Several studies had shown that the problem of plate waste in hospitals ranged from 17% to 67%. This study aimed to determine the extent of plate waste in a district government hospital, the type of food item wasted and the factors contributing to food waste. A oross»sectional study was conducted in a district hospital, involving four third class wards. A total of 300 patients were included in the study. A plate waste was dehned as the proportion of edible portion of food served that was discarded by patients. The serving size was established by weighing each food item served over breakfast, lunch and dinner on a seven·day rotation menu, using the procedure recommended by the National Food Service Management, During the study period, the left over from each patient’s plate was weighed for all meals. The plate waste for each patient was determined by dividing the total weight of the left over with the average serving weight for the same serving in the same ward. Each patient was also given a self-administered questionnaire to obtain information on reasons or not consuming the ood items served. The overall mean ercentage plate waste of all food served in the four wards was 42.6%. Plate wastage occurred most at dinner (53.2%) and least at breakfast (31 .3%). Vegetables were the most wasted food items. Females wasted significantly higher than males for all meals. Food taste, portion size, appetite and staff service efficiency were factors found signihcantly contributing to plate waste. With almost half of the food served was wasted, hospital management need to direct more attention towards addressing the problem of plate waste since it has both nutritional and cost implications.
The construction industry is an important industry in the Malaysian’s economy. Much has been said about the quality of the product as well as the image of the industry due to the small percentage of local workers on site. The industry’s welfare and safety record is not at all encouraging. To stop the rot, the government has taken important and significant steps by the establishment of the Malaysian Construction Industry Development Board (CIDB) and the National Institute of Occupational Safety and Health (NIOSH). These efforts have shown some significant positive improvement in the perception and action of those involved in the industry but we are still far from the standard shown in other developed countries in terms of site safety. This paper is to discuss the roles and responsibilities of the key players in the industry be it the clients, consultants or contractors. The focus is on the ‘upstream’ activities i.e. the pre-construction stage, rather than the ‘downstream’ i.e. the construction phase of a project.
The emergence of severe acute respiratory syndrome (SARS) had caused fear and anxiety of unprecedented proportion. To examine the impact of SARS on the medical students in a private medical university, a self-reporting questionnaire study was carried out to assess the factual knowledge, anxiety level and perception of the crisis, among the students. The two-week study (between 12 and 23 May, 2003) was carried out three weeks after the first reported SARS-related death in Malaysia. Ninety-one Phase I (junior) and 113 Phase II (senior) students completed the questionnaires. A large majority of students of Phase I and II were correct in their factual knowledge and were sensible in their perception of the future and the handling of the crisis by government(s). However, phase 1 students expressed significantly greater degree of anxiety compared to Phase II in relation to attendance and personal protection in hospital, and in meeting people coughing in public places. The lesser degree of anxiety expressed by phase II senior students may be due in part, to a more realistic assessment of SARS risk brought about by maturity, time spent in hospital and interaction with clinical lecturers and medical staff.
This paper sets out the practice of traditional, alternative and/or complementary medicine in Malaysia. It gives an overview of the types of alternative medicine available, and the legal regulation, or lack of it within the current setting. The relevant policies and governmental action in this area are highlighted. Relevant case law decisions in this area are also included. The practice of spiritual healing as one form of traditional medicine, and its role within the spectrum of alternative medicine is dealt with briefly. The significant question of integration of alternative medicine within the existing allopathic system is addressed. The paper concludes that as interest in, and usage of alternative medicine is not likely to decrease, certain measures must be taken by the relevant authorities to ensure among others, the safety and efficacy of these medicines.
In Malaysia exposures in the workplace are regulated under the Factories and Machinery Act (FMA), 1967 and also under the more comprehensive Occupational Safety and Health Act (OSHA) enacted in 1994. With OSHA 1994 the philosophy of legislating safety and health in the workplace changed from one that was very prescriptive and containing detailed technical provisions under FMA, 1967 to one that is more flexible and encourages self-regulation under OSHA 1994. OSHA 1994 is supported by regulations, codes of practices and guidelines to further clarify the provisions in the Act. Under the FMA 1967 emphasis was on safety while with OSHA 1994 there has been equal emphasis on addressing health hazards in the workplace. Regulations for occupational exposures are developed by the Department of Occupational Safety and Health with tripartite and stakeholder consultation. When developing these regulations International Labor Organization Conventions, laws of other countries and occupational exposure standards adopted internationally are reviewed. The government also conducts surveys to collect information on both exposures and health effects in workplaces to have better understanding on specific occupational health problems. Effective law enforcement is crucial in ensuring compliance to safety and health law. The challenge at the moment is to ensure all employers and employees, particularly those in the small and medium enterprises, understand and comply with the provisions stipulated in the legislation.
