Migration of health workers 'Brain drain' is defined as the movement of health personnel in search of a better standard of living and life quality, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. The debate about migration of health workers from the developing to the developed world has remained pertinent for decades now. Regardless of the push and pull factors, migration of health care workers from developing countries to developed ones, have done more harm than good on the health care deliveries in the developing countries. This article reviews the literature on the effects of cross-border migration of health care professionals.
When medical and surgical intervention cannot alleviate all of the impairments resulting from diseases of the eye, visual rehabilitation can help reduce the disability and increase the quality of life. Data from 169 patients seen at the UKM Low Vision Clinic (UKM LVC) over the past 2 years were examined and analysed. The age ranged from 6 to 87 years of age. The main cause of ocular pathological categories was conduction (63.9%), media (24.9%) and congenital (11.2%) related problems. The main causes of low vision at UKM LVC were congenital cataract, retinitis pigmentosa, glaucoma, cataract and diabetic retinopathy. 84% of these patients received low vision devices to improve their near or/and distance vision. The most common optical devices dispensed at UKM LVC were near high addition spectacle, hand magnifiers and stand magnifiers. Medical, vision care and rehabilitation professionals working together can offer a comprehensive treatment plan for the visually impaired, offering these patients the very best services to increase their quality of life.
In a clinical controlled trial involving repeated measures of continuous outcomes such as quality of life, distress, pain, activity level at baseline and after treatment, the possibilities of analyzing these outcomes can be numerous with quite varied findings. This paper examined four methods of statistical analysis using data from an outcome study of a clinical controlled trial to contrast the statistical power on those with baseline adjustment. In this study, data from a CCT with women with breast cancer were utilized. The experiment (n=67) and control (n=74) were about equal ratio. Four method of analysis were utilized, two using ANOVA for repeated measures and two using ANCOVA. The multivariate between subjects of the combined dependents variables and the univariate between subjects test were examined to make a judgement of the statistical power of each method. The results showed that ANCOVA has the highest statistical power. ANOVA using raw data is the least power and is the worst method with no evidence of an intervention effect even when the treatment by time interaction is statistically significant. In conclusion, ANOVA using raw data is the worst method with the least power whilst ANCOVA using baseline as covariate has the highest statistical power to detect a treatment effect other than method. The second best method as shown in this study was in using change scores of the repeated measures.
As women with breast cancer are living longer, issues beyond survivorship like the much neglected sexual functioning and issue of quality of life have become increasingly important. Experiences of significant alterations in sexual functioning need to be addressed. However, these sexual issues are often not acknowledged in our traditional medical model of health care delivery. This paper briefly reviews the changes in sexual functioning after a diagnosis of breast cancer, with implication for clinical practice and medical curicula.
Background: A randomised single blinded clinical trial comparing the effectiveness of two methods of cataract surgery with intraocular lens implantation: extracapsular cataract extraction (ECCE) and phacoemulsification (PEA) was carried out at Hospital Universiti Kebangsaan Malaysia (HUKM) between March 2000 and August 2001. Methods: The effectiveness of cataract surgery was assessed from the quality of life specifically for vision via Visual Function 14 (VF-14) preoperatively, one week, two months and six months after surgery. Results: The result showed that there was a significant increased in VF-14 scores after a week, two months and six months postoperation compared to the score before surgery for both techniques. However there was no significant difference in VF-14 scores when compared between ECCE and PEA. Conclusions: This study indicated that both techniques give equal benefit to cataract patients. Since effectiveness of cataract surgery with intraocular lens implantation is unrelated to operative procedures, less costly technique should be promoted.
