Haematuria is a common presentation of bladder cancer and requires a full urologic evaluation. This study aimed to develop a scoring system capable of stratifying patients with haematuria into high or low risk groups for having bladder cancer to help clinicians decide which patients need more urgent assessment. This cross- sectional study included all adult patients referred for haematuria and subsequently undergoing full urological evaluation in the years 2001 to 2011. Risk factors with strong association with bladder cancer in the study population were used to design the scoring system. Accuracy was determined by the area under the receiver operating characteristic (ROC) curve. A total of 325 patients with haematuria were included, out of which 70 (21.5%) were diagnosed to have bladder cancer. Significant risk factors associated with bladder cancer were male gender, a history of cigarette smoking and the presence of gross haematuria. A scoring system using 4 clinical parameters as variables was created. The scores ranged between 6 to 14, and a score of 10 and above indicated high risk for having bladder cancer. It was found to have good accuracy with an area under the ROC curve of 80.4%, while the sensitivity and specificity were 90.0% and 55.7%, respectively. The scoring system designed in this study has the potential to help clinicians stratify patients who present with haematuria into high or low risk for having bladder cancer. This will enable high-risk patients to undergo urologic assessment earlier.
BACKGROUND: Primary health care workers (PHCW) are the front-liners in any infectious disease outbreaks. The recent outbreak of H1N1 influenza demonstrated that uptake of H1N1 vaccination remained low amongst PCHW despite its proven effectiveness. This trend is worrying as PHCW are the first point of contact in any emerging outbreak of future influenza epidemic. To investigate factors influencing willingness of H1N1 vaccination amongst PHCW.
METHODS: A cross-sectional survey using self-reported questionnaire assessing perception and practice towards H1N1 Influenza A vaccination. A score of 34/50 was used as a cut-off score that divide good and poor perception. Logistic regression analysis used to explore the association between acceptance to be vaccinated and chosen variables.
RESULTS: The mean age was 33.91 (SD: 8.20) with mean year of service of 9.23 (SD: 8.0). Acceptance of H1N1 vaccination was 86.3%. A total of 85.9% perceived the vaccination can prevent serious disease. Willingness to be vaccinated influenced by perception at risk of having illness (OR: 10.182, CI: 1.64-63.23, P 0.013) and need for vaccination (OR: 11.35, CI: 4.67-27.56, P < 0.0001).
CONCLUSIONS: PCHW were generally willing to be vaccinated should H1N1 Influenza epidemic emerges in the future. However, acceptance of vaccination was influenced by factors of benefit to prevent illness and reduction of spread of the illness. Fear of side-effects remained a barrier toward acceptance which should be taken into account in planning of preparation for future wave of outbreak.
BACKGROUND: This paper presents the level of colorectal cancer awareness among multi-ethnic rural population in Malaysia.
METHODS: A rural-based cross sectional survey was carried out in Perak state in Peninsular Malaysia in March 2011. The survey recruited a population-representative sample using multistage sampling. Altogether 2379 participants were included in this study. Validated bowel/colorectal cancer awareness measure questionnaire was used to assess the level of colorectal cancer awareness among study population. Analysis of variance (ANOVA) was done to identify socio-demographic variance of knowledge score on warning signs and risk factors of colorectal cancer.
RESULTS: Among respondents, 38% and 32% had zero knowledge score for warning signs and risk factors respectively. Mean knowledge score for warning signs and risk factors were 2.89 (SD 2.96) and 3.49 (SD 3.17) respectively. There was a significant positive correlation between the knowledge score of warning signs and level of confidence in detecting a warning sign. Socio-demographic characteristics and having cancer in family and friends play important role in level of awareness.
CONCLUSIONS: Level of awareness on colorectal cancer warning signs and risk factors in the rural population of Malaysia is very low. Therefore, it warrants an extensive health education campaign on colorectal cancer awareness as it is one of the commonest cancer in Malaysia. Health education campaign is urgently needed because respondents would seek medical attention sooner if they are aware of this problem.
