Introduction: Help-seeking pathway in psychiatry is the important link between the onset of a mental disorder and mental health service provision. Understanding of the help-seeking pathway can help us to device more effective strategies for early detection and treatment.
Objectives: To determine the help-seeking pathways and treatment delaying factors of in-patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV - Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and treatment delaying factors were determined through face-to-face interview and semi-structured questionnaires.
Results: The number of non-psychiatric helpseeking
contacts prior to first consultation with psychiatric service ranged from 0 to 10. The mean number of contacts was 2.3 ( 2.6), and median was 1 (IQR = 0 to 3). About a third of them (32%) had three or more non-psychiatric contacts. The most common point of first non-psychiatric contact was with traditional healer 24 (48%), followed by general practitioners 12 (24%), and only 14 (28%) of them sought help directly from psychiatric service. The most common reason reported for delay in seeking psychiatric treatment was, “not aware that changes were related to mental illness” (74%).
Conclusions: History of contacts with traditional healers was common among in-patients with first episode psychosis in HKL. Treatment delay was mainly contributed by factors related to lack of awareness on psychosis. More strategic mental health education program is needed for early detection and treatment of psychosis.
Objective: The aim of this study is to compare the prevalence of life events among parasuicide patients
with the prevalence of similar life events among age, sex and race matched patients with non-chronic
medical illness. Methods: A hospital-based case-control study using convenience sampling method
was conducted in Hospital Kuala Lumpur for a period of three and a half months. A total of 50 patients
admitted consecutively after an episode of parasuicide and who fulfilled criteria for entry into the study
agreed to participate. For each case one age-, sex- and race-matched control was selected from the list of patients who were admitted to the same hospital for non-chronic medical illness. Result: Statistical analysis showed that compared with medically ill patients, parasuicide patients had significantly higher prevalence of threatening life events six months (p
Background: In Malaysia, the prevalence of hypertension amongst adults aged 30 years and above has increased from 32.9% in 1996 to 40.5% in 2004 and to 42.6% in 2006. Information on the prevalence of hypertension among adolescents is lacking.
Objective: to determine the prevalence of hypertension among Malay secondary school students in Putrajaya.
Methods: A cross sectional study was carried out in Putrajaya, Malaysia. The sampling frame consisted of a list of all the 12 secondary schools in Putrajaya. Three schools were selected using table of random numbers. All Malay students aged 13 years old to 17 years old from the three selected school students were included in the study. Blood pressure was measured after the respondents had rested for at least 5 minutes using a standard mercury sphygmomanometer. Three blood pressure measurements were taken for each respondent. Systolic blood pressure [SBP] was defined as the average of three SBP readings and diastolic blood pressure [DBP] was defined as the average of three DBP readings. Data was analyzed using SPSS 18.
Results: The overall mean SBP and DBP were 108.9 mmHg and 63.2 mmHg respectively. The prevalence of pre-hypertension and hypertension among the male was 16.2% and 12.9% respectively as compared to 5.8% and 10.2% respectively in the females. The overall prevalence of prehypertension and hypertension was 11.1% and 11.6% respectively. The prevalence increased with age (p<0.05). There was a significant positive correlation between BMI and SBP (r = 0.52, r2 = 0.27, p= 0.001) and BMI and DBP (r = 0.38, r2 = 0.15, p= 0.001). The mean SBP was significantly higher in males (111.7 mmHg) as compared to 106 mmHg in females (p<0.001). The mean DBP in males (63.5 mmHg) was slightly higher as compared to 62.9 mmHg in females but the difference was not significant.
Conclusions: Prevalence of hypertension and pre-hypertension is high. There is an urgent need for implementation of a comprehensive CVD prevention program and routine blood pressure measurements should be taken in school children to improve the detection, prevention and treatment of hypertension
Keywords: Prevalence, Hypertension, Adolescents, Putrajaya, Malaysia
Health care workers (HCW) are constantly exposed to blood-borne illnesses through needle stick injuries (NSI). Despite the increasing trend of NSI, evidence regarding the actual practice of universal precautions among these HCWs is lacking. This study assessed the practice of universal precautions towards prevention of NSI among HCWs in a teaching hospital setting.
