Background: All healthcare services are moving towards quality management system including ISO 9000 due to pressure from various stakeholders involves and also to improve healthcare quality. The objective of this study was to measure the satisfaction level among the outpatients in ISO Certified Klinik Kesihatan Bandar Baru Bangi, Selangor. Also to identify the relations of patient’s satisfaction with the sociodemographic factors and service dimensions such as general satisfactions, technical quality of clinic staffs, interpersonal aspect of clinic staffs, time with doctors, communications with clinic staffs and availability/accessibility of clinic.
Methodology: A cross sectional study was carried out from February 2008 to Jun 2008 and a total of 240 respondents in the clinic were selected using universal sampling. Only those who are Malaysians aged 18 and above and complied with the inclusions criteria’s were selected as the respondents to fill up the Patient’s Satisfaction Questionnaire III.
Results: The study found that the satisfaction level of the respondents in Klinik Kesihatan Bandar Baru Bangi, Selangor were remarkable with 78.8%.It has been shown that the predictor factors of total patient’s satisfaction were general satisfaction (AOR=5.06, CI= 1.51-16.96), technical quality of clinic staff (AOR = 3.09, CI= 1.13-8.43), interpersonal aspect of clinic staff (AOR = 2.96,CI= 1.04-8.42), availability/accessibility of clinic (AOR = 9.38, CI= 9.37-87.95) and communication of clinic staff ( AOR=17.90, CI=3.74-85.73) with the R2 = 67.7%.
Conclusion: The satisfaction level among the respondents in Klinik Kesihatan Bandar Baru Bangi, Selangor were remarkable with percentages of 78.8%. The study has shown that service dimensions factor influenced the patient’s satisfaction such as general satisfaction, interpersonal aspect of staff, communication of staff, technical quality of clinic staff and availability/accessibility of clinic. It could have also been contributed by the implementation of ISO and it can only be confirmed by carrying out a comparison study of patient’s satisfaction in clinics with and without ISO certification.
Study site: Klinik Kesihatan Bandar Baru Bangi, Selangor, Malaysia
Background: Cardiovascular disease is the number one cause of death globally and is projected to remain the leading cause of death. If the trend is allowed to continue, by 2015 an estimated 20 million people will die from cardiovascular disease (mainly because of myocardial infarction and strokes). The number of cardiovascular disease cases in Malaysia has increased to 14% in five years from 96,000 cases in 1995 to 110,000 cases in 2000.
Methods: The cost to treat patients admitted to Universiti Kebangsaan Malaysia Medical Center (UKMMC) Malaysia, diagnosed with Acute Uncomplicated ST Elevated Myocardial Infarction (STEMI) was calculated by using two different methodologies, namely step down costing methodology and activity based costing using clinical pathway.
Results: Cost for each stay per day at the cardiology ward using the step down methodology is RM596.42. The treatment cost is estimated from RM1, 789.26 to RM 4,771.36. The average cost per episode for STEMI care with the average length of stay for 5.6 days is RM3, 340(SD ±596.42. The cost of coronary PCI procedure in step costing is RM 13,950.00. Hence, the total cost incurs for STEMI with PCI is RM 17,290.00(SD ±596.42) by using step down method. (an average cost per episode is RM3,340, plus the cost of coronary procedure of RM 13,950.00 . However by using the ABC the cost of STEMI (PCI) with an average length of stay for 5.6 days is RM 20,431.39. The study showed the ABC method was higher by 15.3% than the step down costing.
Conclusion: The cost in managing STEMI (PCI) with the average length of stay of 5.6 days was calculated by using two different methodologies, namely step down costing methodology and activity based costing. Cost of treatment calculated by using activity based costing are higher because all resources used are incorporated in detail. The ABC method was higher by 15.3% than the step down costing. The difference is within 80-20 rules and the biggest percentage of cost in both methodsis procedure or PCI cost.
Background: A cross sectional study was carried out to determine the prevalence of microbiological contamination in ready- to-eat food and factors affecting it in Melaka from February 2008 till May 2008 in collaboration with the Food Safety and Quality Unit and District Health Offices in Melaka Tengah, Alor Gajah and Jasin.
