Introduction : Limited access to health services, variations in quality of health care and pressure to contain escalation of health care cost are problems in health care systems that are faced by all the societies in the world especially in developing countries. There is an urgent need to conduct a study to assess perception of individual towards health care services in the new planned National Healthcare Financing Scheme.
Objective : The study objective is to examine the perception towards health care services among the farming community and to assess the willingness to contribute to The New National Health Financing Scheme.
Methods : A cross sectional study involving farmers in the state of Selangor in Peninsular Malaysia was conducted. A total of 400 farmers as the household head were selected using multistage random sampling method.
Results : The respondents’ mean score of perception towards public healthcare services were higher than the respondents’ mean score of perceptions towards private healthcare services except for accessibility and convenience aspects. There was no association between willingness to contribute to The New National Healthcare Financing Scheme and perception towards public healthcare services but there was association between willingness to contribute to The New National Healthcare Financing Scheme and perception towards private healthcare services.
Conclusion : Perception towards healthcare services is an important element in the implementation of The New National Healthcare Financing Scheme as it will determine the willingness of an individual to contribute to it.
Background: Without any doubt, the combo of user ID and password are the most used authentication method in the computing and internet environment. However, due to the enormous number of accounts that require password authentication, users tend to develop bad habits in their password practices which in turn will put their account security at risk. With the increasing use of computing in health-care settings and the use of EMR in hospitals, such practices are a cause for concern.
Methods: This is a cross-sectional study using self-administered questionnaires, investigating the practice of the respondents in keeping their passwords secure. Respondents in this survey are the undergraduate students of Faculty of Medicine, Universiti Kebangsaan Malaysia.
Results: Among the findings are that 87.4% of the respondents used the same password for more than one account. If a user used the same password for several accounts, it might trigger a domino effect if any of the account passwords were compromised. A total of 98.9% of the respondents memorised their password only in their mind, without writing down the password anywhere. This may lead to using easily guessable passwords which may introduce additional security risk to their accounts. The majority of the respondents (96.6%) never or rarely change their passwords. The study also showed that 82.7% of the respondents used passwords which are 6-8 characters in length. Longer passwords are usually safer but harder to remember. The questionnaire also explored the users’ password combination style, whether they used numbers only or combination of numbers and alphabets or some other pattern. A total of 39.1% used letters only but 27.6% used combination of numbers only which is less secure. About 77% of the respondents used personal information such as their birthday date or a person’s name as part of their password.
Conclusions: This habit may make their password guessable to people who are close to them. In conclusion, most medical students are not practising safe password conduct and they should be educated on this. If not, patients’ data confidentiality may be compromised in the future due to such practices.
Floods are natural disasters that occur without much warning. Natural disasters can result in negative impact due to highly stressful event. Floods can cause mental and emotional disorders to the victims and could also induce stress and trauma either in the short or long terms. This research was carried out to recognize the psychological sequelae of floods and how to overcome them. This study describes the cross sectional descriptive pattern of flood victims in Johor. The DASS Test Questionnaire which is a measurement tool endorsed by the Family Development Institute, Ministry of Health Malaysia was used. We carried out the research in 3 districts of Johor which were the worst hit areas by the flood disaster. Twenty-three percent of the participants were males while 77% were females. The DASS Test Questionnaire showed that 13% were mildly depressed, 7% moderately depressed and 3% were severely depressed. It also revealed that 22% were mildly anxious, 19% moderately anxious, 5% severely anxious and 4% had very severe anxiety. On the stress scores, 15% suffered mild stress, 11% were moderately stressed while 2% were severely stressed. A committee to conduct the motivation programme for the state of Johor was formed by Jabatan Kesihatan Negeri Johor with the cooperation of the PROKEM committee from Hospital Permai, Johor Bahru. This committee headed by the Deputy Director of Health (Medical Division) attempted to overcome the psychological sequelae suffered by flood victims. The activities conducted by the PROKEM staff and staff from the Ministry of Health were monitored by the committee based at Hospital Permai, Johor Bahru. The Bilik Gerakan was in operation for 24 hours a day with meetings conducted every morning and evening to brief and debrief members of staff who were going to carry out the motivation programme. Feedback was also obtained from staff on their return from the various relief centres.