Methods: This cross-sectional survey involved a newly-designed self-completed questionnaire assessing demographic data, exposure to NSI and practice of universal precautions. Questionnaires were distributed to every ward and completed questionnaires were collected after a period of 7 days.
Results: A total of 215 HCWs responded to the survey. 35.8% were exposed to bodily fluid, with 22.3% had NSI in the last 12 months. Blood taking was the commonest procedure associated with NSI. Of practices of universal precautions, recapping needle and removing needle from syringe were still wrongly practiced by the HCWs assessed.
Conclusion: NSI among HCW are still common despite the introduction of universal precautions in our hospital. Incorrect practices in handling sharps should be looked into in order to reduce the incidence of blood-borne illnesses through NSI in the hospital.
Preventive fogging is defined as space spraying of insecticide against mosquitoes in order to prevent outbreak of mosquito borne infection. Despite provision of various preventive andcontrol activities against dengue and chikungunya infection by Ministry of Health Guideline, the detail on preventive fogging has not yet specified. However, this has been adopted by certain institutions as part of the routine strategies against dengue outbreak. A study on preventive fogging was conducted in one of the hostels in Universiti Putra Malaysia. The research was done for 16 weeks in which one routine fogging activity was done at the mid period of study. The main objectives of this study were to determine the effectiveness of preventive fogging activities against Aedes mosquitoes and to identify the distribution and abundance of Aedes mosquitoes in the area. Method: The fogging activity was carried out by the management staff as part of their preventive measures in the student hostels. Ovitrap was used as an indicator to monitor the impact of fogging activity and its continuous surveillance was monitored weekly. The ovitraps were placed indoors and outdoors. Species identification was carried out in the laboratory. The SPSS program was used to analyse the statistical data on the effectiveness of fogging activity. Larval count (indoors and outdoors) and ovitrap index (OI) readings were identified as ovitrap surveillance data for statistical analysis. Results: The results showed that Aedes albopictus was the only species of the genus Aedes found in this hostel. The area had been highly infested by Ae. Albopictus as indicated by high Ovitrap Index ranging between 48.33% to 90.00%. The mean (SD) of Ovitrap Index was reduced from 71.67% (12.73%) (before the preventive fogging), to 69.42% (14.40%) (after the fogging). Overall reduction in mosquito and larval density was also observed between pre and post fogging activity in this study. Conclusion: The implementation of preventive fogging has favourably reduced the dengue vector population up to 5 weeks after the introduction of preventive fogging. However, sole dependency on preventive fogging may lead to insecticide resistance. Revisiting the policy on preventive fogging; and identifying it as an additional tool for preventing dengue infection in higher learning institutions are recommended.
The objectives of this study were to determine the prevalence of the urban poor and its health related factors in Selangor. This cross-sectional study was conducted in the community of Selangor. Data was collected from January 2006 to June 2006. Three out of nine districts were selected to be involved in the study, which were Klang, Kuala Langat and Petaling. A Multistage Stratified Proportionate Systematic Random Sampling was used for this study. The sampling was carried out by the Statistics Department of Malaysia. The survey frame was based on the information gathered from the Population and Housing Census in year 2000. The respondents were interviewed by trained research assistants using a structured pre-tested standardized questionnaire prepared in Malay and English languages. A monthly income of RM706 and less was used to define urban poor based on the guidelines given by the Economy Planning Unit of Malaysia (2004). SPSS 16.0 version was used to analyze the data. Out of 2535 respondents interviewed in this study, 2491 respondents answered the questionnaire completely (response rate 98.3%). Out of 2491 respondents, 202 (8.1%) had a monthly income of RM706 and less. Analysis of the urban poor respondents found that majority were aged between 18 to 40 years old (55.9%), and 29.7% had diagnosed medical illnesses, where hypertension, diabetes and asthma were the most common illnesses at 12.4%, 10.9% and 5.0% respectively. About 10% of the urban poor respondents had physical disabilities such as blurring of vision (7.9%), hearing problems (1.0%) and other disabilities (1.0%).