Methods: A purposive sampling of 101 food premises was carried out and 202 ready- to-eat food samples were collected and analysed microbiologically using standard methods. A total of 202 food handlers were randomly selected for questionnaire interview while rectal and nasal swabs were taken from them to determine their healthy carrier status of pathogenic food bacteria.
Results: Results showed that the overall prevalence of microbiological contamination in ready- to-eat food was 35.1%, while prevalence by type of food was 42.0% for main dishes and 9.8% for staple food. The majority of the contaminations were due to coliforms (14.9%), total plate counts (12.4%) and Staphylococcus aureus (3.5%). The mean score for food premise inspection was 77.21 ± 10.32 and the prevalence of healthy carrier status of pathogenic food bacteria among the food handlers was 15.8%. The level of food handling practices among food handlers was influenced by sex (p=0.012) and formal training on food handling courses (p=0.009). There was a significant negative correlation between age and level of food handling practices among the food handlers (r = -0.163; p = 0.02). Poor food handling practices (p=0.02) and poor hygiene status among the food handlers (p
Background: This cross-sectional study aimed to investigate the prevalence of the caregiving burden among women who are caregivers to elderly with stroke and factors influencing it. Respondents identified through purposive sampling at the Universiti Malaya Medical Centre from October to December 2007.
Methods: Direct methods of data collection (clinical and housing) and indirect (postal) used a structured questionnaire distributed to the guards. Measurements taken include sociodemographic variables of patients and caregivers, the patient, the care, relationships with caregivers and patients with information about stroke. Zarit Burden Interview (ZBI) short version was used to measure the burden of care. Carers' Assessment of Managing Index (Cami) was used to assess coping strategies. A total of 96 respondents took part in this study.
Results: The study showed that prevalence of caregiving burden was 35.4%. Burden of care was found to have significant relationships with factors such as marital status, caregivers (p = 0.017), family income (p = 0040) and the patients (p = 0.000). Significant correlation obtained for the coping strategies with the burden (r =- 0228, p 0026).
Conclusion: The conclusion shows that policy makers and program managers should appreciate and assist caregivers in performing the role of care. Intervention programs should be designed to suit the needs of the heterogeneous guardian.
Background: Level of comfort in working environment can contribute to increase level of health, emotion during working, level of safety, quality and productivity of work. A study of physical factors (heat, noise and lighting) is important to determine the level of comfort during working. This study was carried out to study those physical factors upon comfort level during working among Casting Shop workers in a car manufacturing factory.
Methods: Instruments for the physical monitoring including Questemp°36 Thermal Environment Monitor, Sound Level Meter and Lux Meter were used at seven measured areas. The information about the level of comfort during working was collected using questionnaires among 65 respondents by random sampling method.
Results: Measured data showed there were four measured areas which Wet Bulb Globe Temperature indoor (WBGTi) value are above the standard limit recommended by ACGIH, three measured areas recorded noise level above the standard limit recommended by Factories and Machineries (Noise Exposure) 1989, while there was no measured area recorded lighting reading below the standard limit recommended by MS ISO 8995:2005. Result from questionnaire found that the majority of the workers did not feel comfortable towards the heat and noise level in their workplace while most of the respondents felt comfortable towards lighting level in their workplace. Mean of WBGTi reading and lighting reading have a significant difference (p
Background: Safety and health audit study is a part of occupational safety and health risk assesment. Thus, student’s residential audit is important in order tu ensure the safety rules which implemented by the management is appropriate and follow the standard set forth. Furthermore, it also important to determine places, area or situation that might lead to hazard risk so that prevention step could be plan and implement.
Objective: This study was to determine the safety level of students residential in physical aspects.
Methods: Safety inspection or audit conducted is in accordance with criteria and indicators listed in the checklists that have been formed based on the audit forms from the Department of Safety and Health (DOSH), National Institute of Safety and health (NIOSH) and the Occupational Safety and Health Committee of UKMs (JKKP). Several indicators are also included in the audit form as to ensure it covers all the technical aspect and suited with the college conditions. The safety level for each of the blocks in KDO is categorized using points and percentage score obtained.
