Despite the debates of the benefits of continuing mammography screening among elderly women, studies in Malaysia have shown that the prevalence of breast examination declines after age 45 years and for mammogram per se, the prevalence of examination increases until age of 64. This study aims to determine the prevalence of mammogram screening among elderly women in Hulu Langat, Selangor and its relationship with factors such as demographic factors, family history of breast cancer, perceived health status, perceived general psychological factor and lifestyle factors. Data used were from a cross sectional study of health status among community in Hulu Langat area by the Department of Community Health, Universiti Kebangsaan Malaysia carried out from the year 1998 till 2002. However this paper focused on the database involving elderly women age 60 and above. The sample population was 652. The mean (standard deviation) age was 67.17 (5.995). Only 8.3% of the elderly women claimed to ever had mammogram screening done. Hence, the prevalence of mammogram screening is still low among elderly women in Hulu Langat. Having family history of breast cancer (p < 0.001) and perceived positive psychological status (p=0.003) had shown significant associations with mammogram screening among them. It is therefore important for researcher to further look into the reasons behind this and qualitative exploration is highly recommended.
Health impact related to smoking is a critical public health predicament especially in pregnancy. However there is not much data available to describe the magnitude of the problem. Hence this study was conducted to determine the prevalence of smoking and its socioeconomic factors among antenatal mother and their opinion related to tobacco control measures. A cross sectional study was carried out involving newly registered antenatal mothers attending all government health clinics in Penang. Prevalence of ever smoking among antenatal mother is 1.4%, of which 42.4% is still smoking at first antenatal visit. It was found that single mothers are more likely to smoke (OR, 14.23: C12.52-53.27). It was also noted that spouse smoking (OR, 5,14: CI 1.95-17.09), primigravida (OR, 2.7: C1 1.3-5.62), age group less than 30 years old (OR, 2.41; CI 1.03-6.09) and living in urban area (OR, 2.33; CI 1.01 — 6.47) have a higher risk to indulge in smoking behaviour. Muslim OR 0.29; C1 0.14 - 0.60) and Malay (OR 0.22; CI 0.10 - 0.47) pregnant mothers are noted to be less likely to smoke as compared to non Muslim and non Malay. More than 85% of them agreed with the tobacco control measures regardless of their smoking status. Most of respondents agreed the influential people in community L;11T · such as medical personnel, teachers and parents should not smoke.
The Ministry of Health had instructed all state hospitals to go for Accreditation. Accreditation is considered to be a more appropriate tool forquality assurance in a hospital setting than ISO 9000.The objective of this research was to study doctors perception towards the implementation of Accreditation in state hospital. Self-administered questionnaires were sent through mail to doctors in eight clinical departments of all state hospitals. From 832 questionnaires sent, 297 responded (36%),i.e. 84 specialists and 2/2 medical officers. The study showed that 69% doctors knew that their hospital was implementing Accreditation. There were more clinical specialist (9I%) who were involved in accreditation as compared to Medical Ojicers (73%). 83% of doctors believed that accreditation can assist in assuring quality in their hospital. Those who do not, thought that quality can be assured stajfing was adequate (67%) and accreditation does not assess patient care
(33%). The study also showed that 7I% of doctors knew that their hospital was implementing MS ISO 9000. A 77% of doctors believed that ISO 9000 can assist in assuring quality in their hospital. Those who do not, thought that quality can onhi be assured Jstajfng was adequate (27%) and ISO 9000 was only meant for industry (8%). In conclusion, doctors believed that Accreditation and MS ISO 9000 can assist in assuring quality in their hospitals. Amongst, those who do not, majority thought that quality can only be assured staffing was adequate.
