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: Social misconduct amongst adolescents is a worrying and ever growing problem in Malaysia, despite efforts taken to overcome it.
Methods : A cross sectional study was conducted among secondary school students in Melaka Tengah District to measure the prevalence and determine the factors associated with social misconduct amongst adolescents. A total of 414 form four students were recruited by systematic random sampling fulfilling the study criteria between Jun to September 2008, from eight randomly selected secondary schools in the district. Data were collected using a structured self-administered questionnaire and analyzed using SPSS software version 12.0. Socio-demographic, housing and family factors in relation with social misconduct were studied.
Results : The prevalence of the social misconduct in this study was 70.5%. The most prevalent misconduct includes loitering (37.4%), truancy (30.0%), watching pornographic films (28.7%), and involved in pre-sexual activities (23.7%). The factors that showed significant association with social misconduct were sex and race.
Conclusion : The prevalence of social misconduct is high among adolescent and males as well as Malays are at higher risk. Activities planned for adolescents should be stressed on the danger and effects of social misconduct and be more focused towards male and Malay adolescents.
Background : Family planning is a method to control family size and to increase the intervals between chidbirths using multiple methods of contraceptives.
Objectives : This study aims to determine the pravelance of family planning practice among married women (wife less than 55 years old) and its related factors and also to determine the husbands knowledge on family planning and their support.
Methodology : This is a cross sectional study done through direct interviews amongst 118 married couples in Kampung Sesapan Batu Mingkabau, Hulu Langat Selangor.
Results : On family planning practise, 43.2% of couples is currently practising, 22.0% have practiced but stopped and 34.8% have never used any types of family planning methods. As high as 75% of wives received support from their husband to pratice family planning. There is a significant association between family planning practice and wife’s age, husband’s age, wife’s occupation, wife’s education, wife’s knowledge and husband’s support. Husband’s knowledge , number of live children and husband’s education have no significant assocation in influencing family planning practice.
Conclusion : To achieve better knowledge and family planning practises, husband’s involvement and support must be encouraged to ensure the correct informations and support are delivered to both couples. Approach through husbands is regarded as one of the key factors to the success of rural women family planning practice.
Introduction : Cervical cancer can be prevented through pap smear screening and its proper management of high risk cases. High level of knowledge regarding pap smear screening will encourage women to do pap smear as recommended.
Methadology : A cross sectional study was carried out in Jun 2007 to find out the level of knowledge regarding pap smear among married women in Kg. Sesapa Kelubi, Hulu Langat Selangor. Universal sampling was conducted using guided questionnaire and data was analysed using SPSS version 12.
Result : A total of 154 women participated in this study. Only 3.9% of respondents practiced pap smear as recommended and only 51.3% of them have high level of knowledge with 27.9% has no knowledge regarding pap smear. Women between the ages of 20-35 years old have higher level of knowledge (77.9%). The only factor that showed significant association with level of knowledge in this study is level of education. Age, income, gravida and occupation did not show any significant association.
Conclusion : The effectiveness of pap smear screening program should be regularly evaluated to determine the problem of its low coverage. Proper strategy should be planned to increase knowledge among women and their participation in pap smear program.
Introduction : Studies on stress among diabetic patients with complications are not much conducted locally. In this study the researchers would like to find out the magnitude of the problem among the Malaysian.
Methodology : A cross- sectional study was conducted to determine the prevalence of stress and its associated factors among the diabetes mellitus patients with complications at Raja Perempuan Zainab II Hospital, Kota Bharu, Kelantan. The translated Personal Stress Inventory questionairse was used to measure the stress among the respondents.
Finding : The prevalence of stress was 36.8%. The study showed that the employment status of respondents has significant association with stress in which higher numbers of unemployed respondents were stressed as compared to the employed respondents. Other sociodemographic factors, namely duration of having diabetes mellitus and type of complications developed by the patients were not significant.
Conclusion : Once the poor and unemployed patients were diagnosed to have diabetes mellitus either with or without complication, the health staffs should refer them immediately to the relevant agencies for help. By doing so, these patients could be prevented from having stress later. Outreach programmes in the community should be carried out regularly for an early detection and treatment of chronic diseases including diabetes mellitus to prevent patients from developing any complication.