Results: Based on the overall score, the average safety score in percentage for areas in KDO are preceded by general office with score 85.5% followed by residential blocks with 71.5%, facilities with score 71.2% and administration block with 70.9%. The results of the study show that most of the areas are at least in a safe level.
Conclusion: Roles of employer and college administration, significant OSH programme and safety audit are important factors as to ensure the safety of student's residential college.
Introduction: Relatives play an important role in patient care - not only providing social support but also help to complement the existing care. They must be empowered with relevant knowledge and skills of patient care including motivating patient towards immediate healing and acceptance of his fate. Although these are various approaches, the media is regarded as the most effective method in educating the family or the relatives. This paper highlights the significant role of the media as an educational tool to mobilize patient’s relatives in total patient care.
Methodology: This is a review conducted on reports, observations and feedbacks gathered from various sources involved in patient education in hospital setting. It was endorsed by a series of in-depth expert forum under patient education module.
Results: Relative empowerment has been identified to be as an important role and yet it is not fully utilized. The manpower resources are so scarce and crucial in patient as well as relative education. The media is the only alternative educational tool that could compliment the educational needs. Of all potential media available in the market we have recognized at least four types of media that can be optimally resourced and used. Through manipulation of its content and making it interactive, the role of media seemed to be extremely effective in patient management that include relatives.
Conclusion: The role of media in relative’s education in support of patient care is undeniable. The media with the most potential should be identified and the management of its content to be enhanced. It must be incorporated with an interactive approach in order to have more self-involvement and undersatanding of its content.
Introduction: In view of high healthcare expenditure, Malaysia also faces problems in healthcare financing. The policy option is to establish a national health financing scheme. However, it is a problem to develop mechanisms to cover social insurance package to more than one third of the population working in informal sector such as farmers. Therefore, there is an urgent need to assess the ability and willingness of the farming community. The main objective was to study the ability and willingness in the farming community to contribute to national healthcare financing scheme.
Methodology: This a cross sectional study involved 400 farmers in Selangor. A total of 92.3% farmers were able to pay for the healthcare.
Results: Willingness to contribute to The national healthcare financing scheme were RM2.00 per month.
Conclusion: The education level influenced the ability to pay while the educational level and per capita income influenced willingness to pay.
Introduction: Diabetes Mellitus is a chronic disease and major cause of chronic renal disease. Chronic renal disease can be prevented if known risk factors were been early detected. Albuminuria is the earliest clinical evidence of chronic renal disease. Objectives of this study is to identify the incidence of albuminuria and relationship between albuminuria with socio demographic and clinical factors such as blood sugar control, blood pressure control, excessive body mass index and hypercholesterolemia.
Methodology: Data been collected from patient’s record that been regularly follow up at Primary Healthcare Clinics in Negeri Sembilan. Duration of study follow up was from the date of they been diagnosed of Diabetes Mellitus Type 2 until detection of albuminuria or 1st July 2007,end date of data collection then survival analysis been done.
Result: Majority of study population was female 60.9% and Malay 69.7%. Mean age was 59.9 ± 10.7 and duration having Diabetes Mellitus was 7.0 ± 6.3 years. Only 22% achieved optimum glucose (HbA1c < 6.5%), controlled blood preassure 130/80 mmHg 42.3%, level of cholesterol <4.5 mmol/L only 22.7 %, 11.4% of patients having ideal body weight < 23 kg/m2. The incidence of Diabetes Mellitus Type 2 was 24.4 cases per 1000 population. The median of follow up duration was 22 years; with minimum follow up was 7 months and maximum 42 years. Survival analysis showed that the median of free albuminuria among cases was 22 years (CI 95%:16.5 – 27.4). The log rank test showed no significant relationship between high blood pressure, excessive body mass index and hypercholesterolemia with albuminuria. This study noted that the occurrence of albuminuria seems to be higher among those were hypertensive (26.6%), and excessive body mass index (24.7%).
Conclusion: Percentage of Diabetes Mellitus Type 2 patient that achieved optimum clinical target still very low. Early detection of albuminuria is very important as preventive measure of diabetes nephropathy. Good blood pressure control and ideal body weight also prevent of occurring diabetes nephropathy complication.
Keywords: Diabetes Mellitus Type 2, albuminuria, survival analysis.
