Objectives: Pancreatic cancer is an aggressive silent killer with a median survival of a few months. It is the
fourth leading cause of cancer death in the United States. The aim of this study was to evaluate the prognostic
factors affecting the survival of patients with adenocarcinoma of the pancreas in Malaysia.
Methods: This retrospective study examined 107 patients with adenocarcinoma of the pancreas from 2002
to 2012 at University Malaya Medical Centre. The factors evaluated were age, sex, race, smoking habits,
performance status, the presence of jaundice, pre-treatment CA 19.9 serum level, the location of a primary
tumour, tumour grade, tumour staging and intent of treatment.
Results: The median survival for the overall study population was 7.0 months (95% CI 5.1-8.8 months) with
1, 3, and 5-year survival rates of 30.8%, 8.4% and 3.7% respectively. The survival was 16.1 months (95% CI
7.7-24.4 months) for stage 1, 15.5 months (95% CI 8.1-22.8 months) for stage 2, 8.4 months (95% CI 6.1-10.8
months) for stage 3, and 3.8 months (95% CI 2.9-4.7 months) for stage 4. In multivariate analysis, independent
and unfavourable prognostic factors which retained significance were performance status, tumour stage and
treatment intent.
Conclusions: The biological characteristics are important as predictors of survival in patients with pancreatic
cancer. Longer survival is possible if the disease is identified in its early stages with good performance status.
Further development and evaluation of novel screening strategies need to be established to improve early
detection of this disease.
Background: Hepatitis C Virus (HCV) is a major public health problem worldwide. About 130- 200 million people
are infected with HCV worldwide leading to 500,000 deaths annually (WHO 2014). Healthcare workers (HCWs)
have played an important role in the transmission of HCV infection, either as victims or as sources of infection.
Objectives: To determine the prevalence of HCV, antibodies (Abs) RNA and genotypes among the female HCWs
in Baghdad and to identify whether HCWs were infective or only infected.
Subjects and Methods: A cross-sectional study involving 1001 women attending 17 health care centres in
Baghdad, Iraq, was carried out. Information on type and duration of their occupation was obtained. HCV Abs
(anti-HCV) were tested using a third generation enzyme immunoassay (EIA-3) and immunoblot assay (Lia
Tek-111). Molecular analysis using RT-PCR and DNA enzyme immunoassay (DEIA) for HCV-RNA and genotype
detections were carried out for 63 serum samples.
Results: Only 160/1001 (15.98%) were HCWs. Anti-HCV and HCV- RNA seroprevalence were significantly higher
(6.37%, p=0.0057, 88.83%, p= 0.011 respectively) among HCWs than non HCWs. HCWs were at a significantly
higher risk of exposure to HCV infection (OR=2.75, 95% C.I. =1.31-5.79). There was no significant association
between HCV genotypes and the HCWs. HCV-4 showed higher expression (62.5%) among HCWs.
Conclusion: Female HCWs were infective and infected with HCV, thus there is a need for medical equipment
to be sterilized and cleaned thoroughly.
Background: School children are at great risk of nutrition-related chronic diseases. Their eating pattern in
school is influenced by the availability of food served within the school environment. The purpose of this
paper was to determine the effectiveness of a canteen-based food nutrition intervention, designed according
to the theory of planned behaviour, on the knowledge, perception and choices of healthy food among primary
schoolchildren.
Methods: This was a prospective intervention study using a two-group design. Six school canteens from the
ninety-eight primary schools were randomly allocated to an intervention group or a control group. All the
food handlers in the intervention group were given a twelve-week training course in food nutrition. On the
completion of the course, 293 Standard Six students from these schools, were interviewed with a nutritional
questionnaire on food in their school canteens. The training programme for the intervention group and the
questionnaire for the students were developed and validated for the study, and a power calculation made for
the sample size of students.
Results: The students in both groups were homogeneous in gender and body mass. The mean body mass
index (BMI) was 19.26 (SD: 0.38) and 19.47 (SD: 0.39) for the intervention and the control group respectively.
There were more schoolchildren in the intervention group who purchased foods in school canteens (p 0.0036)
of milk and milk products (p 0.034), and white rice (p
Introduction: Providing adequate and equal access to healthcare is a key goal towards achieving universal health coverage. However, social and demographic inequalities in accessing health care services exist in both developed and developing countries. This study examined the demographic and socio-economic factors associated with the lack of access to public clinics in the Greater Kuala Lumpur area.
Materials and Methods: The study employed a survey involving 1032 participants. Data were collected using self- administered questionnaires distributed between October and December 2015 in the Greater Kuala Lumpur area.
