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.
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
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
Introduction : The 2006 -2007 flood in Johore which displaced more than 312,386 residents of the state was an extraordinary event and tested everyone preparedness. The disaster caused massive material, economic and environmental losses exceeded the state and local community capacity, forcing them seeks help from other states. Needs assessment, effectiveness of health services as well as leadership and nongovernment organization involvement were evaluated and constitute lessons learnt from the experiences.
Methodology : This is a descriptive review of the Johore flood. The review was based on literature search using established data and published reports of previous disasters. Discussion will focus on the 4 S’s of the surge capacity that is Structure, Staffing, Supplies and System (policies & procedures). Result : Structure- although 49 or 14% of health facilities in the state were affected by the flood, health services continued to be given. Majority of the relief centers were schools with better facilities. Funding for repairs obtained early approval as estimation of damages was timely applied. Temporary isolation centers for the conjunctivitis outbreak was appropriate implemented. Staffing- Leadership was assumed by the Johore State Health Department, the strongest and most prepared health sector. Needs assessment resulted in additional staff being deployed from other states allowing local staff to have their break from work as well as personal stress. Local staff became multi-skilled players. Training in disaster preparedness has to be of utmost priority to support such needs. Supplies- Personnel protective and pest control equipment, and medical supplies were adequately supplied. The laboratory services were well prepared. Pamphlets, posters, buntings and banners were distributed including five new health promotion materials. System- Flood disaster plan of action was well in place resulting in efficient management of the operating rooms, data management, coordination of services and disease surveillance through early warning system.
Conclusion : Public health preparedness is a matter of good governance and management based on evidence and experience. There is a need for a permanent and stable program for the Ministry of Health to prepare and coordinate the response to all disasters.
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 : The aim of this study was to determine the prevalence and the pattern of falls in community dwelling older people attending a primary care clinic in Kuala Lumpur, Malaysia.
Methods : A cross sectional study was conducted in an urban primary care clinic. Participants aged 60 years and older were included in the study. A structured questionnaire, assessing socio-demographic variables, medical and falls history was administered by one investigator over a 3-month period in 2004.
Results : A total of 151 respondents participated in this study with a response rate of 72%. The prevalence of falls was 47.0% over the previous 12-months period. Fifty-seven percent reported experiencing recurrent falls. Majority (61%) of falls occurred in the home and the two most common places were the bathroom (27%) and stairs (27%). Sixty-one percent of older people who fell, sustained an injury and most sought medical attention.
Conclusion : In conclusion, falls are common amongst older people attending this primary care clinic. It occurred commonly in the home in the bathroom and near stairs. However, a larger local community study is warranted to determine the prevalence and risk factors for falls in Malaysia.
Study site: primary care clinic in Kuala Lumpur, Malaysia
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.
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.
Skim Sistem Saraan Malaysia (SSM) telah diperkenalkan pada tahun 2002 menggantikan skim Sistem Saraan Baru (SSB) kepada kakitangan sektor awam. Satu kajian keratan rentas telah dijalankan ke atas Pakar Perubatan Kesihatan Awam (PPKA) pada 2004 yang bertujuan untuk mendapatkan persepsi mereka mengenai skim SSM. Semua PPKA yang berdaftar dengan Persatuan Pakar Perubatan Kesihatan Awam (PPPKA) yang berkhidmat dengan Kementerian Kesihatan Malaysia (KKM) dipilih sebagai responden. Kajian ini menggunakan borang soalselidik yang diisi sendiri oleh responden. Kadar respon kajian ini ialah 70.0% iaitu 217 responden. Kajian ini mendapati sebanyak 80.6% PPKA tidak bersetuju dengan pelaksanaan SSM, hanya 7.4% bersetuju dan sebanyak 12.0% berkecuali. Kelemahan-kelemahan utama SSM yang dikenalpasti oleh responden yang tidak bersetuju dengan SSM ialah prosedur atau skim perkhidmatan yang kabur(83.9%), peperiksaan Tahap Kecekapan yang tidak releven (54.1%) dan kenaikan pangkat terjejas (40.5%). Hasil kajian ini dapat membantu pihak-pihak yang terlibat memperbaiki kelemahan-kelemahan SSM supaya pelaksanaannya menjadi lebih mantap dan dapat menangani kelemahan yang wujud di dalam skim tersebut.
Introduction: Pre-pregnancy care is an important strategy in prevention of adverse maternal and fetal health as well as continuity of good child care. In multi-ethnicity country such as Malaysia there are many cultural, religion and beliefs related to certain life stages.
Methodology: A cross sectional study was conducted among the Indian ethnic group to assess the prevalence and factors associated with pre-pregnancy care. A study was conducted in Taman Manickavasangam Hulu Langat Selangor among the age group of 18-45 year old women.
Result: There were 90 respondents participated in self administered questionnaires. There were 65 respondents (72.2%) married, 24 (26.7%) single and one widow (1.1%). Using a scoring method of analysis (high and low) showed that 55 (61.1%) have high score in knowledge on pre-pregnancy care. The prevalence of pre-pregnancy care practice showed that 63 (70%) scored as high practice. Using correlation analysis showed that there was a significant association between the practice score and increasing age (P=0.03). However, only history of previous pregnancy showed a significant association with the pre-pregnancy care practice and no association found between the practice and knowledge score.