Through the six domains of the health-related quality of life (HRQOL) - physical, psychological, level of independence, social relationship, environment and spirituality or religion - ten out of one hundred randomly selected studies were analysed and evaluated as a theoretical outcome of self care using health products such as food supplements, multivitamins and minerals. A reconstructed HRQOL tool was used in the qualitative and the quantitative analysis and evaluation of the ten selected studies. A Critical Appraisal Skills Programme tool was also used in making sense of the evidences of the study trials. The Population, Intervention, Comparison and Outcome guide focused the protocol for the selection of the studies used in this meta-analysis. A probability sampling generated a uniform distribution of the populations. The manner of consuming or the route of administration, the volume and the preparation of commercially prepared health products were neither analysed nor evaluated as the exclusion criteria. Of the ten studies, nine gave a high significance to the six domains of the (O.R. = 90% / p =
Objective: This study intends to investigate the reliability, validity and patients’ perception towards the Malay Hospital Anxiety Depression Scale (HADS) and Malay McGill Quality of Life Questionnaire (MMQoL) in Terengganu cancer patients. Methods: It was conducted cross-sectionally in Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, Malaysia
recruiting 80 patients fulfilling the inclusion criteria. Socio-demographic data was analyzed descriptively and presented as frequencies. To examine patients’ perception towards the applicability and practicality, completion time, comprehension, comprehensiveness difficulty and instrusiveness of the instruments were inquired via a 5-item survey. For reliability purposes, the internal consistency reliability (Cronbach's α) was calculated while
Spearman’s rank correlation coefficient (rs) was used to examine the strength of associations between and within instruments (convergent/divergent validity). Results: To the majority of patients, both HADS and MMQoL instruments were considered clear, comprehensive and not difficult to complete (completion time < 10 minutes). The internal consistency reliability
for both HADS and MMQoL domains ranged from moderate to high. Within HADS itself, the individual items produced strong correlations with their own domains than with other domains (rs ≥ 4.0). Similarly, majority of individual items in MMQoL correlated stronger within their own domains compared to other domains (except Existential Well-Being and Support Issues) supporting validity. Conclusion: The overall findings suggested that both instruments have exhibited adequate evidence of reliability and validity plus being perceived as favourable for assessing health outcomes among cancer sufferers.
Study site: Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, Malaysia
Device, Questionnaire & Scale: Malay Hospital Anxiety Depression Scale (HADS); Malay McGill Quality of Life Questionnaire
Twenty-one patients who underwent ablative surgery for head and neck cancer at Bristol Dental Hospital and School, England between the years 1996 and 2002 were enrolled in the study. A self-completed questionnaire based on Head and Neck Specific measures was addressed to the patients. The overall post-operative quality of life among these patients is acceptable. About half of the patients complained of moderate to severe difficulty in opening mouth wide (55%) and dry mouth (45%) and about one-third had major problems in swallowing solid food (36%), sleep disturbance (32%), trouble eating and enjoying meals (32%) and speech problems (32%). The study shows a tendency for the quality of life to improve steadily with increasing post-operative interval. It is hoped that the results will provide an insight into the patients' functional and psychological recovery, which will in turn help to facilitate the planning of appropriate strategies to improve their quality of life.
Background: This paper examined the importance and influence of post-transplantation follow-up visits on the quality-of-life (QoL) of living kidney donors in Malaysia.
Methods: Based on data collected from 80 living kidney donors, the relationship between QoL and the frequency of follow-up visits was examined. QoL was measured using standard SF-8 questions to capture its different dimensions.
Results: Donors in the 1991–1998 donation cohort have low QoL, especially in the domains of physical and vitality, compared with the other two cohorts (1999–2005 and 2006–2012). The mean scores showed that donors who never went for any follow-up activities visits experience low QoL in most of the categories, particularly those related to physical activities, implying the importance of follow-up activities visits in influencing the donors’ QoL. Lower QoL was recorded for respondents that never received post-transplant treatment.
Conclusion: Although this study found no serious post-transplant QoL issues in Malaysia, it is still important to set up a donor registry and provide free and mandatory follow-up visits for all donors in order to adequately monitor their health.
Chronic obstructive pulmonary disease (COPD) patients are reported to have cardiovascular instability which leads to greater limitation for activities there by leads to poor quality of life. Physical training proved to be one of the moderators of these limitations. However, uncertainty prevails among the protocol and duration. The present study investigated the effect of physical training on blood pressure, heart rate and Rate pressure Product (RPP) among COPD patients. A total of thirty COPD patients aged between 40 to 55 years were recruited for the study based on the inclusion and exclusion criteria and were assigned in to experimental group (15 patients) and control group (15 patients). The mean difference of blood pressure, heart rate and RPP were analyzed using paired t-test. There was significant difference between the pre and post test values of all parameters between experimental and control group with p< 0.05. Diastolic blood pressure showed to be less significant compared to the systolic blood pressure. This showed that specifically designed physical improved the cardiovascular fitness among COPD patients.
