Emotional disorders are common human emotional states that include anxiety, depression, social impairment and somatic symptoms. Emotional disorders are common in the community and therefore an important issue in primary care practice. The objective of this study was to determine the prevalence of emotional disorders among adults at a rural primary care clinic in Malaysia and to identify the associated factors. A cross-sectional study was conducted at Klinik Kesihatan Sungai Mati, Muar, Johor from 1st November to 31st December 1998. A self-administered 30-item General Health Questionnaire (GHQ-30) was used to screen for emotional disorders. Out of 414 patients seen during the study period, 368 fulfilled the selection criteria and agreed to participate in the study (response rate 88.9%). The prevalence of emotional disorders among the adult patients in this study was 15.2%. Factors such as age, race, gender, marital status, education level and employment were analyzed for association with emotional disorders. However, none of these factors were found to be significantly associated with emotional disorders in this study.
Introduction: Little is known about anxiety symptoms among diabetic patients, especially among those who are living in rural areas in Malaysia. Thus, the aim of this paper is to investigate the prevalence of anxiety among diabetic patients and factors associated with anxiety in rural communities in Malaysia.
Methods: A cross-sectional study involving 464 diabetes mellitus patients in rural health districts and outpatient clinics in Malaysia was conducted. Each participant was interviewed using the Hospital Anxiety and Depression Scale.
Results: Respondents consisted of 193 (41.6%) males and 271 (58.4%) females. The mean age of participants was 59.65 ± 10.16 years and the mean duration of diabetes mellitus was 6.9 ± 6.3 years. Results indicate that 15% of the participants have anxiety symptoms. Multiple logistic regression analysis revealed that patients with history of ischemic heart disease and depression and those who were underweight have higher anxiety scores with adjusted OR 5.06 (95% CI 1.79 to 14.27), 27.71 (95% CI 14.23 to 53.98) and 14.6 (95% CI 2.49 to 84.82), respectively.
Conclusions: This study suggests that although the prevalence of anxiety among diabetics is low, primary care physician should be trained to identify high risk patients and to manage their condition in order to improve the clinical outcome.
The population of Malaysia is estimated in 2018 to be around 32.04 million and 23.5% of the population resides in rural areas. The Ministry of Health has provided healthcare services to the rural areas with the access of modern healthcare facilities based on the two-tier healthcare system. In remote areas, mobile health clinic is the extension of healthcare service by the nearest static health clinic. However, most of the remote areas only covered by a community clinic or Klinik Desa which is limited for mother and child healthcare. There is demand from the people in remote areas for static health clinic or Klinik Kesihatan. Objectives: This study is to evaluate and compare the effectiveness between two health services in remote areas applied in Sabah. This study also determines which type of health services that able to worth the service to people in remote areas. Methods: This is a descriptive study. Data was taken from HMIS report (Per PL 206) under Sabah State Health Department. The data analysed by using Microsoft Excel. Results: This study was conducted based from the data obtained in 2015 till 2017 for the number of patients attended to static health clinics and mobile health clinics on selected remote areas. For example, Jambongan Health Clinic only have an average of 10 – 15 patients per day while the Mobile Health Clinic team under Beluran Health District which covers the adjacent remote areas of Jambongan Island have more than 20 patients per day on a single visit. Another example is from Terian Health Clinic in Penampang, which only have an average of 5 – 10 patients per day. However, on the mobile health team on a single visit to the village next to Terian which is Kg. Buayan, the average patients attended for the service is mo re than 20 patients. Conclusion: From the study, it was noted that people in remote areas prefer the mobile health service to visit their villages. This can be due to financial issue and limitation of transportation service to the nearest static clinic. The density of population and the development of the rural areas play important roles for the healthcare service to be effective in remote areas.
INTRODUCTION: Diabetes-related distress (DRD) refers to patient's concerns about diabetes mellitus, its management, need of support, emotional burden and access to healthcare. The aim of this study was to translate and examine the psychometric properties of the Malay version of the 17-item Diabetes Distress Scale (MDDS-17) in adult patients with type 2 diabetes mellitus (T2D).
