Introduction : The purpose of this study was to determine the quality of life (QOL) of breast cancer survivors based on socio-demographic and clinical characteristics.
Methods : A cross-sectional study was performed on 125 breast cancer survivors from the outpatient clinics. FACT-B (Functional Assessment of Cancer Therapy-Breast) questionnaire was used to assess survivors’ QOL.
Results : Survivors with low body mass index (BMI) (underweight) were found to have the lowest overall QOL. Those who were overweight had a higher overall QOL, and those who were normal-weight had the highest QOL. Low educational level, being underweight and low monthly household income were significantly associated with lower overall QOL Tamoxifen use and employment status were significantly associated with QOL in some domains. Time since diagnosis to QOL interview was significantly associated with greater scores in emotional well-being (EWB). Multiple linear regression indicated that age, marital status, monthly household income, surgery and histological grade were indicative of the patients QOL.
Conclusion : The four primary factors related to better QOL were high educational level, high income, normal body weight and greater duration from the time of diagnosis to the time of interview. Age, marital status, income, lumpectomy and histological grade were indicative of the patient QOL.
Study site: Oncology and Surgical clinics; Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objective :This study was performed to determine changes in diet and lifestyle among breast cancer survivors in Malaysia.
Methods :This was a qualitative study done on fifteen survivors (8 Malays and 7 non-Malays) obtained from the Oncology and Surgery Department, National University of Malaysia Hospital. The study was conducted using a semi-structured interview format. The data obtained were sorted into various categories via content analysis.
Results :Majority of breast cancer survivors increased their fruit and vegetable intake following diagnosis. Some non-Malays changed to vegetarian whereas all the Malays remained on the same dietary pattern. As far as exercise was concerned, all Malays did not exercise before diagnosis, but did so after diagnosis, whereas most of non- Malays did not exercise either before or after diagnosis.
Conclusion : Some changes were noticed in dietary and lifestyle behaviors after diagnosis among some survivors. The differences were due to their different cultural and religious backgrounds.
Introduction : The purpose of this study is to explore the differences of quality of life (QOL) of Malay and non-Malay breast cancer survivors using qualitative method.
Methods : Data was collected using in-depth face to face interview. List of the patients were obtained from Oncology & Surgery Departments and contact numbers were obtained from the medical record. The interviews were conducted either in their home or in the hospital after the appointment has been made.
Results : The majority of the Malays were unable to fulfill the needs of their families. However, the non-Malays were able to fulfill the needs of their families. The majority were satisfied with social interaction and the relationships with their families and friends. In terms of feelings, most survivors felt sad, angry and sometimes they feel like they were going to die early. However the majority coped well with their illness. Regarding sleep, all Malays did not have any sleeping problems, but most of the non-Malays reported serious problems. All survivors were worried about the other female members of the family of getting the same illness. Most survivors did not have any problems with altered body image.
Conclusion : Malays did not have any sleeping problems, but most of the non-Malays reported serious problems. However, the majority of survivors coped well with their illnesses.
Introduction : Nursing is an occupation associated with high risk of developing back pain due to their nature of work practices. The aim of this study was to determine the prevalence of back pain among nurses working in government health clinics and hospitals in Port Dickson and the factors associated with it.
Methods : A cross sectional study was conducted involving 126 nurses working in government health clinics and district hospital in Port Dickson. They were universally sampled. A selfadministered questionnaire, assessing personal and socio-demographic characteristics, back pain, work factors and psychosocial factors.
Results :The prevalence of back pain among nurses was 79.4% and factors that showed significant association were workplace (p=0.026) and carried heavy load (p=0.043).
Conclusion : Where one work and nature of work one does has been shown in this study to be important issues to be considered in helping to manage back pain related to work. It is also recommended that staff need to be encouraged to do exercise to strengthen the back muscles, increase spinal flexibility and blood circulation to the spine as well as need to be reminded regarding ergonomic adjustment at work.
Introduction : Social problems among adolescents are on the increasing trend. Their involvement in different kinds of high risk behaviours could lead them into juvenile delinquency. Early adolescence is the stage where they are easily influenced. However, this is the period where they should be captured for health prevention enhancement.