Results: Of the 1032 participants, 535 were public clinic users. A quarter (25.8%) of the users stated that they did not have access to public clinics in their residential area. A multiple logistic analysis showed that the elderly, the women, those from ethnic minority groups, those of lower family income, and the private sector workers were more likely not to have access to public clinics than their counterparts.
Conclusions: The existing level of accessibility to public clinics could be improved by increasing the number of clinics. Clinics should be established to focus more on reaching the elderly, the women, the ethnic minority groups, the poorer families, and the private sector employees.
Introduction: Studying in a university can be stressful for any undergraduate student, and the excessive
stress is associated with physical and mental health problems. The purpose of the study was to examine the prevalence and determinants of perceived stress among undergraduate students in a Malaysian university.
Methods: 456 undergraduate students participated in this study. The Perceived Stress Scale and the Student Stress Survey (SSS) were implemented as indicators; PSS as a global measure of perceived stress, and the SSS for the identification of the sources of stress.
Results: The prevalence rate of perceived stress among the undergraduate students was 37.7%. The overall PSS mean score was 27.5 ( SD 4.763), with a cut-off value of perceived stress at 28. Multivariate logistic regression model identified that the female student (OR 1.995, 95% CI 1.313-3.031) and the first year student (OR = 2.383, 95% CI 1.047-5.422) perceived more stress than the others.
Conclusion: The present study demonstrated a high prevalence rate of perceived stress among undergraduate students in general, and the female and the first year undergraduate students in particular. There is a need for further studies on the borderline stress of the undergraduate students and the sources of stress.
The study aimed at government efforts in making maternal and child healthcare services more available to
rural women, many of whom who still seek care from traditional practitioners during the postpartum period
after childbirth. In this research, we explored the role of traditional practitioners, such as Traditional Birth
Attendants (TBAs), herbalists and spiritualists, in traditional maternity care and the implications for the health
of the expectant mother, foetus or baby. This qualitative inquiry used purposive sampling and snowballing to
select the respondents in their various localities. It was observed that the traditional practitioners performed
both spiritual and medical roles during pregnancy and childbirth.
In the study, we discovered that both mothers and babies were exposed to health risks, as administration
of the herbal medicines and assistance at deliveries were carried out under unhygienic conditions. The
techniques used in labour management were not in compliance with the recommendations of the World
Health Organisation. The stages of maternity were characterised with the application of herbal concoctions
with spirituality attached.
The study recommends re-examination of mediating socio-cultural factors to professional health care. There
is a need for the Ghana Health Service to ensure the efficacy and safety of herbal drugs as well as to monitor
the production and application of such medicines.
Background: The rise in substance-use-related problems among Malaysian adolescents called for a study to
assess the efficacy of an anti-drug educational program to improve the knowledge, attitude and perception
(KAP) of Malaysian students regarding substance use.
Methods: This study involved 573 students from four Malaysian Chinese schools in Malacca. Each student
filled out a Likert-scale mandarin translated questionnaire (KAP-C) on substance use ( Pre-test). Following an
educational program on substance use, the KAP-C questionnaire was given again to the students, immediately
following the program (PT 1), and after a month (PT 2) and two months (PT3) of the programme.
Results: The students showed improvement in knowledge of the types of substance use in PT 1 (p
This is a retrospective case control study conducted between 1 January 2005 and 30 June 2006 at the Hospital Tuanku Jaafar, Seremban, Malaysia. The objective was to study the maternal sociodemographics and foetal characteristics associated with premature delivery. There were 387 cases selected universally and 387 controls selected by using systematic random sampling involving every 13 cases. The patients were women who had delivered their babies before 37 completed weeks, while the control were women who had term deliveries during the same period. Data were collected using structured questionnaire through secondary data. Results showed that having multiple pregnancies (OR=8.33, 95% CI: 2.91, 23.84), congenital abnormality (OR=4.6, 95% CI: 0.98, 21.84) and intrauterine growth retardation (OR=15.59, 95% CI: 3.69, 65.82) were the risk factors of premature delivery. Being an ethnic Indian also raised the odds (OR=1.67, 95% CI: 1.14, 2.43) but this was not significant in the multivariate analysis. Other sociodemographic characteristics did not contribute significantly to the risk factors for premature delivery in this sample. In conclusion, foetal characteristics were found to be significantly associated with premature delivery after adjustment for other confounding factors.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
Social anxiety is explained as noticeable anxiety or fear in one or more social situations where the individual is exposed to possible analysis by others. This research is aimed to determine the association between perfectionism and social anxiety among adolescents in Selangor, Malaysia. A final sample of 327 participants, between 13 to 18 years old, was collected. Data collection was conducted in two public secondary schools and two private high schools in Selangor. This survey included three instruments of analysis: The Child-Adolescent Perfectionism Scale, Kutcher Generalized Social Anxiety Disorder Scale for Adolescents and Demographic Questionnaire. The results showed that there is a significant positive association between perfectionism and social anxiety. This study has proved the positive association between perfectionism and social anxiety among adolescents in Selangor, Malaysia. Therefore, it is important to identify those students with these issues and guide them in an effective way to overcome the issues.