The state of Johore, Malaysia had been hit by the worst flood in the Malaysian modern history on the 19th December 2006 (first wave) and the 12th January 2007 (second wave) affecting all the eight districts. A total number of 157,018 and 155,368 Johore population had been displaced by the first and the second wave event respectively. The Johore State Health Department activated the Flood Action Plan which include mobilising medical teams to conduct daily clinical examinations on the flood victims and health teams to inspect flood relief centres, food premises and homes at flood-hit areas with regard to prevent and control communicable diseases. The spreadsheet format was used to collect data on diseases, injury and death throughout the Johore flood disaster period starting from the 19th December 2006 until 19th February 2007. Analyses showed that 19,670 flood victims (36.3%) had communicable diseases and 34,530 (67.0%) had non-communicable diseases. As for the communicable diseases and symptoms/syndromes related to communicable disease, 41.3% were acute respiratory infections (ARI) followed by 25.9% skin infections, 19.1% fever, 10.1% acute gastroenteritis (AGE) and 3.0% acute conjunctivitis. Other infectious diseases include 61 notifiable diseases (46 food poisoning, 14 dengue fever and one tuberculosis), 20 leptospirosis (with two deaths), 20 chicken pox and two melioidosis cases. The Batu Pahat district had the highest incidence for the majority of the communicable diseases because of the prolonged flooding period. No cholera, typhoid, malaria, measles or hand-foot-mouth disease (HFMD) cases were detected among the Johore flood victims. Trends of disease incidence follow the number of evacuees placed in the relief centres corresponding to respective wave. A total of 507 flood victims had physical injuries related to flood mostly due to fall onto wet floor at the relief centres. Fifteen deaths due to drowning were mainly caused by accidental fall into the flood water. The incidence of communicable diseases encountered had been appropriately anticipated and managed attributed to enhanced public health control programmes augmented by syndromic and laboratory surveillance on potentialy fatal infectious diseases. Equal emphasis should be given to the surveillance and control of chronic diseases.
Background and Objective : Johor was affected by the worst flood in 100 years in December 2006 and again in January 2007. The concern that improper sanitary facilities and contaminated water supply at relief centres would result in contaminated food made monitoring of food hygiene vital. The objective of this paper is to describe food hygiene surveillance activities carried out in flood relief centres and flood affected areas and the challenges faced in carrying out these activities.
Methodology : The food hygiene surveillance activities were carried out by the Assistant Environmental Health Officers (AEHO) in the districts. Among the surveillance activities carried out are inspection of food preparation areas in relief centres, inspection of food premises in flood affected areas and food sampling. Premise inspections were carried out using a specific inspection format. Food samples taken were sent to Public Health Laboratory, Johor Bahru for microbiological analysis. Anti typhoid vaccination for food handlers were also carried out. Apart from that, observations made by the health teams were alsotaken into account.
Results : A total of 3,159 food preparation areas in relief centres were inspected. During the same period, a total of 2,317 food premises in flood affected areas were inspected as soon these premises started operating after the floods. Inspections showed that 69 food preparation areas in relief centres and 181 food premises in flood affected areas had unsatisfactory hygiene. A total of 1,566 holding samples were taken and 425 samples were sent to the laboratory for analysis. Forty-six of the samples analysed were found to be positive for pathogenic bacteria such as e. coli, staphylococcus aureus and salmonella.
Conclusion : The health personnel from the Johor Health Department in various districts carried out an excellent job in ensuring food safety during the floods. There were no outbreaks of food poisoning. However analysis of food samples taken during the floods did show the presence of pathogenic organisms but probably their numbers were not high enough to cause any food poisoning. The promotion and enforcement of food hygiene requirements should be carried out continuously to ensure that every individual understands the need for hygiene and food safety during disaster situation such as flood.
Introduction : Shift work is practised in manufacturing industry to increase production capacity up to three times compared to the normal daily eight hours working system and able to optimize the utilization of machine and equipment. However, shift work has negatif effects on human social interaction, health and safety.
Methodology : The study was conducted to evaluate production workers’ perception on the effects of working at night shift. The respondents of the study were production workers in Company X in Kuala Lumpur. The Data was collected using self administered questionnaires. The study objectives was to study the work schedule design, to find out their perceptions on the effects of night shift and to study on personal factors, employees’ level of acceptance on the work schedule design and personal factors that cause safety and health disruption.