METHODS: A standard procedure was used to translate the English 17-items Diabetes Distress Scale into Malay language. We used exploratory factor analysis (EFA) with principal axis factoring and promax rotation to investigate the factor structure. We explored reliability by internal consistency and 1-month test-retest reliability. Construct validity was examined using the World Health Organization quality of life-brief questionnaire, Morisky Medication Adherence Scale, Patient Health Questionnaire and disease-related clinical variables.
RESULTS: A total of 262 patients were included in the analysis with a response rate of 96.7%. A total of 66 patients completed the test-retest after 1 month. EFA supported a three-factor model resulting from the combination of the regimen distress (RD) and interpersonal distress (IPD) subscales; and with a swapping of an item between emotional burden (EB; item 7) and RD (item 3) subscales. Cronbach's α for MDDS-17 was 0.94, the combined RD and IPD subscale was 0.925, the EB subscale was 0.855 and the physician-related distress was 0.823. The test- retest reliability's correlation coefficient was r = 0.29 (n = 66; p = 0.009). There was a significant association between the mean MDDS-17 item score categories (<3 vs ≥3) and HbA1c categories (<7.0% vs ≥7.0%), and medication adherence (medium and high vs ≥low). The instrument discriminated between those having diabetes-related complication, low quality of life, poor medication adherence and depression.
CONCLUSION: The MDDS-17 has satisfactory psychometric properties. It can be used to map diabetes-related emotional distress for diagnostic or clinical use.
Dzulqarnain Ahmad Iskandar Shah, Nursabrina Roslan, Khairun ‘Izzah Zamansari, Tuan Nur Athirah Tuan Mohd Rahimi, Shahida Mohd-Said, Haslina Rani, et al.
The important role of non-dental healthcare professionals (HCPs) in promoting oral health is well-accepted and has received increased attention in recent years. However, greater efforts are needed to train them in ensuring better competency in delivering this role. The aim of the present study is to assess oral health and care knowledge among HCPs by further exploring possible challenges faced by them in managing oral health problems, particularly in regard to patients in a public primary healthcare clinic. In the case of the current research, a focus group discussion was carried out with ten HCPs who are directly involved with patients from different units within the health clinics. In particular, the questions developed for the focus group discussion were divided into two parts: (1) knowledge on oral health and its link to general health, and (2) issues and challenges faced by HCPs in handling patients with oral health problems in their daily routine. The session was recorded on a digital audio tape, the responses were then transcribed, followed by the grouping of the scripts which were then qualitatively analysed. The results revealed that majority of the participants appeared to have good knowledge of general and basic oral health; however, only very few of them were aware of the relationship between oral health problems with systemic conditions. Meanwhile, one of the main challenges faced by HCPs in handling patients with oral health problems is their limited knowledge of oral health problems. Specifically, the main challenges refer to the management of medically compromised patient requiring dental treatment as well as the difficulty in changing the mindset of patients regarding oral health issues, especially in terms of seeking dental treatment. In conclusion, it has been clearly observed that HCPs involved in the present study have good knowledge of general health and oral health but limited knowledge related to oral health to systemic health. Furthermore, they tend to face numerous challenges when dealing with patients, especially due to their limited knowledge of oral health facts and drug prescription for oral problems. Therefore, there is an urgent need of additional training for both HCPs and dental teams for the purpose of enabling both parties to provide coordinated and comprehensive service to patients with oral health problems at the primary healthcare clinics.
Keywords: Interprofessional collaboration; care coordination; multidisciplinary; oral health knowledge; healthcare professionals
OBJECTIVES: To assess drug use pattern and the effect on glycemic and blood pressure (BP) control in type 2 diabetes mellitus (T2DM) and hypertensive patients. Furthermore, to evaluate the duration of drug use and antecedence in diagnosis.
