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.
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: 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: 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.
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.
OBJECTIVES: To determine the prevalence of cases and episodes of needlestick injury among three groups of health care workers in the past one-year, the level of knowledge on blood-borne diseases and universal precautions and the practice of universal precautions. Other factors associated with the occurrence of needlestick injuries and the reporting of needlestick injuries were also analysed.
METHODS: A cross-sectional study was conducted in May 2003 to study the needlestick injuries among 285 health care workers (doctors, nurses, medical students) in a public teaching hospital in Negeri Sembilan, Malaysia.
RESULTS: The prevalence of needlestick injuries among the respondents was 24.6% involving 71 cases i.e. 48.0% among doctors, 22.4% among medical students, and 18.7% among nurses and the difference was statistically significant (p<0.001). There were a total of 174 episodes of needlestick injury. Prevalence of episode of needlestick injuries was highest among doctors (146%), followed by nurses (50.7%) and medical students (29.4%). Cases of needlestick injuries attained lower scores on practice of universal precautions compared to non-cases (p<0.001). About 59% of cases of needlestick injury did not report their injuries.
CONCLUSIONS: The study showed that needlestick injuries pose a high risk to health care workers and it is underreported most of the time. Many needlestick injuries can be prevented by strictly following the practice of universal precautions.
Nurses’ job performance is defined as the effectiveness of a person in carrying out his or her duties related to patient care. Aim of this study is to measure job performance among nurses in a tertiary hospital and its associated factors. A cross-sectional study was conducted among nurses selected from four departments, which were Obstetrics & Gynecology (O&G), medical, surgical and Cardiac Care Unit (CCU)/High Dependency Unit (HDU). A Malay validated Six-Dimension Scale of Nursing Performance (6-DSNP) questionnaire was used to measure job performance. Nurses who have one child more compared to other nurses had significantly lower total mean score of job performance by -0.06 (95% CI 0.11, 0.01). Nurses working in medical department [adj.β=0.16 (95% CI 0.01, 0.30)] and CCU/HDU [adj.β= 0.33(95% CI: 0.17, 0.50)] had significantly higher total mean scores of jobs performance compared to O&G department. Effective strategies and re-examining work conditions are imperative for better job performance.
Study site: Department of
Medical, Department of Surgical, Department of
Obstetrics & Gynecology (O&G) and Cardiac Care
Unit/ High Dependency Unit (CCU/HDU) of Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Global views emphasize the need for early; effective intervention against the atherogenic dyslipidemia associated with type 2 diabetes and metabolic syndrome to reduce the risk of premature cardiovascular diseases. Our aim was to determine the clinical practices and compliance among dyslipidemia with type II diabetes and hypertension in multiracial society.
BACKGROUND: Despite a better understanding of the pathophysiology of asthma, presence of reliable diagnostic tools, availability of a wide array of effective and affordable inhaled drugs and simplified national and international asthma management guidelines, asthma remains poorly managed in India.
OBJECTIVE: The Asia-Pacific Asthma Insight and Management (AP-AIM) study was aimed at understanding the characteristics of asthma, current management, level of asthma control and its impact on quality of life across Australia, China, Hong Kong, India, Malaysia, Singapore, South Korea, Taiwan and Thailand. This paper describes the results of asthma management issues in India in detail and provides a unique insight into asthma in India.
METHODOLOGY: The AP-AIM India study was conducted in eight urban cities in India, viz: Ajmer, Delhi, Kolkata, Rourkela, Chennai, Mangalore, Mumbai and Rajkot from February to July 2011. Face-to-face interviews were conducted in adult asthmatics and parents of asthmatic children between the ages of 12 and 17 years with a confirmed diagnosis or a treatment history of 1 year for asthma.
RESULTS: Four hundred asthmatics (M:F::1:1.273), with a mean age of 50 ± 17.8 years, from across India were studied. 91% of the asthmatics in India perceived their asthma to be under control, however, none of the asthmatics had controlled asthma by objective measures. Asthmatics in India believed that their asthma was under control if they have up to 2 emergency doctor visits a year. The quality of life of these patients was significantly affected with 93% school/work absenteeism and a loss of 50% productivity. Seventy-five percent of the asthmatics have never had a lung function test. The common triggers for asthmatics in India were dust (49%) and air pollution (49%), while only 5% reported of pollen as triggers. Eighty-nine percent of Indian asthmatics reported an average use of oral steroids 10.5 times a year. Only 36% and 50% of Indian asthmatics used controller and rescue inhalers with a majority preferring the oral route of asthma medication.
CONCLUSIONS: This study has clearly highlighted the fact that asthma management in India remains very poor, with a significant proportion of patients experiencing bothersome symptoms and worsened quality of life. There is a need for an urgent review of this situation and initiate active measures at local as well as national levels to improve asthma care in India.
Study site: Home visits
Objectives: To assess the feasibility of a computer-based Standard Gamble (SG) visual prop whilst measuring utilities of different asthma health states at the same time.
Methods: Twenty adult asthma patients literate in either Malay or English language were conveniently sampled from a public hospital in Penang, Malaysia. They were interviewed by two trained interviewers using a bilingual script. Each patient was requested to value the given health states using Visual Analogue Scale (VAS) prior to SG exercise. There were three chronic health states (C1-C3) for 10 years, three temporary states (T1-T3) for 3 months, and two anchor states (healthy and dead). During the SG exercise, the visual prop was fully operated by the interviewers. The probability of being in a worse state was changed in a ‘ping-pong’ fashion until the indifference point was reached.
