Background: Nowadays, most medical laboratories in Malaysia practice occupational safety and health based on standard operating procedure and sometimes ad-hoc characteristic limited to only internal use. The level of compliance of the national occupational safety and health management system (OSHMS) guidelines among medical laboratories in Malaysia is still largely unexplored.
Methods: This study was carried out on 34 medical laboratories consisting of 17 public medical laboratories and 17 private medical laboratories in Klang Valley using self-administered questionnaire based on guideline of OSHMS6. This study covered 112 medical laboratories units including pathology chemistry (18), microbiology (20), virology (7), histopathology (16), cytopathology (17), hematology (19) and 15 multi discipline medical laboratories.
Results: This study showed the level of compliance to the national OSHMS guideline among medical laboratories who are MS ISO 15189:2004 accredited & have a higher scores (p
Background: The occupationally acquired accident and injuries in Malaysian medical laboratories are still largely unexplored prior to this survey. Some of these questions are attempted in this survey and act as source of reference for the number and accident injuries in medical laboratories in the area of Klang Valley and also in Malaysia.
Methods : This survey was carried out based on recordable cases throughout the calendar year of 2001 to 2005 from 3 main medical laboratories of Hospital Kuala Lumpur (HKL), Hospital Universiti Kebangsaan Malaysia (HUKM) and Pusat Perubatan Universiti Malaya (PPUM).
Results : The average annual incident rate for this three medical laboratories is 2.05/100 full time equivalent (FTE) employees. The annual incident rate in individual medical laboratory is 2.04/100 FTE (HKL), 2.07/100 FTE (HUKM) and 2.04/100 FTE (PPUM) employees, respectively. The most common injury that is 25.3% of the total cases reported was due to cuts by sharp objects and the second most common injury was exposure to biohazard and chemical substances which constitutes 19.9% of the total cases. . Needle prick injury (16.8%), fire (8.4%), fall/slip (6.3%) and gases leak and locked in cold room were reported as one case each.
Conclusion : The average incident rate from this study is remarkably similar compared with the incident injury rate reported by BLS (2006) which is 2.1/100 FTE in the average size of medical laboratory and diagnostic. Besides this incident rate of injury and illness as a comparison, it also can be used as a benchmark to evaluate the safety performance among medical laboratories in Malaysia.
Background : A safety culture practice through prevention needs skillful, knowledgeable and competencies workers. The effectiveness of occupational safety and health programme implementation needs the knowledge related to Occupational Safety and Health Acts, 1994 (OSHA 1994) and its regulations.
Objective : This study was to determine the level of knowledge and awareness towards Occupational Safety and Health (OSH) aspects among workers in medical laboratory.
Methodology : A cross-sectional study was carried out on 34 medical laboratories in which 17 were from private and another 17 laboratories were from public sectors. It consists of 112 medical laboratory disciplines. Data were obtained using self-administered questionnaire consisting of 33 questions related to Occupational Safety and Health (OSH). Each question was coded “know” and “do not know” and respondents were needed to state their understanding towards each OSH issue tendered.
Results : Respondent’s level of knowledge was analyzed according to socio-demography and socioeconomic factors. OSH level of knowledge among medical laboratory workers showed that there are significant differences (p0.05) in OSH knowledge according to between sex, marital status, income and services sectors among workers in medical laboratories. Only about 60.5% of respondents knew the existence of OSHA 1994, whereas those who knew about OSHA 1994 regulations were below than 50.0% from overall respondents.
Conclusion : Promotion and practices of dynamic safety culture through prevention needs high knowledge of OSH.
Background : Risk management strategy at the workplace needs two way interactions between employee and employer. Therefore, study on risk perception among workers based on scientific analysis is needed to gain knowledge and understanding on how workers perceived risk at the workplace in order to design risk management strategies more effectively.
Methodology : A cross sectional study was carried out among 628 respondents from 36 medical laboratories in the public and private sector in Klang Valley. Using a self administered questionnaire, respondents were required to perceive risk on 30 hazards which have been identified in the medical laboratory. Each hazard was encoded by using Likert scale 1= not risky, 2= risky but low, 3= moderate risk, 4= high risk and 5= very high risk.
