Introduction Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. A physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. This paper presents some information regarding medical ethics, including the values and principles of ethical conduct. Later the requirements of consent form is presented to guide the researchers before conducting a study.
In the cold winter month of January 2012, two post graduate students from the Department of Community Health, Universiti Kebangsaan Malaysia (UKM), went on a two weeks field attachment with the Division of International Health (Public Health), Niigata University Graduate School of Medical & Dental Sciences (NU). This report is an account of our first hand learning experience about the public health system and culture in Niigata, Japan. Famously known as the 'Snow Country', Niigata prefecture is approximately 350 kilometers north of Tokyo, in the middle of the west coast of Honshu island, facing the Sea of Japan. It borders on the east with Fukushima prefecture, which was badly affected by the great tsunami disaster in March 2011. Niigata has a population of two and a half million, of which 21.3% is above the age of 65. Niigata University is located in Niigata City, the capital of Niigata prefecture. This attachment was under the UKM-Global Student Mobility Programme (Outbound) and it was taken as an opportunity to improve the memorandum of understanding between UKM and NU. The objectives were to gain knowledge and experience in various public health issues in a developed nation like Japan. Specifically, we were interested to learn about the local public health programmes, the influenza surveillance system, public health programmes for the elderly population, the Geographical Information System (GIS) and the Japanese culture in general. (Copied from article).
Carpal tunnel syndrome (CTS) is a hand disorder which indicates the presence of symptoms such as pain, numbness, and muscle weakness among the patient. CTS is an occupational related disorder which can occur in any profession. However, it can be prevented and managed. The aims of the research were to determine the prevalence of acquiring CTS among nurses who worked in the wards and occupational risk factors involving the upper limbs during nursing tasks performance. The specific aims were to determine the relationship between the prevalence of acquiring CTS and individual factors (age, gender, race, educational level, duration of work and medical history), relationship between the prevalence of acquiring CTS and occupational risk factors in nursing tasks. Nurses profession was chosen as they are performing multitask involving upper limbs especially the wrist joints. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the level of severity in CTS. Occupational risk factors were assessed by using the Rapid Upper Limb Assessment (RULA). This research was a cross sectional mode which was carried out at a government university medical centre from November through December 2010. Eighty nurses were involved in the research. The respondents were required to fill in the socio-demographic information sheet. Those having CTS were required to fill in the BCTQ. Assessments were performed by observing of the job activity through RULA. The results showed that the prevalence for nurses acquiring CTS is 7.5%. The RULA assessment also indicated that the risk factor was in the highest level with a score of 7. No relationship was shown between the prevalence of CTS and race, gender, educational level and medical history. Significant relationship was indicated by the prevalence of CTS and occupational risk factors. In conclusion, a significant prevalence of CTS related to age of more than 30 years old, Malay races compared to Indian, working experience of more than 10 years and respondents with right hand dominant. Occupational risk factors also indicated among the active nurses. Therefore, it is important for us to modify the work environment, work flow, work methodology and ergonomic factors in order to prevent the nurses from acquiring CTS. Furthermore, education about the condition of CTS should be implemented and reinforced especially among the higher risk nurses.
Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
The relationship between healthcare services and inequalities is more likely when a group that shares a salient identity faces severe inequalities of various kinds. Such inequalities may be catalyzed by economic, social, political or concern cultural status. The objectives of this review are to identify the issues and challenges involve in healthcare inequalities, to compare factors contributes to healthcare inequalities and to purpose suggestions and recommendations for improvement based on issues and challenges between United States and India. Comparing annual year healthcare report, documentation of healthcare institutional, Ministry of Health's report and circular, official institutional website, scientific healthcare journals, articles and reports published in 1994 until 2011 regarding healthcare inequalities between United States and India. Health inequalities in the healthcare system contributed by the different in socioeconomic status and accessibility to the healthcare facility due to high cost of treatment has been common risk 'Catastrophic' factors to the inequalities in both countries. Health financing system and resource allocation that benefit only the upper class social spectrum of the population. Disparities occur due to the imbalance in distribution of wealth, discrimination and change in the world economy. Adapting healthcare system that provides care to all classes of people need improvement as no healthcare system is perfect. This matter must be tackle urgently as it's a matter of national concern.
