Objective: This study was conducted to determine prevalence and factors associated with obesity in Selangor, Malaysia. Methods: A population-based cross-sectional study was conducted in all districts of Selangor State. All individuals, 15 years and above in the selected households, were included. A pre-tested structured questionnaire was used to collect the data. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. Statistical analysis was performed using Stata 8.2 taking into account the complex survey design. Results: The overall mean age of the 2219 respondents was 36.6(95% CI 35.7 – 37.6) years. There was no significant difference in the mean age of the males and females (p=0.697). The majority of the respondents were Malays (52.9%), followed by Chinese (30.9%), Indians (15.4%) and
other races (0.9%). The overall mean BMI was 24.1 kg/m2 (95% CI=23.8- 24.4). The overall prevalence of obesity was 12.2% (95% CI 10.6%, 14.0%). There was no significant difference in the prevalence of obesity in the males compared to females (p>0.05). The prevalence of obesity increased with age up to the ages of 40-59 years and then decreased after 60 years. The highest prevalence of obesity was in the 40-59 years age groups in both sexes. The overall prevalence of obesity was significantly higher amongst the Malays (15.2%) compared to the Indians (11.6%) and Chinese (7.3%). Multivariate logistic regression analysis showed that only age and ethnicity were associated with obesity. Sex and educational level were not associated with obesity.
Introduction: As eating disorders such as anorexia nervosa and others are generally becoming more prevalent, it is essential to have a culturally accepted and locally validated questionnaire that is able to detect abnormal eating habits. Objective: To translate the Eating Disorders Examination Questionnaire (EDE-Q) into Bahasa Malaysia (BM) and to determine the construct validity, reliability and other psychometric properties of the BM version. Method: Two parallel forward and backward translations were done in BM in accordance to guideline. Its validation was determined by using confirmatory factor analysis among 298 secondary school children. Results: The BM EDE-Q had very good internal consistency with global Cronbach’s alpha value of 0.879. For construct validity, majority of the items managed to produce values of more than 0.4 for confirmatory factor analysis with four unforced distinct factors detected. Conclusions: Analyses of reliability and validity of this BM version of EDE-Q yielded satisfactory results. The BM version produced in this study had good psychometric properties and it is applicable to the Malaysian population. Findings indicated that cultural factors in eating habits certainly influences the effort to adapt the questionnaire within a Malaysian setting.
Introduction: Women are exposed to stress such as working full time while still being responsible for the family and house.
Objective: The objective of this study was to determine the prevalence of depressive symptoms among adult women in Selangor, and to determine the potential risk factors associated with depression.
Method: A community based cross sectional study was conducted in all districts of Selangor state, Malaysia in July 2004. Multi stage stratified proportionate to size sampling method was used to collect data. The Patient Health Questionnaire (PHQ-9) was used to determine the presence or absence of depressive symptoms among the respondents. All respondents aged 20 to 59 years old in the selected households were interviewed.
Results: Out of 1032 women, 972 agreed to participate in this study, giving a response rate of 94.2%. The mean age of the respondents was 37.91 ± 10.91. Majority were Malays (54.9%), married (83.8%) and had secondary education (54.5%). The results showed that the prevalence of depressive symptoms was 8.3% in Selangor. Race, religion, education level, history of having a miscarriage within the last 6 months and history of difficulty in getting pregnant were significantly associated with depressive symptoms (p<0.05). Women with history of a miscarriage within the last 6 months and absence of formal education were potential risk factors for depressive symptoms (OR, CI = 2.576 (1.165-5.696), p<0.01 and OR, CI = 5.766 (1.949-17.053), p < 0.01).
Conclusion: Depressive symptoms among adult women in Selangor was 8.3% and was associated with race, religion, education, history of miscarriage and difficulty in getting pregnant. The main potential risk factors were having a miscarriage within the last 6 months and absence of formal education.
Keywords: Depressive symptoms, Prevalence and Risk Factors, Selangor Women
The aim of the study was to acquire background information on computer literacy among schizophrenia patients in Kota Bharu, Malaysia, prior to the introduction of a computerised cognitive remediation programme in the local setting.
Method: Fifty consenting consecutive patients with schizophrenia attending the Universiti Sains Malaysia Hospital psychiatric clinic were surveyed using the Computer Literacy Scale (CLS), a scale designed to specifically look at their level of computer knowledge, confidence and attitude towards computers.