Little is known about the sero-prevalence of diphtheria anti-toxoid antibody levels among medical students in Malaysia. They too, just like other health care workers (HCWs) are at risk of contracting and transmitting diphtheria. Fortunately, this can be prevented by giving a specific vaccine: the diphtheria, tetanus and pertussis (DTP) vaccine. Nonetheless, data from local or regional surveys are needed before any decision is made by the respective authorities. General objective: We studied the epidemiology of diphtheria anti-toxoid antibody levels and vaccination history amongst medical students and staff in Faculty of Medicine and Health Sciences, Universiti Putra Malaysia. Specific objectives: We determined the level of diphtheria anti-toxoid antibodies amongst pre-clinical students and staff. Methodology: A total of 152 sera were collected from subjects aged 19 to 63, and diphtheria anti-toxoid levels were measured by an enzyme-linked immunosorbent assay. Results: One hundred and fifty-two (94.4%) blood samples out of 161 participants were successfully withdrawn, which comprised 105 (69.1%) and 47 (30.9%) medical students and staff, respectively. A total of 77.6% and the other 22.4% of the subjects had full and basic protection, respectively. Higher levels were predominant amongst males and they were 1.3 times more protected than females in 20-29 year-old group (85.1% vs 66.2%; odd ratios 1.25 [95% CI 1.03-1.50]; P=0.03). No significant difference in the levels of immunity among subjects for ethnicity and academic position (P>0.05). Recommendations: Level of full protection against diphtheria toxin should be clearly defined by broad population based studies using several comparable detection methods. Medical students and staff with basic protection should be closely monitored or should be given a booster dose for those who are at high risk of acquiring the disease. Thus, a standard degree of coverage should be clearly determined for health workers to prevent a potential outbreak. Conclusion: Students and staff possess immunity towards diptheria toxin however the level of full protective antibody is yet to be determined in future.
Introduction: In Malaysia, cardiovascular diseases (CVD) have been the leading cause of death for the past 40 years. Hypertension is the leading treatable risk factor for CVD mortality.
Objectives: to determine the prevalence and factors associated with hypertension among University Putra Malaysia staff.
Methods: A Cross sectional study design was used in this study. The sample was selected using table of random numbers. Two blood pressure measurements were taken from respondents aged 30 years and above. Data on socio-demographic variables and lifestyle-related risk factors were collected using a pre-tested structured questionnaire. Weight and height measurements were also taken.
Results: Out of 517 respondents selected, 454 subjects agreed to participate, giving a response rate of 87.8%. The overall mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) for 454 respondents was 126.2 mmHg and 80.17 mmHg respectively. The mean SBP was significantly higher in males (129.68 mmHg) as compared to the females (122.65 mmHg). The mean SBP and DBP significantly increased with age in both males and females (p<0.05). There was a significant relationship between SBP and BMI (r = 0.55, r2 = 0.30 p <0.001) and diastolic blood pressure and BMI (r = 0.53, r2 = 0.28, p <0.001). The overall prevalence of hypertension was 34.4% and 33.9% had pre hypertension. Hypertension was significantly associated with age, gender, family history of hypertension, BMI and alcohol consumption. Conclusions: Prevalence of hypertension and pre-hypertension is high. There is an urgent need for implementation of a comprehensive CVD prevention program. Routine blood pressure measurements should be taken to improve the detection, prevention and treatment of hypertension.
Keywords: Hypertension, Prevalence, Risk Factors, University Staff, Prevalence
This study determined the association between nutritional status and the use of protease inhibitors (PI)
containing regimen among HIV-infected children receiving treatment at the referral centres in Klang
Valley. A total of 95 children currently on antiretroviral (ARV) therapy, aged one to eighteen years, were recruited using purposive sampling. Demographic data, anthropometric measurements, medical history, were collected using a structured questionnaire. Serum micronutrients levels and lipid profile were also examined using blood samples. Mean age was 8.8 3.9 years and 44.2% were on PI. Age ( 2 = 10.351, p = .006), weight-for-age ( 2 = 6.567, p = .010), serum selenium ( 2 = 4.225, p = .040) and HDL-C ( 2 = 7.539, p = .006) were significantly associated with the use of PI. Fewer children on PI were deficient in selenium as compared to those not on PI. On the contrary, more children on PI were underweight and had low HDL-C. The use of PI was found to have both positive and negative effects with better selenium level but poorer HDL-C level and weight status.