OBJECTIVE. Chronic obstructive pulmonary disease (COPD) is a one of the major cause of death and disability worldwide. This study aimed to compare the quality of life (QOL), Activity of Daily Living (ADL), Pulmonary Function Test (PFT) and general health symptoms pre and after hospital-based respiratory physiotherapy program among COPD patients. METHODS. Pre and post intervention study was conducted between January and July 2010. A total of 54 subjects aged between 30 to 40 years old were recruited for this study using universal sampling method from Alzawia Teaching Hospital, Libya. Data collected were socio-demographic data, QOL (before and after the intervention) using the Short Form-36 (SF-36) questionnaire, ADL using the Barthel Index and the General Health Symptoms.
RESULTS.. The mean SF-36 score for QOL is 30.13 (SD = 8.06) and 63.46 (SD = 13.53) before and after the physiotherapy respectively (with the p <0.0001). Patients’ Activity of Daily Living mean scores are 70.18, (SD = 16.50) and mean = 88.89 (SD = 13.28) before and after program (p< 0.0001). The general medical condition mean score after respiratory physiotherapy is 3.72 as compared to 4.96 before the respiratory physiotherapy (p< 0.0001). Pulmonary Function Test shows improvement in actual/predicted FEV1 ratio in all 54 cases with mean improvement from 55.85 before to 81.67 after the pulmonary physiotherapy (with the p <0.0001).
CONCLUSION. Hospital based respiratory physiotherapy program had significantly improved QOL, pulmonary function and activities of daily living among the subjects.
Accepted 13 January 2012.
Introduction The purpose of this study is to explore the reasons of Shisha smoking among teenagers in Ipoh, Perak.
Methods Data was collected using in-depth face to face interview. Purposive convenient sampling was used to select volunteer respondents from one of the Shisha restaurant located at Ipoh. The interviews were conducted for 15-20 minutes, recorded using video tape. The data obtained was transcribed and coded for the purpose of thematic analysis.
Results All respondents were influenced by peers in their first attempt in Shisha smoking. Other reasons attracting them to continue smoking Shisha include appealing smell and the flavoured taste of Shisha, easy to access, perceived that Shisha was not addictive and its’ cheaper price. In terms of perception on health risk, all respondents believed that Shisha was less harmful compared to cigarette smoking.
Conclusions More educational programme, health talk about risk of Shisha should be developed and conducted to rectify the misconception about health risk of Shisha smoking. The target population should be focus on male teenagers who smoke Shisha in order to control the widespread Shisha smoking in Malaysia.
Accepted 8 February 2012.
Introduction Social norms, though an important contributing factor of adolescent smoking in developed countries, has not been extensively studied in Malaysia. The objective of this study was to determine the association between certain perceived norms regarding smoking with smoking status among Malaysian secondary school students in Kota Tinggi, Johor.
Methods Data were collected from 2311 respondents consisting of 1379 male and 923 female secondary school students in Kota Tinggi district via a self administered questionnaire. Five perceived norms regarding smoking were assessed, namely: perceived peer smoking prevalence, perceived parental reaction towards adolescent smoking, perceived public perception of adolescent smoking, ever noticed peers smoking inside and outside school and perceived enforcement of anti-smoking policy in school and their association with smoking status. Multiple logistic regressions controlling for gender, peer smoking and family smoking was performed.
Results Of the five perceived norms, four were associated with smoking status, (perceived peer smoking prevalence (p
In July 2010 Universiti Kebangsaan Malaysia (UKM) and Niigata University (NU) signed a memorandum of agreement to continue collaboration in joint planning and implementation of education, research and practice services in the field of medicine.This collaboration is also a good opportunity for Doctor of Public Health (DRPH) postgraduate candidates to gain experience on the practice of public health in handling public health issues, planning the healthcare facilities, delivering a quality public health services, enforcing public health policies/regulations and finally learn about the health systems in general at other countries especially from developed country like Japan. Experiencing Health Care and Culture in Niigata, Japan.
INTRODUCTION: Malaysia participated in the second phase of the Global Adult Tobacco Survey (GATS) in 2011. GATS, a new component of the Global Tobacco Surveillance System, is a nationally representative household survey of adults 15 years old or above. The objectives of GATS Malaysia were to (i) systematically monitor tobacco use among adults and track key indicators of tobacco control and (ii) track the implementation of some of the Framework Convention of Tobacco Control (FCTC)-recommended demand related policies.