Background: Set-up errors are errors which are inevitable in radiotherapy. However, they should be kept to a minimum to achieve the maximum radiation dose to a tumour as to maximise treatment efficacy. This study aims to quantify those errors and assess if they remain within the tolerance limit of 5 mm in all directions. This study will also determine the adequacy of the margins for set up error for 3DCRT of rectal cancers at University of Malaya Medical Centre (UMMC).
Methods: A total of 20 rectal cancer patients (July 2018 to May 2019) who were treated with radiotherapy amounting to a total of 119 CBCT images were included in the study. Population systematic errors and random setup errors were calculated.
Results: Population systematic errors and random setup errors in the vertical, longitudinal and lateral direction were tabulated in Table 1. There is a large deviation (>5 mm) noted in some patients’ setup between the first 3 days and the next successive day of imaging. Clinical target volume (CTV) to planning target volume (PTV) margin were calculated using Van Herk’s margin recipe (M=2.5Σ+0.7σ). The margins were 5.0 mm, 6.2 mm, and 4.0 mm for vertical, longitudinal and lateral directions, respectively. The systematic error for the population was 1.1 mm, 0.9 mm, 0.9 mm in the vertical, longitudinal and lateral directions respectively, while the random error is 3.2 mm, 5.7 mm and 2.5 mm in the vertical, longitudinal and lateral directions respectively.
Conclusion: All of the patients involved in the study were within tolerance limits at some point in their treatment. The results demonstrated that a larger margin is needed in the longitudinal direction. Weekly CBCT is also necessary after the initial 3-day imaging to ensure that patients are kept within the tolerance limits.
Migration is a widespread phenomenon throughout the world and it has been under way since time immemorial. While studies have focused on the causes of migration and the impact of migrants, studies focusing on the emotional experience of the left-behind older persons’ adjustments in their twilight years after the departure of their adult children, are few and far between. Thus, the perspectives of these left-behind older parents/persons are less understood. This paper aims to contribute to the literature by addressing the gap which will be filled through the experiences of left-behind Malaysian older persons. Drawing on in-depth interviews extracted from a qualitative study that focused on the strength of long-term marriages among Malaysian Chinese couples, this paper captures four older couples’ experiences that depict their feelings about their adult children’s migration. Analysis suggests that the children’s migration was induced by a lack of support and resources, followed by unequal educational opportunities. To deal with the gap left by their children, these older urban parents depend on kinship connection and community support in times of need. Government initiatives may also be able to empower the community in innovating and implementing plans which are tailored to the needs of the older parents left behind by children who have migrated. The living arrangements and recent bereavement experiences captured from the older couples can serve as cues for healthcare professionals and social support providers to assess the risks of social isolation and suicide among these left-behind older parents.
Background: Urinary incontinence is a common problem among older women. The objective of this study was to determine the prevalence of urinary incontinence among older women aged 55 years and over in the Klang valley, the most densely populated urban area in Malaysia, and to determine any potential ethnic differences.
Methods: This study used cross-sectional data from the Malaysian Elders Longitudinal Research (MELoR) study. A total of 863 participants were included, with a mean age of 67.97 ± 7.50 (S.D.). They were selected by simple random sampling from the electoral rolls of three parliamentary constituencies.
Results: The prevalence of urinary incontinence was 30.8%. Mixed urinary incontinence (UI) was present in 44.7%, stress UI in 39.1% and urge UI in 16.2%. Ethnic Malays (38%) were more likely than ethnic Indians (32.3%) and Chinese (29.7%) to have UI. Ethnic Malays were also more likely to have stress UI and Indians were more likely to have urge UI .
Conclusion: The prevalence of UI in this study was comparable to other Asian and worldwide studies. The significant association between ethnicity and UI, however, has not been reported in any previous studies. Further studies should identify factors which may determine these ethnic differences in UI.
Background: In Malaysia, the prevalence of adolescents’ suicidal ideation has increased over the years. Therefore, it is crucial to investigate the predictors of suicidal ideation among adolescents. Hence, the aim of this study was to examine the predicting effects of depression and self-esteem on suicidal ideation among Malaysian adolescents. In addition, the relationships between depression, self-esteem, and adolescents’ suicidal ideation were explored as well.