This study explores the quality of life, social integration and the effects of perceived stigma of people with mental illness living in the community. Adopting a complimentary mixed method, this study was represented by 165 people with mental illness in Kuching, Sibu and Miri. Findings indicated that the quality of life scale was poor, 49.67% and 78.43% often experienced stigma. Anticipated stigma 43.79%; 16.99% all the time and 4.58% never experienced stigma. Findings also noted that people with mental illness living in the community are still largely depending on and needed continuous support from their family members/carers for financial aid and their living arrangement for a “better” quality of life. Where treatment is concerned, follow up care at home by health care providers continue to play a significant role. In order to “erase” the perceived or stigma experienced, establishing therapeutic relationship, communication and creating awareness on “stigma discrimination paradigm” poses a phenomenal challenge in the current misrepresentations of mental health messages.
Health traditionally has been compared using mortality and morbidity and in recent years health related instruments have been utilized along to complement those measures. Health related quality oflife instruments are important because they provide patient's opinion and decision of management and for monitoring and evaluating health status. The quality of life instruments such as health related quality of life questionnaires are increasingly being used and these questionnaires are classified into disease specific and generic questionnaires. They require proper assessment using psychometric analysis of reliability and validity, For reliability, the two common analyses are the test-retest and internal consistency and for validity, it requires the assessment of content validity and analyses of construct validity and criterion validity. Reliable and valid quality of lhfe questionnaires provide consistent and accurate information. The purpose of this paper is to provide crucial assessment and analyses of the reliability and validity of health related quality of life questionnaires.
The Aging Male Symptoms Scale (AMS) measures health-related quality of life in aging men. The objective of this paper is to describe the translation and validation of the AMS into Bahasa Melayu (BM). The original English version of the AMS was translated into BM by 2 translators to produce BM1 and BM2, and subsequently harmonized to produce BM3. Two other independent translators, blinded to the English version, back-translated BM3 to yield E2 and E3. All versions (BM1, BM2, BM3, E2, E3) were compared with the English version. The BM pre-final version was produced, and pre-tested in 8 participants. Proportion Agreement, Weighted Kappa, Spearman Rank Correlation Coefficient, and verbatim responses were used. The English and the BM versions showed excellent equivalence (weighted Kappa and Spearman Rank Coefficients, ranged from 0.72 to 1.00, and Proportion Agreement values ranged from 75.0% to 100%). In conclusion, the BM version of the AMS was successfully translated and adapted.
Researchers all over the world have continuously contributed knowledge on common human cancers and its related risks. Despite these mountains of information, the trend of cancer problems has not significantly declined and perhaps in certain occasion, it gradually increased affecting those who are previously known to be less risky'. Cancer is still identified to be one of the top leading killer worldwide and is also the main source of psychosocial burden of the community particularly to the caregiver' Its problems are expected to be further increased as human beings are constantly modified and manipulated by unpredictable and dynamic human activities and globalization phenomena. Furthermore, the current advances in cancer therapy and others clinical interventions are not always guaranteed of a permanent cure, improve survival or prognosis, sustainable compliances, prolonging life and improving quality of life, thus the mortality and its associated biological and management complications are still prevalence. (Copied from article).
