BACKGROUND: Antibiotic resistance is a rising problem in Malaysia. For instance, high antibiotic prescribing rate for upper respiratory tract infection and inappropriate choice of antibiotic is a significant healthcare concern in Malaysia. Our main objective was to study knowledge, attitude and practice of antibiotic prescribing among medical officers in Kedah, Malaysia.
METHODS: A cross sectional study was conducted in outpatient departments of health clinics and hospitals in Kedah from June 2013 until December 2013. Sample size was 118 and systematic sampling was conducted. Research tool used was a validated questionnaire from studies conducted in Congo and Peru.
RESULTS: Response rate was 84.8%. Majority of our respondents were female doctors (71.0%), local graduates (63.0%), and practiced for 4 years or less (61.0%). 52.0% of the respondents prescribed antibiotics more than once daily. Mean knowledge score on antibiotics was 5.31 ±1.19 (95% CI: 5.06; 5.54). More than half (62.0%) of our respondents were confident in antibiotic prescribing and there were merely 18.0% of them consulted any colleagues prior to prescription. There was a significant difference in frequency of antibiotic prescribing between junior doctors and senior doctors (P-value: 0.036). In addition, there was also a significant association between frequency of antibiotic prescribing and awareness of antibiotic resistance in their daily practice. (P-value: 0.002).
CONCLUSION: Knowledge on antibiotic was moderate among our medical officers and antibiotic prescribing was frequent. Training and courses on appropriate antibiotic prescribing should be emphasized to ensure the best practice in antibiotic prescription.
INTRODUCTION: Despite the high prevalence rates of depression amongst chronic pain patients reported globally, the condition is often under-recognised and under-treated. Depression frequently complicates the effective management of pain and is associated with poor quality of life. This study aimed to explore the incidence of depression and its' associated factors in a sample of chronic pain patients in Malaysia.
MATERIALS AND METHODS: This descriptive cross-sectional study was conducted amongst clinically diagnosed chronic pain patients from the pain management clinic of Hospital Tengku Ampuan Rahimah over a period of seven months. Socio-demographics and clinical data were obtained from patients' interview and medical records. The validated Depression Anxiety Stress Scale-21 (DASS-21) was used for screening and Mini International Neuropsychiatric Interview (MINI) was used to establish the depression diagnoses among the patients. Numeric pain intensity scale was used to assess the severity of pain.
RESULTS: Eighty-three patients with a mean age of 50.4±12.50 years participated in this study. The majority of the patients were females (56.6%), married (85.5%) and being employed (49.4%). The percentage of depression was 37.4%. Depression was significantly associated with severity of pain (p<0.001) and the duration of pain (p <0.05).
CONCLUSION: Almost one third of chronic pain patients in this study have depression. Depression was significantly associated with the severity and duration of pain. Depression should be regularly screened among patient with chronic pain.
INTRODUCTION: Leptospirosis is endemic to tropical regions of the world and is re-emerging as a new danger to public health in Malaysia. the purpose of this particular study was to determine the common leptospiral serovars present in human communities living around wildlife reserves/disturbed forest habitats. the objective of this study was to estimate the seroprevalence of leptospirosis and finding infecting serovars in villages surrounded habitats where wildlife lives in Sarawak, Malaysia.
METHODS: A cross-sectional serological survey of 198 humans was conducted in four villages around Kuching, Sarawak between January 2011 and March 2012.
RESULTS: A seroprevalence of 35.9% (95%cI 29.2-43.0) to the MAt was detected in the tested humans. Antibodies to serovar Lepto 175 Sarawak were most commonly detected (31.3%; 95%cI 24.9-38.3) and were detected in individuals at all four locations. the presence of skin wounds (Or 3.1), farm animals (Or 2.5) and rats (Or 11.2) were all significantly associated with seropositivity in a multivariable logistic regression model.
CONCLUSIONS: the results of the current study are important as wildlife may act as reservoirs of leptospires for humans. Health authorities should expand disease control measures to minimise the spill-over from wildlife to humans visiting, living or working in the sampled locations. the pathogenic status of serovar Lepto 175 Sarawak also requires further investigation.
BACKGROUND: Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain.
OBJECTIVES: This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices.
METHODS: This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012.
RESULTS: Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (p<0.001). The level of education as well as past history of ischemic heart disease did not significantly influence the patients' choice of transportation.
CONCLUSION: The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultural and logistic factors may need to be addressed.
