Substantial studies reported musculoskeletal disorders among the working population in the developed country, however, a limited number of studies were conducted in Malaysia. The objective of this cross sectional study was to determine the physical activity risk factors for low back pain among automotive workers in Selangor. Modified Risk Factors Questionnaire (RFQ) was used to assess physical activity with the occurrence of low back pain. The significant physical activities associated with the 12 months point prevalence are lifting weight (
Being a student, especially postgraduate student, could expose to stress, and being international postgraduate student would exposed to more stress to the student. This study was conducted to assess stress level among international postgraduate students and its associated factors. A cross sectional study was conducted among international postgraduate students registered at UKMMC, Cheras campus, Kuala Lumpur. Questionnaires were distributed to 119 students,. Main international student are Arabs (52.4%). The stress prevalence is 54.8%. Younger age group are more stressful with mean age 33.94 (P=0.004), while shorter duration is associated with stress, P=0.035. Relationship with neighbour and relationship with local colleagues are shown to be associated with stress with P value 0.011 and 0.005 respectively. This study reveals the presence of significant prevalence of stress among international postgraduate students. The student socio-demographic character that has shown to be associated with stress in this study was age. The poor relationships with local colleagues as well as the poor relationships with the neighbours have shown to contribute to the stress among international students.
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.
Impact of health care on the population health has been measured in terms of morbidity and mortality but this measurement doesn’t distinguish between children, adults and the elderly. It does not also take into account the losses that occur because of handicap, pain, or other disability. Therefore, measures of population health which combine information on mortality and non-fatal healthboutcomes to represent the health of a particular population as a single number was introduced. QALYs and DALYs are both common outcome measures in economic evaluations of health interventions. QALYs is the comprehensive measure of health outcome because it can simultaneously capture gains from reduced morbidity (quality gains) and reduced mortality (quantity gains) and combine these into a single measure. DALYs is primarily a measure of disease burden where it combines losses from premature death and loss of healthy life resulting from disability. Although QALYs and DALYs are almost similar in their basic concept but there are few distinct differences which must be paid attention to in order to correctly utilize these measures.
A study was conducted at Greentown Health Clinic, Ipoh to assess and classify asthma by levels of control based on the Global Initiative for Asthma (GINA). The secondary objective was to identify those patients whose control was suboptimal. A total of 102 patients were included in this study based on random sampling between 25th April 2008 and 6th June 2008. Standard Asthma Control Questionnaires were used to classify asthma and levels of control. Baseline Peak Expiratory Flow Rate (PEFR) measurements and PEFR at audit visits were also recorded. All data were analysed using SPSS version 13. The study showed that only 39.2 % of the patients were classified as having controlled asthma, 34.3 % had asthma that was partly controlled and 26.5 % of the patients had uncontrolled asthma. Among those patients who had inadequate asthma control, more than half of them had nocturnal attacks and exacerbations. These findings demonstrate the need by the attending doctor to improve assessment of the patient’s control of asthma by actively questioning the patients and subsequently improving management to achieve optimal control of asthma.
Study site: Klinik Kesihatan Greentown, Ipoh, Perak, Malaysia
Top-down costing and activity based costing are the most frequent costing methodologies used for analyzing cost. Top-down costing is accomplished by assigning total expenditure of hospital to patient by apportioning the expenditure of cost centers (unit of service) in hospital to give the cost per patient per visit, per day or per admission. Conversely, activity based costing is accomplished by tracking every resource used by patient individually. Since this study started in 2009, Top-down costing calculation was based on financial year in 2009 with adjusted up to 12.6% from 2008 data. This percentage was taken based on the trend of hospital expenditure during 2005 till 2008. An assumption was made that non-financial data (performance and administrative data) for 2009 was similar to 2008. Top-down costing was calculated using Clinical Cost Modeling Software developed by Unit Case-mix of UKMMC to obtain cost of elective lower segment caesarean section (LSCS) per day at ward which was RM922. Whereas activity based costing was calculated using clinical pathway of elective LSCS. Given the average length of stay in 2009 was 4 days, the cost of elective LSCS according to top-down costing was RM3, 688 and activity based costing was RM1774. As a result, cost of elective LSCS is 108% higher using top-down costing.
Adolescents are known to obtain information regarding sexual and reproductive health from a variety of sources and not just during formal lessons in schools. This cross-sectional descriptive study was carried out to determine the source of information on sexual and reproductive health among Form four secondary schools girls in the Klang Valley as well as parents’ relationship profile. A total of 520 secondary school girls were recruited for the study. In this study, the source of information on puberty and sexual topics were categorized as follows: first level of importance - mothers, second level of importance - siblings, third level of importance - fathers, fourth level of importance - friends, fifth level of importance - teachers and sixth level of importance - books/internet. A majority of respondents agreed that their mothers were the first level of importance they sought for information on puberty (74.8%) and sexual topics (53.8%). Thirty nine point three percent (39.3%) of respondents reported it was very easy to have a dialogue with their mothers while only 10.0% of the respondents said it was very easy to have a dialogue with their fathers. While this was the case, only 6.3% of the respondents reported discussing sex-related matter with their mothers.
