Objective: To determine the perceived risk of developing cancer in a suburban community in Malaysia. Methods: A cross sectional study using a simple random sampling was conducted among residents aged 18 years old and above (n=520) who had never been diagnosed with cancer, in selected households in a suburban area of Pahang state in Malaysia. The study instruments were a validated questionnaire on risk perception, an automatic blood pressure monitor, a weighing scale and a measuring tape. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 and the p value was taken at p <0.05 as significant. Result: This study revealed that only 5.0 percent individuals perceived they were at risk cancer, whilst the perceived severity was 41.3 percent. Multivariable analysis showed a significant association only for a family history of cancer (adjusted OR of 4.80; 95% CI = 1.45-15.82) (p=0.010) among this population. Conclusion: The perceived risk of developing cancer in the selected suburban community of Pahang state in Malaysia is low as compared to that for other non-communicable diseases in this country, whilst the perceived severity was higher than for other diseases. Thus, considering the importance of correct perceptions for behavioral changes, more health education and promotion is needed to make the community better aware of the actual threat of cancer.
An effective sharps injury prevention program includes several components that must work in concert to prevent healthcare personnel from suffering needlesticks and other sharp related injuries. Sharp injury management program in Kementerian Kesihatan Malaysia (KKM) is currently at surveillance state outlined in the Manual of Sharp Injury Manual Surveillance 2007. Latest data showed that as much as 1405 cases reported in Kementerian Kesihatan Malaysia facilities in 2011. In Hospital Melaka, high sharp injury prevalence was recorded with 25 per 1000 healthcare worker being affected each year. However, according to World Health Organization, surveillance data tend to underestimate the true rate of sharp injuries between 18% and 70%. Although reasons for sharp injury underreporting are well documented in many studies, less in known on what motivates healthcare personnel to report their injury. In order to encourage healthcare workers engagement to prevention program, these motivators need to be determined. Various factors affecting reporting behavior can be divided into organizational factors and health belief. The objective of the study is 1) to determine the level of awareness and compliance on sharp injury reporting among healthcare workers in Melaka, 2) To identify the relationship between awareness of reporting, organizational factors and health belief with sharp injury-reporting behavior among healthcare workers, 3) To determine the impact of awareness on reporting, organizational factors and health belief with sharp injury reporting behavior among healthcare workers, 4) To suggest improvements in sharp injury prevention program. Healthcare workers who reported sharp injury between 2011 and 2015 were invited to answers questionnaires pertaining these factors. Descriptive statistics, mean scores and multiple logistic regression were used for the analysis. Results and recommendation are discussed.
Objective: The aim of the study is to determine the prevalence of gestational diabetes mellitus (GDM), its associated risk factors, foeto-maternal outcomes and prevalence of postnatal diabetes mellitus (DM).
Methods: This is a cross-sectional study using retrospective data from existing antenatal records of new antenatal women who registered at 72 public health clinics in Selangor in January 2014.
Results: A total of 745 antenatal records were reviewed. The prevalence of GDM women was 27.9% (n = 184). GDM risks were higher in women aged 35 years old and above and in those with maternal obesity. GDM women had a higher risk of having a non-spontaneous vaginal delivery compared to non-GDM women. The prevalence of postnatal DM among GDM mother was 12.1%. Working GDM mothers were at higher risk of developing postnatal DM.
Conclusion: The prevalence of GDM among newly registered women attending antenatal public health care in Selangor was higher than previous studies. Health care personnel need to be vigilant in screening women with risk factors.
Comparing to primary surgery, revision ACL reconstruction is more technically demanding and has a higher failure rate. Theoretically, rehabilitation can improve knee function after ACL reconstruction surgery. This study aimed to compare knee stability, strength, and function between primary and revision ACL reconstructed knees. 40 primary and 40 revision ACL reconstruction surgeries were included between April 2013 and May 2016. Patients with revision surgery had a higher anteroposterior translation comparing those with primary reconstruction (median laxity, 2.0 mm vs. 3.0 mm, p = 0.0022). No differences were noted in knee extensor at 60°/sec or 180°/sec (p = 0.308, p = 0.931, respectively) or in flexor muscle strength at 60°/sec or 180°/sec between primary and revision ACL reconstruction knees (p = 0.091, p = 0.343, respectively). There were also no significant differences between functional scores including IKDC score and Lysholm score in primary versus revision surgeries at 12th months after index operation (p = 0.154, p = 0.324, respectively). In conclusion, despite having higher anteroposterior instability, patients with revision ACL reconstruction can have non-inferior outcomes in isokinetic knee strength and function compared to those with primary ACL reconstruction after proper rehabilitation.
