event of a crash, limited studies were conducted to find out the status of seatbelt use among rear passengers in Malaysia. This study was conducted to the determine seatbelt use among rear passengers in Malaysia in conjunction with the introduction of the rear seatbelt law that took effect on 1st January 2009.
Methods Two methods were used; the roadside observations and surveys. A total of 4180 rear passengers were observed during the road side observation and 793 rear passengers were interviewed in the survey.
Results About 41.8 % (95 % CI: 38.3, 45.4) of rear passengers interviewed reported that they “Always/Often’ wore safety belts, while roadside observation recorded slightly lower rate (36.2 % [95 % CI: 34.8, 37.7]). Based on the roadside observation method, male rear passengers were more likely to use rear seatbelts as compared to female rear passengers (with Odd Ratio: 1.17 (95 % CI: 1.03, 1.33)). Both methods consistently reported that rear passengers of Multipurpose Vehicle (MPV)/Sport Utility Vehicle (SUV) (survey method “always wear”: 39.3 %, Odd Ratio: 2.02 [95 % CI: 1.13, 3.61], roadside observation method: 51.9 %, Odd Ratio: 2.23 [95 % CI: 1.89, 2.62]) were two times more likely to wear seatbelts as compared to rear passengers of a car.
Conclusions The two research methods indicate rear passengers in Malaysia were consistently having low seatbelt usage rate. As the rear seatbelt advocacy and enforcement programme are new in Malaysia, efforts to advocate rear seatbelt use should be strengthened. The changes in rear seatbelt usage rate need to be tracked regularly and as an alternative to roadside observation method, interview survey method could be used to measure the seatbelt usage rate and to identify the reason for not using safety belt among rear passengers.
It all started with a SSM research. SSM, which is an abbreviation for ‘Special Study Module’ is a unique module in the curriculum of the Medical Faculty National University of Malaysia (UKM), where each students were required to do a medical research in the field that we have interest in. Being interested in the field of public health, 3 of my friends and I did a research on the prevalence of tuberculosis in Cheras using the graphic informational system (GIS) to map each case of tuberculosis on the map of Kuala Lumpur. Our supervisor was Associate Professor Dr Shamsul Azhar, who is himself an expert on the field of GIS study and has been doing his PhD research using the same system in Niigata University, Japan for almost 4 years. During one of our SSM meetings, he mentions that the post-graduate students in UKM has done several visits to Niigata University and brought up the idea that maybe the undergraduate students like us could do the same. (Copied from article).
Introduction Prolonged mechanical ventilation among cardiac surgery patient has been
found to be correlated with negative clinical outcome and increased
healthcare resources utilization. Prolonged mechanical ventilation (PMV)
was defined as the accumulative duration of 24 hours or more of
postoperative endotracheal intubation starting from transfer of the patient to
cardiac ICU. This study is aimed to identify the risk factors preoperative,
intra operative and postoperative for prolonged ventilation among cardiac
patients in AL-Thawra Modern General Hospital (TMGH).
Methods Observational study design was conducted during a two-month period (from
1 August 2014 to 30 September 2014). It was among 70 patients who were
admitted to cardiac surgery intensive care unit in Al-Thawra Modern General
Hospital and selected by convenient sampling. The soci-demographic
characteristic and clinical patient data were collected using short
questionnaire developed by researcher. All patients had the same anesthetic
and postoperative management. Statistical analysis was performed with SPSS
version 20 and using bivariate analysis and multivariate logistic regression.
The p-value of < 0.05 was found to be statistically significant.
Results Incidence of prolonged mechanical ventilator post cardiac surgery was 37.1%
(26/70) through bivariate analysis, multivariate logistic regression. Low
Ejection fraction of Left Ventricle was inversely related to mechanical
ventilation time (AOR= 0.872) with 95% confidence interval [0.790 - 0.963],
hemodynamic instability were associated with prolonged mechanical
ventilation time (AOR=16.35) with 95% confidence interval [2.558 -
Conclusion Low ejection fraction of Left Ventricle and Hemodynamic Instability post
operation were identified risk factors for prolonged mechanical ventilation
post cardiac surgery.