Objectives : A cross-sectional study was carried out to identify factors associated with risk taking behaviours involving form one adolescents in selected secondary schools in Johor Bharu.
Methods : Using self administered questionnaires, a total of 280 respondents were recruited via multi-stage sampling.
Results : The prevalence of risk taking behaviour among respondents was 66.8%. Going to video games and karaoke centres was the most popular risk taking behaviour (46.8%) to be followed by truancy (30.7%). Among all the factors studied, being male (AOR=4.5, 95% CI 2.39-8.4), Malay (AOR=7.5, 95% CI 3.30-17.19), and having negative perception towards teachers (AOR 0.3, 95% CI 0.16-0.65) were risk factors for such behaviour among respondents. However, coming from an intact family (AOR=0.1), 95% CI 0.02-0.47) was found to be protective against risk taking behaviour.
Conclusion : Intact family structure and having positive perception towards teachers were found to be protective against risk taking behaviours among adolescents.
Population ageing is inevitable in Malaysia as a result of declining fertility rates. Steps can be taken to face this challenge. These include ways to promote “healthy ageing” and “compression of morbidity” and ways to promote “productive ageing”, i.e., keeping the elderly economically and socially engaged. This article, based on a review of the literature, argues that it is illogical to force people into compulsory retirement at an arbitrary age when they can continue to contribute actively to society. Instead, ways can be devised to promote healthy ageing, prolonging independence and encouraging productive ageing through gradual economic and social disengagement of the individual depending on the individual’s physical health, mental health, contribution to society and personal inclination and preferences. Public policy in general and public health policy in particular can be designed or redesigned to help achieve this.
Introduction: Physiological changes in the oral cavity and dental-related complications may occur during pregnancy. These intraoral changes that occur during pregnancy combined with lack of routine dental check-ups and delays in treatment for oral disease, place pregnant women at higher risk for dental infections. The objectives of this study was to assess the knowledge and awareness of pregnant women on periodontal disease and its effect on pregnancy, to investigate the relationship of their knowledge and awareness with level of education and the barriers of oral healthcare utilization among pregnant women.
Methodology: A self-administered questionnaire with an introductory letter and consent form were given to pregnant women who came for their routine maternity check-up at the Obstetrics and Gynecology Clinic, Kuala Lumpur Hospital. Data entry and analysis was done using Statistical package for Social Sciences (SPSS) version 12.
Result: Ninety-two pregnant women responded to the questionnaire. Only 23.9% answered correctly to the question on what is plaque. However, 45.7% knew that plaque can cause gum disease and a majority of the respondents 72.8% also knew that bleeding gum is an indication to inflamed gums. The result shows that, although 59.8% of the respondents were aware that it is necessary to brush their teeth frequently during pregnancy, only less than half of the respondents (44.6%) were aware that dental plaque and poor plaque control may cause periodontal disease among pregnant women. The majority (33.7%) feels that the long waiting time in the clinic would be their main barrier in seeking dental treatment.
Conclusion: A majority of pregnant women have limited knowledge and poor awareness on periodontal disease and its effect on pregnancy.
Study site: Obstetrics and Gynecology Clinic, Kuala Lumpur Hospital
Introduction: Diabetes Mellitus is a chronic disease and major cause of chronic renal disease. Chronic renal disease can be prevented if known risk factors were been early detected. Albuminuria is the earliest clinical evidence of chronic renal disease. Objectives of this study is to identify the incidence of albuminuria and relationship between albuminuria with socio demographic and clinical factors such as blood sugar control, blood pressure control, excessive body mass index and hypercholesterolemia.
Methodology: Data been collected from patient’s record that been regularly follow up at Primary Healthcare Clinics in Negeri Sembilan. Duration of study follow up was from the date of they been diagnosed of Diabetes Mellitus Type 2 until detection of albuminuria or 1st July 2007,end date of data collection then survival analysis been done.
