A prospective study done In al Zaafaranya General Hospital in Baghdad/Iraq In the period between April 2003 and February 2007. Ninety two patients admitted to the surgical wards diagnosed as Intestinal obstruction. The aim is to find out the possible common conditions resulting in causing this common surgical emergency. Also to compare the provisional clinical diagnosis about ischemic obstruction and the definitive post operative diagnosis. To encourage post graduate students to use their clinical abilities with the few laboratory and radiological facilities available needed to decide about the management of those patients.
Primary health care is an approach to health and a spectrum of services beyond the traditional health care system while primary care is just one element within PHC that focuses on health care services. The present status of PHC in Malaysia and the strides it has made in uplifting the health status of the nation is described. The challenges that the Malaysia health system are facing have necessitated a review of the structure of the whole health system and reforms in PHC will ensue in due course. The concept of 1Care, the proposed re-structuring of the health system, is discussed with emphasis on the reform in the PHC delivery system. The reforms are aimed at addressing three main concerns on seamless integration of care especially for the management of chronic diseases, ensuring universal coverage and responsiveness of the health system in the face of increasing client expectations and patient safety. The opportunity for macro reform to improve the health of Malaysians by developing a sustainable and high performing health care system is being seized by the Ministry of Health in 1Care. The micro reforms are discussed as regards to increasing access to services, development of primary health care teams to deliver comprehensive PHC, the application of ICT, the renewed emphasis on health promotion & prevention activities and a renewed focus on community empowerment and participation. Support in terms of human resource, governance & funding models, capacity building in monitoring & evaluation as well as change management to affect the reforms are identified. The paper concludes with lessons learnt from other countries and the importance of systemic reform for a well functioning health delivery system.
Accepted 07 August 2011.
Introduction Chronic kidney disease (CKD) has emerged as a major medical illness that drew the attention of the community. This research focused on the prevalence of five contributing factors to the progression of CKD, namely blood pressure control, glycaemic control, lipid control, smoking and alcohol intake, and explored significant association between these variables. This was a crosssectional study that examined the progression of CKD based on the worsening of CKD stages.
Methods This study was conducted among CKD patients with type 2 diabetes mellitus who attended Nephorology Clinic, UKMMC from April to May 2011. The progression of CKD was observed for 3 consecutive visits with 3 months intervals between the visits. Information regarding demographic data and social history were obtained through face-to-face interview, followed by case note review of the blood results. Data collected was analysed using SPSS version 19.0.
Results A total of 201 respondents were investigated, which included 39.3% (n=79) female and 60.7% (n=122) male. The mean age for the respondents was 66.9 years old (±SD 9.00). Among the respondents, 71.5% had poor glycaemic control; 59.7% had poor blood pressure control; 65.2% had poor lipid control; 19.9% smoked and 3.5% consumed alcohol. There was poor correlation, there were statistically significant association between systolic blood pressure control with the glomerular filtration rate (GFR) (p=0.001; r=-0.229). From this research, high systolic blood pressure was associated with low GFR, which indicated poor kidney function and resulted in progression of CKD.
Conclusions This study has clearly demonstrated that the control of blood pressure was essential in delaying the progression of CKD.
Accepted 11 August 2011.
Introduction Despite of its importance for preventing fatal and severe injuries in an event of a crash, limited studies were conducted to find out the status of seatbelt use among rear passengers in Malaysia. This study was conducted to the determine seatbelt use among rear passengers in Malaysia in conjunction with the introduction of the rear seatbelt law that took effect on 1st January 2009.
Methods Two methods were used; the roadside observations and surveys. A total of 4180 rear passengers were observed during the road side observation and 793 rear passengers were interviewed in the survey.
Results About 41.8 % (95 % CI: 38.3, 45.4) of rear passengers interviewed reported that they “Always/Often’ wore safety belts, while roadside observation recorded slightly lower rate (36.2 % [95 % CI: 34.8, 37.7]). Based on the roadside observation method, male rear passengers were more likely to use rear seatbelts as compared to female rear passengers (with Odd Ratio: 1.17 (95 % CI: 1.03, 1.33)). Both methods consistently reported that rear passengers of Multipurpose Vehicle (MPV)/Sport Utility Vehicle (SUV) (survey method “always wear”: 39.3 %, Odd Ratio: 2.02 [95 % CI: 1.13, 3.61], roadside observation method: 51.9 %, Odd Ratio: 2.23 [95 % CI: 1.89, 2.62]) were two times more likely to wear seatbelts as compared to rear passengers of a car.