Dengue incidence has grown dramatically in recent decades and become a global incidence especially in the
urban area. Ministry of Health (MOH) Malaysia reported that the number of dengue cases since January
2014 until June 2014 was 38. 411 cases which was higher compared to the number reported in year 2013 (10,
910 cases). The objective of the study was to determine the knowledge and preventive practices of dengue
among residents in Flat Pandan Indah, Ampang Selangor. A cross sectional study design with convenience
sampling method was adopted in this study. A total of 298 respondents living in Flat Pandan Indah were
recruited based on the inclusion criteria. A validated questionnaire that measures knowledge and preventive
practices of dengue was completed by respondents. More than half of the respondents had scored 61.7%
with good knowledge regarding dengue. However, 50.3% of the respondents had a limited extent of dengue
practice. Almost all of the respondents (95.6%) reported that television or radio as the main source for
information on dengue. The common preventive measures used by the respondents were cleaning the
house (n=148, 49.7%), eliminating standing water around the house (n=123, 41.3%) and covering water
containers in the home (n=120, 40.a3%). There was no correlation between dengue knowledge and
preventive practice score (p = 0.109). The study revealed that majority of the respondents had good
knowledge regarding dengue but the practices to prevent dengue are poor. Thus, health education program
focusing on dengue prevention practices should be done on the community members in the future.
This quantitative-oriented research was conducted to identify factors that contributed to errors in dispensing medication among nurses and to understand why nurses did not report their errors in dispensing. In this study a total of 284 U29 nurses participated in focusing on factors contributing to medication errors and failure to report the errors. In this study, analysis of the data collected was made in two sections; dispensing errors and failure to report the errors in giving medication. According to Evans et al. (2006) although nurses may not admit directly to such errors, they expressed their perceptions towards situations described in the questionnaire items as contributing to medication errors among nurses. Almost all in the sample of 284 chose not to report medication errors because they could not identify the cause of dispensing errors; other nurses perceived that the individual involved is not competent in performing the task. Other reasons include fear that the action will be exposed by the management, to avoid publicity from the media, and there is no difference in reporting or not reporting the medication errors. This study was done not only for exploring factors of medication errors; it also aspires to identify problems that arise in hospital services and in order to maintain the quality of health care. The management should consider the impact of medication errors and failure to report medication errors on the nursing profession and quality image of the hospital.
Introduction: A survey in 2011 reported that the prevalence of diabetes in Malaysia is 20.8% (2.8 million people) and 88% have uncontrolled diabetes. Diabetic foot ulcer (DFU) is one of the common diabetes complications in Malaysia that leads to other devastated situation including infection, amputation and death. In Pahang, 95% of the patients have uncontrolled diabetes and 50% of them suffered from DFU. Self-wound management is an important element in reducing the risk of further complications of DFU. However, little is known on the patients' understanding of diabetes and their practice of self wound management. This study aimed to understand the knowledge, attitude and practice of self-wound management among patients with diabetic ulcer in Pahang.
Materials and method: A quantitative, cross-sectional study was conducted in a tertiary hospital in Pahang involving 100 participants. Participants were recruited using purposive sampling from April 2017 until May 2017. Participants' knowledge, attitude and practice of self-wound management were measured using self-administered questionnaires. Additionally, the data on socio-demographic was gathered. The data was computed into SPSS and analyzed using descriptive and inferential statistics.
Results: Out of 100 participants, 95% of them had good knowledge on diabetes and DFU, 84% had a positive attitude towards self-wound management and 56% perceived good practices of self-wound management. However, a chi-square test between knowledge on diabetes and DFU and practice of self-wound management found no significant interaction (p > 0.05). Meanwhile, there was a significant interaction between attitude and practice of self-wound management (p < 0.05).