BACKGROUND: Undergraduate medical students have been the most distressed group among the student population. Depression and anxiety have been found to be more prevalent in this group of students compared to others.
OBJECTIVE: This study was conducted to determine the prevalence and predictors of suicidality among undergraduate medical students in a public university.
METHODS: This was an analytical cross-sectional study, conducted in a public university in Selangor, Malaysia. Data were collected using self-administered questionnaires from January to February 2013, and analysed using the Statistical Package for Social Sciences Software (version 21).
RESULTS: Out of 625 undergraduate medical students, 537 (85.9%) participated in the study. The prevalence of the suicidality among undergraduate medical students was 7.0%. The significant predictors of suicidality based on multiple logistic regression were the respondent's lifetime suicide attempts (Adjusted Odds Ratio, AOR 10.4, 95% CI 2.7 to 40.9); depression (AOR 5.9, 95% CI 1.5 to 23.0); breaking off a steady love relationship (AOR 5.4, 95% CI 1.3 to 22.4); hopelessness (AOR 4.9, 95% CI 1.1 to 21.6); and something valued being lost or stolen (AOR 4.4, 95% CI 1.2 to 15.9).
CONCLUSION: These findings indicate that mental health care services should be strengthened at university level. The results show a need for an intervention programme to reduce suicidality among the undergraduate medical students.
INTRODUCTION: The lack of evidence that proves the benefit of traditional and complementary medicines (T & CM) in treating chronic medical conditions does not deter its usage among patients worldwide. Prevalence of usage among post-stroke patients in Malaysia especially is unknown. This study aims to determine the prevalence, practice and perception of T & CM use among stroke survivors attending an outpatient rehabilitation program in a teaching hospital.
METHODS: A cross-sectional study was conducted among 104 post stroke patients attending an outpatient rehabilitation program. A structured self-administered questionnaire was used to collect data on sociodemographic and clinical profile of patients, as well as types of therapy used and perception on T & CM usage. Descriptive analysis was done, and bivariate analysis was used to determine associations between categorical data.
RESULTS: Mean age of patients was 62 years (SD 12.2), 54% were Chinese and 75% of the patients had ischaemic stroke. Mean age of T & CM users was younger compared to non- T & CM users (61 years vs. 66 years, p=0.04). Two-thirds (66%) of patients admitted to concurrent T & CM usage while attending conventional post stroke rehabilitation. Acupuncture (40.4%), massage (40.4%) and traditional Chinese medicine (11.5%) were the most common T & CM used. Positive perception was recorded in terms of ability of T & CM usage to relieve post stroke symptoms (68%), and it was safe to use because it was made from 'natural sources'. Negative perception recorded: T & CM caused significant adverse effects (57.6%) and was not safe to be used in combination with other conventional medicines (62.5%).
CONCLUSIONS: Concurrent T & CM usage among post-stroke patients attending structured outpatient rehabilitation program is widely practised especially acupuncture, massage and traditional Chinese medicines. Overall the perception towards its use is favourable.
OBJECTIVES: Low back pain (LBP) is one of the most common health problems faced by health care professionals due to their occupational lifestyle. This study aimed to quantify the prevalence of LBP among clinicians, and to identify its associated factors.
METHODS: A cross sectional study was carried out in King Khalid University Hospital (KKUH) among 460 clinicians from different specialties. A validated questionnaire of 21 items was used to collect data. Chi-square test and odds ratios were used to observe and measure the association between categorical variables. Binary logistic regression by Wald method was used to identify independent factors associated with LBP (yes/no).
RESULTS: The prevalence of LBP was found to be 59.4% (244) with 38% of them reported as severe. The distribution of prevalence among consultants, registrars and residents was 110 (45.1%), 91 (37.3%) and 43 (17.6%) respectively. Out of 114 (46.7%) surgeons who suffer from LBP we found, orthopaedic surgeons had 10.2% prevalence of LBP. Male clinician (odds ratio: 1.7; 95% Confidence Interval (CI): 1.1- 2.8), consultant (4.1; 95% CI: 2.1-8.3), registrar (2.2; 95% CI: 1.2-4.2), more than 10 hours/week near bedside (1.8; 95% CI: 1.1-3.0), bending backwards at work (8.3; 95% CI: 5.1-13.4) and pulling objects during work (3.1; 95% CI: 1.7-5.6) were found to be independent statistically significant associated factors of LBP.
