A comparative pilot study was conducted to determine the difference in the reduction of total serum bilirubin in a group of infants who had phototherapy at home compared to an in-patient group on hospital phototherapy. Eighteen infants with unconjugated hyperbilirubinaemia who fitted the selection criteria were put under the mobile home unit (Bluelite Portable Light) placed in the home. A control group of 18 infants with the same matching characteristics had intense phototherapy in the hospital using a unit with top and bottom light sources. The infants were matched for race, starting total serum bilirubin level, birth weight (up to 250 grams) and age of baby at initiation of phototherapy (up to one-day difference). It was observed that the mean daily decrease in serum bilirubin concentration was significantly more in the home group as compared to the hospital group (t=2.95, df=17, P<0.05). The mean duration of treatment was significantly less for the home group as compared to the hospital group (t=2.84, df=17, P<0.05). None of the infants who had home phototherapy were re-hospitalized. Phototherapy related complications were mild and comparable in both groups. The result suggests that home phototherapy is safe and effective in bringing down the concentration of serum bilirubin for term babies with uncomplicated hyperbilirubinaemia.
On December 26, 2004, an earthquake triggered a devastating tsunami that caused death and destruction in twelve countries including India, Indonesia, Malaysia, Maldives, Seychelles, Somalia, Sri Lanka and Thailand. One of the authors was a volunteer with FELDA WAJA AMAN MALAYSIA medical relief team that served the Aceh victims from 16th February to 24th February 2005 (8 weeks post tsunami). A study to determine the pattern of health ailments was conducted among children aged 18 years and below based at Seuneubok Camp, 30 km from Banda Aceh. All respondents were from Pulau Aceh and the total number of children seen and examined was 60. About 18% had lost their fathers, 10 % had lost their mothers and 27% had lost one or more of their siblings. 77% suffered some form of health ailments. The common health ailments were diarrhea (61%), respiratory complaints (59%) and fever (20%). About 38 % of preschoolers had loss of appetite and 28% had sleep disturbances. About 35% of the elementary school children suffered from sleep disturbances, 29% of the young adolescents suffered from headaches and 24% had sleep disturbances. Nearly a quarter (24%) of all the children felt fearful and anxious about the disaster. Nevertheless, 56% of the respondents wanted to return back to Pulau Aceh, although 14 % did not want to go back. Interestingly, 73% of the children voiced their gratitude to God for having been saved from death.
Home phototherapy treatment has been available in the Klang Valley (comprising Petaling ]aya, Kuala Lumpur; Shah Alam and Klang) since 2003. This study was conducted to create awareness of the existence of home phototherapy and its usage in Malaysia. This was a retrospective study using 1297 informed consent forms that parents had to read and sign prior to the commencement of home phototherapy. lt was found that the majority ofthe babies was males (41.2%), at or over 36 weelds gestation (97.2%), from areas in Selangor (57.4%), fully breastfed (53 %) and referred by doctors (98%). The mean age of the babies at initiation of lwme phototherapy was 6. 7 days. The mean bilirubin level at the start of home phototherapy was 243.8 umoVL and the mean bilirubin level at the end of home phototherapy 5 was 139.3 umoVL. The mean decrease in bilirubin level was 103.12 umoVL and the mean number of days of usage was 3.5 days which is a daily decrement of about 29 umoVL (29.46 + 13.8). Home phototherapy remains a viable clinical option for full term babies with physiological jaundice.
A cross sectional study to determine general health and body composition was conducted for comparison between rural samples (Teluk Intan, Perak) and urban samples (Klang Valley, Selangor). Systematic random sampling was used in Z health clinics in Klang Valky and 4 health clinics in Telult Intan, Perak The results showed that urban population was more heterogeneous (Malay 63.7%, Indian 19.8%, Chinese 14.9%) compared with the rural population (Malay 75%, Indian 22.1%, Chinese 2.9%). Mean age for urban population was 44 2 1.6 years and for rural was 50 i 14.4 years. There was significant difference in the BMI (p < 0.05) between urban and rural populations where more people in the urban areas had higher BMI. There was a significant difference in the waist hip ratio (p < 0.05) between urban and rural areas where more people in the urban areas had above normal waist hip ratio. There was no significant difference in chronic diseases suffered and family medical history of the rural and urban samples.
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.