Result : Overall, the study showed that working in the medical laboratory was perceived to of moderate risk. When comparing among ethic groups, the Malays had the highest perception of risk (3.07±0.88) as compared with Indians (3.03±0.88) and the Chinese (2.78±0.90). Employee with higher education and position level perceived low level of risk compared to those with lower education and position level. For those working in different types of laboratories, there are significant difference on risk perception, (p=0.001). Employees who work in government sector perceived higher (3.12±0.93) risk compared to workers in private sector (2.85±0.88). In terms of OSH based knowledge, those with higher level of education and position have a high score knowledge on OSH compared to those have lower education and position level.
Conclusion : This study showed that risk perception among workers in medical laboratory is influenced by socio-demography factor such race, education level, job position and the laboratory where the respondents are working.
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 : Family Health Development Division is one of the earliest divisions in Public Health Department, Ministry of Health Malaysia. The division has progressed each year with the extension and expansion of the scopes of services since the establishment of Maternal and Child Health Unit in 1956. The services currently include school children, adolescent, adult and elderly health and also known as life-course perspective: from womb to tomb.
Objectives : The objective is to elaborate and explain the reformation of primary health care services implemented in the past and present.
Methods : The methodology applied is compilation, data review and comparison from annual report, action plan report, articles, speeches, specialists and stake holder view.
Results : The focus of Primary Health Care Service is covering health promotion, disease prevention, early detection and treatment, acute disease care, disease limitation and rehabilitation, clinical support services and teleprimary care. The reformation is caused by factors such as globalization, modernization, growth of health market, emergence and re-emergence of diseases, and development of medical technology. Three health fields that have underwent and under going reformation are concept and wellness practise in primary healthcare, primary healthcare clinical support services development and primary healthcare informatics development. The outcome of these reformations is the increment of service quality and outstanding services for patients and health staffs.
Conclusion : Health reformation in primary healthcare is greatly needed to give excellent services for primary health care for today and future.
Introduction : Economic evaluations can provide “value-for money” information to those making decisions about the allocation of limited health care resources. In particular, economic evaluations can be used to identify interventions that are worth providing and those that are not. Furthermore, evaluations can be used with other approaches to help set priorities, such as program-budgeting marginal-analysis.
Methodology : Compile and systematically describe from the publications, articles and reports on economic evaluation in healthcare decision making.
Result : A high quality economic evaluation should provide decision makers with information that is useful, relevant, and timely. In addition, evaluations should be based on rigorous analytical methods, be balanced and impartial (credible), and be transparent and accessible to the reader. There are many situations where economic evaluations can assist decision makers: decisions by various levels of government or administrative bodies (e.g., regional health authorities, hospitals, drug plans) to fund a program, service or technology, pricing decisions by government regulators and technology manufacturers, clinical practice guidelines, priorities for research funding by governments and researchbased firms, post-marketing surveillance and updates of economic information based on the use of the technology in the “real world” (which can then be used to inform one of the other types of decisions).
Conclusion: This requires that decision makers take a broad view of the impact of a technology, and decision that are more explicit and transparent. The ultimate test of an evaluation is whether it leads to better decision in the presence of uncertainty, and results in the more efficient and effective use of resources.
Background : Miscarriage is a common problem in pregnancy which can occur during early, mid or late pregnancy. Incomplete miscarriage can be treated expectantly, medically or surgically. The most preferred method used in UKMMC is using sharp curettage.
Methodology : This study is conducted in the UKMMC from 1st January 2010 to 30th March 2010. The purpose of this study is to analyze the cost of treating incomplete miscarriage using metal sharp curettage from the provider’s perspective per patient-day.
Result : A total of 17 samples were eligible for analysis from 46 patients who fulfilled the inclusion and exclusion criteria. The cost is derived from cost calculation on capital and recurrent costs. Results showed that the average cost for treating incomplete miscarriage using sharp curettage per day is RM252.56. Recurrent costs contributed 83.3% of the total treatment with overhead cost was the biggest percentage (51.6%). Discussion The treatment cost for incomplete miscarriage using sharp curettage is found to be higher as compared to medical approach according to literatures. The higher cost of surgical approach was mainly attributed to the recurrent cost which is included in the calculation.
Conclusion : Effective usage of the operation theatre and all resources should be managed and utilized well in order to achieve optimum outcome.
Introduction: Relatives play an important role in patient care - not only providing social support but also help to complement the existing care. They must be empowered with relevant knowledge and skills of patient care including motivating patient towards immediate healing and acceptance of his fate. Although these are various approaches, the media is regarded as the most effective method in educating the family or the relatives. This paper highlights the significant role of the media as an educational tool to mobilize patient’s relatives in total patient care.