The objective of this study was to find out whether integration of Information and Communication Technology (ICT) in a Primary Health Care Clinic improves client’s waiting time. This was a descriptive study based on a total of 588 clients, i.e. 291 clients from an ICT integrated primary health care clinic, which was Putrajaya Health Clinic and 297 clients from a manual health clinic, which was Salak Health Clinic, from 5th December 2000 until 10th January 2001. Clients attending both clinics during this study period were systematically random sampled. Information was obtained from structured questionnaires. Data were analysed with Statistical Package for Social Sciences (SPSS) version 10.0. Selected quantitative time variables, their mean and standard deviation were calculated. Integration of ICT in a primary health care clinic did not improve client’s waiting time. It was demonstrated by this study that the integration of ICT in Putrajaya Health Clinic led to significantly longer average waiting time (39.76 minutes) and longer average total time spend in the clinic (57.14 minutes) as compared to a manual clinic, Salak Health Clinic where its average waiting time was only 23.13 minutes and average total time spend in the clinic was 39.15 minutes. Based on the findings, it is possible that integration of ICT in a primary health care clinic could not play as a significant factor for improving or reducing client’s waiting time in Putrajaya Health Clinic yet, at least not for the time being. This is the first study to document waiting times specifically in our first ICT integrated primary health care clinic. Since it was found that integration of ICT in a primary health care clinic had made client’s waiting time significantly longer than the waiting time in a manual clinic, it could be interesting for future research to look into client’s satisfaction in an ICT environment clinic.
Key words: ICT, client satisfaction, primary care
Most people with musculoskeletal problem suffer pain at multiple body sites. The most frequent form of multisite pain studied is chronic widespread pain (CWP). Focusing solely on CWP may exclude the commoner form of multisite pain which is less wide spread. Therefore, studies on multisite pain which do not consider the spatial distribution of pain can be beneficial to tackle the overall problem of musculoskeletal pain. Nevertheless, multisite pain has been defined differently in the studies among workers. The absence of uniformed definition will jeopardize the understanding of this musculoskeletal problem. A review was thus carried out to identify how multisite pain were defined, how they influenced the reported occurrence of multisite pain and whether the definition determined the physical work exposures assessed in previous studies among worker. A systematic review was initiated by the search of electronic databases for multisite pain. Articles were included and excluded based on the selection criteria. A final of nine full text articles were reviewed. It was found that the difference in the definitions lies mainly in the body sites considered and the pain characteristics. The characteristics of pain influenced the multisite pain prevalence more than the sites.It wasdifficult to conclude whether the definition used determined the physical work exposures since only five studies were involved and three of them had similar research team which may explained the usage of similar exposures. The findings from this review, however, could not be inferred due to the small number of studies involved.
A cross sectional study to measure the prevalence of domestic violence and the factors associated with it among women who seek treatment at Hospital Pontian Out Patient Department was carried out in September 1998 until April 1999. The study sample was chosen through systematic random sampling. A total of 370 women between 15 to 49 years were selected and the response rate was 100%. The Results show the one year prevalence rate of domestic violence was 16.8% and life- long prevalence of domestic violence was 35.1%. Studies shows significant difference between the prevalence of domestic violence by age, marital and working status, age at marriage, knowledge, attitude and action to be taken toward domestic violence. Percent of victim is higher among women less than 20 year old, single, still schooling, negative attitude and action towards abuse and less knowledge of place for seeking help. Factor that contribute significantly toward domestic violence among single women is the lack of positive action in dealing with violence and among married women are early marriage(<25 year), lack of positive action in dealing with violence and lack of moral support from husband and family.
Key words: prevalence of domestic violence, mangsa keganasan, associated factors, contributing factors
Study site: Outpatient clinic, Hospital Pontian, Johor, Malaysia
Child restraint system (CRS) can protect children in the event of crash and reduce the severity of injuries. As such, it
is crucial to understand the prevalence of CRS usage and knowledge attributes on CRS usage among drivers. This
study aims to assessdrivers’ knowledge on CRS usage.A semi-structured questionnaire was developed and pilot tested
to verify its validity and reliability. The questionnaireaddressesdrivers’ knowledge about CRS currently available in
the Malaysian market, the types of restraints used and views on fitting restraints to passenger vehicles. Seventy four
percentfrom 500 respondents cited that they are usingor theyhave used CRS,64% knowabout CRS and its function, and
43% areawareof ISOFIX. In short, majority of the respondents are aware of CRS use and functions. Awareness and
education program should berigorously introduced to public towards the implementation of the CRS law.