METHODS: GATS Malaysia 2011 was a nationwide cross-sectional survey using multistage stratified sampling to select 5112 nationally representative households. One individual aged 15 years or older was randomly chosen from each selected household and interviewed using handheld device. GATS Core Questionnaire with optional questions was pre-tested and uploaded into handheld devices after repeated quality control processes. Data collectors were trained through a centralized training. Manuals and picture book were prepared to aid in the training of data collectors and during data collection. Field-level data were aggregated on a daily basis and analysed twice a week. Quality controls were instituted to ensure collection of high quality data. Sample weighting and analysis were conducted with the assistance of researchers from the Centers for Disease Control and Prevention, Atlanta, USA.
RESULTS: GATS Malaysia received a total response rate of 85.3% from 5112 adults surveyed. Majority of the respondents were 25-44 years old and Malays.
CONCLUSIONS: The robust methodology used in the GATS Malaysia provides national estimates for tobacco used classified by socio-demographic characteristics and reliable data on various dimensions of tobacco control.
Study name: Global Adults Tobacco Survey (GATS-2011)
Iodine deficiency is still prevalent worldwide and it is the main cause of goiter, thyroid dysfunction and mental retardation. The aim of the study was to determine the iodine status and goiter prevalence among the school children in Terengganu. The representative sample consists of 1163 primary school children aged 8-10 years old randomly selected from urban and rural schools in Terengganu using stratified systematic random sampling technique. Urinary iodine levels in spot urine were determined by in house modified micro-method while goiter assessment was carried out by palpation of thyroid gland. The status of iodine deficiency was determined by the median urinary iodine concentrations (UIC) and total goiter prevalence (TGP) in accordance with the WHO criteria. The result showed the median [inter-quartile range (IQR)] urinary iodine concentrations was 78.7µg/L (50.1µg/L -120.0µg/L) indicating the iodine intake was slightly lower than recommended range of 100 µg/L. The rural school children had a significantly lower Iodine levels (median UIC=72.4µg/L, IQR=46.7µg/L -113.0µg/L) than the urban school children (median UIC=87.7µg/L, IQR=54.5 µg/L - 127.5µg/L). The total goiter prevalence (TGP) was 5.7%. The prevalence of goiter was significantly higher in rural (TGP=6.9%) compared to urban areas (TGP=3.6%). The study revealed that school children in Terengganu showed mild iodine deficiency and the condition is more pronounced in children from rural areas. The findings emphasize the importance of intervention implementation, universal salt iodization to ensure sufficient intake of iodine among the Terengganu school children.
Influx of foreign students in Malaysia calls for a study on safety of food in Malaysia restaurants as perceived by them. This study aims to investigate perception of foreign students regarding food safety and personal hygiene practice of food handlers in Malaysia restaurants. A six sections Likert scale questionnaire was used. A total of 350 questionnaires were distributed during this study between March 2011 and March 2012 to the international students from 26 countries of the world in various public and private institutions of higher learning in Klang Valley, Malaysia. Among the distributed questionnaires, only 155 were correctly filled, retrieved and analyzed. Ninety-one respondents (59%) were male while 63 (41%) were females. A total of 107 (69%) were undergraduates and 29 (19%) were postgraduate students. One hundred and thirty-nine (90%) respondents were local or foreign restaurants. Eleven respondents (7%) did not patronize any of the restaurants. Among factors influencing choice of restaurants are closeness to residence, price of food and quality of food were the most important factors 62 (38%). Twenty-seven (28%) eat in restaurants because of the similarity of the food to that of their home country. Of the most preferred food, Nasi ayam, 89 (57%) top the list, next was Nasi goreng ayam, 14 (14%) and African food, 23 (15%). Nasi lemak was the least food preferred 3 (2%). A total of 104 (67%) respondents were of the opinion that handlers kept short nails, 91 (59%) do not pick nose, 108 (55%) stated that food handlers cough or sneeze while handling food. Ninety-eight respondents (64%) also stated that serving of food with unprotected hands were observed. The result of this study showed that although food handlers are aware of the need for personal hygiene, more awareness needs to be created.