Conclusion: Good knowledge on diabetes and DFU do not determine the patients’ practice of self-wound management. However, positive attitude towards self-wound management would contribute to the practice and willingness of the patients to selfmanage their foot ulcer wound at home.
The existence of new entity called occult hepatitis C virus (HCV) has
become a raising and escalating concern among healthcare professionals worldwide. It
is defined by the presence of viral RNA in liver and/or peripheral blood mononuclear
cells (PBMCs) within non HCV-infected patients. Previous study had shown the occult
HCV is infectious and capable of transmitting the virus to another host. Till today, HCV
infection remains common among hemodialysis patients despite having the best
preventive plans. Because of this, there is a significant concern about the source of viral
transmission. The aim of the study was to identify and characterize occult HCV infection
in PBMC sample of hemodialysis patients. This was an observational and cross sectional
study. (Copied from article).
Introduction: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage and detection of S. aureus leukotoxins among medical students of Universiti Teknologi MARA. Methods: Both sides of the anterior nares of 136 volunteers, comprising 68 preclinical and 68 clinical medical students, were swabbed and immediately cultured onto mannitol salt agar for growth of S. aureus. Standard microbiological techniques were conducted to identify and confirm the S. aureus colonies and susceptibility test against oxacillin were conducted by using Kirby-Bauer method to determine their resistance to methicillin. Polymerase chain reaction was performed for detection of leukotoxins, i.e., Panton-Valentine Leukocidin (PVL) and -haemolysin genes. Results: Nineteen students (14%) consisting of 10 preclinical (14.7%) and 9 clinical (13.2%) were nasal carriers of S. aureus. However, none of the S. aureus isolates were MRSA. No PVL gene was detected but eight of them were positive for -haemolysin gene. Conclusion: There were no MRSA nasal carriers among the medical students, but a low prevalence of S. aureus nasal carriers was detected. These carriers do not pose as high risk because none of the strains of S. aureus possess both the -haemolysin toxin and the PVL toxin that are associated with tissue necrosis.
Stress reduces the performance and productivity of employees.
One of the most important stressors originate from organizational factors,
which are decision latitude, psychological demand, social support and job
insecurity. This creates four kinds of jobs: passive, active, low strain and high
strain. The objective of the study is to determine the association between
organizational factors with occupational stress and cortisol level among
lecturers in University Selangor. This cross-sectional study used a purposive
sampling, which involved 45 lecturers from various faculties. The instrument
used in this study was Job Content Questionnaire (JCQ) which is a
Psychosocial Job Assessment Instrument designed by Karasek et al., (1998).
The questionnaire has been translated to Malay version by Edimansyah et al.,
(2006). 10ml of blood sample was collected from each respondent by certified
phlebotomist. Results from the statistical analysis showed that majority of the
respondents were female (75.6%), aged below forty years old (82.2%), married
(77.8%) and hold a master degree (68.9%). Most of the respondents were
found having low decision latitude 35(77.5%). Majority of the respondents
were also found in passive group 13(28.9%) which were having low
psychological job demand and low decision latitude, while others are in low
strain 11(24.4%), high strain 11(24.4%) and active group 10(22.2%)
respectively. There was a significant association between two organizational
factors with occupational stress level, which are decision latitude and
psychological job demand (p0.05). As a
conclusion, two out of four organizational factors, which are decision latitude
and psychological job demand showed a significant association with
occupational stress levels. Cortisol as one of stress biomarkers may not be
significant due to small sample size.
A cross sectional study was conducted among tea plantation workers in Cameron Highlands from July to December 2006 to study the prevalence of low back pain and factors associated with it. One hundred and six tea plantation field workers participated in the study. Data was collected using self-administered questionnaire. Time motion studies were also conducted for 3 different job categories. The prevalence of back pain experienced throughout their work in the plantation was 81.1% and the prevalence of low
back pain experienced in the past 12 months was 64.2%. Feeling the need to work as fast as possible was a significant predictor of low back pain and increased the risk by 3.5 times, therefore it is suggested that both the management and workers give serious attention to this particular aspect to reduce the incidence of low back pain.