CONCLUSION: The high prevalence of LBP among clinicians and its associated factors indicates that clinicians should maintain good posture and avoid sudden movements during working hours in hospital to reduce this occupational health problem.
INTRODUCTION: This study aims for construct validation using two approaches, i.e., exploratory factor analysis and Rasch Model.
METHODS: A cross sectional of 313 male workers from multiple worksites had completed self-administered Malay translated version of Three-Factor Eating Questionnaire- R21. Data quality was assessed by misfit person criteria, dimensionality, summary statistic, item measure and rating (partial credit) scale followed by exploratory factor analysis and internal consistency reliability assessment.
RESULTS: The dual approaches of construct validation analysis were complement to each other. Rasch analysis supported the theoretical constructs of three eating behaviour dimensions among respondents. In contrary to exploratory factor analysis, it did show presence of a newfound factor (∝=0.04) came up from the separation of the cognitive restrain and uncontrolled eating however, the correlation between the two respective sub-factors were fair (r=0.39) and weak (r= -0.08). Both analyses had detected three problematic items but those items were psychometrically fit for used for current study setting. The data had adequate psychometric properties. Cronbach's alpha for cognitive restraint, uncontrolled eating and emotional eating were 0.66, 0.79 and 0.87 respectively. Rating scale quality was conformed to standard criteria.
CONCLUSION: Malay version TFEQ-R21 with promising psychometric properties and valid measures for eating behaviour dimensions among male workers aged between 20 to 60 years old is now available. Further development should focus on the items in relation to Malaysian cultural adaptation before its use for daily practice in future setting.
INTRODUCTION: Psoriasis is a common, chronic, relapsing, immune-mediated inflammatory disease. Our objective is to review the clinical profile, co-morbidities, and outcome of patients with psoriasis.
METHODS: This is a cross-sectional study of outpatient psoriasis patients attending the dermatology clinic, Hospital Sultan Abdul Halim (HSAH) between January 2012 and June 2014. Data collection was based on Malaysian Psoriasis Registry.
RESULTS: Among 296 patients with psoriasis, Malays were the most common 175 (59.1%), followed by Indians 82 (27.7%), Chinese 37 (12.5%) and others 2 (0.6%). Male to female ratio was 1.2:1. More than half (54.7%) of the patients had early onset disease (age 40 or less). Only 26 patients (8.8%) have positive family history. The most common clinical presentation was chronic plaque psoriasis (89.9%), followed by erythrodermic psoriasis (4.7%), guttate psoriasis (3.0%) and pustular psoriasis (1.7%). Twenty eight percent had nail involvement while arthropathy was seen only in 14.7%. Common triggers were sunlight (46.0%), stress (31.1%), trauma (5.4%), food (4.0%), pregnancy (4.0%), and upper respiratory tract infections (2.7%). Co-morbidities observed include ischaemic heart disease (7.1%), hypertension (26.7%), dyslipidemia (17.6%), and diabetes mellitus (22.0%). All patients were on topical medications. About 6.8% of the patients were treated with phototherapy. One third of patients (35.5%) were given systemic therapy. Out of these, 84 patients (80.0%) were on methotrexate while only 16 (15.2%) on acitretin. None was on cyclosporine or biologic. In term of disease severity, 41.7% of patients had BSA >10% and 31.4% patients had DLQI > 10.
CONCLUSION: Our patients show a similar clinical profile and outcome as our Malaysian psoriasis population. However they tend to have a more severe disease. There is a need for a more effective targeted therapy for a better outcome.
INTRODUCTION: Cardiovascular diseases are the main cause of morbidity and mortality in Malaysia. There is evidence of high traditional and complementary medicine (TCM) use among population with cardiovascular risk and there have been anecdotal reports about substitution of conventional medicines with TCM. We investigated the prevalence of TCM use, treatment preference and substitution of conventional medicines in study population with cardiovascular risk factors in Pahang, Malaysia.
METHODS: A cross-sectional survey was conducted using an interviewer-administered questionnaire in five districts of Pahang. A total of 1250 households were chosen through proportionate and systematic sampling. Respondents aged 18 years and above were selected.