Results: The majority of the patients studied have had schizophrenia for 5 years or less. While the majority of them have used computers befoie, about half had a poor level of knowledge, although they showed reasonable confidence and a positive attitude towards computers. Few played computer games.
Conclusions: Implementation of a computerised cognitive remediation programme in the Malaysian setting has a promising potential based on the results of this study but the programme needs to be adapted in light of the negative attitudes towards the use of games.
Study site: Psychiatric clinc, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
A study was conducted to evaluate the extent of sleep problems among children aged between 6 to 15 years old who were followed up at Penang Hospital Paediatric Clinic for various neurological disorders and compared to those with other paediatric illnesses and their healthy siblings. A parental questionnaire was used to assess sleep problems in 48 children with neurological disorders and compared to 46 of their healthy siblings, 59 children with non-neurological paediatric illnesses and 67 of their healthy siblings. Sleep problems were clustered into five subscales: bedtime difficulties, parental involvement at time of sleep, sleep fragmentation, parasomnias and daytime drowsiness. Children with neurological disorders had significantly more sleep problems than did their siblings, those with non-neurological paediatric illnesses and their healthy siblings (p < 0.001). This was particularly so in areas of bedtime difficulties (p>0.001), the amount of parental involvement (p
Lumbar puncture (LP) is an important procedure both for diagnostic and therapeutic purposes. In Kelantan, Malaysia, on many occasions consent for this procedure is not granted by patients or guardians. The aim of this study was to find out the factors that influence the decision to grant or refuse the consent for LP. This was a cross-sectional study in which 86 parents (who agreed or refused to give consent for LP on their child) were interviewed by using a standard questionnaire. A scoring system was used to assess their knowledge about the purpose and technique of the procedure. Consent for LP was granted in 23 and refused in 27 children. The refusal rate was significantly higher when family members other than parents made the decision. The factors which did not play a statistically significant role in decision-making included: age of the child and parents; gender of the patient; number of children in the family; patient's birth order among the siblings; place of residence; monthly income of the family; parents' level of education; and number of days after admission when LP was requested. The factors that positively influenced the decision to give consent included knowledge about the purpose of LP and underlying disease. In order to receive positive consent for LP it is concluded that the parents/guardians and other family members who may influence the decision-making should be explained the role of LP in (1) making diagnosis and (2) choosing right antibiotics for treatment. They should also be informed about the side-effects of antibiotics, which may be used unnecessarily in unconfirmed cases of central nervous system infections.
Objective: Self-esteem is an important component of psychological health. In Malaysia, Rosenberg’s self-esteem scale remained the single most popular utilized scale for studying global self-esteem. This study aims to design a language, culture and illness specific self-esteem questionnaire. Methods: The study consisted of 2 phases. The first phase was to generate items for the new self-esteem questionnaire (SSES) in Bahasa Malaysia. Literature review on the concept of selfesteem and its’ content was conducted. This was followed by expert opinion from professional care-givers. The items were qualitatively validated by healthy subjects and patients with schizophrenia from the same locality, culture and language. The second phase consists of quantitative validation of the items. Items in the new scale were analyzed based on the responses from 165 stable schizophrenia outpatients. The validated Malay version of Rosenberg Self-Esteem scale (RSES) was used concurrently as a comparison. Results: The SSES displayed good internal consistency for its two domains
(Cronbach’s alpha=0.88, 0.81) and test-retest reliability (ICC), ranged from 0.44 to 0.87. Its construct validity was confirmed by confirmatory factor analysis. The concurrent validity of SSES and RSES using Pearson correlation was 0.77. The Cronbach’s alpha for the validated Malay version of RSES is 0.67. Conclusion: This study presents a new self-esteem questionnaire (SSES) which has high concurrent validity with the standard RSES and confirms the reliability and validity of SSES in Malay patients with Schizophrenia.