This was a pilot study comparing the success between early versus late external cephalic version (ECV) involving primigravidae with singleton breech pregnancy. They were randomised into early (34–36 weeks) and late (37-40 weeks) ECV groups. A total of 44 women were initially randomised into 22 women for each group. The overall ECV success rate was acceptable in both groups although insignificantly higher in the late ECV group (55.6% versus 46.7%, p= 0.732.) Caesarean
section in the early ECV group was higher (80% versus 72.2%). Early ECV group had women with higher BMI (29.5 versus 26.8 kg/m2, p=0.107), anterior placentation (60% versus 38.9%) and extended breech presentation (55.6% versus 44.4%; p= 0.296). In conclusion, early ECV in primigravidae showed no better success rate than late ECV. Maternal obesity, anterior placentation and extended breech presentation should alert to failure risk.
Research examining whether psychological eating style is related to healthy or unhealthy eating patterns is required to explain the mechanisms underlying non-communicable diseases and obesity. The purpose of this study was to investigate whether eating style predicts the nature of food consumption. This was a cross-sectional study of 588 adults (males = 231 and females = 357). Eating style (i.e. restrained, emotional, external eating) was measured using the short version of the Dutch Eating Behaviour Questionnaire (DEBQ). The nature of food consumption was assessed using self-reports of consumption of fruits and vegetables, sweet foods, junk food, and snacks.The results revealed that restrained eating was higher in females and overweight participants. External eating,a higher frequency of snacking,and a higher frequency of junk food consumptionwere more prevalent among the younger participants. Consistent with previous Western studies, emotional eating was found to be the main predictor of consumption of less healthful foods (sweet foods, junk food, and snacks), whereas external eatingpredicted the intake of sweet foods. The intake of fruits and vegetableswas associated with restrained eating. In light of the significant associations between eating style and the nature of food consumption, acknowledging individuals’ eating styleshas implications for tailoring effective nutritional programs that address obesity and the chronic disease epidemic.
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.
Cervical cancer is preventable by detecting precancerous states through Pap smear screening, followed by appropriate treatment. In Malaysia, even with a high incidence of cervical cancer and accessible screening program, the uptake of Pap smear screening was still low. Lack of knowledge, embarrassment, fear for the test and results are the factors reducing participation. The aim of this study was to determine the change in knowledge and attitude regarding the Pap smear screening as well as knowledge on cervical cancer among women in Mukim ]aya Setia after educational intervention. A community trial was conducted in August 2005 where 80 women were randomly selected. The women were interviewed for assessment prior to the intervention, using a set of structured questionnaire. The women underwent educational intervention programmes on cervical cancer and Pap smear screening. After a week, the women were re-assessed using the same set of questionnaire for their post intervention knowledge and attitudes. Scores were given for each answer, which were totaled and analyzed. The mean (SD) age was 41.1 (10.37) years. Most were housewives (87.5%), within the low income group (91.2%), of less than RM 1000.00 income per household. Most of the women received their education up to the secondary level only (97.5%). Despite their poor economic status, most of them had more than three children (68.8%). There was a significant improvement in knowledge of Pap smear (mean difference= 4.3, 95% CI= 3.55, 5.10) and cervical cancer (mean difference= 10.7, 95% CI= 10.03, 11.37) as well as attitude to Pap smear (mean difference= 7.1, 95% CI= 5.72, 8.47) after educational intervention. The knowledge and attitudes towards Pap smear screening as well as knowledge on cervical cancer among rural women in Mukim ]aya Setia, Kota Bharu improved after educational intervention.
Malaysia's healthcare delivery system in Vision 2020 will be recognized as one of the world’s best. Putrajaya Health Clinic is our first paperless health clinic in Malaysia that incorporates the Health Information System (HIS). This system cuts across programmes and sections in the operational work process in the clinic with the ultimate aim of achieving a paperless status. This clinic provides a comprehensive health care service at the point of contact and focuses on wellness, clientfriendly, seamless and borderless care with e]§‘icient use of resources and towards high a quality of service. This health clinic which seesthe majority of the attendance being well persons, through the immunization programme, antenatal, postnatal, family planning, school health, and well clinics for child and adult, will continue to extend and further expand its services to include geriatric, ill mental, occupational and rehabilitative care. The e-government within Putrajaya will facilitate the use of an
appointment system, which can be done through e—mail, fax, telephone or walk-in. Information and
communication technology will also facilitate the promotion of health education for individuals and communities. To facilitate efective streaming or screening of clients/attendees, a simple triage system is introduced. Prompt, short and accurate is the rule for triaging, thus providing timely and ejfective care. New information and communication technologies will allow healthcare providers to adopt a more virtual, more integrated and more distributed approach in the delivery of health services. It was documented that the average contact time at the triage counter in Putrajaya Health Clinic was 1.16 minutes, i.e. the shortest among other services provided here.