Result: Majority of study population was female 60.9% and Malay 69.7%. Mean age was 59.9 ± 10.7 and duration having Diabetes Mellitus was 7.0 ± 6.3 years. Only 22% achieved optimum glucose (HbA1c < 6.5%), controlled blood preassure 130/80 mmHg 42.3%, level of cholesterol <4.5 mmol/L only 22.7 %, 11.4% of patients having ideal body weight < 23 kg/m2. The incidence of Diabetes Mellitus Type 2 was 24.4 cases per 1000 population. The median of follow up duration was 22 years; with minimum follow up was 7 months and maximum 42 years. Survival analysis showed that the median of free albuminuria among cases was 22 years (CI 95%:16.5 – 27.4). The log rank test showed no significant relationship between high blood pressure, excessive body mass index and hypercholesterolemia with albuminuria. This study noted that the occurrence of albuminuria seems to be higher among those were hypertensive (26.6%), and excessive body mass index (24.7%).
Conclusion: Percentage of Diabetes Mellitus Type 2 patient that achieved optimum clinical target still very low. Early detection of albuminuria is very important as preventive measure of diabetes nephropathy. Good blood pressure control and ideal body weight also prevent of occurring diabetes nephropathy complication.
Keywords: Diabetes Mellitus Type 2, albuminuria, survival analysis.
Introduction : Johor Bahru has one of the highest rates of dengue disease in this country in spite of the implementation of COMBI (Communication for Behavioural Impact) in 2001.
Methods : To identify factors contributing to this problem, a case control study was conducted, focusing on risk factors such as the weather (rainfall and temperature), environment and sociodemography. Cases were selected from confirmed dengue cases from January to June, 2006. Controls were selected from patients who had no past history of having dengue illness from Health Clinics in Johore Bahru. Both case group and control group were matched by age and sex. All risk factors were analysed using SPSS version 11.5.
Results : Results from time-series analysis indicated that the cases of dengue illness were related to changes in the minimum temperature (r =-0.149; p
Introduction: To determine the effectiveness of the enhance enforcement programmes (The Ops) on the percentage of seatbelt wearing among front occupants in Malaysia.
Methodology: The roadside observations for measuring the seatbelt wearing among front occupant were conducted before, two weeks and six months after the Ops. The study was conducted in selected states representing four different zones (Northern, Southern, Eastern and Central zones) of Peninsular Malaysia.
Result: A total of 12,298 drivers and 11,212 front occupants were observed for their seatbelt wearing status through out the study. Percentage of seatbelt wearing among drivers and front passengers were increased from the baseline of 82.6 % and 74.4 % to 92 % (95 % CI: 91.2, 92.7) and 87.0 % (95 % CI: 85.9, 88.0) after two week, but declined to 85.7 % (95 % CI: 84.4, 86.8) and 76.8 % (95 % CI: 75.2, 78.3) after six months of the Ops respectively. Pre and post analysis revealed that after 2 weeks, the Ops were significantly effective in increasing the seatbelt wearing among front passengers and drivers with the RR (95 % CI) of 1.17 (1.14, 1.20) and 1.12 (1.10,1.13) respectively. However, after six months, the effectiveness of the Ops was reduced for both type of vehicle occupant.
Conclusion: This study sheds light on the importance of the enhance enforcement programme for increasing the seatbelt wearing in Malaysia. However, in order to give more impact on seatbelt wearing, the strategy and the frequency of the enhance enforcement programme in Malaysia may need to be revised.
Introduction: The purpose of this article is to review the definitions of food security and food insecurity as well as the concepts related to food security.
Methodology: This is a systematic review on a few papers, research, and articles according to studies and research by various organizations, experts, scholars on food security in developed and developing countries.
Result: The first definition of food security was given to reflect the comprehensive concerns on the availability of world food supplies. The definition was expanded to incorporate accessibility of food for all people at all times. Then, the complex definitions of food security incorporated food accessibility and availability as well as the quality of food intake. Latest definition integrates the social aspect of food that should be accessed in a socially acceptable way. Broad definition of food insecurity and several terms that closely related were also discovered. The four main concepts of food security from these definitions were identified; availability, accessibility, acceptability and adequacy. These concepts of food security are relevant to micro, meso and macro levels of social and administrative organizations. Conclusion: Understanding definitions and concepts of food security can assist researchers, policy makers and program implementers to conduct research that address the issues of food security.