Tooth wear is the non-carious loss of tooth tissue due to attrition, erosion and/or abrasion. The amount of wear that accelerates physiological tooth wear is referred as pathological tooth wear. This study aims to determine the prevalence and mean scores according to mouth quadrant of raw tooth wear (RTW) and pathological tooth wear (PTW) and investigate sex association with PTW among 16-year-old secondary school children in Kota Bharu, Kelantan. This cross-sectional study involves 688 participants randomly selected from eight government secondary schools. The Smith and Knight Tooth Wear Index (TWI) was used. Data were analyzed using a simplified Microsoft Excel program developed based on the index to quantify PTW. Bar graphs were plotted to highlight the mean scores according to mouth quadrant. About 44% of participants were male and 56% were female. The prevalence of RTW and PTW among subjects was 100% and 20.1% respectively. It was found that 32.8% of tooth surfaces were affected with RTW and 0.7% of study subjects already had exposed dentine. The most affected quadrant for RTW and PTW was the upper and lower incisal quadrant respectively. Males had 92% more odds of developing tooth wear compared to females. In conclusion, all subjects have some degree of wear. About one-fifth of the study subjects were affected by PTW. The patterns of wear were similar to those encountered in the Western societies. There was statistically significant association between sex and PTW.
Overweight during adolescence has many psychological consequences and low self·esteem is the immediate detrimental effect observed. Adolescents with low self»esteem are at risk for many emotional and behavioural disorders while high self-esteem adolescents experience an incremental improvement in their quality of life. The objective of this study was to compare seh'-esteem between overweight and non-overweight Malay adolescents in Kota Bharu, Kelantan. A cross-sectional study was conducted between January to ]une 2005 among 1364 students selected from ten co-educational government secondary schools in Kota Bharu using stratified multistage cluster sampling. A set of guided self-administered questionnaire which included a Malaysian version of Rosenberg Self-Esteem Scale and Body Mass Index measurement was used. Data was entered using SPSS 12.0 and analysed using STATA 8. O. The prevalence of overweight among secondary school students in Kota Bharu was 12.5% and there was no significant difference in self-esteem between overweight and non-overweight students. However, the findings may not be generalized to out-of-school youth and other ethnic groups in this country. Infomation on other modifers, such as parental acceptance or lack of concern regarding the child’ obesity was not elicited in this study. It is an important protective factor for self-esteem and need to be included in future studies.
A cross»sectional study using self administered questionnaires on sociodemographic and service factors influencing locum practice was undertaken among all Government medical officers in Negeri Sembilan and Malacca for 8 months from 2 7 April 1999 to 9. l January ZOOO. Universally chosen samples were made of 335 Government medical officers from both the 'Public Health Division' and ”Hospital Division' and from 154 who responded, only 147 samples were chosen and analysed in the study. Results revealed that locum were still being practised by 51 .9% of male Government medical officers, 41 .0% of Government medical ofhcers aged less than 30 years, 43.4% of Government medical officers who had served less than 5 years and 55.6% of Government medical officers who had earned nett income less than RM 1 000. Meanwhile, 80.9% of Government medical officers who had earned gross income more than RM 5 OOO did not practice locum during the study. Logistic Regression analysis then revealed that locum practice among Government medical ofhcers can positively be influenced by gender (male) , Malay ethnic, service duration of less than 5 years, practice in the 'Public Health Divisionl and nett income of less than RM 1 OOO (p
\Elderly abuse exists in our society but is hardly ever reported. This problem often remains undetected because of poor public awareness and lack of knowledge among health care personnel. This article addresses the definition of elderly abuse, characteristics of the abused elderly and their abusers as well as strategies to detect and manage it. Collaboration between health care professionals and government bodies is needed to identify and manage elderly abuse. Ultimately, a legislative "Elder Protective Act" should be implemented to safeguard the rights of our vulnerable elderly.