Satu kajian keratan rentas telah dijalankan untuk melihat kesan pendedahan haba ke atas perubahan fisiologi di kalangan pekerja lelaki sebuah kilang pembuatan komponen otomotif di Shah Alam, Selangor. Seramai 46 orang yang berkerja di bahagian foundri telah dipilih sebagai responden kajian. Pemboleh ubah yang dikaji adalah WBGT Dalaman, kadar haba metabolik, suhu teras badan, tekanan darah, denyutan nadi dan kadar denyutan nadi. Hasil kajian mendapati nilai min WBGT Dalaman di bahagian operasi foundri adalah sebanyak 28.96 0C. Pekerja foundri terdedah kepada haba semasa
proses peleburan besi, proses memasukkan silika dah debu besi ke dalam acuan pembentukan, dan pembentukan teras. Purata masa pengukuran yang paling singkat adalah selama 2 jam dan 8 jam untuk keseluruhan tempoh pendedahan. Ujian Bonferroni menunjukkan terdapat perbezaan yang signifikan di antara suhu teras badan sebelum syif bermula dengan 2 jam selepas syif bermula (p = 0.05) dan di antara sebelum syif bermula dengan selepas tamat syif 8 jam bekerja (p < 0.001). Terdapat perkaitan yang lemah di antara suhu teras badan dengan kadar denyutan nadi sebelum syif bermula (r = 0.293, p = 0.048) dan di antara suhu teras badan dengan tekanan darah sistolik selepas tamat syif 8 jam bekerja (r = 0.309, p =0.036). Kadar denyutan nadi responden adalah berada di antara julat 51 hingga 98 denyutan perminit, menunjukkan tidak terdapat tuntutan aktiviti kerja yang berlebihan ke atas fisiologi. Min suhu teras badan (36.37 ± 0.53 0C) dan kadar denyutan nadi (74.50 ± 10.10 per minit) selepas tamat syif 8 jam menunjukkan pekerja mempunyai kawalan
tubuh badan yang baik terhadap pendedahan haba. Tiga daripada empat seksyen kerja yang dikaji mempunyai bacaan WBGT Dalaman melebihi 28 0C (ACGIH TLV). Pekerja terdedah kepada tegasan haba yang sederhana sepanjang kajian ini berlangsung, walaubagaimanapun, suhu teras badan, kadar denyutan nadi dan tekanan darah masih tidak mencapai tahap tegangan kepada fisiologi.
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
Patient waiting time was introduced to orthodontic clinics in 2009 as a Key Performance Indicator (KPI) in the Ministry of Health Malaysia (MOH) as a measure of client satisfaction. A cross-sectional pilot study was carried out in 2009 in all four main government orthodontic clinics in Selangor. The objectives were to measure patient actual waiting time and evaluate conformance to this KPI. The sample comprised of 5,286 patients; 9.2% from Tanjung Karang, 37.1% Kajang, 29.3% Klang and 24.4% Shah Alam. There were 33.8% punctual, 44.2% early and 21.9% late patients. The mean actual waiting time (AWT) in Selangor was 30 min (SD 24.7); shortest in Tanjung Karang (16.5min, SD 15.3) and longest in Shah Alam (47.9min, SD29.6). AWT was 21.9 min (SD 17.4) for patients punctual for appointments, 40.3 min (SD 40.3) for early patients and 21.9min (SD19.8) for late patients respectively. Although the mean AWT was long for early patients, 20% of them were seen earlier than their appointment time. All four clinics complied with the MOH KPI performance target (>50%) with a mean compliance of 87.5% for Selangor. There is statistically significant difference in punctuality of patients in different clinics (p
Treating tuberculosis (TB) remains a public health challenge in many developing countries. Treatment success rate in Malaysia is on declining pattern from 78% in 2000 to 48% in 2006. This study will determine factors associated with unsuccessful treatment among pulmonary TB patients. A retrospective cohort study was conducted on notified and treated pulmonary TB cases in Kota Bharu district Kelantan between January 2006 and December 2007. To identify the associated factors, univariate comparison and multiple logistic regressions were performed. Among the 765 patients identified, 472 (61.7%) cases fulfilled the criteria and were analyzed. There were 316 males and 156 females and their mean (SD) age was 45 (17.9) years. In univariable analysis, age, gender, educational level, employment status, family incomes as well as coexistence of extra-pulmonary TB, smoking, co-morbid disease (diabetes mellitus), HIV status, sputum cultures, chest X-ray findings and duration of delay for diagnosis were all found to have significant relationship with unsuccessful pulmonary TB treatment outcome. After adjusted for the confounders, the significant predictors for unsuccessful tuberculosis treatment were age (Adj. OR 1.09; 95% CI: 1.03-1.15), HIV positive (Adj. OR 23.04; 95% CI: 3.01-176.22) and advanced chest X-ray findings (Adj. OR 6.51; 95% CI: 1.50-28.23). A large proportion of unsuccessfully treated cases could be identified at entry
by screening for age, chest X-rays and HIV status and specially targeted measures could be taken. The use of directly observed treatment short-course (DOTS) should be given more focus and priority among this high risk group of patients.