Result : A total of 200 production workers participated in the study. The result of the study shows 61% of production workers took sick leave and 43.5% were absent between 1 and 2 times a month. In terms of health and safety disruption, 77% of respondents agreed that they faced lack of focus with family and friends, 75.5% of them did not have enough sleep and 76.5% felt sleepy during working time. Regarding the work schedule and workstation design, 81.5% said they felt uncomfortable because they were required to stand during working and 77% felt that the resting period provided by the factory was too short and inadequate. More than 70% of the respondents proposed the rest period should be extended from the current 40 minutes to one hour. More than 80% of respondents agreed they would feel comfortable if standing at work is changed to sitting work system.
Conclusion : To minimize the unwanted effect of night shift among the production.
Background: A cross sectional study was carried out to identify the level and factors associated with patients’ satisfaction in antenatal clinic at Hospital Universiti Kebangsaan Malaysia.
Methods: A total of 150 respondents were selected by using convenience sampling method. Data was collected via structured questionnaire with face to face interview. The obtained data was analyzed by using SPSS version 11.5.
Results: Majority of the respondents were Malay (72%), while Chinese (18%) and Indian (10%).
Age of the respondents around 19 to 40 years old with tertiary education level (50.7%) and most of them are working (76.4%). More than half of the respondents were satisfied with the service that they received (56.7%), while the others (43.3%) not satisfied. Generally, most of the respondents were satisfied with interpersonal aspects from the staff (62%), technical quality of the doctors (79.3%), efficacy (78%), availability (50.7%), and the financial aspect (70%). Meanwhile, the respondents were not satisfied with the several aspects i.e. accessibility (61.3%), convenience (51.3%), and continuity of care (81.3%). In bivariate analysis, the result of this study showed that there were only two factors significantly related with level of satisfaction (p
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Background: A cross-sectional study on work-related stressors among nurses in a public teaching hospital had also attempted to explore functions of coping strategies in determining stress.
Materials and Methods: A structured bilingual questionnaire (English-Malay) on symptoms and sources of stress, and coping style measure was disseminated to medical and surgical nurses working in a teaching hospital in Kuala Lumpur. Socio demographic information and stress management methods were inquired. Frequency in workplace stressors were assessed using Nursing Stress Scale. Stress symptoms and home-life stressors were evaluated using Personal Stress Inventory. Measurement of coping strategies was performed using Coping Orientation for Problems Experienced questionnaire.
Results: A total of 181 questionnaires were disseminated and 151 (83.4%) were satisfactorily completed by nurses. It was found that the prevalence of work-related stress among medical and surgical nurses was 49.3% (N=74/150). Analysis of dichotomized outcome (between Stress and No stress group) illustrated high workload (t-value=4.122; p
Introduction : The focus of this paper is to evaluate effectiveness of health education material produced and identify effective educational methods in disseminating health-related information. The study explores the knowledge, attitude and practice level among flood victims in Sub-District Sri Medan, Batu Pahat.
Methodology : Convenient sampling method was adopted as a technique to get 195 respondents aged 18 years and above who had stayed in flood relief centres in the district. A set of questionnaire designed to collect data on demography, effectiveness of health education material, accessibility to education materials, preferable educational methods during flood situation, and flood victims knowledge, attitude and practices.
Result : The study found no association between knowledge level and practice of seven steps hand washing. Result showed poster was regarded as most preferable method in disseminating health related information during flood. No association was found in demographic determinants and knowledge. The length of stay in relief centre has significant association with the level of knowledge obtained.
Conclusion : The use of qualitative and quantitative methods together able to determine accurately the effectiveness of the health education materials used during the disaster as well as the impact in behavioral change.
Background : Foot ulcers and its complications are an important cause of morbidity and mortality in diabetes. The aim of this retrospective study is to determine the ulcer-free survival in diabetic foot and its relevant predictors in a cohort of diabetic patients in the primary health care setting.
Methods : Data of newly diagnosed diabetics (n=1121) who received treatment in five health centers in the district of Kuala Langat, Selangor between 1st January 1999 until the 30th June 2008 were studied. Information was gathered by reviewing patient’s medical records. All patients were followed until 31st December 2008. The duration of ulcer-free survival was measured from the date of being diagnosed as diabetic until the development of the ulcer.