RESULTS: The study population with cardiovascular risk factors who used TCM was higher than the general population (31.7% versus 25.9%). There were no clear preferences in using TCM by gender, age groups, educational level and income even though other bumiputeras showed a slight inclination towards TCM use. Among the study population with cardiovascular risk factors who consumed TCM, 20-30% of them were using TCM as a substitute for their conventional medications. Respondents from the younger age group (18-40 years) (57.1%), highest educational level (43.2%), other bumiputeras (38.4%) and highest income group (31.4%) preferred the combination of both conventional and traditional medicine.
CONCLUSION: TCM use among population with cardiovascular risk factors is high. The high preference for combination therapy of TCM and conventional medications among young adults and the use of TCM to substitute conventional medications show that much research is needed to provide proven TCM therapies to avoid self-mismanagement of cardiovascular risk in Malaysia.
OBJECTIVES: The objective of this study was to compare empathy levels between first year and second year medical students at a Malaysian University.
SETTING: A Malaysian University offering undergraduate medicine.
PARTICIPANTS: 204 undergraduate medical students were included in the data analysis (122 first years, and 102 second years).
MAIN OUTCOME MEASURE: Self-reported empathy scores using the Jefferson Scale of Physician Empathy (Student Version) JSPE-S.
RESULTS: The mean empathy score for first year students was 112.1(SD=10.7). This was significantly higher (p<0.038; d=0.31) than second year students (mean=108.8, SD=10.4). No significant difference relating to gender was identified.
CONCLUSION: Cross-sectional results from this study found that that there were differences in self-reported empathy scores between year one and year two students. Further research is required to ascertain if these differences are maintained as students' progress thought their medical degree, and whether other factors such as internships, medical rotations or clinical supervision have any impact of medical students' empathy levels.
INTRODUCTION: Cutaneous adverse drug reactions (cADRs) are common. There are only few studies on the incidence of cADRs in Malaysia.
OBJECTIVE: To determine the incidence, clinical features and risk factors of cADRs among hospitalized patients.
METHODS: A prospective study was conducted among medical inpatients from July to December 2014.
RESULTS: A total of 43 cADRs were seen among 11 017 inpatients, yielding an incidence rate of 0.4%. cADR accounted for hospitalization in 26 patients. Previous history of cADR was present in 14 patients, with 50% exposed to the same drug taken previously. Potentially lifethreatening severe cutaneous adverse reactions (SCAR), namely drug reaction with eosinophilia and systemic symptoms (DRESS: 14 cases) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN: 6 cases) comprise almost 50% of cADRs. The commonest culprit drug group was antibiotics (37.2%), followed by anticonvulsants (18.6%). Cotrimoxazole, phenytoin and rifampicin were the main causative drugs for DRESS. Anticonvulsants were most frequently implicated in SJS/TEN (66.7%). Most cases had "probable" causality relationship with suspected drug (69.8%). The majority of cases were of moderate severity (65.1%), while 18.6% had severe reaction with 1 death recorded. Most cases were not preventable (76.7%). Older age (> 60 years) and mucosal involvement were significantly associated with a more severe reaction.
CONCLUSION: The incidence of cADRs was 0.4%, with most cases classified as moderate severity and not preventable. The commonest reaction pattern was DRESS, while the main culprit drug group was antibiotics. Older age and mucosal membrane involvement predicts a severe drug reaction.
We explored factors associated with alcohol use before or during sex among a sample of 10,861 men who have sex with men (MSM) in Asia who were recruited online for the study. Multinomial logistic regression analysis indicated that having sex under the influence of alcohol was associated with having multiple male partners, seeking partners primarily through gay bar/gym/dance party/friends, selling sex and using multiple drugs during the past 6 months, and unprotected anal sex. More efforts are needed to better assess alcohol use and misuse among MSM in Asia and understand contextual influences on alcohol use and HIV-related behaviors in order to implement culturally-specific interventions.
Adolescent smoking is an emerging health concern in the developing countries. A cross-sectional study is conducted to determine the prevalence and smoking behaviour of adolescents in Sarawak. The prevalence of smoking is 32.8% with mean age of initiation at 12.8±1.9 years. Most (67.2%) adolescents are experimental smokers and the majority (67.9%) did not smoke on a daily basis. Branded cigarettes are preferred (83.1%) and the cigarettes are obtained either from friends (49.1%) or self purchased (43.6%). Students prefer to smoke at their friend's house (31.0%) or at school (25.3%). Smoking prevalence among adolescents in Sarawak is high and begins early. Early intervention on smoking prevention and risk awareness is perhaps more effective if initiated before the age of 12 years.