Methods: By using a multistage cluster sampling method, a cross-sectional study was conducted in secondary schools in Kuala Lumpur, Malaysia. The participants were comprised of 852 adolescents (51% males and 49% females) aged 13-17 years old who completed self-administered questionnaires. Pearson’s Correlation analysis was used to analyse the relationships among depression, self-esteem, and adolescents’ suicidal ideation, while Standard Multiple Regression analysis was used to examine the predicting effects of depression and self-esteem on adolescents’ suicidal ideation.
Results: Depression had a positive correlation with adolescents’ suicidal ideation (r = .290, p < .001), while self-esteem had a negative correlation with adolescents’ suicidal ideation (r = -.283, p < .001). Results also showed that both depression (β = .200, p < .001) and self-esteem (β = -.186, p < .001) significantly predicted adolescents’ suicidal ideation.
Conclusion: The study found that depression is a risk factor, while self-esteem is a protective factor of adolescents’ suicidal ideation.
A 71-year-old lady with rheumatoid arthritis developed painful peripheral vasculitic neuropathy of the lower limbs and was treated with high dose steroid and cyclophosphamide. Eight months later, she presented with left hip and back pain for a week, with minimal relief from regular analgesia. Although the initial pelvic radiograph was normal, a repeat film performed two weeks later showed a destructive lytic lesion in the left pubic bone, confirmed as osteomyelitis with intramuscular collection by MRI. Cloxacillin was started empirically, and when the blood culture isolated methicillin-sensitive Staphylococcus aureus (MSSA), it was planned to be given for six weeks via a peripherally inserted central catheter. Despite an initial response, she became febrile on the fifth week of antibiotic therapy. Subsequent blood culture isolated Trichosporon asahii. Her condition deteriorated, and she succumbed on the fourth day of antifungal therapy. In conclusion, the diagnosis of osteomyelitis pubis, a rare complication of MSSA bacteremia, could be delayed in an atypical presentation.
Venous malformations (VM) of vulva, perineum and pelvis are uncommon condition which may present with cutaneous varices or aesthetically disabling swelling of external genitalia. Herein, we report a young woman who presented with a large left vulva bluish tinged swelling, progressively increasing in size since birth. Computed tomography of the pelvis and lower limbs confirmed the diagnosis of extensive VM of pelvis and perineum. She underwent selective angiogram which revealed venous malformations of left vulva and gluteal region with no arterial supply to the lesion. Surgical excision was performed but complicated with bleeding which necessitate multimodal hemostatic procedures and blood transfusion. There is no recurrent swelling after 5 years follow up. Surgical excision of vulvar venous malformation offer good cosmetic outcome. However, appropriate planning with axial scan, angiogram and operative technique including multimodal hemostatic measure are important steps to achieve good result with no recurrence. We discussed on challenges on management of this case in relation to the currently available literature.
Scrub typhus is an acute febrile illness caused by the bacteria Orientia tsutsugamushi, which can be transmitted to humans through the bite of infected trombiculid chigger mites. Besides the typical clinical features of fever and eschar formation, the central nervous system has been reported to be involved as evidenced of reported cases ranging from meningitis to meningoencephalitis. Here, we describe an atypical presentation of scrub typhus case that occurred in a 34-year-old Malay male who presented with quadriplegia following an insect bite at the back of his neck. Our case displayed unusual findings of this rare condition in a non-aboriginal Malaysian population. Based on previous literature, we emphasized the importance of prompt diagnosis of scrub typhus in order to reduce the mortality and morbidity and to improve the quality of life for patients with complications of this disease.
Depression is a frequent companion of stroke. It is associated with a degree of functional impairment that might adversely affect rehabilitation. A study was carried out to determine the rate of self-reported depression at admission and after six months, and the associated factors, in patients with stroke who were referred for rehabilitation. A multiple binary logistic regression was used to determine the associated factors at six months. Depression was recorded in 45% of patients at admission and in 39% at six months after the stroke. Patients who were employed, those who were depressed at admission, those who did not return to work and those who did not return to driving six months after stroke, were significantly associated with depression.
Introduction: The health effects of inhaling rice dust contaminated with endotoxin include respiratory problems, asthma, chronic bronchitis and chronic obstructive pulmonary disease.Thus, this comparative cross-sectional study aims to associate the concentration of endotoxin levels in inhalable rice dust and the lung function decline among rice millers.