Introduction: Acute gastroenteritis (AGE) is one of the frequent causes of hospitalization in children under the age of five, particularly in a rural setting. This study was conducted to determine the epidemiology of acute gastroenteritis in indigenous children admitted to a rural district hospital in Sarawak. Methods: A retrospective review of indigenous paediatrics cases of acute gastroenteritis
admitted to the ward of Serian District Hospital, a rural district hospital in Sarawak, between the years
2006-2007. The data was collected from the patients’ case notes, obtained with permission from the
hospital management. Data was entered and analyzed using SPSS version 16. Results: During the study period, 234 indigenous children with acute gastroenteritis were admitted with the highest prevalence in 2006 (53.4%). The findings showed higher prevalence was found in children aged 3 years and below (76.5%) and male (56.4%) The minimum duration of hospital stay is 1 day, and the maximum stay is 5 days. The clinical findings showed that the majority of the cases presented with vomiting, diarrhea, dry mouth and tongue, sunken eye, with the majority (76%) reported having mild dehydration. The most common treatment used is oral rehydration solutions (85.4%), followed by intravenous bolus or drip (82.3%), paracetamol (79%) and antibiotic (36.2%). Peak incidence of admissions was between November to January. About 38.5% of the AGE cases admitted were found to be underweight (weight for- age below -2SD). Conclusion: The findings indicated children aged 3 years and below are the most vulnerable to AGE and malnutrition could be one of the predisposing factors. The peak incidence during the raining season at the end of the year indicated a possible relationship between AGE and seasonal type of virus infection. Prevention in the form of proper hygiene at the household level probably will prove to be useful.
Introduction: Amniotic fluid (AF) consists of heterogenous population of cells with high diagnostic
and therapeutic values. The study of rat amniotic fluid cells is very limited, despite the extensive use
of this animal model in biomedical research. Primary culture of rat AF cells, especially from full term pregnancies has not been well established. Here we attempt to determine the suitable medium in
culturing rat AF cells that would enhance the cell viability, growth rate and heterogeneity. Methods:
The cell viability, growth rate and heterogeneity of rat AF cells were compared upon culturing the
primary cells in two different media; Amniomax or RPMI. Cell viability study was carried out using
trypan blue staining, while the growth rate was monitored based on the time required to passage the cells (population doubling time in hour). The heterogeneity of cells was examined based on the morphology of the cells. Statistical analysis was performed using t-test. Results: Amniomax was observed to provide a better culture condition in culturing rat AF cells as the cells are more viable, grow faster and more heterogenous as compared to the cells grown in RPMI. Conclusion: Amniomax is a more suitable medium for high quality and viability of full term rat AF cell culture, as compared to RPMI. Thus, warranting propagation of more rat AF cells for biomedical research.
Introduction: Iontophoresis of vasoactive substances such as acetylcholine (ACh) and sodium nitroprusside (SNP) combined with Laser Doppler fluximetry (LDF) is a non-invasive tool used to determine microvascular endothelial function. This study aims to test the effect of sodium chloride on
non-specific vasodilatation when used as a vehicle in the process of iontophoresis. This study also aims to define the number of current pulses needed to get the maximum effect during iontophoresis with ACh and SNP using low current strength. Methods: The experiment was conducted in five healthy females. Baseline skin perfusion was taken before administration of seven current pulses. Current strength of 0.007 mA and current density of 0.01 mA/cm2 were used. Acetylcholine was used to assess endothelial dependent vasodilatation, while SNP was used to assess endothelial independent vasodilatation. The mean skin perfusion (AU) responses to the iontophoresis of ACh at the anodal and SNP at the cathode leads were recorded. Sodium chloride (0.9%) was used as a vehicle to obtain concentration of 1% for both ACh and SNP. Iontophoresis of pure vehicle (NaCl) was conducted on a separate day to observe the effect of vehicle only on the iontophoresis process at both anode and cathode. Results: Iontophoresis of NaCl showed no significant increase in perfusion compared to baseline at both anode and cathode. Significant increases in skin perfusion were observed with SNP and ACh; a plateau of ACh was reached from the 3rd pulse onwards; while the plateau of SNP was reached from the 4th pulse onwards. Conclusion: NaCl could be used as a vehicle for Ach and SNP during iontophoresis as it did not cause non-specific vasodilatation. Using five current pulses are adequate for iontophoresis of ACh and SNP to assess microvascular endothelial function.