Conference abstract: First IIUM International Dental Conference 2017 [ABSTRACT ID: 73, Oral]
Introduction: Dental therapists are one of the main dental workforce in Malaysia and are exposed to various risk factors of MSD. However, studies on MSD among dental therapists are limited. The objectives of this study were to determine the prevalence, the sites affected, the symptom severity, the impact, the risk factors and the association between individual, biomechanical, physical and psychosocial risk factors with prevalence of MSD among dental therapists.
Materials and Methods: A survey was conducted using self-administered questionnaire which was distributed to all dental therapists in Perak, Terengganu and Kuala Lumpur in February 2017, from which a response rate of 89.2% was achieved.
Results: There was a high prevalence of MSD (87.5%) among the respondents. The MSD was found to be affecting mainly the back (69.7%), neck (66.7%), shoulders (58.7%) and wrists/hands (50.2%) while MSD of the elbow and lower extremities was found to more severe and often affect their daily work. Most of the respondents who reported MSD accommodated their own symptoms with analgesics or sought alternative treatment (20.1%). Majority reported that they often used vibratory instruments (76.1%), involved in biomechanical risk activities, and perceived that they have a high job demand and lack of authority to make decisions related to work. Age (OR: 3.58; 95% CI: 1.644, 7.773), number of extractions (OR: 4.69; 95% CI: 1.348, 16.327) as well as psychosocial factors (OR: 4.05; 95% CI: 1.547, 10.613) were significantly associated with prevalence of MSD.
Conclusion(s): Therefore, preventive measures should be implemented to reduce the burden of MSD.
KEYWORDS: musculoskeletal disorders, dental therapist, impact, symptom severity, risk factor
Introduction: Marital satisfaction is vital to the wellbeing and functioning of the individual and family. Marital dissatisfaction can lead to detrimental effects on mental, physical and family health. The study aimed to determine the proportion of marital dissatisfaction in outpatient setting and its association with sexual functioning and psychiatric morbidity in Kuala Lumpur, Malaysia.
Materials & Methods: A cross-sectional study was conducted in selected primary care using purposive sampling. Data collection was done using socio-demographic questionnaire and several validated Malay version of self-administered questionnaires. Marital satisfaction was measured by the Malay version of Golombok–Rust Inventory of Marital State (Mal-GRIMS).
Results: The prevalence of marriage dissatisfaction in sample population was about 37.3% with almost equal prevalence in both, 36.5% (male) and 37.8% (female). Using a regression analysis, the significant factors that affect marital dissatisfaction were respondent’s age group between 31-40 years old (Adjusted Odds Ratio, AOR. =11.4, 95% Confidence Interval, CI. =1.2-110.9), spouse’s salary of RM1000-RM2000 (lower income category) (AOR=7.3, 95% CI= 1.9-28.1), anxiety case (AOR= 4.8, 95% CI=1.1-21.5), depression case (AOR= 4.8, 95% CI=1.0-22.8), female sexual dysfunction in term of arousal function (AOR= 0.01, 95% CI=0.0-0.7), satisfaction dysfunction (AOR= 9.4, 95% CI= 1.5-58) and pain function (AOR=43.7, 95% CI=1.28 - 1489.2).
Conclusion: Marital dissatisfaction can be influenced by financial factor, sexual dysfunction and presence of psychiatric morbidity. Hence, in management of marital discord, thorough screening of these factors should be prioritized in clinical setting.
Aim: Orthodontic treatment duration is variable and associated with many factors Very few studies looks at operator changes influencing treatment duration and outcome. This study aims to evaluate the influence of operator changes on treatment time and quality.
Methodology: This is a 4-year cross-sectional retrospective study of preadjusted Edgewise two-arch appliance cases treated by single/ multiple operators and finished/debonded by the author. 60 singleoperator (Group 1) and 82 multiple-operator (Group 2) cases were selected and the Peer Assessment Rating (PAR) Index was used to measure treatment outcome.