Dengue is a disease propagated by vectors namely Aedes spp. mosquitoes. One of the effective approaches to control dengue is through integrated vector management and intervention programs. COMBI or Communication for Behavioral Impact is a strategic approach to control the Aedes population as well as dengue cases. This study was conducted at Taman Desa Kolej, Nilai, Negeri Sembilan, an suburban residential area to determine the effectiveness of COMBI, by using questionnaire and entomological survey as well as implementation of an intervention program. We carried out activities such as the establishment of COMBI promoter team, clean up events, talk shows with the residential community and distributed pamphlets containing information about dengue. Results indicated significant difference (p
Osteoporosis-related fractures have been recognized as a major health problem, particularly in the elderly with a high morbidity and mortality rate. The aims of the study were to identify knowledge and perception toward calcium intake among students at UiTM and to explore the differences between genders in dietary calcium intake. A cross sectional study was conducted through 336 students aged 18 to 34 years old. The participants were randomly chosen from the student’s enrolment list. A modified questionnaire was used to obtain the knowledge and perception of the participants. More than half of the participants have low knowledge regarding dietary calcium intake (58.6%), positive view towards the benefits of calcium intake and low perception towards the barrier of calcium intake. Chi square analysis showed a significant difference between male and female for knowledge (p=0.034) and barrier (p=0.002) for calcium intake. Intervention programs should be adopted to increase the knowledge among young adults to improve their health and prevent risk factors. So, health education specifically on calcium intake will be very useful to improve the knowledge and behavior of students.
Medication adherence is very important for the effective treatment or control of various health problems, including chronic disease like diabetes mellitus (DM). However, medication non-adherence among diabetic patients on follow-up treatment is still a global health problem. This study aimed to identify factors associated with medication adherence and to determine methods on how it could be improved. A cross-sectional study was conducted on medication adherence among Malays, Iban and Melanau ethnic groups in Kota Samarahan and Sarikei, Sarawak using the Health Belief Model framework. Interviews with questionnaires, which were tested for its validity and reliability using the Cronbach’s Alpha, were conducted to collect data on the respondent’s socio-demographic and economic characteristics, and health beliefs of 442 respondents. Data was analyzed using SPSS version 17.0 for frequency distribution, measures of central tendencies, significance testing and logistic regression. The medication adherence rates were low in terms of all the treatment indicators such as amount of medication (31.7%), frequency (38.9%), duration (26%), and follow-up treatment (24.2%). The respondent’s socio-economic and economic characteristics have statistically significant association with medication adherence. The respondents adhered towards medication because they believed in its benefits. They also took their medication because they believed in the severity of DM and their susceptibility to its serious complications. The cues to action (medication taking) such as worrying about their socio-economic well-being, effectiveness of medication, and health campaign on diabetic control have influenced medication adherence. However, forgetfulness, distance of clinic, and costs of transport have caused medication non-adherence. The respondent's health beliefs in the benefits of taking medication, perceived severity and susceptibility to DM and its serious complications have contributed towards medication adherence. Their concerns about the socio-economic well-being, effectiveness of medication, and health campaign on diabetic control were positive cues to medication taking behavior. Therefore, modifying the respondent's related health beliefs and reinforcing the positive cues to actions are the relevant intervention strategies that could be used in improving medication adherence among diabetic patients.
The aim of the Fourth Millennium Developmental Goal is to reduce mortality among children less than 5 years by two thirds between 1990 and 2015. Efforts are more focus on improving children's health. The aim of this study was to describe the trend of stillbirth and neonatal deaths in University Kebangsaan Malaysia Medical Centre from 2004 to 2010. A retrospective cross-sectional study was conducted using hospital data on perinatal mortality and monthly census delivery statistics. There were 45,277 deliveries with 526 stillbirths and neonatal deaths. More than half of the stillborn cases were classified as normally formed macerated stillbirth and prematurity was common in neonatal deaths. The trend of SB and NND was found fluctuating in this study. However, by using proportionate test comparing rate, there was a transient significant decline of stillbirth but not neonatal deaths rates between 2004 and 2006. On the other hand, the neonatal deaths rate showed significant increment from 2006 to 2008. When both mortality rates were compared using proportionate test, from the start of the study, year 2004 with end of the study, year 2010, there was no significant decline noted. Trends of stillbirth and neonatal death rates in University Kebangsaan Malaysia Medical Centre within 7 years study period did not show the expected outcome as in Millennium Developmental Goal of two thirds reduction.