Objective: The purpose of this study is to access the prevalence of anxiety disorders and quality of life factors among hematological cancer patients in a Malaysian hospital. Methods: This study used a cross-sectional research design. It was conducted at the Ampang Hospital in Kuala Lumpur, a tertiary referral center for hematological cancer. Anxiety disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI); quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQC30) questionnaire. Results: A total of 105 hematological cancer patients participated in the study, which constituted a response rate of 83.3%. The prevalence of anxiety disorders in our sample ranged from 1% to 24.8%. Overall, compared to patients without anxiety disorders, hematological cancer patients with anxiety disorders reported impaired quality of life in regards to emotional functioning, cognitive functioning, insomnia, dyspnoea, nausea and vomiting, appetite loss and constipation (p
Vitamin D plays an important role in maintaining the physical health as well as the performance of athletes. This cross-sectional analytical study was conducted to determine vitamin D intake, sun exposure and skin types of both indoor and outdoor Malaysian athletes in the National Sports Institute, Bukit Jalil. Method: A total of 28 indoor (badminton, shooting, wushu and fencing) and 36 outdoor (athletics, football and hockey) athletes were recruited for this study. The dietary vitamin D intake was estimated using Vitamin D-specific Food Frequency Questionnaire (FFQ). The Sun Exposure Index (SEI) was calculated from Seven-day Sun Exposure Record while the skin types of athletes were determined using Fitzpatrick Skin Typing Questionnaire. Results: The mean age of the athletes was 21.02±4.11 years and their mean Body Mass Index (BMI) was 22.20±2.22 kg/m2. The mean body fat percentage of outdoor athletes was significantly lower than indoor athletes (p
Globally, one person dies every six seconds as a result of tobacco use. This makes tobacco use the cause of every one out of 10 deaths in adults and the single largest and leading cause of preventable death in the world. The objective of this study was to determine the prevalence of smoking among staff of Universiti Putra Malaysia. For the purpose of this study an analytical cross sectional study design was used and a standardized, pre-tested, while a validated well-structured questionnaire was used for data collection. The prevalence of smoking was found to be 10.0% (26.5% among males and 0.5% among females). In addition, significant associations were found between smoking and gender, religion, marital status, highest educational level, occupation, and family income (p < 0.05). In particular, gender and educational level were significant predictors of smoking. In conclusion, the prevalence of smoking among university staff was shown to be considerably lower than that stated for the national level. However, the University could aim at achieving zero prevalence in the years to come.
Major Depressive Disorder (MDD) in gynaecological cancer patients is a disabling illness with significant mental and physical suffering. Determining the risk factors of MDD in cancer patients enables us to pay more attention to those who are vulnerable and to device effective strategies for prevention, early detection, and treatment. The objective of the study is to determine the prevalence of MDD and its associated risk factors in gynaecological cancer patients at Hospital Sultanah Bahiyah, Alor Star. This is a hospital-based cross-sectional descriptive study of 120 gynaecological cancer patients in Gynae-Oncology Unit in Hospital Sultanah Bahiyah, Alor Star. Mini International Neuropsychiatry Interview (MINI) was used for diagnosis of MDD. Socio-demographic data and clinical variables were collected. MVFSFI (Malay version Female Sexual Function Index) was used to determine sexual dysfunction, and WHOQOL-BREF (World Health Organization – Quality of Life-26) was performed to assess quality of life. The prevalence of MDD in gynaecological cancer patients in the study was 18%. The variables found to be significantly associated with MDD were lack of perceived social support, greater physical pain perception, presence of past psychiatric history, and poorer quality of life. Meanwhile, sexual dysfunction was not associated with MDD. Logistic regression analysis revealed that only the psychological health domain of QOL was significantly associated with MDD, and contributed to 60% of the variation in MDD. The prevalence of MDD in gynaecological cancer patients is higher than those in the general population. In view that MDD can compromise cancer prognosis and patient’s well-being, psychosocial intervention is recommended as a part of multi- disciplinary and comprehensive management of gynaecological cancer.