Results: Group 1 (2.31 years, SD.86) had statistically significantly shorter treatment time than Group 2 (3.25 years, SD1.23). Mean % reduction in PAR scores was high (88.7%), although single operators (92%) showed a slightly higher (p=.04) reduction than multiple-operator cases (86.2%). Post-treatment PAR score was slightly higher in Group 2 (4.6, SD5.4) compared with Group 1 (2.6, SD2.9). There was no significant difference in post-treatment PAR scores with operator changes from within and outside the clinic although there was difference in treatment duration (p=.0001). Possible predictors of treatment duration included number of failed/changed appointments, extractions and pre-treatment PAR. Multiple linear regression model showed significant association of treatment time with failed/changed appointments (p=.0001) and number of operators (p=.0001) although this contributed to 57.5% of possible factors (r=.762) .
Conclusion: Change of operator contributes to increased treatment time by 11.3 months. Although standard of treatment was high in both groups there was slightly better outcomes in single operators. The reduction in PAR score can be predicted more accurately in single operators.
Objective: Lead toxicity constitutes a major environmental risk to health in both animals and humans of all ages. It is more severe in young children than adults. Blood transfusion is an important source of lead exposure and may predispose premature infants to lead toxicity. Thalassaemia is common in Malaysia and majority of patients require frequent blood transfusion. The objective of this study was to determine whether regular blood transfusion contributed to high blood lead levels in paediatric thalassaemic patients.
Method: This was a cross sectional study conducted at the Paediatric Thalassaemia Day Care Unit, General Paediatric Ward and Paediatric Clinic in Hospital Universiti Sains Malaysia (HUSM). A total of 90 patients were included, 45 were thalassaemic transfusion dependant patients and the other 45 were control, who were of the same age and sex with patients group and had never been transfused. The blood samples were taken preand post-transfusion for thalassaemic and control groups. Blood lead levels were analyzed using standard Atomic Absorption Spectrometer (AAS) analysis.
Results: The overall mean plasma lead levels (2.13 + 1.72µg/dL) were lower than those of standard CDC recommendations. The independent t-test showed that plasma lead levels in thalassaemic group were significantly (p < 0.05) lower than the levels in controls. However, the ANCOVA analysis revealed the plasma lead levels were not significantly (p > 0.05) different between the two groups. Thus, suggesting that the reduced plasma lead level in thalassaemic group was due to the administration of iron chelators. Increased frequency of blood transfusion also did not significantly (p > 0.05) increase plasma ferritin or lead levels in thalassaemic patients.
Conclusion: This study shows that transfusion dependent thalassaemic infants have comparable plasma lead levels to those of age- and sex-matched controls, after taking into consideration the administration of iron chelators.
Study site: Paediatric Thalassaemia Day Care Unit, General Paediatric Ward and Paediatric Clinic in Hospital Universiti Sains Malaysia (HUSM)
Background: Cardiovascular disease (CVD) is a leading cause of death around the world including Malaysia. Ischemic heart disease (IHD) is the single largest cause of death in the developed countries and is one of the main contributors to the disease burden in developing countries.
Materials and Methods: This was a cross-sectional study conducted to determine knowledge, attitude, and practice (KAP) regarding the risk of CVD in patients attending an outpatient clinic in Kuantan, Malaysia. A total of 100 patients comprising 52 male and 48 female subjects were selected through convenient sampling method.
Results: Of the total subjects, 86% were Malays. The mean scores (standard deviation) for KAP were 60.75±4.823, 54.36±8.711, and 33.43±4.046, respectively, whereas the maximum scores obtained by the subjects for KAP were 71, 65, and 43, respectively. Regarding questions related to knowledge, 88% subjects knew irregular eating pattern can cause disease and the benefits of vegetable intake. Most subjects recognized that smoking and obesity were CVD risk factors. Regarding questions related to attitude, 96% agreed that exercise can prevent CVD. More than half of the subjects followed healthy lifestyle. There were statistically significant differences observed in knowledge level between sexes (P = 0.046) and races (P = 0.001). Nevertheless, there was no statistically significant difference observed in KAP across different education levels of the subjects regarding the risk of CVD (P-value = 0.332, 0.185, and 0.160, respectively).
Conclusion: This study revealed that patients had good knowledge and attitude regarding CVD risk factors. Yet, the number of smokers is still quite high. Development of better public information system is essential for the well-being of the society.