Results: All patients understood the SG exercise and rated SG easier than VAS. Around 85% (n=17) completed SG within 30 minutes. There was 90% (n=18) who ranked T3 as the worst temporary health state during VAS. Two patients provided logical inconsistency data in SG. The preferences by SG were higher than VAS. Preferences were also higher in temporary states measured by chained SG than other states by conventional SG. The mean utilities for C1=0.56 (SD 0.38), C2=0.47 (SD 0.33), C3=0.53 (SD 0.38), T1=0.65 (SD 0.31), T2=0.53 (SD 0.35), and T3=0.38 (SD 0.38).
Conclusions: The SG methods including the props are feasible for utilities measurement in asthma, based on the agreements achieved with other studies on the pattern of utilities measured in this preliminary study.
This study aimed to explore factors associated, specifically belief factors, with self-reported tobacco smoking status. A sample of 300 students was recruited from a private university in Malaysia. Data was collected using a pre-tested self-administrated questionnaire that investigated various factors including socio-demographics, socio-economic status, smoking behavior and beliefs on tobacco smoking. The main tobacco use in this study sample was cigarettes and the estimated prevalence of self-reported cigarette smoking was 10.3%. In bivariate analysis, self-reported cigarette smoking was significantly associated with socio-demographic, behavioral factors and faculty of study (P<0.05). In multivariate modeling, being male and a non-medical student, did not exercise, having a smoker father and brother or sister, suffering from financial difficulties and having the belief that smokers had more friends, all had statistically significant associations (P<0.05) with self-reported cigarette smoking. Social and interpersonal factors were associated with self-reported cigarette smoking status. A comprehensive health model focusing on changing the social norms of parent and sibling tobacco smoking and students' beliefs, alongside nurturing skills of dealing with stressful situations, warrant implementation.
OBJECTIVES: To evaluate aspirin and clopidogrel resistance/non-responders in patients with acute coronary syndrome (ACS) by using adenosine diposphate and aspirin tests.
METHODOLOGY: In the study patients with ACS loaded with 300 mg of clopidogrel and 300 mg aspirin and patients on stable daily dose of 75 mg of clopidogrel (more than 3 days) underwent PCI. Response to clopidogrel and Aspirin was assessed by Adenosine Diphosphate (ADP) Test (20 µmol/L) and Aspirin Test (Acetyl Acid) (ASP) 20 µmol/L, respectively, using the Multiplate Platelet Function Analyzer (Dynabyte Medical, Munich, Germany).
RESULTS: Sixty four patients were included in this study out of which 57 were with ACS and 7 scheduled for percutaneous coronary intervention (PCI) electively. The proportion of Aspirin good responders and adequate responders were 76.56% and 18.75%, respectively while adequate response and good response to Clopidogrel accounted for 29.7 and 48.4%, respectively Hyperlipidaemia was only co-morbidity associated with higher AUC ADP value (p: 0.046). Hypertriglyceridaemia and serum calcium were weakly correlated with higher AUC ADP serum calcium r=0.08, triglyceride r=0.12. Patients admitted for scheduled PCI and on stable dose of 75mg clopidogrel exhibited lower AUC ADP value as compared to those admitted with acute coronary syndrome given loading dose of 300mg of Clopidogrel. Post loading dose measurement of anti-platelet therapy among ACS patients using the Multiplate Platelet Function Analyzer showed comparable results with other methods.
Conclusions : As determined by Multiplate Platelet Function Analyzer, Aspirin resistance/non-responders in this study in acute coronary syndrome patients accounted for 4.69% while Non-responders in Clopidogrel was 21.9%.
KEYWORDS: Acute coronary syndromes; Anti-platelet therapy; Aspirin; Clopidogrel; Hyperlipidaemia
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.
Primary dysmenorrhea is a womanhood problem around the world and negatively affects quality of life. This study was designed to investigate the prevalence of primary dysmenorrhea and to determine the factors associated with its intensity. A cross-sectional study was carried out among 311 undergraduate female students aged 18 to 27 years in Isfahan University of Medical Sciences, Iran. Socio-demographic characteristics and menstrual factors were obtained through interviews with the help of a pretested questionnaire. The prevalence of primary dysmenorrhea was 89.1%. Residing at home, younger age, lower number of years of formal education for the mother, positive family history of dysmenorrhea, higher severity of bleeding, and shorter menstrual period intervals were significantly associated with the higher intensity of primary dysmenorrhea. Primary dysmenorrhea is a common health concern among young women. Being aware of the factors that are associated with its intensity makes it possible for health professionals to organize better focused programs to reduce the adverse effects of dysmenorrhea.
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.
A cross-sectional descriptive study was conducted among Big Sib students to explore their perceptions of the educational environment at the School of Medical Sciences, Universiti Sains Malaysia (USM) and its weak areas using the Dundee Ready Educational Environment Measure (DREEM) inventory. The DREEM inventory is a validated global instrument for measuring educational environments in undergraduate medical and health professional education.
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.