Introduction : Quality is an important aspect in health care delivery not only because it is one of the most important factors in individual and community health, but it also influences lives in improving lifespan, health status and also reduction in disease and the burden of diseases.
Methodology : This is a systematic review on various papers, studies and articles based on studies and researches done by a few scholars, experts and organizations involved in quality, quality assessment and monitoring.
Results : Quality in health care delivery involves six main aspects including access to services, suitability to the needs, effectiveness, equity, social acceptance and efficiency. Quality is taken from the perspective of the consumers and the providers. Some of the issues surrounding quality assessment are identifying and balancing between the difference perspective among the stakeholders, producing accountable framework of assessment and also finding suitable criteria for outcome assessment. Health care services in Malaysia are provided both by the government and the private sector with each sector has its own advantages, disadvantages and challenges.
Conclusion : The challenges in improving and maintaining quality include balancing advances in science and technology with the available brainpower and human resources. Therefore all agencies should work together in order to provide the best health care delivery and to keep improving the quality in health care services.
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: Safety and health audit study is a part of occupational safety and health risk assesment. Thus, student’s residential audit is important in order tu ensure the safety rules which implemented by the management is appropriate and follow the standard set forth. Furthermore, it also important to determine places, area or situation that might lead to hazard risk so that prevention step could be plan and implement.
Objective: This study was to determine the safety level of students residential in physical aspects.
Methods: Safety inspection or audit conducted is in accordance with criteria and indicators listed in the checklists that have been formed based on the audit forms from the Department of Safety and Health (DOSH), National Institute of Safety and health (NIOSH) and the Occupational Safety and Health Committee of UKMs (JKKP). Several indicators are also included in the audit form as to ensure it covers all the technical aspect and suited with the college conditions. The safety level for each of the blocks in KDO is categorized using points and percentage score obtained.
Results: Based on the overall score, the average safety score in percentage for areas in KDO are preceded by general office with score 85.5% followed by residential blocks with 71.5%, facilities with score 71.2% and administration block with 70.9%. The results of the study show that most of the areas are at least in a safe level.
Conclusion: Roles of employer and college administration, significant OSH programme and safety audit are important factors as to ensure the safety of student's residential college.
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 : Despite the number of information generated by researchers, cardiovascular diseases problem has not clearly declined and perhaps in certain situation it is gradually increasing, affecting people who are previously at low risk. There is a tendency to believe that favourable outcomes can always be expected once intervention activities, like exercise promotion, are carried out, but practical experience gives rise to serious doubt.
Methods : A greater understanding of the socialization mechanisms operating in the adoption of physical activity in CVD control and allow specific exercise prescriptions for communitybased prevention and control is important. This paper highlighted the author’s feeling about controlling chronic diseases by mean of community intervention.
Results : This analysis has strongly believed that the important impetus of any community intervention approach should be oriented in the form of “from people to people”.
Conclusion : More emphasis needs to be placed on effective management and parameters for assessment of its management success.
Gender bias are most obvious in the distribution of income and wealth. This reflects women’s unequal position in the labour market , their less favorable treatment in most social security systems and their lower status within the household. Discrimination against women is also evident in the political sphere. Their access to power is not commensurate with their numbers, their needs or their contributions as citizens. As well as affecting women’s physical and mental health, gender bias also affect the quality of the services they receive. In most developed countries, women are offered equal access to basic health care. However their use of those service may be hindered by a number of gender related factors which are likely to affect poor women in particular. In health organization, gender bias gives significant impact to the evaluation of staff performance, increase stress level and miscommunication. It is also influence the leadership style and also can create ‘glass ceiling’ phenomenon. Job dissatisfaction , absenteeism and high turn over are also the consequences of gender bias. Alongside the development of gender sensitive methods of routine data collection, gender bias in health research will also need to be addressed. Most biomedical research continues to be based on the unstated assumption that women and men are physiologically similar in all respects apart from their reproductive systems. Other biological differences are ignored, as are the social/gender differences that have such a major impact on health.
Introduction: Non-verbal cues are untold words that carry a significant meaning. As a doctor, this remark needs to be perceived correctly. It is an inevitable communication knowledge and skills ought to be mastered in any doctorpatient relationship, particularly when making patient’s assessment.