Conclusions The two research methods indicate rear passengers in Malaysia were consistently having low seatbelt usage rate. As the rear seatbelt advocacy and enforcement programme are new in Malaysia, efforts to advocate rear seatbelt use should be strengthened. The changes in rear seatbelt usage rate need to be tracked regularly and as an alternative to roadside observation method, interview survey method could be used to measure the seatbelt usage rate and to identify the reason for not using safety belt among rear passengers.
Accepted 10 August 2011.
Introduction Cervical cancer (CC) is the second most prevalent female cancer in Malaysia. Almost 70% of its’ causal factors are attributable to oncogenic human papillomavirus (HPV) types 16, 18 and other risk factors. HPV genotypes distributions are also noted to differ by geographical area.
Methods This was cross sectional study conducted in 2007, to determine the influencing factors of HPV positivity and prevalence of HPV infections among patients with cervical cancer in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Patients’ paraffin-embedded cervical tissues kept in the Pathology Department from 1999 to 2007 were randomly selected. A total of 81 medical records with complete information were chosen as samples and patients were contacted for consent. Tissue samples were further derived for PCR DNA for HPV genotyping. Analyses included descriptive statistics; bivariate χ2 test and correlation were used to determine relationship between factors and HPV positivity. Significance level of less than 0.05 was taken as statistically significant.
Results Mean age of cancer diagnosis was at 52 ± 12.2 years. Women of Chinese ethnicity was the highest ethnicity to be HPV positive at 65.4% and squamous cell carcinoma was more commonly found (59.3%) compared with other types of cancers. The prevalence of HPV positivity was 92.6% with type 16 being the most common (74.1%), followed by type 33 (30.9%) and 18 (22.2%). Multiple HPV infections were a common finding at 54.3%. Factors thought to influence positivity i.e. age of intercourse, number of sexual partners, number of parity, smoking status of patients and their partners, oral contraceptive usage, presence of chronic illnesses and cancer stage were not significantly associated with HPV positivity. Increased CC severity level was not associated with increased number of HPV infections (Pearson correlation 0.58; p =0.607).
Conclusions High HPV positivity at 92.6% was found among ICC patients. Factors thought to influence HPV positivity were not significant. The top three HPV genotypes were type 16 followed by type 33 and 18. However, local women HPV serotypes findings need to be replicated in a larger population sample.
Accepted 23 August 2011.
Introduction There is a strong correlation between stress and the quality of care provided by informal carers. In this regard, an accurate understanding about factors
contributing to stress among informal carers is crucial in order to find appropriate interventions to solve their problems.
Methods A pilot study was conducted in October 2009 in the Klang Valley area, to test the instrument liability in the local context. In-depth interviews were conducted with two informal caregivers who are providing full-time care for their chronically-ill family members.
Results Informal caregivers face multiple types of stress. A variety of factors such as financial problems, an unsupportive community, fatigue, the unavailability of social services to assist them and their inability to accept the fact that their loved ones are terminally ill, contribute to their stress.
Conclusions Differences in factors contribute to stress, and lead to the adoption of different styles of coping strategies: emotion and problem focused coping.
Accepted 21 July 2011.
Introduction The extensive and intensive use of pesticides in agricultural practices has exposed farmers to various hazards resulting in varying degrees of health
outcomes.
Methods We conducted a cross-sectional study among paddy farmers in Sabak Bernam district, Malaysia. The objective of this study was to gather baseline information on chlorpyrifos blood level and its relationship with pesticides exposure symptoms.
Results We detected chlorpyrifos in farmers’ blood in 7 percent of the respondents, with mean 7.29 nanogram per millilitre blood (sd 5.84 nanogram per millilitre). The percentage of farmers who experienced at least one pesticide exposure symptoms was 75 percent. However, we found no significant association between chlorpyrifos blood level and its exposure symptoms. The farmers had low scores on safe practice of pesticide use even though they have high marks on knowledge and attitude. We found no significant association between the scores on knowledge, attitude and practice on pesticide use and the chlorpyrifos blood level.
Conclusions The presence of pesticide exposure symptoms proved that most of the farmers were exposed to hazardous effects of pesticides. Specific trainings on safe use and handling of pesticides should be given on regular basis to these farmers to ensure they are protected from hazardous effects of pesticides exposure.