In Malaysia the response to illicit drug use has been largely punitive with the current goal of the Malaysian government being to achieve a drug-free society by 2015. This paper outlines the results of a desk-based situation assessment conducted over a 3-week period in 2004. Additional events, examined in 2005, were also included to describe more recent policy developments and examine how these came about. Despite punitive drug policy there has been a substantial rise in the number of drug users in the country. Over two-thirds of HIV/AIDS cases are among injecting drug users (IDUs) and there has been an exponential rise in the number of cases reported. Further, data suggest high risk drug use practices are widespread. Harm reduction initiatives have only recently been introduced in Malaysia. The successful piloting of substitution therapies, in particular methadone and buprenorphine, is cause for genuine hope for the rapid development of such interventions. In 2005 the government announced it will allow methadone maintenance programmes to operate beyond the pilot phase and needle and syringe exchange programmes will be established to serve the needs of IDUs.
Starting with the duty of Governments to provide adequate resources for the establishment and development of health services, this paper draws on experiences in four developed countries to illustrate the problems and their outcomes. The examples chosen demonstrate the contrast in philosophies and approach to resource allocation for health care.
A self-answered, anonymously completed, nationwide questionnaire survey was conducted between June 2002 and May 2003 among Malaysian doctors through post and at medical meetings. Findings based on 116 government and 110 private doctors who satisfactorily completed the forms (effective respondent rate: 30.1%) showed that more than 70% of government and private doctors claimed familiarity with asthma CPGs but proportionately more private doctors considered them "unworkable" and were reluctant to adopt them in their practice setting, quoting cost as the primary reason. Between those who frequently adopted the CPGs and those who did not, there was an equally high proportion of inappropriate prescribing. Despite the shortcomings of such a survey, our findings suggest that medicinal cost and practitioner's prescribing practices are important in the acceptance and execution of asthma CPGs recommendations.
Three authors describe problematic scenarios of health policy in their respective countries. These examples illustrate the role of government influences in determining resource allocation, legislation, health provision and health outcomes in very different situations. These outcomes are affected not only by attitudes to public health, but also by the legal systems in the countries which are the subjects of this study. The authors draw conclusions about the use and abuse of public health regulation.
Each organization has a particular culture, due to personal interactions, with certain values shared by its members. Corporate culture is defined as ‘the set of shared, taken-for-granted implicit assumptions that a group holds and that determines how it perceives, thinks about, and reacts to its various environments’. Positive corporate culture is linked to increased staff alignment, advanced level of employee commitment, increased employee productivity, enhanced organizational effectiveness and increased profitability. Researchers claimed that most studies suggesting the associations between culture and performance are methodologically weak. Cultural transformation has been a big part of NHS reforms and health system redesign in United States to deliver improvements in quality and performance. Environment, market competition, technology advancement, information age and government policies will influence the cultural change within the organization. Undesirable culture might emerge if the organization does not act appropriately to manage its corporate culture. There are six critical success factors for the implementation of corporate culture changes: committed and effective leadership, clear definition of the desired goals, rigorous implementation of a change management model, effective mitigation of change resistance, active governance structure and a design model, and effective communication. Among the issues in implementing corporate culture within healthcare organizations are middle managers dilemma, cultural diversity and subcultures within the organization, size of healthcare organization and critical mass.
Public health care programme evaluation includes determining the programme effectiveness (outcome assessment), efficiency (economic evaluation), accessibility (reachability of services) and equity (equal provision for equal needs). The purpose of this study was to make comparison on cost·( efficiency and costeffectiveness in managing type 2 diabetes between the Ministry of Health (MOH) health clinics with family medicine specialist (FMS) and health clinics without FMS. A costeffectiveness analysis was conducted alongside across-sectional study at two government health clinics in Machang, Kelantan, one with FMS and the other without FMS. A total of 300 patients, of which 155 from the health clinic without FMS and 145 from the other group were evaluated for sociodemographic and clinical characteristics from August 2005 to May 2006. HbA1c
analysis was measured for each patient during the study period. Macrocosting and microcosting were used to determine costs. The provider cost for diabetic management ranged from RM270.56 to RM4533.04 per diabetic patient per year, withla mean cost of RM1127.91(t906.08) per diabetic patient per year in health clinic with FMS. In health clinic without FMS, the provider cost ranged from RM225.93 to RM4650.13, with a mean cost of RM802.15 (:626.26). Proportion ofgood HbA1c was 17.2% for health clinic with FMS and 10.3% for the health clinic without FMS. The annual mean provider cost per proportion of good HbA1c control (< 7%) (Costefkctiveness ratio/ CER) was RM6557.65.for health clinic with FMS and RM7787.88 for health clinic without FMS. This provider cost-epfectiveness ratio was not different statistically between the health clinic with FMS and health clinic without FMS (p=0.063). The cost of building, equipments, overheads, staff and consumables were higher for FMS group. Sensitivity analysis was performed for three discount rates (0, 5 and 7%). Relative cost-effectiveness of diabetes management in health clinic with FMS and health clinic without FMS was unchanged in all sensitivity scenarios. Even though, there was no significantly difference in provider CER in type 2 diabetes management at Malaysian MOH health clinics, but the provider CER in health clinic with FMS was lower compared to health clinic without FMS. Therefore, we can conclude that the presence of FMS in the health clinic will effectively improved the management of type 2 diabetes.