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan and Hospital Kota Bharu, (HKB), Kelantan
Objective: This study aims to determine the quality of life (QOL) of Malaysian women based on their physical and mental scores and correlates with age and cervical disease severity. Methods: This is a cross-sectional study from Nov 2006 till Dec 2007 from participating
Gynecology-Oncology outpatient and in patient’s wards. QOL interviews used the SF-36 questionnaires. Main domains were the Physical Composite Scores (PCS) and the Mental Composite Scores (MCS). Results: A total of 396 participated in the study. Mean respondents age were 53.31 ± 11.21 years, educated till secondary level (39.4%), Malays (44.2%) with mean marriage duration of 27.73 ± 12.12 years. Among pre-invasive diseases, the cervical intra epithelial neoplasia (CIN) 1 was the highest in percentage of cases
(8.1%). Among invasive cancer, stage 1 cancer was highest (31.1%), followed with stage 2 (28.3%), stage 3 (7.3%) and stage 4 cancers (5.8%). PCS scores are highest among the pre-invasive and stage 1 cancer (F=4.357; p
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Objective: The aim of this study was to identify depression among HIVinfected patients attending Infectious Disease Clinic in University Malaya Medical Centre (UMMC). Methods: This is a cross sectional study on HIVinfected patients attending Infectious Disease Clinic, UMMC. Those who fulfilled inclusion criteria were recruited and interviewed. Sociodemographic characteristics and clinical conditions such as mode of transmission, year of diagnosis, CD4+ counts, drug treatment and clinical stage were collected. The patients were then subjected to self-administered questionnaires, Patient Health Questionnaire, (PHQ-9) and Hospital Anxiety & Depression Scale (HADS). Results: 89 patients were recruited. Scores from PHQ9 showed 32% of depression rate while scores from HADS showed 19% of depression rate among the respondents. Non-self financial supporter, nonalcoholic drinkers and females were more likely to be depressed (P
The objective of the study is to investigate the extent of preventive and promotive health care in the ambulatory management of paediatric gastroenteritis in an incompletely immunised child using the simulated patient methodology. Only 44% of doctors explained to the fathers the nature of their child's ailment. 75% of clinicians prescribed oral rehydration solution but only 4% met the Gold Standard. The questionnaire survey showed that doctors rated immunisation as a very important health message to disseminate to all parents. But only 3% of doctors in the study advised parents to complete each child's immunisation once he is well. The extent of preventive and promotive health care in ambulatory paediatric practice in the Klang Valley is very low. (Copied from article).
Patient satisfaction plays a crucial role in ensuring utilization of healthcare services, continuity of care, and compliance towards treatment. Thus, this study aimed at determining the level of patient satisfaction with the services provided by the UKMMC primary care clinic. A descriptive cross-sectional study involving 317 patients attending the clinic from February to March 2011 was carried out. They were selected through systematic random sampling. Using a validated self-administered Patient Satisfaction Questionnaire-46 (PSQ-46) in English and Malay versions, general satisfaction and satisfactions with five different subscales (doctors, nurses, accessibility, facilities and appointment) were assessed. A majority of the patients (93.1%) were generally satisfied with the overall services. Among the five subscales, patients were most satisfied with the doctors (96.5%), but only 35.6% of the patients were satisfied with the facilities. The proportions of patients who were satisfied with other subscales were: 86.1% (appointment), 82.0% (nurses) and 68.1% (accessibility). There was a significant association between each of the subscales and the general satisfaction (p
Adolescents who overestimate the prevalence of smoking among their peers or other teens are at higher risk to take up smoking. The purpose of this study is to elucidate the factors which are related to adolescents’ overestimation of smoking. We surveyed form four (16 years old) students in Petaling District, Selangor. A sample was selected using two-stage stratified sampling, and data were collected using standardised, self-administered questionnaires. A response rate of 80.4% (n=1045/1298) was obtained, and a total of 943 students were included in the final analysis. About 73 percent (n=688/943) of the respondents overestimated the prevalence of smoking among their peers. The odds of overestimating increased as the number of close friends who smoke increased [Two close friends, OR=3.10(1.67-5.75), three close friends OR=10.81(4.44-26.3) and four-five close friends OR= 12.91(5.31-31.43)]. Those who had an elder brother who smoked (OR=1.95 (1.18-3.24)) and females [2.08(1.37-3.33) were more likely to overestimate peer smoking prevalence. Intervention programmes to correct the misperception of peer smoking prevalence are recommended, in addition to measures to modify the other factors that are amenable to intervention, so as to reduce the risk of smoking initiation among adolescents.
