This paper attempts to explain both the persistence of traditional misconceptions about leprosy as well as the relative ineffectiveness of the Leprosy Control Programme. It has been pointed out that leprosy is a disease with tremendous social significance. To improve the Programme therefore, the human element which is of paramount importance must be identified and rectified. It is felt however, that we the providers should set our own house in order first. We need to find out the knowledge, attitudes and practices of the medical personnel and auxiliaries relating to leprosy, and identify the factors that contribute to their lack of motivation and undesirable attitudes which in turn deter patients from seeking and continuing treatment. Interventions based on the findings of such studies will contribute considerably towards the successful implementation of the Programme.
The suitability of physiology topics taught in the first-year dental curriculum needs to be investigated in the light of the view of the present generation of clinical and preclinical teachers, and students. This was studied in the University of Malaya in order to propose a rational physiology curriculum with proper identification of priority topics. Oral physiology, blood and the cardiovascular system were found to be the most relevant for dental students. Among the systems, high and low priority topics were identified and their relative importance is discussed.
The knowledge and clinical and minor surgical skills acquired by 257 medical students in three universities in Sri Lanka and Malaysia were assessed by a questionnaire after they had completed their training period in ophthalmology. This study showed that many medical students graduating from these universities lacked the basic clinical and minor surgical skills essential for a doctor practising in a community in south-east Asia. The responses also indicated that teaching by consultants in all three universities was inadequate and due to these inadequacies the students requested that the duration of their training period be doubled. Ophthalmology is an important component of clinical practice and proper education in this subject is important. An urgent revision of the aims and objectives of the curriculum in ophthalmology is essential to place greater emphasis on this important and much neglected subject, for which very little curricular time is allotted.
A postal survey of 730 Malaysian dental practitioners was undertaken to assess their awareness and acceptance of the plasma derived hepatitis B vaccine. Only 32% of the 325 practitioners who responded had been vaccinated, 41% intended to be and 15% categorically refused vaccination. The main reservations about vaccine acceptance were fear of side effects including AIDS, cost of the vaccine and lack of information. Vaccine efficacy was not confirmed by serology in two-thirds of the vaccinees and two-fifths of the respondents were unaware that 5% of the vaccinees do not develop a successful antibody response after vaccination. Seventy-eight percent of dentists believed that their risk of contracting hepatitis B was high or very high while 71% recalled having received needle stick injuries in the 3 yr prior to the survey. Only 13% of respondents were aware of delta hepatitis while 63% were aware of non-A non-B hepatitis. The survey has highlighted the need for dissemination of information on hepatitis B vaccine among dentists in Malayasia.
The aim of this postal survey was to assess the utilization, knowledge and attitude concerning sealants among Malaysian dentists. A pretested questionnaire was sent to all dentists (1217) who were on the Dentist Register of Malaysia of 1987. A response rate of 61.1% was obtained. The results indicate that 52.6% of the respondents have used sealants, but of these only 13.6% have used them frequently. The two "knowledge" related questions receiving the most support concerned the suitability of the first permanent molars for sealants and the loss of sealants attributable to problems at the time of application. The two "attitudinal" questions receiving the most support concerned the value of sealants in preventing dental caries and the need for the profession to expand more efforts toward increasing public demand for sealants. Only about 50% of the respondents believed that sealants are cost-effective.