Conclusion: Prepregnancy care helps in screening risk factors of women before conception. This will help in prevention of adverse effect on maternal and foetal. Giving awareness on the importance of having prepregnancy care screening may help women to continue practicing good antenatal care.
Background : The implementation of Occupational Safety and Health Management System (OSHMS) requires a level of measurement. The effectiveness of OSHMS implementation was influenced by inhibiting and supporting factors. The objective of this study was to determine the inhibiting and supporting factors towards the implementation of OSHMS in medical laboratories.
Methodology : The implementation of Occupational Safety and Health Management System (OSHMS) requires a level of measurement. The effectiveness of OSHMS implementation was influenced by inhibiting and supporting factors. The objective of this study was to determine the inhibiting and supporting factors towards the implementation of OSHMS in medical laboratories.
Result : This study showed the level of compliance to the OSHMS MS1722 guideline among medical laboratories who are MS ISO 15189 accredited & have a higher scores in overall measurement indicators OSHMS compared to those do not have SAMM accreditation. Private medical laboratories services have higher scores in overall measurement indicators OSHMS, compared to government medical laboratories. However, there was no significant difference (p>0.05) between medical laboratories which have ISO 9000 quality management system certification, compared to level of compliance to the OSHMS MS 1722 guideline among medical laboratories. There was also no significant difference (p>0.05) between the laboratories who had been operating for more than 10 years compared to those with less than 10 years, towards implementing the OSHMS. Results showed that majority of medical laboratories management perceived that difficulty and complexities of OSH legislation are the most important factor that prevent them from implementing OSHMS in their organization. The most important supporting factor, that medical laboratories management perceived as the most important to comply to the OSHMS were their moral responsibilities towards the community.
Conclusion : In conclusion, the study shows there were many inhibiting and supporting factors that contribute towards effective implementation of OSHMS elements in workplace.
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.
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 : Health management is a tool to ensure an effective running of health program and at the same time avoiding flaws to its components including patients, workers and the entire organization. Risk management is a new concept in health management where the determinants of the problems or the risks are put to minima. It’s strategies are oriented towards prevention as well as controlling to all its administrative system.
Methodology : This is a systematic review on various papers, studies and observations put forwards by risk management experts. It is also supported by feedbacks from many scholars who are involved in research and teaching.
Results : It is been observed that risk management activities have been on practiced in health care delivery system. It is not a new form, but rather a situational action based on certain issues. In fact, it happens in any organization – public or private. Close observation on this area has triggered development of various risk management models including some administrative standard and guidelines.
Conclusion: Risk management is a new approach that need to be practiced by all manager and leader. Its discipline involves interpretation of risk at all angles. It is not only confined to the explicit component, but should also be expended to others area as well. It needs a good sense and good attitude of the manager. The essence of risk management is to minimize the risk to patient, staff, public and the entire organization.
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.
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.
Introduction: This study seeks to identify the socio-demographic and behavioral characteristics of smokers (aged 18 and above), thus develop a predicting model for tobacco abstinence receiving cessation services for tobacco dependence at the Smoking Cessation Clinics (SCC) in government Primary Health Centers in Malaysia. These predictors would improve the effectiveness and efficiency of these clinics.
Methods : Smokers who sought smoking cessation therapy at the SCCs from 1st January 2004 to 31st
December 2004 were chosen randomly from clinic’s registries, and 254 smokers were recruited from 8 clinics chosen through stratified random sampling. Data analyses were performed with SPSS 12.0. 17.3% of smokers attending SCCs were able to quit smoking for at least six months.
Results : Factors significantly contributing to quitting success were elderly smokers (above 40 years old), smoked for more than 15 years, smoked less than ten sticks per day, had a previous history of quitting attempt, self referral to the clinic, high confidence level, attended SCC at least four times, each counseling session lasted for at least 30 minutes and were satisfied with the clinic service. In logistic regression model, smokers aged 40 years and above were 6.7 times more successful to quit, high level of confidence were nine times more successful, smoked more than ten sticks per day were ten times less successful, self referred smokers were ten times more successful and attending for at least 30 minutes counseling session were 12 times more successful.
Conclusion : This study concludes that more concerted effort is needed to approach various groups of target population and SCCs clinic services need to be improved.
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)
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.
Outbreak management in disaster has to be planned and implemented prior to, during and after the disaster is over. The risk of outbreaks following disaster is related to the size, health status and living conditions of the displaced population. The risk is increased due standing water in floods for vector borne diseases, overcrowding, inadequate water and sanitation and poor access to health care. The 2006-2007 flood in Johore resulted in 2 episodes of food poisoning and an outbreak of coxsackie A24 acute haemorrhagic conjunctivitis. Only 19,667 (12.5%) of the 157,018 displaced persons suffered from communicable diseases which comprised of acute respiratory disease 7361(28%), skin infection 4241(19%), acute gastroenteritis 1872(8%) and conjunctivitis 589 (2%). The routine disease surveillance and environmental control were enhanced to cover the relief centers and flood areas. Risk assessment of communicable disease carried out resulted in prompt control measures and good coverage of preventive activities. In conclusion the Johore State Health Department has successfully manage the outbreaks during the major flood.