Comparison of rates of smoking across countries revealed that students are more likely to begin smoking in medical school than to give it up and increase their cigarette consumption rather than decrease it. A cross-sectional survey of all consenting medical students in a private medical university in north Malaysia was conducted in 2008 to determine the prevalence and smoking habits among them. A self administered questionnaire which was returned to the investigators in a sealed envelope was used. Results were tabulated and analysed with SPSS version 13.0 software. The response rate was 83.3% (508/610). The prevalence rate for current smokers was 5.3% (27/508) and for ever smokers 9.3% (47/508). Factors significantly associated with smoking were gender (p<0.001), age group (p<0.001) and family income (p=0.003). The odds of being a smoker was 14 folds high when a family member smoked and the odds of being an ever smoker was almost 6 folds more when a family member smoked. Friends were the most common influence to start smoking and the most common reason to stop smoking among ever smokers. The reasons for not smoking among the never smokers were health concerns and the distasteful smell of cigarettes. A module on how to help medical students to stop smoking should be included in the curriculum of every medical school. This will not only help them become good educators but will prevent them from picking up the habit. Educational intervention should also include family members who smoke.
Key words: smoking, medical students, university, Malaysia
Cognitive Impairment is common in late life and may be due to the normal process of ageing, or associated with physical or mental disorder which contributes to a decrease in quality of life, neuropsychiatric symptoms, increased disability and increased healthcare cost. The aim of this study is to determine the prevalence of cognitive impairment among the elderly members in NACSCOM in Day Care Centres within the Klang Valley and its associated socio-demographic factors such as age, gender and educational level. This cross-sectional study was conducted on 101 members of NACSCOM in Day Care Centres of Damansara,Subang Jaya and Setapak using assisted questionnaires as the research tool. The questionnaire comprising of a total of 10 questions based on Elderly Cognitive Assessment Questionnaires (ECAQ), consisted of three parts, memory, orientation and recall. One correctly answered question earned the respondent one mark. The total score for ECAQ is 10 where respondents with scores of 5 and below were identified as having cognitive impairment. Data collected was analyzed using Chi-square test (SPSS version 18). The prevalence of cognitive impairment among the elderly members of NACSCOM in Day Care Centres within the Klang Valley was 4.0%. This study also showed that there was no statistically significant association between cognitive impairment and sociodemographic factors such as age, gender and education. Prevalence of cognitive impairment among the members of NACSCOM in Day Care Centres within the Klang Valley was found to be low. This could be attributed to the fact that members actively participated in activities organized by NACSCOM. The study also did not find any statistically significant association between cognitive impairment and age, gender and education.
Caregivers may experience the need for information, social support, a range of services and financial support in caring for children with disabilities. However, some of these needs are unmet. This study aims to determine the perceived unmet needs among caregivers of children with disabilities at the Community-based Rehabilitation centre (CBR). A cross-sectional study was carried out among a total of 337 caregivers, who were recruited from 12 CBR centres in Selangor. The unmet needs were assessed using Family Needs Survey (FNS) questionnaire, which included six subscales of needs such as need for information, social support, community services, explaining to others, financial support and family functioning. Caregivers identified the need for information that the child might receive in the future as their greatest need (94.4%) and the least was the need for getting more counseling or help in getting a job (16.3%). The mean score for the overall unmet needs was 18.67 (SD=7.623). Out of six subscales of FNS, the need for information had the highest rating which was 98.3%, followed by need for social support (93.4%), need for community services (84.0%), need for financial support (79.9%), need for family functioning (61.8%) and need for explaining to others (46.2%). The unmet needs varied within the subscales. Therefore, more effective intervention programs are needed in community-based rehabilitation centres to match or reduce those varied unmet needs in order to allow caregivers to provide better care for their children with disabilities.
Occupational stress exists in all professions, but the nursing profession appears to experience more stress at work compared to other health care workers. Stressful conditions at the workplace may cause the high turnover and burnout among nurses. This study objective was to determine the level of stress and its associated factors among in-patient ward nurses. A cross sectional study using the stratified random sampling method was carried out among 114 staff nurses from 5 different departments in a public hospital in Kuala Lumpur. Respondents were requested to complete a single set of validated and self-administered questionnaire, the Depression, Anxiety, Stress Scale (DASS) . Data was analysed using SPSS 17. In general, the prevalence of stress at the department of Medicine was found to be higher compared to other departments studied. There was also a statistical significant relationship between the prevalence of stress and types of department (p 0.05). In conclusion, stress had no significant association with sociodemographic factors (age, marital status and financial status) and working environment except for type of department nurses work in. There might be some other possible confounders that have a bigger potential in becoming stressors compared to those independent variables in this study.