Clinical vampirism in psychiatric practice is very rare and usually associated with schizophrenia, antisocial personality disorder or paraphilia. An Asian case of clinical vampirism is described. It is about a 24-year-old Malay female, paramedic student, who craved for blood since childhood. She injured her sister and herself so that she could access and drink blood. There was no associated psychosis or medical problems. The craving for blood may represent her underlying craving for parental love and attention.
Management of Beta (β)-thalassaemia intermedia in contrast to β-thalassaemia major patients has no clear guidelines as to indicators of adequate transfusion. Regular blood transfusion suppresses bone marrow erythropoietic activity. Serum soluble transferrin receptor (sTfR) concentration is a marker for erythropoietic activity, with increased sTfR being associated with functional iron deficiency and increased erythropoietic activity. This study aimed to determine the use of sTfR as an indicator of adequate transfusion in adult β-thalassaemia intermedia patients. A cross-sectional study was conducted at Hospital Ampang, Malaysia, for six months. Patient group included six β-thalassaemia intermedia and 34 HbE-β-thalassaemia transfused patients. None of the patients were on regular monthly blood transfusions as in β-thalassaemia major. The control group comprised of 16 healthy subjects with normal haematological parameters. Haemoglobin (Hb) analysis, sTfR and ferritin assays were performed. Hb and HbA percentages (%) were found to be significantly lower in patients compared to the controls, while HbE%, HbF%, sTfR and ferritin were significantly higher in patients. An inverse relationship was found in the controls between HbF% with Hb (r = -0.515, p < 0.05) and HbA% (r = -0.534, p < 0.05). In patients, sTfR showed an inverse relationship with HbA% (r = -0.618, p = 0.000) and a positive correlation with HbE% (r = 0.418, p = 0.007) and HbF% (r = 0.469, p = 0.002). Multivariate analysis showed that HbA% (r = 2.875, p = 0.048), HbE% (r = 2.872, p = 0.020) and HbF% (r = 2.436, p = 0.013) best predicted sTfR independently in patients. Thus, sTfR is a useful marker for erythropoiesis. The elevated sTfR in these patients indicate that the transfusion regimen used was inadequate to suppress ineffective erythropoiesis. Hb levels may not be the best target for monitoring transfusion treatment in β-thalassaemia intermedia patients, but the use of sTfR is helpful in individualising transfusion regimens.
Cancer pain is a complex experience and is one of the most common and distressing symptom of breast cancer which affects patients’ functioning in daily activities, their quality of life (QOL), and mood. Yet, there is a great lack of data on breast cancer and pain in Malaysia.
Methods: A cross-sectional study using the Breast Cancer Patient Version of Quality of Life (QOL) Instrument (translated into Malay) and Depression Anxiety and Stress Scale (DASS) were conducted on 87 female breast cancer patients to investigate the impact of pain interference level on their quality of life and depressive level.
Results: The patients were divided into 4 groups based on their rating of how pain and aches have been a problem to them (i.e not a problem [n=18 (20.7%)], mild[n=29 (33.3%)], moderate [n=18 (20.7%)] and severe [n=22(25.3%). Pain and aches ware reported to be the most severe interference problems in QOL physical domain by patients (mean=5.8, SD=2.8), followed by fatigue (mean=6.0, SD=3.1) and sleep changes (mean=6.2, SD=3.5). Patients who reported that pain and aches had severely affected them showed significantly lower score on many aspects of quality of life (Fs > 5, p < 0.005; p < 0.0001) and patients reported pain was not a problem at all demonstrated highest score on all aspects of QOL. Patients with most severe pain interference level showed highest depressive score [F (3, 84) =3, p < 0.05].
Conclusion: The study underscores the impact of pain interference on patients’ quality of life and depressive level. The pain assessment deserves significant attention and therefore a comprehensive biopsychosocial assessment of pain to rule out any related underlying issues is warranted in the management of breast cancer to ensure appropriate intervention given to the patients.