Introduction: Non-verbal cues are untold words that carry a significant meaning. As a doctor, this remark needs to be perceived correctly. It is an inevitable communication knowledge and skills ought to be mastered in any doctorpatient relationship, particularly when making patient’s assessment.
Methodology: This was a systematic communication assessment of a real observations on doctor-patient relationship in various setting. It was supported by feedbacks from many scholars who were involved in research and teaching and also reviews, papers and studies on the said subject.
Results: It has been realized that non-verbal communication was equally important and necessary to complement the verbal one. From all non-verbal cues we have recognized and listed, we have identified at least ten to be the most vital areas to be observed while counseling or consulting a patient.
Conclusion: Non-verbal cues were always present to support doctor in making a final conclusion about his/her patient’s state. If doctor was patience enough, he or she could has a complete profile of his/her patient and this would lead to the improvement in a person’s life. Having an observant attitude and being able to nose around appropriately were skills that have to be learnt, experienced and applied as these might make an effective doctor-patient communication.
Introduction: Physiological changes in the oral cavity and dental-related complications may occur during pregnancy. These intraoral changes that occur during pregnancy combined with lack of routine dental check-ups and delays in treatment for oral disease, place pregnant women at higher risk for dental infections. The objectives of this study was to assess the knowledge and awareness of pregnant women on periodontal disease and its effect on pregnancy, to investigate the relationship of their knowledge and awareness with level of education and the barriers of oral healthcare utilization among pregnant women.
Methodology: A self-administered questionnaire with an introductory letter and consent form were given to pregnant women who came for their routine maternity check-up at the Obstetrics and Gynecology Clinic, Kuala Lumpur Hospital. Data entry and analysis was done using Statistical package for Social Sciences (SPSS) version 12.
Result: Ninety-two pregnant women responded to the questionnaire. Only 23.9% answered correctly to the question on what is plaque. However, 45.7% knew that plaque can cause gum disease and a majority of the respondents 72.8% also knew that bleeding gum is an indication to inflamed gums. The result shows that, although 59.8% of the respondents were aware that it is necessary to brush their teeth frequently during pregnancy, only less than half of the respondents (44.6%) were aware that dental plaque and poor plaque control may cause periodontal disease among pregnant women. The majority (33.7%) feels that the long waiting time in the clinic would be their main barrier in seeking dental treatment.
Conclusion: A majority of pregnant women have limited knowledge and poor awareness on periodontal disease and its effect on pregnancy.
Study site: Obstetrics and Gynecology Clinic, Kuala Lumpur Hospital
Introduction: The effect of stress among correctional officers at the workplace can contribute to various health problems and this also affect their work performance and motivation.
Methodology: Study was done at a prison located at the rural district in Kedah. The study was conducted by using randomized stratified sampling method. A total of 418 self administrated questionnaires were distributed. These questionnaires included socio demographic factor, family and marriage factor, Personal Stress Inventory (using Stress Symptom Scale with 52 items), work related stressors (Job Stress Survey) and Brief COPE (Coping Orientation for Problems Experienced with 28 items).
Result: Response rate was 90.9%. Stress prevalence for correctional officers was 45.8%. Socio demographic factors which have significant relation with stress status were marital status, promotion factor, age, monthly salary, duration of service and number of children (p< 0.05). Family and marriage factor which have significant relation with stress status among married officer were pressure from relatives, clean up house, sexual frustration, conflict with spouse, conflict with children, conflict due to household work and no babysitter (p< 0.05).
Discussion: The study showed that work related stressors that have influence with stress were excessive workload, working after work hours, not enough staff, disgraced words from fellow workers, competition in carrier development and excessive work stress (p< 0.05). Multiple linear regression model was done in this study and revealed factors that explained 52% of variation in stress score distributions were behavioural disengagement, no babysitter, denial, conflict with children, replace other worker’s duty, not enough time with family, competition in carrier development, venting of emotion, positive reframing and emotional support. Coping strategies that have significant effect in reducing stress symptoms are positive reframing and emotional support.
Conclusion: Stress management programs should be implemented and emphasizing on specific stressors and coping mechanism are important to reduce the risk of occupational stress among correctional officers.