Results : The total incidence of diabetic foot ulcer was 9.9% (n=111), with an average annual incidence of 1%. The total incidence of amputation was 1.2%. Mean age of being diagnosed having diabetic was 52+10.7 year old and mean age of being diagnosed having diabetic foot ulcer was 54.68+10.16 year old. The mean for overall ulcer-free survival was 99 months (95%CI:96-102). Male gender (LR=6.56; p=0.01), smokers (LR=3.94; p=0.04), low body mass index (LR=4.45; p=0.03), impaired renal function (LR=5.17; p=0.02) and long duration between follow-up (LR=25.10; p
Background: This cross-sectional study aimed to investigate the prevalence of the caregiving burden among women who are caregivers to elderly with stroke and factors influencing it. Respondents identified through purposive sampling at the Universiti Malaya Medical Centre from October to December 2007.
Methods: Direct methods of data collection (clinical and housing) and indirect (postal) used a structured questionnaire distributed to the guards. Measurements taken include sociodemographic variables of patients and caregivers, the patient, the care, relationships with caregivers and patients with information about stroke. Zarit Burden Interview (ZBI) short version was used to measure the burden of care. Carers' Assessment of Managing Index (Cami) was used to assess coping strategies. A total of 96 respondents took part in this study.
Results: The study showed that prevalence of caregiving burden was 35.4%. Burden of care was found to have significant relationships with factors such as marital status, caregivers (p = 0.017), family income (p = 0040) and the patients (p = 0.000). Significant correlation obtained for the coping strategies with the burden (r =- 0228, p 0026).
Conclusion: The conclusion shows that policy makers and program managers should appreciate and assist caregivers in performing the role of care. Intervention programs should be designed to suit the needs of the heterogeneous guardian.
Introduction : AIDS stigma and incorrect HIV/AIDS information among health care workers will influence the quality of care received by persons living with HIV/AIDS (PLHA). A cross-sectional study was conducted amongst nurses in the Hospital University Kebangsaan Malaysia (HUKM) with the objective of determining their knowledge and attitudes regarding HIV/AIDS and Universal Precautions (UP).
Methods : A total of 450 female nurses were recruited in this study and data were collected via a self-administered questionnaire.
Results : A total of 393 female nurses had completed the questionnaires and majority of them were Malays (95.4%) with mean age of 28.4±3.9 years old. The mean duration of work in the hospital was 6.2±3.6 years. The study results showed a satisfactory level of good knowledge among nurses (69%) and this is statistically significant (p
Introduction : An organization performs well with proper management methods. Participation is a process involving cooperation and collaboration within all levels of individuals, groups or community for the purpose of organization improvement. Empowerment brings the organization further by delegation of power and responsibilities to others for better result.
Methodology : This is a systematic review on various publications, articles and studies based on the findings and researches conducted by experts and scholars involved with participation and empowerment of organizations.
Results : Participation and empowerment are crucial in every organization including healthcare. Its success depends on factors such as proper planning, mutual understanding, regular training and continuous education. They contribute towards better outcome in goal setting, decision making, problem solving and organizational development. There are also various levels of empowerment and participation depending on the type of activities, organisation’s performance and level of authority.
Conclusion : The prerequisite for an organisation’s success is dependent upon holistic participation and appropriate empowerment. The benefits gained from these measures are indeed invaluable. It creates sense of ownership, increases motivation and satisfaction, optimizing resources, promote innovations, enhancing quality and improving efficiency.
Introduction: Behavioural-based safety (BBS) programme is an accident prevention programme emphasized on the aspect of unsafe behaviour, which considerably new in Malaysia. The oil and gas industry is among the industries in Malaysia that has successfully implemented and sustaining the programme. The aim of this study is to measure and evaluate the effectiveness of BBS towards the safety performance in the oil and gas industry in Malaysia that certainly has owned an outstanding safety performance.
Methodology: A cross-sectional study using secondary data involving five indicators in the safety performance in the department of health, safety and environment (HSE) was performed at one of the oil and gas refinery companies in Malaysia. These indicators were chosen based on the frequency of its occurrence from January 2004 to December 2008.