The aim of this study was to determine the profile of patients referred to a specialist oral medicine and oral pathology unit in Kuala Lumpur by reviewing clinical dental records received in Oral Pathology Diagnostic Service (OPDS) in Faculty of Dentistry, UKM from 2001 until 2010. A total of 547 archival biopsy clinical dental records were reviewed and analysed using SPSS version 17.0. Oral and maxillofacial diseases were frequently seen in female (1.3:1), young adults (30.0%) of Malay ethnicity (64.6%). Most of the acquired specimens were from dental specialists (n=451, 84.8%), particularly from oral and maxillofacial surgeons (OMFS) (n=349, 63.8%) compared to general dental practitioners (GDPs) (n=81, 14.8%). Almost all of the biopsy specimens were of soft tissue origin (n=462, 84.4%), derived from lining mucosa (n=197, 36.0%) and were biopsied excisionally (n=325, 59.4%) more often than by incisional biopsy (n=207, 37.8%). A large proportion of the oral and maxillofacial diseases were of reactive (n=188, 34.4%) and inflammatory (n=121, 22.1%) cause. Tumours are mainly benign (n=69, 12.6%) with only small cases are malignant (n=34, 6.2%). The most common histological diagnoses were accounted by mucocele (n=56, 10.2%), pyogenic granuloma (n=47, 8.6%), fibroepithelial polyp (n=38, 6.9%), radicular cyst (n=33, 6.0%) and periapical granuloma (n=29, 5.3%). This study characterizes the clinical profile of patients seen in our oral medicine and oral pathology unit. Present findings can be used as a reference to the clinicians and pathologists in effective patient management and organization in the future.
To date, there has been no systematic research that investigates the rural community awareness and attitudes towards pandemic influenza H1N1 and its prevention measures in the context of Sarawak. There is also no systematic study about whether the initiatives to educate the public undertaken by the government and other agencies have empowered the rural communities to practice an effective self-care within the context of community, that assist to curb the potential spread of this disease. Our research aims to address these limitations. In this paper, we report a survey finding about the awareness and attitudes of the Serian community with regard to this area of research interest. We also investigate the relevant sources of information that the community relies on in understanding about the influenza and how it can spread. Overall, the outcomes of the survey reveal that a majority of our respondents has a relatively low level of knowledge and awareness particularly about the characteristics of the illness and how H1N1 virus can transmit. With regard to prevention measures, a majority of them reported good understanding and awareness about the effective self-care practices that can help to curb the potential spread of the influenza. The top five sources to obtain information about the influenza were: information from family, relatives, friends or neighbours; radio; TV; newspapers; and government health talk seminar or campaigns. The research outcomes can offer pragmatic contributions that can benefit the health campaigners and policy makers.
Rapid Rural Appraisal (RRA) is a systematic, semi-structured activity carried out in the field by a multidisciplinary team that is designed to obtain new information and hypotheses about rural life. This article reports the results of an RRA conducted in Kampung Paris 1 (KGP1), Kinabatangan, Sabah under the Annual Health Promotion Program of the School of Medicine, Universiti Malaysia Sabah. A systematic random sampling was used to recruit the villagers and data was obtained through compilation of pre-existing data, field observation, structured interviews with key informants and villagers. Cardiorespiratory diseases were prevalent in KGP1. Common water sources such as rain water collected in dug wells in KGP1 were unhygienic. Dangerous toxic fumes were produced by the burning of municipal wastes nearby village houses. The villagers of KGP1 were exposed to various farm animals, which may harbor zoonoses. Health care services are limited in KGP1. Villagers who were not poor (>RM897) represented 48% of the population, followed by the poor (RM503-897), 20% and the hardcore poor (1.00 person per bedroom. Poor water hygiene, polluted air from open burning, exposure to farm animals, poverty, poor education, overcrowding and inadequate health care services were among the few possible factors affecting the health of villagers in KGP1. Formal rigorous research should be conducted in the future to facilitate specific health interventions in areas of need such as KGP1.
It all started with a SSM research. SSM, which is an abbreviation for ‘Special Study Module’ is a unique module in the curriculum of the Medical Faculty National University of Malaysia (UKM), where each students were required to do a medical research in the field that we have interest in. Being interested in the field of public health, 3 of my friends and I did a research on the prevalence of tuberculosis in Cheras using the graphic informational system (GIS) to map each case of tuberculosis on the map of Kuala Lumpur. Our supervisor was Associate Professor Dr Shamsul Azhar, who is himself an expert on the field of GIS study and has been doing his PhD research using the same system in Niigata University, Japan for almost 4 years. During one of our SSM meetings, he mentions that the post-graduate students in UKM has done several visits to Niigata University and brought up the idea that maybe the undergraduate students like us could do the same. (Copied from article).