Introduction : An organization performs well with proper management methods. Participation is a process involving cooperation and collaboration within all levels of individuals, groups or community for the purpose of organization improvement. Empowerment brings the organization further by delegation of power and responsibilities to others for better result.
Methodology : This is a systematic review on various publications, articles and studies based on the findings and researches conducted by experts and scholars involved with participation and empowerment of organizations.
Results : Participation and empowerment are crucial in every organization including healthcare. Its success depends on factors such as proper planning, mutual understanding, regular training and continuous education. They contribute towards better outcome in goal setting, decision making, problem solving and organizational development. There are also various levels of empowerment and participation depending on the type of activities, organisation’s performance and level of authority.
Conclusion : The prerequisite for an organisation’s success is dependent upon holistic participation and appropriate empowerment. The benefits gained from these measures are indeed invaluable. It creates sense of ownership, increases motivation and satisfaction, optimizing resources, promote innovations, enhancing quality and improving efficiency.
Background: An effective doctor-patient communication has increasingly being recognized as an important factor in patient care. All means should be oriented towards narrowing communication gap. The essential methods must be searched and doctor must be able to conduct communication session in more pleasing manner.
Methodology: This is a systematic review on observations made on doctor-patient relationship on various setting and supported by feedbacks from many scholars who are involved in research, teaching and also papers and studies on the said subject.
Results: It is been realized that effective communication is not easily done if its process not well complemented and the gap is left widening. From all possible communication gaps recognized and listed, at least ten have identified to be the most essential methods to be prioritized while counseling or consulting a patient.
Conclusion: Effective communication between patient and doctor is the essential prerequisite of good medical practice and especially important for accurate diagnosis and effective treatment. Its mutual benefit can only be observed if all efforts are centered towards managing the communication gap.
Background : Miscarriage is a common problem in pregnancy which can occur during early, mid or late pregnancy. Incomplete miscarriage can be treated expectantly, medically or surgically. The most preferred method used in UKMMC is using sharp curettage.
Methodology : This study is conducted in the UKMMC from 1st January 2010 to 30th March 2010. The purpose of this study is to analyze the cost of treating incomplete miscarriage using metal sharp curettage from the provider’s perspective per patient-day.
Result : A total of 17 samples were eligible for analysis from 46 patients who fulfilled the inclusion and exclusion criteria. The cost is derived from cost calculation on capital and recurrent costs. Results showed that the average cost for treating incomplete miscarriage using sharp curettage per day is RM252.56. Recurrent costs contributed 83.3% of the total treatment with overhead cost was the biggest percentage (51.6%). Discussion The treatment cost for incomplete miscarriage using sharp curettage is found to be higher as compared to medical approach according to literatures. The higher cost of surgical approach was mainly attributed to the recurrent cost which is included in the calculation.
Conclusion : Effective usage of the operation theatre and all resources should be managed and utilized well in order to achieve optimum outcome.
Background : Study of stress among adults in rural community is seldom been conducted and this study aims to see the prevelence of the stress among this group of population.
Methodology : A cross sectional study was conducted to measure the prevalence of stress among the rural people in Hulu Langat District, Selangor using O`Donnell Personal Stress Inventory and coping mechanism practiced by them.
Result : A total of 265 respondents through universal sampling participated in this study. The stress prevalence identified was 16.2%. The factors which have significant association with stress were age, education level, marital status, working women, duration of working per day and body mass index. Diseases such as diabetis mellitus and hypertension showed no association with stress. Preferred coping mechanism used by respondents included emotional support, instrumental support, behavior modification and denial.
Conclusion : Stress among the rural population is high in Malaysia. Measures has to be taken to reduce the stress as it can effect the general health of the people.
Background : The implementation of Occupational Safety and Health Management System (OSHMS) requires a level of measurement. The effectiveness of OSHMS implementation was influenced by inhibiting and supporting factors. The objective of this study was to determine the inhibiting and supporting factors towards the implementation of OSHMS in medical laboratories.
Methodology : The implementation of Occupational Safety and Health Management System (OSHMS) requires a level of measurement. The effectiveness of OSHMS implementation was influenced by inhibiting and supporting factors. The objective of this study was to determine the inhibiting and supporting factors towards the implementation of OSHMS in medical laboratories.