METHODOLOGY: A cross-sectional study design, comprising interview/questionnaire targeting outpatients attending primary health centers in Al Ahsa was adopted. During the interview, their fasting blood glucose, weight, and height were measured, along with their BP. Time and duration of drug use were recorded. The history, sociodemographic data and the presence of any other disease conditions were also documented.
RESULTS: The highest number of uncontrolled BP and poor glycemic control was among the age group of 45 and 49 years. Significant number of the patients (92.9%) had body mass index >30 kg/m(2). The prevalence of developing hypertension before T2DM among participants was 59.9%. A significant number (84%) had uncontrolled hypertension, and 67.3% had uncontrolled T2DM. Drug use pattern revealed single or combinations according to clinical guidelines initially but did not follow through in meeting targets. Majority received angiotensin converting enzyme inhibitors, amlodipine or atenolol for BP control and metformin for T2DM. Patients diagnosed between 1 and 5 years displayed significant poor glycemic and BP control. Significantly, most patients appeared to have been on same prescriptions for a longer time without review.
CONCLUSION: Poor glycemic and BP controls observed in this study could be due to deficient treatment strategy among others. Patients were, however, not adequately managed in line with prescribed clinical guidelines.
BACKGROUND: Smoking cessation clinics have been established in Malaysia since 2004, but wide variations in success rates have been observed. This study aimed to evaluate the proposed pharmacist-led Integrated Quit Smoking Service (IQSS) in Sabah, Malaysia, and identify factors associated with successful smoking cessation.
METHODS: Data from 176 participants were collected from one of the quit-smoking centres in Sabah, Malaysia. Pharmacists, doctors and nurses were involved throughout the study. Any health care provider can refer patients for smoking cessation, and free pharmacotherapy and counselling was provided during the cessation period for up to 3 months. Information on demographic characteristics, smoking behaviours, follow-up and pharmacotherapy were collected. The main outcome measure was the abstinence from smoking, which was verified through carbon monoxide in expired air during the 6-month follow-up.
RESULTS: A 42.6% success rate was achieved in IQSS. Smoking behaviour such as lower cigarette intake and lower Fagerström score were identified as factors associated with success. On top of that, a longer duration of follow-up and more frequent visits were significantly associated with success in quitting smoking.
CONCLUSION: Collaboration among health care practitioners should be the main focus, and we need a combination of proven effective modalities in order to create an ideal smoking cessation module.
Study site: Klinik Kesihatan Luyang, Kota Kinabalu, Sabah, Malaysia
Client satisfaction upon health services is important for public especially for those who have to undergo treatment for tuberculosis (TB) noted for its difficult regime. The purpose of this study is to measure client dissatisfaction level towards TB treatment & services among TB patients in government outpatient health services and the factors that influenced it. This study was carried out in all the districts of West Coast Division of Sabah. It was conducted from June 2002 to November 2002. Study design is cross-sectional, with population samples taken on those who are currently receiving outpatient TB treatment in government health facilities. Questionnaires forms were used as study tool and filled by either by respondent or through the help of trained interviewer. The outcome is based on the total score obtained through Likert scales to determine the proportion of dissatisfied group from the respondents. A total of 488 patients took part in this study. Results of study showed overall percentage of 31.8% dissatisfaction level towards TB
treatment & services, while dissatisfaction towards TB treatment and upon health services alone were 54.3% and 24.0% respectively. The predictive factors for client dissatisfaction towards TB treatment and services are those without education, longer waiting time and have opinion of insufficient number of health staff.
Key words: Tuberculosis, client satisfaction, TB treatment, services, Sabah.