Materials and Methods: The endotoxin level in inhalable dust for both area and personal samplings were collected using 25 mm Glass Fiber (A) filter loaded in IOM samplers connected to a pump by tygon tubing. The pump was operated at 2.0 litres/min and clipped around the breathing zone of the rice millers for eight hours. The endotoxin concentrations were analysed using Limulus Amoebocyte Lysate Chromogenic Endpoint assay at 405 nm. Lung function tests were carried out using Spirometer (Pony FX), for both the rice millers and the non-exposed groups.
Results: Findings for the mean concentration of endotoxin for areas was 0.26(standard deviation (SD) = 0.12) EU/m3 whereas the mean personal inhalable endotoxin level among the rice millers was 0.29(SD = 0.15) EU/m3. Post-shift lung function tests for FEV1/FVC measured appeared lower among rice millers (54%) compared to non-exposed workers (62%), but not statistically significant (p = 0.313). However, there were significant correlations between endotoxin concentration and post-shift LFT parameters of measured FVC, FEV1 and PEFR (p < 0.05).
Conclusion: Despite the low level of endotoxin exposure, proper protective measures should be applied for rice millers for long term protection.
Introduction: Optimal humidity, temperature, improper handling and storage of rice will increase the likeliness of aflatoxin growth in the air. The most common and carcinogenic aflatoxin is Aflatoxin B1 (AFB1) that may cause lung cancer if inhaled. This study aims to associate the exposure of AFB1 in inhalable dust and its respiratory effects among rice millers.
Materials and Methods: This cross-sectional study utilised the purposive sampling method and recruited 76 rice millers as exposed subjects and 48 office workers as the control group. The total inhalable dust was collected using the filter-loaded air samplers for an eight working hours’ exposure. The subjects’ hands were swabbed with cotton pads wetted with 0.5 ml Phosphate buffered Saline Tween-20 solution post shift. The collected samples were analysed for AFB1 by using the ELISA kits. The questionnaire gathering information on sociodemographic, work data and respiratory symptoms were completed. The lung function test was performed for the pre- and post-shifts.
Results: The mean airborne AFB1 at the rice mill area and personal exposure were 2.22 ng/m3 ± 0.07 and 0.25 ng/m3 ± 0.24, respectively. The mean contamination level of AFB1 on hands was 0.25 ng/ml detected on two rice millers (2.3%) while non-detectable in non-exposed workers. The most complained symptoms among rice millers were wheezing and breathlessness (n = 6, 9.2%). There was a significant difference in the mean forced expiration volume (FEV1) for pre- and post-shifts between rice millers and the non-exposed workers, but no significant correlation between the mean AFB1 concentration and lung function. Age and work factors were confounders in lung function.
Conclusion: Despite no association being established in this study, the promotion of wearing suitable personal protective equipment (PPE) is highly recommended to prevent cumulative exposure among the rice millers.
Background: TheJob Demand – Resource Model (JD-R) is a job-stress model that focuses on assessing the effect of the employees’ health-related outcomes, and their performances due to stress induced by their job demands, and job resources. Different occupations possess different combinations of specific job-related demands, and job resources. The Copenhagen Psychosocial Questionnaire (COPSOQ) is an established self-reported tool that has been widely used to measure general job demands through the JD-R model. In contrast, the BDJD-24 is a model that was developed to assess the specific job demands of the bus drivers’ job demands.
Objective: This study aims to measure the validity and reliability of the job demand questionnaire by applying it on the taxi drivers of Malaysia so as to assess their safety performance (safety motivation and safety compliance).
Method: A sample of 33 (N = 333) taxi drivers from the Klang Valley, Malaysia was recruited. Participants completed the questionnaire in the native language (Malay). To examine the psychometric properties of the COPSOQ and BDJD-24, we used the Exploratory Factor Analysis (EFA) derived from SPSS, and then confirmed it with the Confirmatory Factor Analysis (CFA) derived from AMOS.
Results: The internal consistency was found to be acceptable, between 0.71 to 0.84. The CFA revealed that the taxi drivers’ job demands, as proposed, had a 5-dimensional influence. The five demands (i.e. emotional, hiding emotion, sensory, time, and safety) were clearly distinguished in the factor analysis. The KMO was adequate, at 0.78, and the variance for the 5-factor structure was 51.97%. The CFA also confirmed the correlation among these demands.
Discussion: It is found that the COPSOQ and the BDJD-24 measurement were both reliable and valid for measuring the taxi drivers’ job demands. However, the general vs. specific job demands hypothesis, as proposed by the JD-R model, was not supported. The general job demands (emotional demands) were found to be more strongly associated with safety motivation, and safety compliance. The practical implications and limitations of the present study are further discussed in the paper.