Result : This study showed the level of compliance to the OSHMS MS1722 guideline among medical laboratories who are MS ISO 15189 accredited & have a higher scores in overall measurement indicators OSHMS compared to those do not have SAMM accreditation. Private medical laboratories services have higher scores in overall measurement indicators OSHMS, compared to government medical laboratories. However, there was no significant difference (p>0.05) between medical laboratories which have ISO 9000 quality management system certification, compared to level of compliance to the OSHMS MS 1722 guideline among medical laboratories. There was also no significant difference (p>0.05) between the laboratories who had been operating for more than 10 years compared to those with less than 10 years, towards implementing the OSHMS. Results showed that majority of medical laboratories management perceived that difficulty and complexities of OSH legislation are the most important factor that prevent them from implementing OSHMS in their organization. The most important supporting factor, that medical laboratories management perceived as the most important to comply to the OSHMS were their moral responsibilities towards the community.
Conclusion : In conclusion, the study shows there were many inhibiting and supporting factors that contribute towards effective implementation of OSHMS elements in workplace.
Introduction: The purpose of this article is to review the definitions of food security and food insecurity as well as the concepts related to food security.
Methodology: This is a systematic review on a few papers, research, and articles according to studies and research by various organizations, experts, scholars on food security in developed and developing countries.
Result: The first definition of food security was given to reflect the comprehensive concerns on the availability of world food supplies. The definition was expanded to incorporate accessibility of food for all people at all times. Then, the complex definitions of food security incorporated food accessibility and availability as well as the quality of food intake. Latest definition integrates the social aspect of food that should be accessed in a socially acceptable way. Broad definition of food insecurity and several terms that closely related were also discovered. The four main concepts of food security from these definitions were identified; availability, accessibility, acceptability and adequacy. These concepts of food security are relevant to micro, meso and macro levels of social and administrative organizations. Conclusion: Understanding definitions and concepts of food security can assist researchers, policy makers and program implementers to conduct research that address the issues of food security.
Introduction: Back pain associated with sense of pain and less comfort in back part of the body especially at the lower back area. Back pain is an occupational health problem with significant impact to productivity of workers.
Methodology: A cross sectional study was conducted to study the prevalence of back pain towards individual, physical and psychosocial factors associated among body shop’s operators at national Automotive Manufacturers.
Result: A total of 32 operators were involved in this study. Nordic Musculoskeletal questionnaire has been used in this study and body position assessment was done by using Ovako Working Posture Analyzing System (OWAS) method. Study showed the prevalence of back pain among operators throughout their work and in the last 12 months was 93.8% and 87.5% respectively. There are significant association (p0.05) between prevalence of back pain with another individual, physical and psychosocial factor.
Conclusion: This study shows that back pain prevalence were influenced by types of activity and body posture during working at assembling division among workers. Attention should be given to ergonomics factors to prevent back pain incident among automotive industry assembly workers.
Introduction: The aim of this study was to assess the overall diet quality of husbands and wives in a selected urban area in Selangor.
Methodology: This cross-sectional study was carried out in Bandar Baru Bangi, Selangor among 150 married couples aged 20 and above, who voluntarily agreed to participate and were not practicing any special diet. Data were collected using a 2-day 24-Hour Dietary Recall and a Food Frequency Questionnaire (FFQ) to evaluate the quality of diet among husbands and wives using the Diet Quality Index Revised (DQI-R).
Result: Majority of husbands and wives in this study were in the middle-age group, had received tertiary education, had household monthly income of more than RM3, 500 and encompass household size of 3 to 5 persons. The mean DQI-R score for husbands (mean age= 43.33 + 11.16 years) and wives (mean age= 41.28 + 10.93 years) were 67.8 + 9.1 and 64.4 + 9.3 respectively and there was a significant different in scores between the husbands and wives (p < 0.001). In general, the diet quality of this study population was not satisfactory and that the diet quality of husbands was better compared to their wives.
Conclusion: This study gives an insight picture of husbands and wives’ quality of diet. It can be used as a guideline to improve health intervention programs in the future.