A random survey of 400 doctors was carried out over a period of 3 months to determine the factors that would facilitate or inhibit the participation of doctors in continuing medical education (CME) in Malaysia. Regular participation in CME was defined as participation in any activity (self-directed reading or attending organized activities) at least once a month during the past year. It was found that 78% of doctors regularly participated in CME. Working in a hospital environment and being members of the Malaysian Medical Association and at least one specialty organization appeared to be important facilitatory factors in CME participation. These doctors also read the local medical journals regularly and subscribed to other journals. In addition, they were more likely to possess postgraduate qualifications and would have teaching, research, diagnostic or clinical responsibilities as major components of their work. They were more likely to practise in the big cities and would tend to be active in at least one voluntary or social organization. If they were in the Government sector, they were more likely to work in the Universities or in the Hospital Division of the Ministry of Health. The 22% who were less likely to participate in CME were general practitioners in the private sector. They worked long hours with day, evening and/or night shifts every day. If the doctors were in the Government sector, they were more likely to be in the Health Division, working in administration and public health, or they were in the armed forces and other organizations such as local councils. They worked in the smaller towns or in the districts.(ABSTRACT TRUNCATED AT 250 WORDS)
A questionnaire was mailed to 1217 dentists whose names appear in the Dentist Register of 1987 in order to assess their awareness and acceptance of hepatitis B vaccine and their pattern of glove usage. Almost all the respondents (99.6%) were aware of the availability of the hepatitis B vaccine yet only 44.8% have received the vaccine. This is in spite of the fact that the majority (61.2%) of the vaccine non-acceptors have no reservations concerning the vaccine. About 71% and 63% of the vaccine-acceptors and non-acceptors respectively believed that the risk of their contracting hepatitis B was high or very high. About 22% of the vaccine non-acceptors never used gloves when treating patients as compared to 9% among vaccine acceptors. Overall, about 78% of the respondents have experienced needleprick injuries in the 3 years preceding the survey.
A questionaire concerning various aspects of blood pressure measurement and hypertension was answered by 84 out of 98 (86%) doctors and 73 out of 100 (73%) nurses working in various parts of the state of Pahang. 59% and 85% of doctors and nurses respectively agreed that blood pressure should be measured routinely in all out-patients. 48% of medical staff were taught to use and 38% were actually using phase 4 as the diastolic blood pressure despite the general agreement that phase 5 should be used to denote diastolic pressure. 52% of doctors believed that hypertensive patients present with symptoms, the common symptoms cited were headache and dizziness, although it is well documented that hypertension is essentially asymptomatic. 93%, 80%, 69% and 82% of doctors believed that treatment of hypertension can prevent cerebrovascular disease, heart failure, renal failure and coronary artery disease respectively, although prevention of the last complication is yet unproven. Most doctors would begin treating a patient at rather low level of blood pressure, for example, for a man in the age group 40-49, 40% of doctors would begin drug treatment at diastolic pressure of 90 mmHg and 55% at diastolic pressure 95 mmHg. 79% of nurses and 55% of doctors were dissatisfied with the sphygmomanometer they have, the most common complaint was that the cuff-bladder 'blow up' on being inflated.
Study site: doctors and nurses at private general practice, klinik kesihatan, district hospitals, Pahang, Malaysia
In a 6-month study period, 170 pharmacist interventions in an intensive care unit (ICU) were analysed. Of the interventions, 68.8% were solicited and 31.2% were initiated by the pharmacists. The majority of the interventions were initiated by specialists (69.4%) followed by the medical officers (15.9%) and nurses (9.4%). Most of the interventions occurred during the grand rounds (75.9%), followed by ward visits (12.9%) and communication through the satellite pharmacy (10.5%). The most frequent type of intervention made was for indication or therapeutic efficacy followed by general product information, drug regimen, laboratory assessment, disease state, pharmaceutical availability and adverse drug reaction or side effect. It was also found that 83.7% of pharmacists' suggestions were accepted, 6.4% were accepted with changes, and 9.9% were not accepted. The majority of the interventions were made by direct verbal communications followed by telephone and written communications. In conclusion the study indicates that pharmacist therapeutic recommendations form an important integral element of patient care in an ICU.