Result: The results of the study show the presence of a significant difference in the incidence rates of near misses (p=0.008) and medical treatment cases (p=0.035) before and after the implementation of BBS and a very strong negative relationship (r=-0.885) between the incidence rates of near-misses and the rates of BBS observations done. However, analysis on unsafe behaviour does not show a significant reduction from 2006 to 2008. Instead, a significant reduction was seen on equipments failure from year 2006 to 2007 (p=0.021) and 2006 to 2008 (p=0.032).
Conclusion: The study has proven that the BBS is effective towards the reduction of the indicators in the safety performance, involving only the incidence rates of the nearmisses and the medical treatment cases. However, a very strong negative relationship only involves the incidence rate of near misses. A significant reduction was also seen on the occurrence of instrument failure, which is one of the root causes of near-misses. Although there is no significant reduction on thye unsafe behaviour, the reduction of equipment failure is expected to be related to the increase in the level of awareness and safe behaviour as a result of BBS implementation.
Introduction : A retrospective cohort study was conducted among ESRD who received dialysis treatment (Haemodialysis and CAPD) in all government hospitals in the State of Pahang from 1st January 2000 to 31st December 2004.
Objective : The aim of the study was to identify factors affecting the survival of patients undergoing dialysis in the state of Pahang.
Methods : Survival time was measured from the date of dialysis until the subjects died, lost to follow up or until the end of the study period at 31st December 2004.
Results : Diabetes mellitus was the major cause for ESRD (33%) out of 132 subjects eligible for the study. Seven (7.1%) and five (15.2%) deaths occurred among haemodialysis and CAPD patients respectively, but statistically of no difference between the two treatments (log-rank, p=0.093). Factors influencing the survival of haemodialysis patients were diabetes mellitus (p=0.014), albumin (p=0.0005), creatinine (p=0.020) and hemoglobin level (p=0.002), while age of treatment and diabetes mellitus affecting the survival of CAPD patient. Cox Proportional Hazard Regression showed that haemodialysis subjects with low albumin (HR 0.669 df 95% 0.513 - 0.873) and hemoglobin (HR 0.403 df 95% 0.225 - 0.720) level had lower survival rate but none for CAPD.
Conclusion : Good nutritional status, higher hemoglobin level and prevention of diabetes mellitus are important for the survival of haemodialysis patient.
Background : Safety and health is one of major concerns in public health issues. There are lots of injuries or accidents reported in the news which include school accidents and injuries.
Methodology : This survey was conducted among head of primary schools in Kota Bharu from May to June 2004. The objective of this study was to investigate the awareness about safety and health status among school’s head using a questionnaire.
Result : The study showed that knowledge on safety and health among the school’s heads were relatively low (7.7%). Forty-two percent of the schools did not implement any safety and health programme while more than 50 % did not have safety policies in their school.
Conclusions : It is necessary to have specific safety programmes in school in order to improve the safety and health awareness among teachers, staff, students and community.
Background : The management of chronic disease during flood seems to be one of the main challenges to the health care service. Chronic disease becomes worst during flood. Poor condition at the relief centres, loss of assets, fear, and lack of functional health facilities contribute to the morbidity and mortality during and after flood. Poor chronic disease management, especially on severe and uncontrolled hypertension, may threaten lives of victims during flood. In addition, comprehensive treatment cannot be delivered due to destroyed infrastructure, shortage of doctors on duty and delay in getting drug supply. Therefore, all aspects of chronic disease management shall be reviewed and included in the disaster preparedness in order to control and prevent acute incidence and complications of the chronic diseases. Previous Action Plan did not address this issue effectively which had caused many patients not getting their treatment adequately. The aim of this writing is to share experiences in managing chronic disease patients particularly hypertensive patients.
Methodology : A retrospective study based on data collection by health personnel while conducting health screening, clinical examination and giving treatment to flood victims at the relief centres. Hypertensive patients were identified when the victims came for treatment and while the medical team conducting medical rounds. New hypertensive cases as well as uncontrolled cases with no complication were treated and monitored at the relief centres.