Participation and adherence to the law and cultivation of anti-tobacco culture became the important issues for reducing the tobacco use prevalence in the community. Measuring the perception of tobacco policy indirectly measures the acceptability of the law. This study aims to determine the perception of students on anti-tobacco policy in terms of tobacco free school environment and factors that support or deter them. A two-stage cluster samplingtechnique was used for selection of schools with probability proportional to enrolment size followed by stratified random sampling of government and private schools. Data were collected from 6563 secondary school students using
structured questionnaire. Analysis showed that 66.2% of the female students and 33.8% of the male student have strong supportive attitude towards tobacco free school environment. Logistic regression analysis revealed that class grade IX and above, father’s occupation as service, family size less than 6, higher economic status, non smoker, non exposure to second hand smoking in the house and discussion of dangers of smoking appeared to have important influencing factors for tobacco free school environment (p
Health system reform has been a major concern for different countries. The aim of this research was to develop a reliable and valid questionnaire suitable to assess the consequences of health reform process from people's perspective. An extensive literature review used to extract a set of statements as possible indicators for health system reform. Expert panel used to determine the content validity rate (CVR) and the content validity index (CVI). The first version produced in Turkish language and pre-piloted with 20 heads of household. Qualified committee used to translate the Turkish version to English version. Group of eighteen academics and graduate students recruited to tests both versions for parallel test validity. The construct validity of the questionnaire was determined using principal components analysis with Varimax rotation method (PCA). Internal consistency and questionnaire's reliability were calculated by Cronbach's alpha and the test–retest reliability test. A 17- items questionnaire was developed through the qualitative phase. The Bartlett's test was significant (p < 0.001), and the KMO value (0.842) showed that using principal component analysis (PCA) was suitable. Eigenvalues equal or higher than 1 were considered significant and chosen for interpretation. By PCA, 4 factors were extracted (accessibility, attitude and preference, quality of care and availability of resources) that jointly accounted for 85.2% of observed variance. The Cronbach's alpha coefficient showed excellent internal consistency (alpha=0.97), and test-retest of the scale with 2-weeks intervals indicated an appropriate stability for the scale (Intra-class coefficient = 0.96). The findings showed that the designed questionnaire was valid and reliable and can be used easily to assess the consequences of health reform process by comparing the situation before and after the reform from people's perspective.
Pregnant women are at higher risk of transmitting the infections to their foetus. This prompted the “Prevention of Mother to Child Transmission (PMTCT) Program” in Malaysia since 1998. The objective of this cross sectional study was to determine the knowledge, attitude and practice (KAP) of pregnant mothers in the west of Sabah towards HIV/AIDS and its influencing factors. Data were obtained through self administered questionnaires. Results showed that only 32.2% of the
respondents have good knowledge compared to 67.8% who had poor knowledge (p
Aim of study: To describe the residents of nursing home for the elderly in relation to their socio-demographic, physical and mental profiles. Method: A cross-sectional study design was carried out. The elderly in two selected nursing homes in Kuantan, Pahang were interviewed. The respondents were interviewed using a structured questionnaire which included the biodata, social background, and medical illness, presence of cognition, depression and ability to perform basic activities of daily living (ADL). Results: Results are available for 36 respondents out of 41 residents, giving a response rate of 87.8%. Chinese (77.8%), male (63.9%), single or divorced (50%), and low income (69.4%) was consisted the majority. Most respondents (86.1%) suffered from chronic illness, 61.1% were functional dependent (according to Barthel index), 33.3% have cognitive impairment (according ECAQ) and 22.2% have depression (according to GDS-14). The most common functional dependence was mobility on level surface (47.2%), followed by climbing stairs (38.9%).Conclusion: This study had identified chronic illness, cognitive impairment, depression, and functional decline as major health problems of the elderly in nursing homes that require greater attention and intervention.