Methodology: This was a systematic communication assessment of a real observations on doctor-patient relationship in various setting. It was supported by feedbacks from many scholars who were involved in research and teaching and also reviews, papers and studies on the said subject.
Results: It has been realized that non-verbal communication was equally important and necessary to complement the verbal one. From all non-verbal cues we have recognized and listed, we have identified at least ten to be the most vital areas to be observed while counseling or consulting a patient.
Conclusion: Non-verbal cues were always present to support doctor in making a final conclusion about his/her patient’s state. If doctor was patience enough, he or she could has a complete profile of his/her patient and this would lead to the improvement in a person’s life. Having an observant attitude and being able to nose around appropriately were skills that have to be learnt, experienced and applied as these might make an effective doctor-patient communication.
Background: An effective doctor-patient communication has increasingly being recognized as an important factor in patient care. All means should be oriented towards narrowing communication gap. The essential methods must be searched and doctor must be able to conduct communication session in more pleasing manner.
Methodology: This is a systematic review on observations made on doctor-patient relationship on various setting and supported by feedbacks from many scholars who are involved in research, teaching and also papers and studies on the said subject.
Results: It is been realized that effective communication is not easily done if its process not well complemented and the gap is left widening. From all possible communication gaps recognized and listed, at least ten have identified to be the most essential methods to be prioritized while counseling or consulting a patient.
Conclusion: Effective communication between patient and doctor is the essential prerequisite of good medical practice and especially important for accurate diagnosis and effective treatment. Its mutual benefit can only be observed if all efforts are centered towards managing the communication gap.
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.
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.
Flooding is the most frequent of all natural disasters. A flood is any water flow that exceeds the capacity of the drainage system and usually subsides in relatively shorter period. However, the flood that hit Batu Pahat District were different from other districts. Batu Pahat flooding extended for 48 days from the first wave until it subsided fully. It gives positive and negative effects not only to the victims but also to the health care workers (HCWs) while executing their duties during and post flood. This write up aims to share HCW’s experience and voices from those who were involved in the flood disaster. Methods used are brainstorming sessions, discussion, observation and interview. From this study, 10 main themes were highlighted. This flood disaster has given the HCWs to prepare mentally, physically and increase knowledge and skills to face any disaster in the future.
Infrastructure damage due to land slide, fallen bridge and broken and submerged roads become the main constraint in providing good medical services to the flood victims and isolated places in the remote area. The health care provider has to face a huge challenge at delivering the medical services to the flood victims in Kluang district especially to the remote and isolated areas. This gives us a meaningful and valuable experience in managing such problem. From the true experience of the medical and health team and also the flood victims, few problems and major issues were detected. Other than the environmental factor, human error is another major area of concern of which the failure to interact with the District Flood Operation Centre leading to miscommunication resulting in delay of management of the patient. In smaller proportion, poor inter-agency collaboration and lacking of good equipment was also noted to be affecting the health care services. The issues raised here will hopefully be making better in managing disaster in the future.
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.
Past major flooding events for the state of Johore, Malaysia were recorded in 1926, 1967, 1968 and 1971. However, major meteorological phenomena that hit Johore on the 19th December 2006 (first wave) and the 12th January 2007 (second wave) were claimed to be the worst flood disaster in Johore in a 100 years. All eight districts were affected displacing 157,018 and 155,368 population during the first and the second wave event respectively. The Johore Health Department deployed substantial number of medical and health personnel to deal with the Johore flood crisis. Flood-related data were collected on daily basis between 19th December 2006 and 19th February 2007 using spreadsheet format from Flood Operational Rooms located at respective District Health Offices. Among flood victims 34,530 were found to have non-communicable diseases and 19,670 with communicable diseases. No major food- and water-borne disease outbreaks, such as cholera and typhoid, were reported in Johore. High success of public health measures was depending on the workforce of medical and health personnel on the ground. On the other hand, voluntary services offered by non-governmental organisations (NGOs), private sector and other volunteers should be well coordinated without compromising regulatory and ethical requirements. Crisis guidelines and plan of actions shall be updated so that they would be more relevant to the crises encountered on the ground.
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.