A cross sectional study was carried out to evaluate the extent of occupational health problems focusing on some aspects of musculoskeletal symptoms among batik workers in Kelantan, Malaysia. The workers selected must have been in that industry for at least one year. Using cluster sampling, 202 workers were selected from 21 factories. More than half (60.2%) of the workers had been troubled with musculoskeletal symptoms at work. The most common symptoms were pain over the shoulders (41.0%), lower back (34.4%) and ankle (34.4%). Duration of employment, younger age group, prolonged standing and awkward working task were among contributing factors. It is therefore necessary to improve on both ergonomic and psychosocial environments of batik workers in order to prevent these musculoskeletal symptoms.
Being a student, especially postgraduate student, could expose to stress, and being international postgraduate student would exposed to more stress to the student. This study was conducted to assess stress level among international postgraduate students and its associated factors. A cross sectional study was conducted among international postgraduate students registered at UKMMC, Cheras campus, Kuala Lumpur. Questionnaires were distributed to 119 students,. Main international student are Arabs (52.4%). The stress prevalence is 54.8%. Younger age group are more stressful with mean age 33.94 (P=0.004), while shorter duration is associated with stress, P=0.035. Relationship with neighbour and relationship with local colleagues are shown to be associated with stress with P value 0.011 and 0.005 respectively. This study reveals the presence of significant prevalence of stress among international postgraduate students. The student socio-demographic character that has shown to be associated with stress in this study was age. The poor relationships with local colleagues as well as the poor relationships with the neighbours have shown to contribute to the stress among international students.
Objectives: To study the relationship between psychopathology and characteristics of offenders with schizophrenia. Methods: In this cross sectional study, 70 consecutive offenders with schizophrenia (aged 18-65) admitted to Hospital Bahagia Ulu Kinta within a six-month period were studied. Subjects’ psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS). Results: Offenders against person group received treatment at later age (p=0.043) compared to against property and drug or firearm-related offenders groups. Offenders in drug or firearm-related group had significantly higher PANSS negative scores (p=0.015). Unsound mind at the time of offense was significantly associated with high PANSS positive scores (p=0.011) and offenders against person or property groups (p=0.004). Conclusion: Offenders against person had a significantly later age of treatment and probably onset of illness. Unsoundness of mind was significantly associated with positive symptoms and more frequently reported among offenders against person or property. Offenders in drug or firearmrelated
group were significantly associated with negative symptoms.
Increase in cross-sectional muscle area of major muscle groups associated by heavy resistance training has been well documented. However, there has been no published article of changes in the inferior orbicularis oculi muscle when heavy resistance training is applied. We present a case of inferior orbicularis hypertrophy detected on MRI in a gentleman who practised heavy resistance training using his lower eyelids.
Introduction : Selangor’s private clinic registry system had been introduced in 2006 following gazettment of The Private Healthcare Facilities and Services Act. Through the act, data’s from the private clinics can be obtained and its characteristics can be compared between the urban and rural private clinic. An overview of the services can be known and an appropriate action can be planned.
Methodology : A cross-sectional study was done on private clinics registered in state of Selangor. Using databased known as MedPCs (Medical Practice Control System), a purposive sampling was used to select four districts – two urban and two rural. All private clinics in the selected districts were studied and all details shall be collected on line.
Result : District of Gombak and Klang were selected as urban and Sabak Bernam and Kuala Selangor represented rural area. Of a total 625 clinics selected, 90.0% (562) from urban and 10.0% (63) rural. Distributions of clinic were in line with the act. The most prominent services were general treatment (89.4%) and ability to serve more than eight hours daily (89.4%). Medical clinic still dominated at 84.0% compared to dentistry at 16.0%. About 70.6% were operated by male doctors. Though clinic services in rural were relatively as good as urban, the different were significantly observed to the ethnicity of the doctor. Indian doctors more in rural (46.03%), whilst in urban, Malay doctors were more dominant (39.50%). Followed closely by seniority, where rural doctors were much senior (51.02 years old), however, most of the doctors in rural private clinics experienced less exposure in government sectors, compared to those in urban areas.
Conclusion : There were obvious difference in terms of distribution, where more clinics were located in urban compared to rural, but all were still in line to the act and their services were comparable. Most noticeable differences were ethnicity, seniority and past experience working in the public sector. Indian doctors were dominant in rural and Malay in urban. Although rural doctors were more senior, relatively they were less experienced working in the government sector.
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.