With the advent of new technology, the treatment for ureteric stricture has moved from open surgery to endoscopic procedures. Our goals were to review and determine the prognostic factors for success of laser endoureterotomy for ureteric stricture. This is a cross sectional study for all cases that underwent laser endoureterotomy in a single centre from 2002 to 2009. Standard treatment in this centre utilizes holmium laser. The fiber used was 365nm, setting as 1J and frequency 8 Hz; power output 8 W. Confirmation of adequacy of incision wss by either visualization of extra-ureteric fat or extravasations of contrast on fluoroscopic imaging. Success or recurrence of the endoureterotomy was confirmed objectively with evidence of improvement from imaging. Of these 77 patients, 42 cases (61.8%) of the strictures were from upper ureter. Eight cases (11.7%) of mid-ureteric while lower ureter had 18 cases (26.5%). Length of stricture has been grouped into two groups; Short (<1cm) and long (≥1cm) and their distributions were 47.1% and 26.5% respectively. Follow-up duration ranged from six months to 88 months with an average of 19.6 months. Success rate was 76.5% (52 patients) while 16 patients (23.5%) developed recurrence. Stone disease, positive presenting symptoms and short length of the stricture were identified as variables with good predictor. This study achieved a 76.5% of success rate for this treatment modality for benign ureteric stricture in wellselected patients. Success is more likely if patient is symptomatic (earlier treatment) and previous stone disease present as a risk factor.
Study site: Hospital Selayang, Kuala Lumpur
Gastro-oesophageal reflux disorders (GORD) are common in Western countries and has been reported to be increasing in the East. This study assessed the prevalence of GORD among the Nepalese residing in the Brunei Darussalam.
The objective of the study was to investigate the associated factors of sleep quality and behavior among Malaysian tertiary students. The response rate to the questionnaire study was 41.0%. 1,118 students (M = 486, F = 632; mean age = 20.06 ± 1.53 years) were recruited from Universiti and Kolej Tunku Abdul Rahman (Perak campuses) who completed a sleep quality and behavior questionnaire based on Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Horne-Ostberg Morningness-Eveningness Scale (MES) and craving of high-calorie foods. Results showed that students had the following sleeping habits - bed time = 2.41 a.m. ± 3.35 hr, rise time = 9.00 a.m. ± 1.76 hr, sleep latency = 16.65 ± 14.30 min and sleep duration = 7.31 ± 1.45 hr. 32.9% of the students were defined as poor quality sleepers, 30.6% suffering excessive daytime sleepiness (EDS) and 81.6% were categorized as individuals with 'definitely eveningness', defined as people who are definitely most alert in the late evening hours and prefer to go to bed late. There were no significant gender differences in sleep quality, 'chronotype' and EDS. Although there was no association of sleep quality and EDS with cumulative Grade Point Average (cGPA) and class skipping, EDS was associated with the tendency to fall asleep in class. Body Mass Index (BMI) was not associated with total sleep, PSQI, ESS and MES scores. Meanwhile, high-calorie food craving was associated with sleep duration, PSQI and ESS, but not MES. In conclusion, poor sleep behavior among Malaysian tertiary students in this study was not associated with gender, academic performance and BMI, but was associated with craving of high-calorie foods instead.
Hepatitis-B is a life threatening infection resulting in 0.6 million deaths annually. The prevalence of Hepatitis-B is rising in Pakistan and furthermore, there is paucity of information about Knowledge, Attitude and Practice among Hepatitis-B patients. Better disease related knowledge is important to have positive attitude and that will bring the good practices which will prevent the further spread of infection. This study aimed to evaluate knowledge, attitude and practice of Hepatitis-B Patients in Quetta city, Pakistan.
Staphylococcus aureus is usually considered a colonizer but can result in infections under favourable conditions, especially in the healthcare setting. Healthcare workers can be colonized by S. aureus, and may transmit them to patients under their care. We conducted a cross sectional study to determine the prevalence of S. aureus nasal carriers among medical students in Universiti Putra Malaysia (UPM) (from January to June 2011). Our study involved 209 medical students comprising of 111 and 97 preclinical and clinical students respectively. A selfadministered questionnaire was distributed and nasal swabs were collected. Upon identification, the antibiotic susceptibility of the isolates was examined followed by categorical analysis (Chi-square and Fisher's exact tests) with factors associated with S. aureus nasal carriage. Twenty one (10%) S. aureus strains were isolated from 209 nasal swab samples. 14 isolates were from pre-clinical students while the remaining seven were from clinical students. There was no significant association between gender, ethnicity, health status, skin infection and students' exposure to hospital environment with S. aureus nasal carriage (p>0.05). Nineteen (90.5%) isolates were resistant to penicillin and there was also no significant association between penicillin resistant and the students' groups. One (5.3%) isolate was resistant to erythromycin. There was no methicillin-resistant S. aureus isolated in this study.