One hundred and twenty-eight medical students who had experienced a traditional-style preclinical curriculum completed three self-report questionnaires. Using factor analysis of students' responses this study explores interactions between study orientation, preferences for different kinds of learning environment, and evaluations of the physiology course. Such interactions can provide insight into the reasons why students fail to adopt effective learning strategies. Although many students had the intention to understand, they did not adopt a deep approach. Achievement motivation was strong, test anxiety high, and the course was perceived to be competitive. The meaning orientation merged with the achieving orientation; students were thus performance rather than task oriented. These students perceived the course to have been challenging, as did students within the reproducing orientation and who had 'surface' preferences. Students within the non-academic orientation had difficulty coping with the course. The findings suggest that conventional teaching and assessment methods are preventing students from developing appropriate criteria and internal standards for evaluating performance. An illusion of comprehension may prevent students from seeing the need to adopt more effective learning strategies and cause 'good' students with the ability to adopt a deep approach to abort the pursuit of deep understanding. Students' preferences and evaluations of teaching and assessment indicate that students within the different learning orientations have different educational needs. The implications for instruction and evaluation are discussed.
A study of the smoking habits and attitudes toward smoking among 120 doctors at the Hospital Universiti Sains Malaysia was conducted between May to August 1991. Eighteen percent of the doctors were smokers, 13% ex-smokers and 69% had never smoked. All the smokers were male and all except one smoked only cigarettes. Three of the 32 female doctors were ex-smokers. Nineteen of the 21 smokers only smoked in areas where they could not be seen by the public. Most doctors (equally among smokers and non-smokers) had first-degree relatives (mostly males) who were smokers and 28% had relative with smoking-related disease. 81% non-smoking and 43% smoking doctors had advised healthy people to stop smoking. 92% non-smoking and 52% smoking doctors support the smoking-ban in the hospital. Seven of the 21 smokers had never attempted to quit smoking.
A postal questionnaire survey concerning dentists' attitudes toward auxiliaries in Malaysia resulted in a 73.1 per cent response rate. The result of the study indicates that whilst the majority of the dentists agreed that dental auxiliaries usually increase productivity and permit the dentists to devote more time for more challenging tasks, a majority felt uncomfortable to be held accountable for the performance of auxiliaries. A majority of the dentists agreed that dental auxiliaries work best under direct supervision. The perceived value of the auxiliaries was more positive among public sector dentists as compared to private practitioners. Almost three-quarters of the dentists were positive towards legalising properly trained auxiliaries to work in private practice performing mainly preventive procedures. The implications of these findings relative to existing regulations, mode of practice and the future prospect in the delivery of oral health care are discussed.
A questionnaire survey was conducted to examine the attitudes of Malaysian dentists toward patient education and preventive dentistry and the level of preventive care adopted in Malaysian dental practice. An adjusted response rate of 73.1% was obtained. Generally the Malaysian dentists had positive attitudes towards patient education and preventive dentistry including fluoridation. However, a sizable proportion of them considered that preventive measures were no challenge for the dentist. The common preventive measures given to patients were scaling, dental health education, prophylaxis and instruction in correct brushing and flossing in as much as 40 to 50 percent of the queried dentist claimed that these preventive items were provided to most or all of their new patients. In spite of the fact that the majority of the dentists had good knowledge about the application and effects of sealants only about 41 percent of the dentists claimed to have used sealants. More dentists in the private sector reportedly having done so. Also many Malaysian dentists (18.5%) did not use leaded protection for any of their new patients when taking radiographs.
The current status and directions for changes of issues related to quality care in health services in Asian countries--Malaysia, China, Singapore, Japan and Korea are overviewed. In countries with public sector dominated health care systems such as Malaysia. China and Singapore, governmental leadership in quality care is prominent along with legislative backup. Japan and Korea have private sector dominated health care systems and quality care activities are mainly carried out by non-governmental organisations. Hospital accreditation programs are in the developing stages in most countries, although China and Korea started in 1980. Most Asian countries are at the initial stages in quality care activities and focus has been placed on education and training. Asian countries are not exempted from efforts to enhance quality care activities and a new horizon in quality health care is emerging.
The author reflects on 24 years of involvement in WHO activities, and their effect on her own life and on the maternal and child health services in Malaysia.