The World Health Organisation (WHO, 2006) defines teenage pregnancy as a 'teenaged or underaged girl (usually within the ages of 13-19) becoming pregnant.' The term usually refers to women who become pregnant, who have not reached legal adulthood; legal adulthood varies in different countries. The term teenage pregnancy is widely used however, to mean unmarried adolescent girls who become pregnant. Pregnant teenagers face many additional obstetric, medical & social issues compared to women who give birth in their 20s and 30s. Most at risk are mothers under fifteen and those living in developing countries. Complications during pregnancy and delivery are the leading causes of death for girls aged 15 to 19 in developing countries; they are twice as likely to die in childbirth as women in their twenties, with adolescents accounting for 13% maternal deaths worldwide. There is evidence to show (UNICEF Malaysia, 2008) that teenage pregnancy is associated with lower educational levels, higher rates of poverty and that the situation is often repeated with children of teenage parents. In addition, teenage pregnancy is often outside of marriage and therefore carries a social stigma in many cultures and community.
Emotional and behavioural problems among children have been increasing in many western as
well as the eastern countries. Although the problem has been given attention and priority in
terms of early detection, many children with early symptoms of emotional and behavioural
problems has still not been detected at the early stages. This phenomenon is worrying as mental
health problems were shown to be stable in the long run and if left undetected it may manifest
into various problems in adulthood. This paper explores the issues on emotional and
behavioural problems in terms of its definition, prevalence, aetiology, long term consequences
and treatment. It also explores on mental health problems in a non-western country, i.e.
Malaysia including its prevalence and intervention strategies which has been carried out in
overcoming this worrying issue. Finally this review paper stresses the importance of providing
a well-designed epidemiological study in Malaysia in assessing the current prevalence of
emotional and behavioural problems in young children and adolescent
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.
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.
A prospective study done In al Zaafaranya General Hospital in Baghdad/Iraq In the period between April 2003 and February 2007. Ninety two patients admitted to the surgical wards diagnosed as Intestinal obstruction. The aim is to find out the possible common conditions resulting in causing this common surgical emergency. Also to compare the provisional clinical diagnosis about ischemic obstruction and the definitive post operative diagnosis. To encourage post graduate students to use their clinical abilities with the few laboratory and radiological facilities available needed to decide about the management of those patients.
Primary health care is an approach to health and a spectrum of services beyond the traditional health care system while primary care is just one element within PHC that focuses on health care services. The present status of PHC in Malaysia and the strides it has made in uplifting the health status of the nation is described. The challenges that the Malaysia health system are facing have necessitated a review of the structure of the whole health system and reforms in PHC will ensue in due course. The concept of 1Care, the proposed re-structuring of the health system, is discussed with emphasis on the reform in the PHC delivery system. The reforms are aimed at addressing three main concerns on seamless integration of care especially for the management of chronic diseases, ensuring universal coverage and responsiveness of the health system in the face of increasing client expectations and patient safety. The opportunity for macro reform to improve the health of Malaysians by developing a sustainable and high performing health care system is being seized by the Ministry of Health in 1Care. The micro reforms are discussed as regards to increasing access to services, development of primary health care teams to deliver comprehensive PHC, the application of ICT, the renewed emphasis on health promotion & prevention activities and a renewed focus on community empowerment and participation. Support in terms of human resource, governance & funding models, capacity building in monitoring & evaluation as well as change management to affect the reforms are identified. The paper concludes with lessons learnt from other countries and the importance of systemic reform for a well functioning health delivery system.
Introduction Iodine deficiency disorders (IDD), is one of the most important micronutrient
deficiencies which has multiple adverse effects on growth and development.
The aim of this study was to determine the prevalence of IDD among school
children and to elucidate the distribution of iodized salt at household level in
Sarawak, East Malaysia.
Methods This cross-sectional study was conducted among school children aged 8 to 10
years in 2008. A multi-stage probability proportionate to population size
(PPS) cluster sampling method was used to obtain a representative state
sample of 1200 school children. Spot urine samples were collected for the
determination of urinary iodine concentration while the iodine content in salt
was determined using field rapid test kits. The thyroid status was determined
Results Response rate was 92.0% (n=1104/1200). The prevalence of goitre among
school children in Sarawak was 2.9% (5.2% in urban, 0.7% in rural). The
median urinary iodine concentration (UIC) among the school children was
102.1 μg/L (IQR, 62.3-146.5 μg/L). Urban children had significantly higher
median UIC of 109.3 μg/L (IQR, 72.4-159.0 μg/L) than their rural
counterparts [91.9 μg/L (IQR, 55.7-140.2 μg/L)]. The salt samples tested by
rapid test kit (RTK) showed only 46.0% of household salt contained iodine.
Conclusions The present study revealed that the population in Sarawak were of borderline
iodine sufficient with mild IDD seen in rural areas. Hence, the state IDD
control programmes need to encourage and advocate the consumption of
iodized salt in order to eliminate IDD-related health problems in Sarawak.