INTRODUCTION: Various studies in primary care and hospitalized patients have discouraged routine use of chest x-ray (CXR) in medical examination.
PURPOSE: The study aims to determine the prevalence of abnormal routine CXR and cost of one CXR at a public health clinic and discuss the rationale of CXR in routine medical examination.
METHODOLOGY: Data of patients who visited Klinik Kesihatan Bandar Kota Bharu (KKBKB), a public health clinic, from 1 January until 31 December 2010 were examined. The study used cross-sectional design. All patients who came for medical examination and CXR at KKBKB were included. Cost analysis was performed from the perspective of provider.
FINDINGS: About 63.1% of 8315 CXR films in KKBKB were produced as part of routine medical examination. Prevalence of abnormal CXR was 0.25%. The cost of producing one CXR ranges from RM15.87 to RM32.34.
DISCUSSION: Low yield from CXR screening and high cost of CXR are the main concern. CXR screening would also lead to unnecessary radiation; and false-positive screening resulting in physical risk, unwarranted anxiety and more expenditure. CXR screening is appropriately reserved for high-risk patients and those with relevant clinical findings.
OBJECTIVE: The objective of the study was to assess public knowledge and attitudes regarding antibiotic utilization in Putrajaya, Malaysia.
METHODS: A self-administered questionnaire survey was conducted among public attending a local hospital. The four-part questionnaire collected responses on demographic characteristics, recent use of antibiotics, knowledge and attitude statements. Cronbach's alpha for knowledge and attitude statements were 0.68 and 0.74 respectively. Only questionnaires with complete responses were analysed. General linear modelling was used to identify demographic characteristics which contributed significantly to knowledge and attitude. Multiple logistic regression was used to determine the adjusted odds ratios of obtaining an inappropriate response for each knowledge and attitude statement. The relationship between antibiotic knowledge and attitude was examined using Pearson's correlation and correlation between related statements was performed using the Chi-square test. In all statistical analyses, a p-value of < 0.05 was considered statistically significant.
RESULTS: There was positive correlation (p<0.001) between mean knowledge (6.07±2.52) and attitude scores (5.59±1.67). Highest education level (p<0.001) and healthcare-related occupation (p=0.001) contributed significantly to knowledge. Gender (p=0.010), race (p=0.005), highest education level (p<0.001), employment status (p=0.016) and healthcare-related occupation (p=0.005) contributed significantly to attitude. The differences in score between demographic groups were small. Misconceptions that antibiotics would work on both bacterial and viral infections were reported. Approximately three quarters of respondents expected antibiotics for treatment of coughs and colds. Close to two thirds (60%) believed that taking antibiotics would improve recovery. Several demographic groups were identified as 'high risk' with respect to gaps in knowledge and attitude.
CONCLUSIONS: This study has identified important knowledge and attitude gaps as well as people 'at risk'. These findings would be useful in strategizing targeted antibiotic awareness campaigns and patient counselling.
KEYWORDS: Malaysia; antibiotic; attitude; knowledge; public; survey
Study site: outpatient pharmacy department of Putrajaya Hospital, Malaysia
The escalating problem of opiate dependence in Malaysia and the limitations of regimental approach of forced admission to rehabilitation centres had triggered the government to expand the methadone maintenance therapy to become a national programme. This study aimed to evaluate the short-term outcomes of the Methadone Maintenance Therapy programme in one of the busiest hospital in east coast Malaysia. We also explored the prevalence on non-compliance and factors associated to it. A total of 172 patient case notes at Methadone Clinic Hospital Tengku Ampuan Afzan (HTAA) were retrieved for relevant data. A short survey was also conducted to determine the subjects' current employment and marital status. The programme's retention rate was 62% and factors associated with poor compliance were unemployment, low quality of life scores and low dose of methadone. A special attention on the patients with these three risk factors may improve their compliance to MMT. The short-term evaluation of MMT at HTAA revealed favourable findings.