Background : Two of the most common indicators of institutional healthcare quality are Hospital Accreditation Status and Patient Satisfaction. However, the relationship between them is not well understood. In Malaysia, only 20.48% hospitals have been accredited. This is very much less compared to hospitals in America, Europe, Australia and certain Asian countries whereby 90% of their hospitals have already been accredited.
Objective : The objective of this study was to compare the extent to which a patient’s satisfaction is related to hospital accreditation status, to examine the relationship between patient satisfaction and hospital work load and to determine factors that influence patients’ satisfaction.
Methodology : A cross-sectional study was conducted whereby 150 patients from each accredited and non-accredited hospital involved in this study group giving a total of 300 samples. `SERVQUAL’ instrument was used in this study. Patients were interviewed at 2 different times - during admission and upon discharge.
Result : Results showed 34.7% patients were satisfied with services in accredited hospital and 30.6% patients were satisfied with services in non-accredited hospital. `Corporate Culture’ component showed the lowest satisfaction score among the entire dimension in both categories hospitals. Patient satisfaction was noted to be reduced with increase in hospital work load. Other factors which significantly influence patient satisfaction include level of education, employment status and patient income. There was no significant difference in patient satisfaction between accredited and non-accredited hospital in all dimension measured.
Conclusion : Therefore there is no difference of patients’ satisfaction with regards to services provided by accredited and non-accredited hospitals.
Background : A cross-sectional survey was carried out in December 2007 to compare the healthrelated quality of life (HRQoL) of stroke survivors with that of general Malaysian population.
Methodology : Stroke patients were recruited from two community-based rehabilitation centres in Selangor. HRQoL was assessed using Medical Outcome 36-Item Short-Form Health Survey (SF-36).
Result : A total of 61 patients (34 males and 27 females) were interviewed. Majority were Chinese (85%) and a small percentage were Malays (15%). 82% (n=50) were elderly of 60 years and above, and the remaining 18% (n=11) were younger patients. 64% had stroke for one year and more, and 36% were less than a year post-stroke. All subjects were community-dwellers and lived with their families. The result showed that with the exception of bodily pain, the mean score of all SF-36 health domains of stroke patients were lower than that of the general population. The greatest difference was in role physical, followed by physical functioning. Female patients demonstrated higher score than the males in all SF-36 domains, in particular general health (57.2 vs 70.3, p=0.01) and social functioning (52.2 vs 73.1, p=0.00). There were no differences of HRQoL domains after comparison according to poststroke duration (all p>0.05).
Conclusion : HRQoL of stroke survivors is lower than that of Malaysian general population in all SF-36 health domains, with the exception of bodily pain.
Aims : The review was to determine the prevalence of needlestick injury especially among health care personnel and to determine the score of knowledge and compliance to the Standard Universal Precaution.
Method : Twelve theses were reviewed from year 1996 to 2007 of Master in Community Health Science, Master in Community Health and Postgraduate Diploma in Occupational Health of Community Health Department Universiti Kebangsaan Malaysia Medical Center involving of 1645 respondents of health care personnel, support staff and student of nursing and medical. Eleven studies were cross sectional design and only one study was retrospective.
Results : Respondents were dominated by female (74.6%) and Malay ethnicity (65%), as young as 19 years old to 56 years old of age. Majority had received Hepatitis B vaccination (79.4%) but only 37.1% had completed the 3 doses regime. The incidence of episodes of needle stick injury among health care personnel was double (53.7%) compared to final year medical students (20.9%). Needle stick injuries did not occur at random as there were a few health care personnel injured repeatedly. Those who had higher mean or median score for compliance to Standard Universal Precaution were non case of needlestick injury. Work practices had been highlighted in few studies of being risk factors for needlestick injury such as blood withdrawing related activities. Other risk factors were job category, predictive factor for compliance to Standard Universal Precaution, risk perception and training.