Study site: Outpatient clinics, hospitals, Sabah, Malaysia
Purpose- Work ethics are practice and speed that should be practiced during working. This study was conducted to identify positive work ethics among health clinic staff who work at the counter and in the clinic
Design/methodology/approach- This study was carried out from January 2008 until December 2008. Health Clinic staff who work at the counter and in the clinic were chosen as respondents. Self- administered questionnaire was used to gain feedback on work ethic practice among staff. The questionnaire consists of evaluation questions on staff in the respondent's deoaftment
Findings- From the study, approximately B0% of staff have practiced positive work ethics, From 15 work ethics practices, there were only three that should be give attention; i.e. (i) gossiping, (ii) apathetic on reprimand and advice, and (iii) hot- tempered, Improvement strategies need to be formed especially strengthening the soft skills courses and increasing the communication skills to the counter staff, It is also wise to form a leader as a'role model' in improving effective supervisory skills in service counter. Keywords: Work Ethics, Counter Staff, Clinic Staff, Health Clinic
OBJECTIVE: To assess a better strategy to implement oral iron supplementation in preschool Orang Asli children with high prevalence of iron deficiency, as opposed to the current practice, yet inefficient, of daily oral iron supplementation regime.
METHODS: A randomized controlled trial was conducted in preschool children presenting to a remote health center (Klinik Desa Kenang, Sungai Siput, Perak) with iron deficiency state. Oral iron prescribed as a daily unsupervised dose (group A) was compared to a weekly supervised administration (group B) over eight weeks.
RESULTS: Before intervention, iron deficiency was prevalent in these children (91.2%). The mean baseline haemoglobin and ferritin levels of group A were 9.9 (+/- 1.1) g/dL and 8.9 (+/- 1.3) mg/L respectively, and that of group B were 9.9 (+/-1.2) g/dL and 9.7 (+/- 1.9) mg/L respectively. After eight weeks of treatment, the mean rise in haemoglobin and ferritin levels of group A were 1.2 (+/- 0.6) g/dL and 18.1 (+/- 15.1) mg/ L respectively, as compared to group B, where the mean rise in haemoglobin and ferritin levels were 1.8 (+/- 0.7) g/dL and 35.2 (+/- 21.8) mg/ L respectively. The differences in the rise of haemoglobin and ferritin levels of the two groups were statistically significant (p<0.025). Both regimes were however effective in improving the iron status in a short term (88% in group A and 100% in group B), but group B had a better iron improvement (35.2 +/- 21.8 versus 18.1 +/-15.1 mg/L).
CONCLUSION: It was concluded that the supervised weekly oral iron supplementation regime was more effective than the unsupervised daily supplementation for treating iron deficiency in preschool Orang Asli children. Since iron deficiency is so common in these children and in view of the possibility of poor compliance with the unsupervised regime, an intermittent supervised treatment is proposed as the most effective strategy to address this nutritional problem.
Belaga District, in the heart of Borneo, is probably the most remote district in Sarawak. Although Belaga town is now accessible by land (50% are timber camp unsealed road) from Bintulu, the journey takes 5 hours and transport cost is high. Accessibility to Belaga by river is also subject to weather conditions and the town often gets cut off during the dry season and also during the wet season. All these pose immense challenges to the delivery of health care services to the people of Belaga and greatly reduce their accessibility to even basic health services. Access to specialist services is even more challenging as it is only available in Sibu and Bintulu; and visiting clinics in Belaga are infrequent due to the shortage of specialists and difficult transport. (Copied from article).
Non-communicable diseases (NCDs) represent among the most common and debilitating conditions seen in primary care. Patients’ care will often involves multiple providers and follow-up requires persistence by patients and clinicians alike, therefore ideal outcomes are often difficult to achieve. The need for better disease management policies and practice is growing. This is due to the changing demographic profile of the population, the increasing cost of managing people in acute care hospitals and the availability of new technologies and services. All these changes enable a different care paradigm which is more cost effective and provides people with chronic conditions an improved quality of life. Management of the NCDs therefore offers an excellent opportunity to practice chronic disease management - a systems approach designed to ensure excellent care.