Result : It was found that 34,530 cases of non communicable disease (11.1% of the total number of the flood victims) including hypertension and diabetes mellitus were reported in Johor. Kota Tinggi reported a total number of 5,317 cases of chronic disease. There was no data collection on specific chronic diseases collected at the state level during the floods thus the findings representing Kota Tinggi cases only. In retrospective search of 150 flood victims with hypertension in Kota Tinggi, only 95 cases had complete data. Among them 71.6% (68 cases) were hypertensive cases already on treatment and 28.4% (27 cases) were new cases. Also it has been found that 67.4% (64 cases) were uncontrolled hypertension and 32.6% (31 cases) were controlled hypertension. Four cases had been found diagnosed as uncontrolled hypertension with complications and have been referred to hospital.
Conclusion : Comprehensive health strategy for flood victims shall not be focused only on saving lives and giving emergency treatment to patients but also to update and strengthen an overall chronic disease management. Many factors contributed to increase in blood pressure during flooding. Good hypertensive treatment at the relief centres is needed to minimise morbidity and mortality. Information on care and treatment received by flood victims having chronic disease is vital in assessing their health needs during disaster and in formulating disaster preparedness in the future.
Each organization has a particular culture, due to personal interactions, with certain values shared by its members. Corporate culture is defined as ‘the set of shared, taken-for-granted implicit assumptions that a group holds and that determines how it perceives, thinks about, and reacts to its various environments’. Positive corporate culture is linked to increased staff alignment, advanced level of employee commitment, increased employee productivity, enhanced organizational effectiveness and increased profitability. Researchers claimed that most studies suggesting the associations between culture and performance are methodologically weak. Cultural transformation has been a big part of NHS reforms and health system redesign in United States to deliver improvements in quality and performance. Environment, market competition, technology advancement, information age and government policies will influence the cultural change within the organization. Undesirable culture might emerge if the organization does not act appropriately to manage its corporate culture. There are six critical success factors for the implementation of corporate culture changes: committed and effective leadership, clear definition of the desired goals, rigorous implementation of a change management model, effective mitigation of change resistance, active governance structure and a design model, and effective communication. Among the issues in implementing corporate culture within healthcare organizations are middle managers dilemma, cultural diversity and subcultures within the organization, size of healthcare organization and critical mass.
Introduction : A cross sectional study was conducted among married women in Kg. Sasapan Kelubi, Hulu Langat, Selangor, Malaysia. The objective of the study was to identify the prevalence of Pap Smear practice and it`s influencing factors.
Methodology : Universal sampling was conducted from door to door to all married women who agreed to be involved in this study. Guided questionnaire was used as the main instrument in this study. The data was analyzed using SPSS version 12.0.
Result : A total of 154 respondents gave their feedback. Mean age in this study was 23.3±4.4.years. Only 66 respondents (42.9%) have had the pap smear with only 6 respondents (3.9%) practiced as per recommended schedule. The reasons for the respondents never practicing pap smear were no knowledge (n=46,52.3%), scared (n=22, 42.5%), shyness (n=21,23.9%), no free time(n-6,6.8%), unconcerned (n=3,3.4%), no female doctors (n= 6,6.8%), not bother, health clinic too far and high cost (n=1,1.1%). The only factor that showed significant association with pap smear practice was the score of knowledge about smear whereby respondents who underwent pap smear showed higher score compared to those respondents who never underwent pap smear.
Conclusion : The study showed that more efforts is required to improve knowledge and awareness among married women in rural area in order to overcome the knowledge gap, wrong perception and other reasons that prevent acceptance pap smear practice among them.
Keywords : married women, pap smear practice, rural area, Malaysia
Satu kajian keratan rentas telah dijalankan ke atas 285 orang penduduk yang berumur 18 tahun dan ke atas di Kg. Bangi Daerah Hulu langat, Selangor D.E. dari 6-12 Mac 2006. Objektif kajian ini adalah untuk melihat prevalens senaman dan faktor yang mempunyai hubungan dengannya. Kaedah persampelan universal telah digunakan dan pengumpulan data melalui borang soalselidik berpandu. Alatan yang digunakan termasuk penimbang berat Seca dan sfigmomanometer yang telah di kalibrasi, stateskop dan pita pengukur ketinggian. Hasil kajian menunjukkan hanya 13.7% daripada responden yang di kaji di dalam kategori cukup bersenam mengikut definisi kajian. Antara faktor-faktor yang mempunyai hubungan yang signifikan dengan prevalens cukup bersenam adalah jantina (p=0.004), tahap pendidikan (p=0.02) dan status perkahwinan (p