Introduction Elderly are often associated with multiple social and health problems. Family members are important in helping them doing their daily activities. For elderly diabetics, family support has a role in diabetes management and glucose control. The aim of this study is to explore the perceptions of elderly diabetics regarding the role of family support on their glucose control.
Methods This qualitative technique was a part of the study on glucose control and its associated factors among elderly diabetics. It was conducted from February until May 2009 in Kulim. Ten respondents were purposively sampled based on their glucose control. HbA1c 6.5% or less was considered as good glucose control. In depth interview, using semi-structured interview guide was used in this study. The conversation had been taped, transcribed to verbatim and analyzed manually using thematic analysis.
Results All ten respondents perceived that family support did not play a role on their glucose control. They believed that self-awareness and self-determination were important to control the glucose level. Those with good glucose control practiced healthy diet, and not affected by food prepared by their family members compared to those with poor glucose control. However, both groups claimed that, they did not receive much advice from their family members and no special food was prepared for them. Conclusions Elderly diabetics should be motivated on self-determination and focusing on good glucose control. Health education should be given to patients and their family members to increase their diabetes knowledge especially on useful advice and proper food preparation. It could motivate the elderly diabetics to control their glucose level.
Introduction Children with cerebral palsy (CP) are often prescribed Rehabilitation and Seating Systems (RSS) to assist in daily activities, posture improvement and prevention of muscular-skeletal complications. In Sarawak, a special project to produce RSS was started under a partnership of a Japanese physiotherapist, health department and the community using local material.Aim To document the RSS project and to determine usefulness and costaffordability of these systems for cerebral palsy children and their families.
Methods The details of RSS manufactured were retrieved from the clinic notes and secretary file. Parents of children who received the seating systems between July 2004 and September 2008 were invited to complete a 5-point Global Parental Perception Questionnaire (GPPQ) between December 2008 and January 2009.
Results 277 RSS were manufactured between July 2004 and February 2011 (which included modified wheel chair, wooden chair, corner chair, buggy chair and standing frame), and used by children all over Sarawak. Parents of 73 children who used the seating systems completed the 5-points GPPQ. Ten families required full sponsorship. Children spent more time sitting up and brought outdoor more often after the systems became available. Majority of parents reported positive experience in their children with sitting ability, smiles, interaction with people, learning skills and easiness of doing physiotherapy. No change was noted with passing of motion drooling / oral secretion. Most parents agreed that the cost was affordable and worth paying.
Conclusions A community based initiative to manufacture RSS by using locally available material and skill, at affordable price for the parents was feasible and useful for the family/children with CP.
Intake and Output (I/O) records in hospitals were often found to be incomplete and illegible. The form used to record I/O is not user-friendly - i.e., they feature miniscule boxes, 'total' lines that do not correspond with shift changes and lack of instructions. Complaints often received from Specialists & Doctors regarding calculation errors or no totalling of I/O. Moreover, Nursing Sisters objective rounds often saw incompleteness of I/O chart. This study aims to identify the types of mistakes in recording the existing I/O chart. The second aim is to find out whether shift totalling of I/O chart helps in reducing mistakes. We try to determine whether the identified mistakes were repeated in the new I/O Chart. This study was conducted from October till December 2010 in 9 selected wards in Sibu Hospital. Data collection was divided into 3 phases. A pre-implementation audit using a checklist was carried out. The compliance rate of completeness of documentation of I/O Chart was 63%. A one month trial of new I/O chart was being done in the selected 9 wards. Post implementation audit showed a significant improvement of compliance rate (88%). Feedback from health care workers (N=110) showed that, 89% of doctors (n=17) and 60% of nurses (n=93) in the sample prefer to use the new format as more practical and relevant to the changing shift of nurses and doctors' ward round. It is suggested to implement the new format to increase compliance rate of documentation of I/O charting. Briefing should be given to nurses periodically and the new format should be introduced to nursing students in nursing colleges.
Developmental disabilities in young children are common, and the prevalence is estimated as high as 0.1-1.75% in the children population for each disabilities. With increasing awareness and health expectation, more children with Developmental disabilities are presenting to health care professionals, and at earlier age. Literatures also suggested the importance of early intervention programme in determining the outcome of this group of children. Therefore, it is vital for health professionals who have direct contact with young children are competent in detecting children with possible Developmental disabilities, and have the basic knowledge about some of the common disorders in order to discuss the issues with the parents. It is also important to work with the various resources available in the local community, such as non-governmental organisations for children with special needs, schools offering special education programmes and inclusive classes, and the allied health who provide cares to this group of young children and their family. A lot of information are also available online, and may be offered to help parents gaining more understanding regarding these Developmental disabilities.