Methodology: This is a review conducted on reports, observations and feedbacks gathered from various sources involved in patient education in hospital setting. It was endorsed by a series of in-depth expert forum under patient education module.
Results: Relative empowerment has been identified to be as an important role and yet it is not fully utilized. The manpower resources are so scarce and crucial in patient as well as relative education. The media is the only alternative educational tool that could compliment the educational needs. Of all potential media available in the market we have recognized at least four types of media that can be optimally resourced and used. Through manipulation of its content and making it interactive, the role of media seemed to be extremely effective in patient management that include relatives.
Conclusion: The role of media in relative’s education in support of patient care is undeniable. The media with the most potential should be identified and the management of its content to be enhanced. It must be incorporated with an interactive approach in order to have more self-involvement and undersatanding of its content.
Workplace bullying has drawn greater attention in the last one and half decades. Despite its recognition by many organizations and countries, it is still rife. Why is that so? Could it be that the root of the problem has not been addressed? Or, could it be due to difficulties and resistances in embarking preventive and control measures. In this paper, we will examine the possible causes of workplace bullying based on a proposed model. In depth discussion of the personal and organizational factors are made while the work group and societal factors are dealt with in brief. In summary, the root of workplace bullying is multi-factorial. Understanding the complexity and subtlety of workplace bullying is pertinent in the effort to prevent or curtail it.
Introduction : It is no doubt that the success of any health organization depends so closely on its managerial functions. To achieve this, the leader or manager as the core strategist of its organization must in all time be updated with the latest evidence-based information so that he or she can be easily operationalized his or her management function in more effective and sustainable manners. It depends largely on scientific literatures that published relevant articles within this scope. Unfortunately, management topics related to health care system is scattered published and this has indirectly affect manager to access the latest scientific documents.
Methods : We examined the practice of well known international journal in health care namely New England Medical Journal (NEMJ) on its role in propagating latest health management topics to its prospective clients.
Results : The result showed that a total of 31% health management topics were published throughout 2007 out of 1140 articles appeared. Of these, about 33% were confined to general health administration. The remaining articles were related to healthcare delivery practices (24%), medical ethics and legal matters (17% each), and manpower issues and training (9%).
Conclusion : Focus on managerial related articles relatively low as compared to clinical and other evidence-based medicine that clearly dominated health management issues.
Introduction: To determine the effectiveness of the enhance enforcement programmes (The Ops) on the percentage of seatbelt wearing among front occupants in Malaysia.
Methodology: The roadside observations for measuring the seatbelt wearing among front occupant were conducted before, two weeks and six months after the Ops. The study was conducted in selected states representing four different zones (Northern, Southern, Eastern and Central zones) of Peninsular Malaysia.
Result: A total of 12,298 drivers and 11,212 front occupants were observed for their seatbelt wearing status through out the study. Percentage of seatbelt wearing among drivers and front passengers were increased from the baseline of 82.6 % and 74.4 % to 92 % (95 % CI: 91.2, 92.7) and 87.0 % (95 % CI: 85.9, 88.0) after two week, but declined to 85.7 % (95 % CI: 84.4, 86.8) and 76.8 % (95 % CI: 75.2, 78.3) after six months of the Ops respectively. Pre and post analysis revealed that after 2 weeks, the Ops were significantly effective in increasing the seatbelt wearing among front passengers and drivers with the RR (95 % CI) of 1.17 (1.14, 1.20) and 1.12 (1.10,1.13) respectively. However, after six months, the effectiveness of the Ops was reduced for both type of vehicle occupant.
Conclusion: This study sheds light on the importance of the enhance enforcement programme for increasing the seatbelt wearing in Malaysia. However, in order to give more impact on seatbelt wearing, the strategy and the frequency of the enhance enforcement programme in Malaysia may need to be revised.
Introduction : Stress is part of our life. It can happen anywhere including in medical school. Medical school is perceived as being stressful because their difficulties in education, longest period of study and dealing with the patients. Stress can be perceive as negative or positive. Coping strategies are the method that we can use to prevent stress when it comes to us. The aim of this study was to determine the prevalence of stress and coping strategies among of medical students in National University of Malaysia, Malaysia University of Sabah and Universiti Kuala Lumpur Royal College of Medicine Perak.