Water filters are being increasingly promoted and used in the home. There are many types of commercial water jilters available for domestic use but almost all of them employ a physical filter media and an activated substance. The study showed that water filters effectively removed suspended solids and residual chlorine. However, as far as removing colhform bacteria is concerned, in ZZ .5% of the cases, bacteria were in fact introduced into the water. And in 20% ofthe cases, the amount of bacteria introduced was “too numerous to count (TNTC)". Furthermore, water hlters can lose their ability to filter bacteria without losing their ability to filter suspended solids and residual chlorine. This highlights the necessity of some authorized body looking into the claims made by these water filter manufacturers and impose certain standards to ensure that at the very least, the water quality ofthe hltered water is not worse than the unfiltered water.
The unstable living situation in Iraq in the last 10 years after 2003 war affected the daily life of most Iraqis, and especially the children. The objective of this study was to explore the effects of an unstable living environment on children’s health. A community-based qualitative study was done to collect data from 20 mothers of children (age 7 to 8years old) through in-depth interview (IDI). Data was recorded using tape recorders and was later transcribed and analyzed using qualitative thematic analysis techniques. The majority of mothers interviewed said the past nine years of unstable security in the capital had affected their daily life; some mothers also expressed concern about their child’s nutritional status, their eating habits during the school day, and the unhealthy food being sold at school canteens. As a conclusion, the unstable living situations in Baghdad city after the last war had affected the cognitive and nutritional development of children. More precautions should be taken by parents to ensure their children safety in the future.
Employee satnfaction surveys can provide the information needed to improved levek of productivity, job and loyalty. Management can identify the factors of job issues and provide solutions to improve the working environment. A cross sectional descriptive study on employee satisfaction among a health care district office’s staff was conducted in Perak in March - April 2006. A total of 19 staff were randomly picked and interviewed in the data collection process. Almost all understand the objectives of the administration unit (94%) and were satisfied with the management leadership’s style (78%- l 00%) . Majority agreed that their relationship with immediate superior and within the group was harmonious and professional (89%) and they preferred an open problem solving method in handling conflict (72 %). The most common type of incentive rewarded by the administration to express gratitude to their staff was certificate (56%); bonus and medal (33%); and informal gesture (28%). Majority (83%) were also satisfied by the method used to disseminate the information in their units. Majority agreed that the working environment in the administration unit were conducive (72%), their ideas were equally considered during decision making sessions (89%) and training opportunities were similarly given to them by the management (72%). This study revealed that employee satisfaction was determined by several factors such as management leadership's style, opportunity to contribute skills and idea; reward and incentive; and conducive king environment.
Men’s health remain unclear term for majority of general population as well as physician worlwide. Nowadays there is an increase interest in addressing men’s requirement in health care as a separate branch. When discussing about men’s health, it is fair to say that even a man himself does not know much about men’s health. Most of them think that men’s health is just a discussion on sex. This thought is not entirely right. The scope of men’s health is actually larger than the male sex organ itself. To define men’s health, we have to look at man holistically.
Children less than 6 years old are the most vulnerable group to get harm from Environmental Tobacco Smoke (ETS) exposure, especially their respiratory system. To determine the prevalence of ETS exposure and its association with asthma like symptoms among children less than 6 years old. A cross sectional study was conducted in between January till April 2014 among parents with children less than 6 years old in Selangor, Malaysia. A total of 142 parents were selected by simple random sampling and data were collected using guided questionnaire on ETS exposure and asthma like symptoms (cough and wheeze) among their children. A total of 52.8% of children found to be exposed to ETS, and 43.7% were exposed from their father. ETS exposure significantly associated with cough without cold (adjusted OR=5.46, 95% CI 2.37, 12.61), dry cough at night (adjusted OR=3.74, 95%CI 1.41, 9.95) and cough upon physical activity (adjusted OR=3.08, 95% 1.07, 8.89) among these children. Children less than 6 years old are vulnerable to respiratory problem due to ETS exposure especially on cough symptoms. More strategies should be developing to reduce the exposure to ETS.