Introduction Special Olympics (SO) Inc. is an organization for people with intellectual disability (ID) to actively engaging in Olympic-type sport and participating in competition. Special Olympic Inc. provides Healthy Athletes Programme (HAP®) in screening and providing health education to Special Olympic Athletes. Objective To study the body mass index (BMI), blood pressure (BP), visual acuity and hearing status of children and young adult with ID in Special Olympics Sarawak. Methods Health data were collected by trained health professionals under HAP®held in conjunction with Special Olympics Sarawak State Games on 17th and 18th April 2010 in Sibu. Health data collected were athletes' weight, BMI, BP, ear canal screen and hearing status (oto-acoustic emission, pure tone audiometry), as well as eye health and visual acuity, using guidelines set by HAP®. Results 195 athletes attended the State Games in 2010 of which 138 were screened. Significant number of athletes was considered overweight / obese (31.5% for children and 36.9% for adult). More than 20% of the adult athletes were hypertensive or at risk of hypertension. Sixteen percent of the adult athletes had hearing loss. More than half of the adult and children athletes never had eye checks, and a significant numbers of them had abnormal eye tests results. Conclusions Health screening conducted during the HAP® is a useful screening program in this population. Health data collected can bring awareness to athletes and their family, and corrective measures in hearing and visual impairment can be taken immediately.
The World Health Organisation (WHO, 2006) defines teenage pregnancy as a 'teenaged or underaged girl (usually within the ages of 13-19) becoming pregnant.' The term usually refers to women who become pregnant, who have not reached legal adulthood; legal adulthood varies in different countries. The term teenage pregnancy is widely used however, to mean unmarried adolescent girls who become pregnant. Pregnant teenagers face many additional obstetric, medical & social issues compared to women who give birth in their 20s and 30s. Most at risk are mothers under fifteen and those living in developing countries. Complications during pregnancy and delivery are the leading causes of death for girls aged 15 to 19 in developing countries; they are twice as likely to die in childbirth as women in their twenties, with adolescents accounting for 13% maternal deaths worldwide. There is evidence to show (UNICEF Malaysia, 2008) that teenage pregnancy is associated with lower educational levels, higher rates of poverty and that the situation is often repeated with children of teenage parents. In addition, teenage pregnancy is often outside of marriage and therefore carries a social stigma in many cultures and community.
Pregnancy and childbirth are generally regarded as a turning point for women even though it is not an illness. This is because the physiological and psychosocial adaptation can bring about stress and anxiety. Ontologically a pregnant woman is not merely an object that can be classified as a
primigravida or according to her obstetric condition. The contention is that she is also a daughter, a working woman, and a wife with her past, present and future. All these determine who she is and influence how she thinks, acts, feels and behaves during childbirth (Polt, 1999). This journal is about Heideggerian hermeneutic study: Malaysian Chinese women’s expectations and lived experiences of childbirth.
Introduction The purpose of this paper is to demonstrate the effectiveness of using TelePrimary Care (TPC) to monitor immunization programmed in a clinic. Japanese Encephalitis (JE) vaccination was selected as an example because its coverage has not been satisfactory when compared to that of other vaccinations, which generally exceed 90%.
Methods Data for all children who were eligible for JE vaccination (age range from 9 months to 30 months) who attended Sarikei Health Clinic between 1 January 2007 till 31 June 2008, was extracted from the TPC database and analyzed for completeness and timeliness of JE vaccination.
Results The analysis showed that although 1,243 children were eligible to receive their first dose of J vaccine at 9 months of age, only 560 (45%) received it. 15 (3%) received on time, and 545 (97%) received it late (age range from 10 months to 20 months). Out of the 560 who were scheduled to receive their second dose of JE vaccine four weeks after the first, 382 (88%) received it on time, and 55 (12%) received it late. Only 78 (18%) out of 429 children aged between 18 months to 24 months received their booster dose; 52 (67%) received it on time and 26 (33%) received it late.TPC not only enables health staff to monitor immunization coverage and timeliness accurately, but it also helps them to identify defaulters quickly so that these children can be traced and immunized. Doing these tasks manually is time-consuming and tedious, leading to delays in tracing defaulters.
Conclusions TPC provides an effective system for staff to easily access real time child health data to monitor and audit their immunization programme and take remedial action where necessary.
Study site: Klinik Kesihatan Sarikei, Sarawak, Malaysia