Study site: Psychiatric clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
This study investigates the views of general medical practitioners (GP) to the extended role of the community pharmacists (CP). A self-administered questionnaire was distributed to all private clinics (n=438) run by GPs in the state of Penang. The questionnaire asked GP's views on ideas for new services provided by community pharmacists. Three hundred and twenty-seven questionnaires were collected, giving a response rate of 74.5%. More than 50% of respondents were in favour of the community pharmacist involvement in activities of providing public health education (58.7%), contacting GPs on matters related to prescribing and prescription errors (56.0%), and referring patients who exhibit drug-related problems (53.0%). However, the respondents had a mixed opinion regarding the roles of CPs in smoking cessation programme (34.8%) and providing drug information to physicians (43.0%). Additional research is needed to explain GPs attitudes towards the acceptability of the new role of the pharmacist.
INTRODUCTION: Our study was to examine prevalence and treatment outcomes of medical emergencies at two urban public health clinics in the Petaling district, Selangor, Malaysia.
METHODS: A prospective universal sampling was employed to recruit all emergencies over one month period (12 April to 11 May 2011). A structured case record form was used to capture demographic data, whether the index case was selfpresenting or decided by health care workers as a medical emergency, presenting complaints, diagnoses, concurrent chronic diseases and their treatment outcomes at the clinic level. Emergency presentations and diagnoses were classified according to the International Classification of Primary Care, revised second edition (ICPC-2-R).
RESULTS: A total of 125 medical emergencies with 276 presenting complaints were recorded. The mean age was 30.7 years old (SD 19.9). The prevalence of medical emergency was 0.56% (125/22,320). Chief complaints were mainly from ICPC-2-R chapter R (respiratory system) and chapter A (general and unspecified), 40.0% and 28.0% respectively. The most common diagnosis was acute exacerbation of bronchial asthma (34.6%). Forty percent were referred to hospitals. After adjusting for age and gender, patients who presented with painful emergency (OR 4.9 95% CI 2.0 to 11.7), cardiovascular emergency (OR 63.4 95% CI 12.9 to 310.4) and non-respiratory emergency were predictors of hospital referral (OR 4.6 95% CI 1.1 to 19.1).
CONCLUSION: There was about one medical emergency for every 200 patients presenting to these urban public polyclinics which were mainly acute asthma. More than half were discharged well and given a follow-up.
Study site: Klinik Kesihatan Seri Kembangan and Klinik Kesihatan Puchong, Selangor, Malaysia
In translating clinical research into practice, the summarization of data from randomized trials in terms of measures of effect to be readily appreciated by the point-of-care clinicians is important. In this context, the body of literature highlighted the 'number needed to treat' as a useful measure. The objectives of our study were to assess how meta-analyses described number needed to treat and corresponding 95% CI, and to explore issues related to reporting number needed to treat in the selected meta-analyses.
Compare the performance of Lea Symbols and Sheridan Gardiner charts against the standard test chart used to determine reduced VA during vision screening among pre-schoolers.
The objective of this cross-sectional study was to determine the factors associated with the attitudes toward premarital sexual activities among school-going adolescents in Kelantan, Malaysia. It was conducted among 1032 secondary school students using a self-administered validated questionnaire. Multiple logistic regression revealed that the risk factors for having permissive attitudes toward practice of premarital sexual activities were male students (odds ratio [OR] = 1.83; 95% confidence interval [CI] = 1.34-2.48), being less religious (OR = 2.02; 95% CI = 1.49-2.73), and younger age group of students (13 to 14 years old; OR = 1.42; 95% CI = 1.05-1.92). Having good knowledge on sexual and reproductive health was a protective factor against permissive sexual attitude (OR = 0.27; 95% CI = 0.20-0.36). In conclusion, male and young adolescents were at risk of having permissive attitudes toward sexual behaviors, but good knowledge on sexual and reproductive health and being more religious may protect them from it.