Objective: The purpose of this study was to evaluate the effectiveness of nutrition education intervention among university students in terms of social, psychological factors and nutrition-related Quality of Life (NQoL) outcomes after receiving a 10-week nutrition education. Longitudinal and randomised study design was adopted for the study. Methods: A total of 417 respondents from four public universities in Terengganu were randomly assigned to either intervention group (IG = 205) or control group (CG = 212). The IG received nutrition education through three tools; 1) conventional lecture, 2) brochures and 3) text messages via short messaging system (SMS) while the CG not received any intervention. Students completed the Malay version of NQoL (6 domains; 49 items; Likert-type responses=1-5) and SF-36 (8 domains; 36 items) at pre-intervention and post-intervention. Data analysis was carried out by using SPSS 16.0 utilising descriptive and parametric statistics. Results: Ninety-one percent of participants (IG = 178; CG = 202) completed the study (age = 19.1±1.1 years; female = 87.6%; Malay = 98.2%). After controlling for possible confounders (eg. weight, waist, hip circumferences and pre-intervention scores for each domain), IG possessed relatively higher NQoL score in Food Impact (p = 0.001), Social / Interpersonal (p = 0.008), Physical Functioning (p = 0.011) and Overall NQoL (p = 0.001). However, Psychological Factors did not show any significant difference for both groups. Conclusion: Although the intervention did not generate significant impact in the psychological component over a period of 10 weeks, significant positive impacts in Social/Interpersonal aspects and NQoL were clearly shown. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 39-53.
The diagnosis of pathological fractures is on the rise. The morbidity involved does not only burden the patient and their families but it has a great toll on the healthcare system as well. Early identification of the patient at risk is an invaluable tool to cut cost and improve the patient's quality of life. Multiple renal pathologies have been highlighted in relation to the risk of pathological fractures; however, complications in renal tubular acidosis have been rarely documented. Nevertheless, prompt action with adequate and relevant patient education ultimately can reduce the associated morbidity. We present a case of poor control of the disease and its debilitating pathological fracture complications.
Introduction: Auditory hallucination (AH) is often unexplored in depth in clinical practice. This study sought
to ascertain the relationship between AH, depressive symptoms and quality of life (QOL) and its association
with socio-demographic and clinical variables.
Methods: This was a cross sectional study done in a
psychiatry unit involving 60 schizophrenic patients between 18 to 60 years old. Psychotic Symptom Rating
Scale – Auditory Hallucination subscale (PSYRATS-AH), Calgary Depression Scale for Schizophrenia (CDSS)
and World Health Organization Quality of Life-Brief scale (WHOQOL-BREF) were used as instruments.
Results: Alcohol intake was found to be significantly associated with the severity of AH. A significant
moderate positive correlation was found between AH total score and CDSS (r=0.53, p
Premature ejaculation (PE) reduces sexual satisfaction and quality of life.
Both SSRI Fluoxetine and Dapoxetine have been used in the treatment of PE. Fluoxetine
is used as off-label treatment meanwhile Dapoxetine is the first SSRI specifically
designed for PE with short half-life and few side effects. (Copied from article).
Complicated crown-root fractures account for a small percentage of traumatic dental injuries seen in children; however, management of these injuries can be very challenging to clinicians. Factors such as complexity of the injury, patient's age and dentition stage, patient's cooperation, and parental demands may have some bearing on the type of treatment undertaken and its outcomes. In some children, these injuries may have significant impact on their quality of life. The purpose of this article is to describe two cases of complicated crown-root fracture which were successfully managed through orthodontic extrusion using a sectional fixed orthodontic technique. The basis for the treatment technique and its favourable outcomes were highlighted with its advantages and drawbacks.
Psychological aspects of a person, such as the personal value and belief systems, cognition and emotion, form the basis of human health behaviors, which, in turn, influence self-management, self-efficacy, quality of life, disease control and clinical outcomes in people with chronic diseases such as diabetes mellitus. However, psychological, psychosocial and behavioral interventions aimed at these groups of patients have yielded inconsistent effects in terms of clinical outcomes in clinical trials. This might have been due to differing conceptualization of health behavioral theories and models in the interventions. Assimilating different theories of human behavior, this narrative review attempts to demonstrate the potential modulatory effects of intrinsic values on cognitive and affective health-directed interventions. Interventions that utilize modification of cognition alone via education or that focuses on both cognitive and emotional levels are hardly adequate to initiate health-seeking behavior and much less to sustain them. People who are aware of their own personal values and purpose in life would be more motivated to practice good health-related behavior and persevere in them.