Methods : This study involved 450 medical students through stratified sampling in which 150 medical students from each of the three universities. This study was conducted through self administered questionnaires. The questionnaires included were socio demographic factor, Personal Stress Inventory (using Stress Symptoms Scale with 52 items), BRIEF COPE (Coping Orientation for Problems Experienced with 28 items). The determination of cut off point for stress symptoms score was using Receiver Operating Characteristic (ROC) curve.
Results : Response rate was 90.8%. The prevalence of stress among medical students were 44.1%. The contributory factors to the stress were financial problems, stress of up coming examination period, relationship problems with parents, peers, siblings and lecturers. Coping mechanisms which had significant association with stress includes self distraction, venting of emotion, denial, behavioral disengagement, humor and self blaming. Multiple linear regression analysis revealed a significant association (p
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 effect of stress among correctional officers at the workplace can contribute to various health problems and this also affect their work performance and motivation.
Methodology: Study was done at a prison located at the rural district in Kedah. The study was conducted by using randomized stratified sampling method. A total of 418 self administrated questionnaires were distributed. These questionnaires included socio demographic factor, family and marriage factor, Personal Stress Inventory (using Stress Symptom Scale with 52 items), work related stressors (Job Stress Survey) and Brief COPE (Coping Orientation for Problems Experienced with 28 items).
Result: Response rate was 90.9%. Stress prevalence for correctional officers was 45.8%. Socio demographic factors which have significant relation with stress status were marital status, promotion factor, age, monthly salary, duration of service and number of children (p< 0.05). Family and marriage factor which have significant relation with stress status among married officer were pressure from relatives, clean up house, sexual frustration, conflict with spouse, conflict with children, conflict due to household work and no babysitter (p< 0.05).
Discussion: The study showed that work related stressors that have influence with stress were excessive workload, working after work hours, not enough staff, disgraced words from fellow workers, competition in carrier development and excessive work stress (p< 0.05). Multiple linear regression model was done in this study and revealed factors that explained 52% of variation in stress score distributions were behavioural disengagement, no babysitter, denial, conflict with children, replace other worker’s duty, not enough time with family, competition in carrier development, venting of emotion, positive reframing and emotional support. Coping strategies that have significant effect in reducing stress symptoms are positive reframing and emotional support.
Conclusion: Stress management programs should be implemented and emphasizing on specific stressors and coping mechanism are important to reduce the risk of occupational stress among correctional officers.
Background : Study of stress among adults in rural community is seldom been conducted and this study aims to see the prevelence of the stress among this group of population.
Methodology : A cross sectional study was conducted to measure the prevalence of stress among the rural people in Hulu Langat District, Selangor using O`Donnell Personal Stress Inventory and coping mechanism practiced by them.
Result : A total of 265 respondents through universal sampling participated in this study. The stress prevalence identified was 16.2%. The factors which have significant association with stress were age, education level, marital status, working women, duration of working per day and body mass index. Diseases such as diabetis mellitus and hypertension showed no association with stress. Preferred coping mechanism used by respondents included emotional support, instrumental support, behavior modification and denial.
Conclusion : Stress among the rural population is high in Malaysia. Measures has to be taken to reduce the stress as it can effect the general health of the people.
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.
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.
Background: A randomised clinical trial was carried out to study the cost-effectiveness of continuous venovenous hemofiltration using high volume and standard volume.
Methods: Study was done through interviews involving patients or their relatives and document review on patients’ treatment and progress note during the hemofiltration therapy in the Intensive Care Unit, Hospital University Kebangsaan Malaysia. Study also involved secondary data analysis and a structured questionnaire survey to assess the treatment and medical cost incurred by the hospital during the continuous venovenous hemofiltration therapy.
Results: The result of this study showed that the continuous venovenous hemofiltration given at high volume 4-6 litres/hour is more cost effective than standard volume of 2 litres/hour. The Sequential Organ Failure Assessment (SOFA) score reduction in the high volume hemofiltration is 3.0 units over 24 hours. This reduction is higher than the standard volume hemofiltration which is only 0.5 unit over 24 hours.
Conclusions: High volume hemofiltration is more cost effective than standard volume therapy, where only RM 5,552 compared to RM 23,512 is needed for every one unit of SOFA score reduction respectively.
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