Background: Recently many medical schools have incorporated Evidence Based Medicine (EBM) as part of their undergraduate teaching. The aim is to provide a firm base of EBM to the medical students early on, so that they can understand the importance of EBM. Medical schools are encouraged to teach EBM to students but yet the education setting, learner level, modes of instruction, skills covered and teaching methods are not standardised and varies worldwide. In Cyberjaya University College of Medical Sciences (CUCMS), EBM was incorporated in the curriculum since 2009. EBM concepts was taught formally to the MBBS students during four weeks Research and Evidence Based Medicine Course (REBM). Students were exposed to the various thinking processes, formulation of clinical questions, searching evidence, intermediate biostatistics, research methodology and critical appraisal. Besides that, Good Clinical Practice (GCP) and research proposal development also include in the course. The objective of this paper is to describe
CUCMS experience of teaching EBM for undergraduate medical students.
Methods: This report analysed students feedback using a questionnaire which included a Likert scale and open-ended questions.
Result: Overall, three batches of students gave positive feedbacks regarding the course with constructive suggestions on room for improvement.
Conclusion: From our first three years’ experience in conducting the course, we concluded that the four-week EBM course offered was practical in instilling EBM principles.
This study is to determine the prevalence and the associated factors of low-back pain (LBP), which has multifactorial causes, among ambulance workers in Kelantan, Malaysia. The cross-sectional study involved ambulance workers in the emergency department in all government hospitals in Kelantan. Those who did not consent, complete or return the questionnaire as well as having rheumatic diseases were excluded from the study. The participants were asked to answer a self-administered questionnaire in English. Descriptive analyses and Chi-square test were used. A total of 168 respondents had completed the questionnaires with a response rate of 85.0%. Questionnaires with more than 95.0% items completed were included in the analysis (n=143). The respondents had a higher proportion of male than female (63.6% versus 36.4%). Assistant Medical Officer comprised of 60.0% of all respondents and the rest were nurses. The respondents’ age ranged between 23 to 58 years old with a mean age of 38.27 and standard deviation (SD) of 7.27. The mean duration of involvement in ambulance service was 9.68 years (SD 6.97). The majority (98.5%) of the respondents were Malay. Gender, smoking status and hobbies were the associated factors of LBP among ambulance workers. The modifiable risk factors should be emphasized to the ambulance workers as a measure to prevent the development of LBP.
Objective: To compare the mean duration of diarrhea between children taking yogurt and with the group taking commercial probiotics, containing lactobacillus in acute watery diarrhea. Materials and
Methods: This descriptive study was conducted in the Department of Pediatrics, Services Hospital, Lahore. The duration of this cross sectional study was 6 months, from June 2013 to November 2013. A total of 200 children suffering from acute watery diarrhea were involved in the study after the informed consent under the said hospital. Their demographic information was recorded and later divided in two groups of 100 each; group A received yogurt and group B was given commercial probiotic. The duration of diarrhea was observed in both groups. The results were compared by using independent sample t-test.
Results: The average duration of diarrhea in group A, was 1.98 + 1.31 day while that in group B was 3.09 + 1.64 days. Student's t-test was applied and the difference between the two groups was found to be statistically significant (p< 0.05).
Conclusions: Treatment with yogurt significantly decreases the mean duration of diarrhea as compared to probiotic among patients with acute watery diarrhea.
Introduction: Vaccine-preventable diseases such as pertussis are re-emerging in Malaysia during recent years.
Objective: This research aims to study the local incidence of clinical pertussis among paediatric patients admitted to Hospital Tuanku Fauziah, Perlis over two-year period.
Method: A cross-sectional study was designed in Department of Paediatrics, Hospital Tuanku Fauziah, Perlis from 1 January 2013 till 31 January 2015. Data were collected from medical and laboratory record of cases admitted for clinical pertussis. Analyses for descriptive data were done using frequency and percentage; Pearson chi-square or Fisher exact was used to test association.
Results: 81 cases of clinical pertussis were included in the study. Out of this, there were a total of 28 confirmed cases of pertussis. There was a steady increment in the incidence of pertussis throughout the study period. Cyanosis emerged as the only clinical sign significantly associated with pertussis (p = 0.011). Majority of the confirmed pertussis cases were too young to be immunized (n = 13, 46.4%).
Conclusion: Reappraisal of local health system to strengthen herd immunity in the community is warranted to control disease spread.