Conclusion : Even though the review could not extrapolated to general population of healthcare personnel but it gave some illustrated pictures to what had happened in small clustered locations. Episodes of needle stick injury was 53.7% for past 12 years, it was double in comparison to final year medical students in year 2001. 13.2% were injured repeatedly. The score of knowledge was more the 50% of range but compliance to Standard Precaution made differences in being cases or non cases among respondents. The seroconversion status till date was unknown.
Introduction : Mersing, a district in north-east Johore was also affected by the recent worst flood in 100 years that striked Johore. Orang Asli settlements were among the worst affected by the flood in Mersing due to their location along the river. For Kg. Peta, not only flooded, the communications as well as the access roads were also tarnished. This settlement situated very deep interior about 100 km from Mersing town and next to Endau- Rompin National Park. Besides the distance, the geography and the communication issues make the flood operation even more difficult. Even then, the welfare of this minority group was never been neglected. Our Medical and Health Teams made a move in but unfortunately were also been trapped in between the flood waves.
Methodology : It was a qualitative finding. The data for this report were collected from various means. Some data were collected through informal interview among the staffs that being trapped, head villager and the dwellers, local head departments of government and non-government organizations. Others were from the relevant photographs, formal flood returns as well as through the observation.
Finding : The existence of very good involvement, cooperation and coordination from various agencies was the main factor that ensures all the villagers of Kg. Peta received our services despite of many difficulties or challenges. During this disaster, no outbreak of infectious disease or death from the settlement was reported. The welfare and the needs of all who affected and those involved in the flood operation were taken care off. Therefore, we believed that without good support and cooperation from others, we will not be able to deliver our services and their welfare especially when health was concerned will be deprived. The objectives of this write up were to share our experience in managing flood in very remote area and to show the importance of good integration between agencies in disaster management.
Introduction: The effect of stress among correctional officers at the workplace can contribute to various health problems and this also affect their work performance and motivation.
Methodology: Study was done at a prison located at the rural district in Kedah. The study was conducted by using randomized stratified sampling method. A total of 418 self administrated questionnaires were distributed. These questionnaires included socio demographic factor, family and marriage factor, Personal Stress Inventory (using Stress Symptom Scale with 52 items), work related stressors (Job Stress Survey) and Brief COPE (Coping Orientation for Problems Experienced with 28 items).
Result: Response rate was 90.9%. Stress prevalence for correctional officers was 45.8%. Socio demographic factors which have significant relation with stress status were marital status, promotion factor, age, monthly salary, duration of service and number of children (p< 0.05). Family and marriage factor which have significant relation with stress status among married officer were pressure from relatives, clean up house, sexual frustration, conflict with spouse, conflict with children, conflict due to household work and no babysitter (p< 0.05).
Discussion: The study showed that work related stressors that have influence with stress were excessive workload, working after work hours, not enough staff, disgraced words from fellow workers, competition in carrier development and excessive work stress (p< 0.05). Multiple linear regression model was done in this study and revealed factors that explained 52% of variation in stress score distributions were behavioural disengagement, no babysitter, denial, conflict with children, replace other worker’s duty, not enough time with family, competition in carrier development, venting of emotion, positive reframing and emotional support. Coping strategies that have significant effect in reducing stress symptoms are positive reframing and emotional support.
Conclusion: Stress management programs should be implemented and emphasizing on specific stressors and coping mechanism are important to reduce the risk of occupational stress among correctional officers.
Background : Safe potable water is critical during and post flood. In the pre-flood period, Johore has an excellent, systematic and comprehensive water supply system. More than 98.6% of Johore population received treated water supply from the water treatment plants.
Methodology : Data collection was performed by conducting additional water sampling at routine sampling stations as well as the flood relief centres, water tankers (lorries) and static water tanks. Water treatment plant outlet and water tanker inlet shall have a minimum level of 2.0 mg/l of residual chlorine so that reticulation, water tanker outlets and static water tanks would have at least 0.5 mg/l as a measure to prevent the incidence of water borne diseases. Sampling was done everyday to monitor water quality at the flood relief centres as well as flood-hit areas. Inspections and surveillance on sanitation were also conducted on latrines, solid waste disposal systems and on the surrounding environment.