The NCD team has developed a comprehensive approach to chronic disease care. We would like to describe the NCD Program in Ampangan Health Clinic which represents many typical government health clinics in Malaysia and the processes by which it was developed. Included are specific examples of the tools and how they can be used by individual clinicians in caring for patients. The integration of Chronic Disease Management Services into health care systems is the direction being undertaken to tackle the burden of chronic disease. Disease management supports the shift in healthcare from an emphasis on managing the acute episode to managing the entire disease course, highlighting both prevention and maintenance of wellbeing for patients with chronic diseases. Disease management promotes better integration and coordination of care across all aspects of the health sector.
Sleep quality can vary in relation to one’s general well-being and in the elderly, it is often affected by the presence of medical or psychological conditions. This study aims to determine the frequency of different components of sleep quality in the elderly, and their relationships with psychosocial and medical attributes. A cross-sectional study was conducted on 123 attendees aged 60 years and above at Pusat Perubatan Primer Universiti Kebangsaan Malaysia. Sleep quality and psychological distress were assessed using the validated Malay versions of Pittsburgh sleep quality index (PSQI) and Hamilton anxiety depression scale (HADS) respectively. Information on medical comorbidities and medications were obtained from the participants, their doctors and medical notes. Almost half of the patients experienced poor sleep quality (47.2%) which was significantly associated with older mean age (69.5 ±4.55). There was no statistical significance between sleep quality and other sociodemographic characteristics (gender, ethnicity and living arrangement). Most patients described their sleep quality as subjectively generally “fairly good” (69.1%) despite PSQI scores indicating poor sleep quality. A majority of the patients (59.3%) were on follow-up for 3 or more medical illnesses, with heart disease as the only medical comorbidity significantly associated with poor sleep quality. Most of them also complained of only “mild difficulty” with their sleep. Among the 7 sleep components of PSQI, “sleep disturbance” was the most frequent experience. Most experienced mild sleep disturbance (87.8%) and usage of hypnotic agents was low (6.5%). Only 23.6% of patients had significant psychological distress (HADS scores ≥ 8), with positive correlation with sleep quality.
Study site: Pusat Perubatan Primer, Universiti Kebangsaan Malaysia (PPPUKM), Kuala Lumpur, Malaysia
Job satisfaction is defined as pleasurable or positive emotional state which results from the appraisal of one’s job or job experience. It is often determined by how well outcome meet or exceed expectations. There are many factors which are related to job satisfaction among family physicians. Data on satisfaction among family physicians varies from country to country. This study aimed to determine the level of job satisfaction among family physicians in Malaysia and its associated factors. A cross sectional study was performed among 117 family physicians in Malaysia between July 2012 and December 2012. A questionnaire consists of socio-demographic characteristic, professional and health clinic characteristics and Warr-Cook-Wall job satisfaction scale was used. The results showed that 85% of Malaysian family physicians are satisfied with their job. They are mostly satisfied with hours of work, colleagues and fellow workers, and freedom to choose own method of working. They are least satisfied with physical working condition, rate of pay and recognition. Female gender and less number of health clinics in-charged were associated with increased in overall job satisfaction. Most of the family physicians in Malaysia are satisfied with their job. However there are certain areas that should be looked into which are physical working condition, rate of pay and recognition. Malaysian family physicians should receive equal career opportunity, promotion and salary scale like other specialties
To assess the oral health related quality of life
(OHQoL) of a selected population of Malaysian adults and to compare the OHQoL by periodontal status. Material & Methods: This cross-sectional study comprises a convenient sampling of fifty subjects from the Primary Care Unit, Faculty of Dentistry, University of Malaya. OHQoL was assessed using the Malaysian version of Oral Health Impact Profile-14 (OHIP-14). Basic periodontal examination (BPE) was performed on all subjects to determine their periodontal status. Descriptive statistics and bivariate analysis were performed.
Results: Psychological discomfort, physical pain and psychological disability domains were the most affected dimensions in this population. Subjects with income levels >RM2,500 had higher impacts on their OHQoL as compared to those from other income levels (p0.05).