This descriptive cross sectional study was conducted to assess patient's satisfaction by evaluating the waiting time experienced by 27 (54%) inpatients and 23 (46%) outpatients who sought treatment at a private hospital in Selangor from 15th of May 2006 until 3rd of]une 2006. Majority of the patients (78%) were in the range between Z 1 - 40 years old and well»educated. Almost half (48%) were in the human resources employment category, 20% were in administration and marketing and 10% were professionals. Majority of them earned from RM1000-1999 (34%) and RMZ000-3999 (32%). Almost all of them (96%) agreed that the medical care that they had been receiving in the hospital was just about perfect. 98% agreed that the doctors treated them in a very friendly and courteous manner and 96% rated the care given by nurses as g0od/ excellent. 88% to 92% said that their communication with the doctors, nurses and other staff were good/ excellent. 80% waited less than 15 minutes at the registration counter, 52% waited less than 15 minutes to see the doctor and 44% waited less than 15 minutes at other places such as pharmacy and x-ray. Overall, 94% rated the level of services in the hospital as good/ excellent, Almost all (90%) would like to recommend the hospital to their friends and relatives. Our study demonstrated that the majority of the patients were satisfied with the doctors, nurses and environment of the private hospital. The average waiting time of patient before being attended to by a doctor was less than 30 minutes.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
This study was conducted to determine the patterns of disease and treatment at two disaster sites. Studies prior to this have shown that all natural disasters are unique in that each affected region of the world have different social, economic and health backgrounds. However, similarities exist among the health effects of different disasters which if recognized can ensure that health and emergency medical relief and limited resources are well managed. This study found that although Aceh and Balakot were two totally different areas with reference to locality and climate it was noticed that the patterns of disease two months post disaster are similar the commonest being respiratory conditions followed by musculoskeletal conditions and gastrointestinal conditions. For the treatment patterns it was observed that the two areas prescribed almost similar, types of medicine mainly for gastrointestinal and respiratory systems. However in Aceh, there were more skin treatment and in Balakot there was more usage of musculoskeletal drugs.
Stress has been recognized one of the factors causing disease. About 70-80% of all diseases may be stress related. Thus, stress management can be a part of an early measure of disease prevention. A descriptive cross sectional, randomized study was conducted to determine the stress inducing factors among preclinical students (universal sampling) in a public university in Selangor, Malaysia from 24th April to May 2005. A total of 163 students (52.8% year 1, 36.8% year 2 and 10.4% year 3) were interviewed in the data collection process. The main reasons students entered - medical school was because of their own interest or ambition (65%) and family influence (20.9%). Majority (76.4%) suffered moderate to great stress over hot conditions in lecture hall, tutoriaV small group session rooms and laboratories while 53.4% suffered when using the other facilities like cafeteria, toilet and transportation:. Almost all (95.1%) felt that examination was the most stressful, followed by early clinical exposure sessions (68.1%), problem·based learning sessions (62.5%), hospital visitations (59.7%), tutoriay small group sessions (49.3%), practical class (44.5%) and attending lectures (3 8.5%). Musculoskeletal System was the most stressful module among the first year students, followed by Nervous System and Gastrointestinal System with the percentage of 94.2%, 90.7% and 88.4% respectively while, 95% of the second year students felt that General, Hemopoietic ci? Lymphoid and Nervous System are the most stressful modules. This study revealed that academic sessions and lack of conducive teaching and learning environment as the main stress inducing contributors to preclinical medical students.
A cross-sectional study was conducted in May 2007 on stress and stress self management among the prisoners and wardens of a prison in Selangor. This study was conducted as part of an elective posting for second year medical students and the topic was chosen to add on to the body of knowledge on stress among prisoners and wardens. A self administered questionnaire was distributed by random sampling and the respondents consisted of 100 prisoners and 97 wardens. Majority of the prisoners did not have stress with reference to interpersonal factors such as conflict with cellmates, conflict with wardens and conflict with inmates, For interpersonal factors, majority of the prisoners experienced stress because they felt bored (78%), thought they had no bright future (63%) and they also had no visitors (61%). Stress resulted in physical effects, whereby 67% admitted that they experienced health problems and 64% experienced sleep disturbance. Emotional effects of stress experienced by the prisoners were sadness (67%), anxiousness (63%) and confusion (56%). The major spiritual effect was regret (84%) followed by feeling closer to God (78%) and feeling high spirited (59%). The major social effects experienced by
the prisoners were low self esteem (63%) and embarrassment (58%). Methods of stress self management were prayers and conduct of religious activities (87%), sharing problems with friends (78%), doing recreational activities (77%), sleeping (72%) , doing a hobby (68) and seeking help from doctors (57%). As for the wardens, with reference to interpersonal factors, high level of stress was experience with reference ta prisoners behavior (82.5%) and problems with higher authorities (83.5 %), For intrapersonal factors, sleep disturbances (64%), career problems (76.3%), financial problems (73.2%) and feeling bored (75.3%) highly contributed to stress. Wardens physical effects were 38.1% health problems and 29.9% sleep disturbances. For emotional effects, must of them were depressed (54.6%), anxious (67%), angry (63.9%), confused (64.9%), frustrated (59.8%), threatened (53.6%) and patriotic (51.5%). The spiritual effect were feeling closer to God (86.6%), feeling responsible for duties (82.5%), regret doing the job (74.2%), feeling high spirited (58.8%). For social effects, low self esteem is the highest effect experienced (68%). Wardens managed stress by praying and conducting religious activities (91.8%), recreational activities (88.7%), doing a hobby (85.6%), sleeping (74.2%), and sharing problems (68%).