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.
The quality of the health care services has been always a big responsibility and sensitive issue. Health care delivery is complex and critical for many reasons related to management and organizational planning and development. Health system reorganization is one of the approaches that health care managers adopt to overcome dysfunction. Clinical Microsystems (CM) is believed to be a one of vital steps in providing a high quality of patient care through system reorganization. CM has the potential to drive the health care to greater success through proper understanding, process and resource planning and health outcomes continuous assessment and improvements. CM integrate patients, providers and family needs and roles to form a vision of community system that cooperate for better outcomes .The components of an effective CM are produce quality, patient safety, and cost outcomes at the front line of care. This article aims to explore the concept, characteristics models and components of these Clinical Microsystems. It also highlights the steps to initiate, plan and sustain this innovation in hospitals in a systematic manner.
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.
This study was conducted to determine the proportion and factors associated with periodontal disease among younger adult attended Al Fatah Dental Faculty in Libya. A cross sectional study with universal sampling methods was carried out from July 2010 until September 2010 among 70 Libyan subjects aged between 20-35 years. The data in this study was collected using self administrated questionnaire, followed by oral examination done by trained dentists. The results of this study showed that, the prevalence of periodontal disease in Libyan subjects was 75.7%. Gender, oral care habits, smoking were found significantly associated with presence of periodontal disease. Gingivitis has been found the most common types of periodontal disease (94%). High percentage of periodontal disease in this study was among men (87.9%) compared to women (69.9%). In conclusion, modifiable factors like changing lifestyle such as avoiding smoking and practicing oral care can be promoted to prevent periodontitis.
Majority of doctors show no interest in research although research is now a requirement and is being done in every field of medicine. The objective of this survey was to describe the involvement in research activities among doctors in Penang and Seberang Jaya hospitals in Penang. A self-administered questionnaire was used. A total of 302 doctors participated in the survey. The differences in age (p=
In October 2011, the National International Health Regulations (IHR) 2005 Focal Point for Malaysia received notification from the United States’ Centers for Disease Control and Prevention (CDC) of a probable Sarcocystis outbreak amongst 23 travellers from six countries who had vacationed on Tioman Island between June and August 2011. The Ministry of Health, Malaysia (MOH) in collaboration with the Department of Veterinary Services, Malaysia (DVS) conducted a cross sectional study in November 2011 to determine the presence of Sarcocystosis among humans, animals and in the environment in Tioman Island. Epidemiological investigations conducted involved a community health survey of 44 residents in Kampung Salang, Tioman and review of outpatient attendance cards for suspected or confirmed cases of Sarcocystosis. Twenty-eight fresh stool samples were collected and sent to the National Public Health Laboratory (NPHL) for detection of Sarcocystis oocysts using fluorescence microscopy. Water samples taken from 27 water sampling points around the island were processed and analysed under the fluorescence microscope using ultraviolet (UV) light at the Institute for Medical Research (IMR) to detect the presence of Sarcocystis sporocyst. DVS collected 84 faecal samples from four types of domesticated animals and then analysed them at the Veterinary Services Centre in Tioman Island for Sarcocystis oocysts and other parasitic ova and cysts using qualitative Floatation Technique. The results showed that Sarcocystis was not present in humans, animals and in the environment in Tioman Island during the study period. Further surveillance among humans, wildlife and the environment is needed to determine Sarcocystis endemicity in Tioman Island.
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
Improvement in the service quality system of health clinics in Malaysia had increase with the increase of national development. However, customer dissatisfaction towards regular service still has become an issue in the provision of health service in clinics throughout this country. This study aims to identify factors that influence customer satisfaction such as sociodemographic factors of patients, the location of clinic (rural or urban) and the most important SERVQUAL dimensions in determining customer satisfaction. This study conducted in October and November 2008 in Hulu Langat District. SERVQUAL questionnaires were used. Probabilistic sampling was used for the selection of respondents and the number of samples for each clinic was based on the workload of the clinic. Overall, the results showed that there are differences in levels of customer satisfaction between urban clinic (25.8%) and rural (30.7%). The most critical service quality dimensions for urban clinics are the responsiveness and reliability dimensions with a mean value of -0.7018 and -0.7434. Responsiveness, existence and reliability are the weakest quality service dimensions (mean -0.6317, -0.6718 and -0.6028) in rural clinics. It was found that customers’ ethnicity and education affect customer satisfaction in both the urban and rural clinics. Gender and type of work are factors that affect customer satisfaction only in urban clinics. Overall customer satisfaction at health clinics in Hulu Langat District is low. The difference between urban and rural clinics show the customers' needs in the area is different.
Key words: Customer satisfaction, SERVQUAL, health clinics, services.