The prevalence of HIV/AIDS among drug addicts in Malaysia is high, especially among intravenous drug users. The present treatment and rehabilitation of drug addiction is considered as a failure. The government finally decided to start on Drug Substitution Therapy in early 2005 as an effort to prevent the spread of HIV/AIDS in the country.
The Intensive Care Unit (ICU) is a therapeutic place for monitoring critically ill patients. However, it is a stressful area for the patients and it is causing them great anxiety. Previous studies have identified three groups of stressors in ICU namely; physical, psychological and environmental. The aims of this study were to determine the ICU stressors as experienced by patients and to determine the level of stressors felt by patients in ICU. A cross sectional study was done on 70 patients from two tertiary hospitals in Malaysia. A face-to-face interview with structured questionnaire was used for patients. Data collection occurred from 15 December 2006 to 31 January 2007. The five major ICU stressors perceived by patients were pain, being stuck with needles, boredom, missing their spouses and being too hot/cold. The ICU physical stressors were the major items ranked by post ICU patients. The findings from this study provided a set of baseline information to the health care providers, particularly ICU nurses in Malaysia, with which to provide better care for the patients in ICU.
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.
A twin registry is a registry of twin pairs (monozygotic = MZ and Dizygotic = DZ) who are willing to consider participating in health-related research. Twins are able to help researchers study the impact of genetic and environmental factors on health and the treatment and prevention of disease in a special way. Throughout the world, twin registries have been established by the governments via the National Health and Medical Research in order to put researchers in touch with twins who might be willing to take part in particular projects. In Australia, for example, more than 30,000 pairs of twins have joined the registry, making it the largest volunteer registry of its kind in the world. However, in some countries such as Denmark, the first twin registry was born in a medical faculty and it was then expanded to the National Twin Registry of Denmark. (Copied from article).
Food and fuel prices have soared in recent years affecting most adversely the poor and those with fixed incomes. Since 2000, wheat price in the international market has more than tripled and maize prices have more than doubled. The price of rice, the staple of billions in Asia, has tripled in the past year. The surge of food prices has been blamed on multiple factors including higher energy and fertilizer costs, greater global demand, drought, the loss of arable land to biofuel crops and price speculation. In light of the spiraling rise in food prices, there is the prospect of increasing rates of under-nutrition worldwide. As it is, 800 million are estimated to be suffering from chronic malnourishment, with another 2.1 billion people living close to subsistence levels on less than US$2 a day. Some perspectives of the food production experience of Malaysia are shared here as a case of a country that has built up capabilities and resources through high level of foreign and domestic investment leading to a diversified economy. In response to the recent surge in the price of rice, the Malaysian government announced the setting up of a dedicated fund amounting to US$1.25 billion to increase production of food including fruits and vegetables, and targeting 100% self-sufficiency in rice, by growing rice on a massive scale in Sarawak. During the current five-year development plan for the period of 2006-2010, (Ninth Malaysia Plan), the role of the agriculture sector is considerably enhanced to be the third pillar of economic growth, after manufacturing and services. Among the measures taken, are those aimed at increasing incomes of smallholders and fishermen mainly through improving productivity. These measures include encouraging more rice farmers to participate in mini-estates and group farming, providing financial assistance to rehabilitate cocoa, pepper and sago smallholdings, enhancing the capabilities of coastal fishermen, and setting up of a special program to assist poor households in the agriculture sector to diversify their sources of income. The various socio-economic programs in Malaysia that have been put in place over the years may have cushioned to some extent so far the severity of the dramatic hikes in food prices.