Various studies have reported that excess body weight may increase the risk to various diseases and death. A study reported that adolescents who were overweight were almost 18 times more likely than their leaner peers to be obese in early adulthood and were 8.5 times more likely to have hypertension as young adults. Therefore, this study was conducted to determine the body composition and four dietary factors i.e., prudent diet habits, calorie control habits, dietary fat/ cholesterol and sodium/salt control which may affect blood pressure and the risk of heart disease among year 1 medical students in a public university in Selangor. Body composition was determined by measuring the body mass index (BMI) and body fat percentage. None of the female students showed excellent/good eating habits while majority were fair (37.7%) and poor/very poor (62.3%). Nearly half of the male students showed excellent/good eating habits (42.5%), but more than half (57.5%) were poor/very poor. Majority of the female (85.7%, 85.7% and 94.8% respectively) and male students (80.9%, 57.5% and 93.6% respectively) showed excellent/good eating habits in calorie, dietary fat and salt control. Majority of the students (64.9% female and 61.7% male) have normal BMI values while 24.7% of female and 10.6% of male students were underweight (BMI values less than 18.5). Only a small number of female students were overweight (5.2%) and obese (5.2%). However 14.9% of male students were overweight and another 12.8% were obese.
The knowledge, attitude and practice of breastfeeding among young mothers during pre-Baby Friendly Hospital Initiative implementation was conducted at seven private hospitals in Malaysia. A structured interviewer administered questionnaire was given to all mothers (n=Z52) visiting the antenatal/postnatal clinic of the hospitals. The main respondents were Malays (57.5%) and Chinese (35%) . For most mothers, breastfeeding was combined with supplementary feeds of formula milk, with only 30% breastfed exclusively. The majority of mothers knew that breast-milk contained antibodies and can prevent illness, however many were unaware of breastfeeding's contraceptive effect if practised exclusively. Most mothers did not relate breastfeeding as being environmental friendly. Generally, there was no knowledge gained from the experience of having more children with reference to breastfeeding. Most mothers were influenced by their own beliefs regarding choice of feeding method. Therefore, a mother was empowered with the knowledge of all practical aspects of breastfeeding, it would encourage her to breastfeed her baby.
Study site: seven private hospitals in Malaysia
A cross sectional descriptive study of 2048 subjects was conducted to determine the prevalence of depression and factors influencing depression among students in secondary school from urban and rural areas in the state of Selangor, Malaysia. The children's depression inventory (CDI) developed by Maria Kovacs was used in this study. Students who participated in this study come from two urban schools and three rural schools. It was found that in the yield for scores for five factors were 9.2% have negative mood, 5% have interpersonal problems, 8.3% have ineffectiveness, 9.8% have anhedonia and 10.6% have negative self esteem. Following the interpretive guidelines for the T-scores, it was found that 10.3% of the students were much above average in the depression scale. This study also found that: 1% of students were smoking, 1.6% of students were gum sniffling, 0.9% took drugs, 4.1% took alcohol and 9.9% took things from other people. Females were more depressed than males. The Chinese students were more depressed compared to Indian students. Students whose parents had no formal education or had only primary education were more depressed than students whose parents had secondary, college or university education. Depression increased with increasing number of siblings. Depression contributed to the habit of drug abuse, gum sniffing and stealing but not to smoking and alcohol abuse. Suicidal tendencies were more likely among the depressed students. It is imperative that not only caregivers but also teachers have to be equipped with the knowledge, attitude and skills to assist secondary school children cope with their emotions, handle conflicts and manage stress early so that a more productive society will develop in the future.