Results : A total of 6,283 water samples had been collected during and post flood. Violations on E. coli, turbidity and residual chlorine were 0.8%, 0.6% and 4.0% respectively with the Kluang district recorded the highest percentages for all the three parameters. A number of 621 wells had been inspected with 378 of them (60.9%) had been chlorinated. In order to ensure environmental cleanliness, 26,815 houses in 708 villages had been visited. Out of them, 2,011 houses (7.5%) were not satisfactory. Sanitation inspections found that 1,778 latrines, 2,719 domestic water sewerage systems and 2,955 solid waste disposal systems were under substandard conditions thus remedial actions had been taken immediately.
Conclusion : Although the flood disaster was massive with prolonged flooding period, however, an overall quality status on treated water supply was satisfactory whilst sanitary hygiene was under control. Hence, the incidence of communicable disease especially water borne diseases would not progress into serious outbreak, in fact, neither cholera nor typhoid was reported during the Johore flood disaster.
Past major flooding events for the state of Johore, Malaysia were recorded in 1926, 1967, 1968 and 1971. However, major meteorological phenomena that hit Johore on the 19th December 2006 (first wave) and the 12th January 2007 (second wave) were claimed to be the worst flood disaster in Johore in a 100 years. All eight districts were affected displacing 157,018 and 155,368 population during the first and the second wave event respectively. The Johore Health Department deployed substantial number of medical and health personnel to deal with the Johore flood crisis. Flood-related data were collected on daily basis between 19th December 2006 and 19th February 2007 using spreadsheet format from Flood Operational Rooms located at respective District Health Offices. Among flood victims 34,530 were found to have non-communicable diseases and 19,670 with communicable diseases. No major food- and water-borne disease outbreaks, such as cholera and typhoid, were reported in Johore. High success of public health measures was depending on the workforce of medical and health personnel on the ground. On the other hand, voluntary services offered by non-governmental organisations (NGOs), private sector and other volunteers should be well coordinated without compromising regulatory and ethical requirements. Crisis guidelines and plan of actions shall be updated so that they would be more relevant to the crises encountered on the ground.
Objective : This scientific writing is meant for describing the problems faced by pharmacy staffs during heavy flood situations in Johore and the actions to be taken for solving these problems.
Methodology : This finding is in accordance to the observations, experiences and interview of staffs (through questionnaires), who are involved directly and indirectly in preparations of emergency during flood. Efficiency of pharmaceutical services provided during flood is evaluated.
Result : Several problems were identified when providing pharmaceutical services, such as purchasing and supplying of items, pre-packing, preparing drug charts, visit to relief centers, post-flood health campaign, and doctors from NGOs prescibing medicines out of MOH drug formulary. During the period of flood, usage of drug and non-drug items increases drastically resulting in the current stock in store were not sufficient to compensate for the high demand. Moreover, inaccessibility of certain roads in districts such as Segamat and Kota Tinggi, aggravated and worsen the problems of obtaining goods from suppliers. Workload of pharmacy staffs increased especially in activities such as pre-packing and preparing drug charts due to shortage of manpower.
Conclusion : Even though workload increased drastically during flood, pharmaceutical services provided by the state pharmacy are still able to maintain good quality services to cater for the need of healthcare professionals and patients. Throughout the flood period, all the difficulties and hurdles faced by us had been solved; due to the cooperation from other agencies. Besides, by writing this article, a disaster preparedness guideline is produced for the purpose of improving management of future disasters.
Infrastructure damage due to land slide, fallen bridge and broken and submerged roads become the main constraint in providing good medical services to the flood victims and isolated places in the remote area. The health care provider has to face a huge challenge at delivering the medical services to the flood victims in Kluang district especially to the remote and isolated areas. This gives us a meaningful and valuable experience in managing such problem. From the true experience of the medical and health team and also the flood victims, few problems and major issues were detected. Other than the environmental factor, human error is another major area of concern of which the failure to interact with the District Flood Operation Centre leading to miscommunication resulting in delay of management of the patient. In smaller proportion, poor inter-agency collaboration and lacking of good equipment was also noted to be affecting the health care services. The issues raised here will hopefully be making better in managing disaster in the future.