This study is aimed at seat design optimization for high-speed train based on the Malaysians sitting anthropometry
data focusing on seat fit parameters. An analysis of anthropometry data composed of 15 dimensions that are
required in seat design was done with 50 male subjects. These data were collected through direct measuring
methods with standard equipment. According to the Malaysian automotive seat fit parameters, the backrest width,
backrest height, cushion width, and cushion length were established based on these anthropometric dimensions:
interscye breadth (5th percentile female and 95th percentile male), hip breadth (95th percentile female), sitting
shoulder height (5th percentile female), and buttock-popliteal length (5th percentile female), respectively. This
study uses the CATIA software to design and analyse the proposed seat design. The fit parameters proposed for the
new design are seat height, 380mm; cushion width, 450mm; backrest width, 450mm and backrest height, 850mm.
The CATIA human activity analysis (based on Rapid Upper Limb Analysis, RULA) was also executed. From the study,
the new conceptual seat design gives the most optimized fit when compared to the current seat.
Oil palm workers are exposed to ergonomics problems in their routine works. Although many technological advances have been developed, a large number of workers are still using manual handling tools in their daily work. A study was done to identify and solve the problems or issues of material handling effect on oil palm collectors and loaders during their daily work activities. A cross sectional study was done in an oil palm plantation in Negeri Sembilan, Malaysia. Twenty five workers were selected randomly to participate in this study. Musculoskeletal symptoms were recorded using Modified Nordic Questionnaires and awkward postures of the workers were assessed using Rapid Entire Body Assessment (REBA). Result showed that 61% of workers were exposed to high risk level and 39% to very high risk level of working posture problems. In conclusion, majority of oil palm collectors and loaders need to correct their working posture as soon as possible. The manual handling activities need to be improved with respect to correct procedure for health and safety concerns.
The Malaysia Diagnosis Related Group (MY-DRG®), established since 2002, is a patient classification system that stratifies disease severity and categories patients into iso-resource groups. Casemix can be used to estimate costs per episode of care and as a provider payment tool in health services. Casemix has also been used to enhance quality and improve the efficiency of health services. Hence, estimation cost per DRG is important especially in developing countries where costing data are still scarce. We embarked on a study to determine the costs of the diagnostics laboratory services for each MY-DRG® based on the severity of illnesses. Most costing studies for diagnostic laboratory services usually focus on the cost of consumables and equipment alone and employed the step-down costing method. Very few studies applied Activity-Based Costing (ABC) method to estimate the costs for diagnostic laboratory services. This study was done with the purpose of developing the diagnostics laboratory cost using the ABC method. All medical cases discharged from UKM Medical Centre (UKMMC) in 2011 grouped into MY-DRG® were included in this study. In 2011, a total of 2.7 million diagnostic laboratory investigations were carried out in the Department of Diagnostic Laboratory Services in UKMMC. ABC was conducted from January to December 2013 in all units of the department. Cost of 242 types of diagnostic laboratory services were collected using a costing format. Out of 25,754 cases, 16,173 (62.8%) cases were from the medical discipline. After trimming using L3H3 method, 15,387 cases were included in the study. Most of the cases were on severity level one (44.6%), followed by severity level two (32.3%) and severity level three (23.1%). The highest diagnostic laboratory service weight was for Lymphoma & Chronic Leukemia, severity level III (C-4-11-III) with the value of 5.9609. Information on seven cost components was collected form each procedure: human resources, consumables, equipment, reagents, administration, maintenance and utilities. The results revealed that, the biggest cost component for human resources was in Molecular Genetic Unit (89.6%), consumables (34.8%) from Tissue Culture Unit, equipment (11.2%) and reagents (68.1%) from Specialized Haemostasis Unit. In conclusion, the accurate and reliable cost of the diagnostic laboratory services can be determined using ABC. Top management of the department should be able to use the output of the study to take appropriate steps to reduce unnecessary wastages of resources in the various units of the services.