Conclusion: Subjects with high income levels had high impacts on their OHQoL. Those with periodontitis experienced higher impacts on their OHQoL as compared to those who had a healthy periodontium or gingivitis and affected a wide range of domains of quality of life.
A survey of smoking habits among the students attending the Student Health Clinic for various ailments showed:
(1) Smoking in women is very uncommon (only 2 out of 79; 2.53%)
(2) About 30% of men smoke (106 out of 322; 32.9%)
3. The majority of these had commenced smoking before they entered the university.
4. The majority smoked filter tipped brands.
5. Where the mothers in the family smoked, the sons seem to take to smoking more readily.
6. Knowledge of the effects of smoking on health was poor, but equal in all three groups viz in women and in both smoking and non-smoking men.
Diversified leisure involvement pose various health benefits to the elderly population. However, some elderly are too focus on doing a particular type of activity during their leisure time such as religious activity. This study aims to explore factors that could possibly contribute to the higher involvement in religious activity among the Malay ethnic elderly in Malaysia. In depth interviews were conducted, involving a total of 20 elderly aged 60 years and above with stratification by background characteristics. Each interview was conducted for an average of 15 to 30 minutes. They were purposively selected from two health clinics located in two different districts in the state of Selangor, representing an urban and a rural area. Majority of the elderly interviewed perceived that by engaging in religious activities such as prayer and reciting the Holy Quran or old Islamic scripture gives them serenity or calmness. Additionally, they also felt that involvement in such activities is very synonymous with being old and therefore one should be actively involved in religious activities with increasing age. In view of the lack of diversity of leisure involvement among the elderly and the passive and solitary nature of some of the religious activities, the elderly should be made aware of the importance of participating in other types of leisure activities especially physical activities. Although, they gain spiritual and social benefits from involving in religious activities, they also need to perform other form of activities that can improve the physical health status.
Introduction : Nursing is an occupation associated with high risk of developing back pain due to their nature of work practices. The aim of this study was to determine the prevalence of back pain among nurses working in government health clinics and hospitals in Port Dickson and the factors associated with it.
Methods : A cross sectional study was conducted involving 126 nurses working in government health clinics and district hospital in Port Dickson. They were universally sampled. A selfadministered questionnaire, assessing personal and socio-demographic characteristics, back pain, work factors and psychosocial factors.
Results :The prevalence of back pain among nurses was 79.4% and factors that showed significant association were workplace (p=0.026) and carried heavy load (p=0.043).
Conclusion : Where one work and nature of work one does has been shown in this study to be important issues to be considered in helping to manage back pain related to work. It is also recommended that staff need to be encouraged to do exercise to strengthen the back muscles, increase spinal flexibility and blood circulation to the spine as well as need to be reminded regarding ergonomic adjustment at work.
While the prevalence of visually impaired children constitutes a small portion of the visually impaired population, it is important to determine whether the low vision services available are utilised by these children. This is important as previous studies have shown that children have a very high rate of successful low vision device use compared to adults. This was a cross sectional retrospective study. Fifty nine low vision clinic children records were evaluated. The results showed that 25.4% of the children were categorised as with moderate low vision, 30.5% with severe low vision and 40.7% were categorised as blind. The major causes of low vision were congenital cataract, congenital nystagmus, congenital glaucoma, macular degeneration and retinitis pigmentosa. Low vision rehabilitation for near work using magnifiers improved the vision of 30.5% of the low vision children. This finding suggests that 1/3 of low vision children could benefit from low vision rehabilitation. The low vision devices most commonly prescribed to the children in this study were stand magnifiers, hand-held magnifiers and spectacles. This study illustrates the key role of optometrists in the management of visual impairment in Malaysian children. It would appear that the establishment of low vision services in government hospitals using trained optometrists is a cost effective method of service delivery. Therefore more low vision children would have access to proper low vision rehabilitation and through that rehabilitation, their quality of life can be improved.
Key words: children, low vision
Study site: Klinik Penglihatan Terhad Pusat Perubatana, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia