Objective To determine the prevalence of diseases and its association with the sociodemographic factors (age, sex and ethnicity) among elderly patients admitted to a tertiary hospital in Malaysia.
Design A cross sectional study was conducted at various wards in the year of 2002. There were 9 333 respondents in this study selected by universal sampling. Setting A tertiary hospital in Malaysia. Main outcome measures Association between sociodemographic factors and prevalence of diseases. Results The mean age of the respondents was 68.9 + 6.8 years. Majority of the respondents were male (53.3%), Malays (43.7%) and married (73.2%). The prevalence of neoplasm was 15.5% followed by cataract (7.2%), diabetes mellitus (5.0%), hypertension (4.7%) and anemia (0.5%). There were significant association between gender and hypertension, diabetes mellitus, anemia and cataract (p
Passive smoking among pregnant mothers has been associated with numerous maternal and fetal effects. The aim of this study was to determine the effects of passive smoking on the fetal outcome among women who delivered at the Maternity Hospital Kuala Lumpur. This cross sectional study was carried out at the Maternity Hospital Kuala Lumpur in July 2004. Universal sampling of the women who delivered at the hospital was used and data was collected by interview using pre-tested questionnaire and patients’ medical records. Analysis was done by SPSS version 11.5. More than 75% were Malays, between 21 to 35 years, married, received secondary education, housewives and family income between RM 1000 – RM 1999. Seventy-seven per cent of the women were exposed to environmental tobacco smoke and majority were exposed at home and for less than 1 hour a week. There were significant relationships between duration of exposure with exposure at workplace, exposure at home and exposure in the car. Most of the babies delivered were males, term, normal weight and normal. Health education of the adverse effects of smoking to the pregnant women, spouses and family members need to be intensified by the hospital and the Ministry of Health.
MeSH terms: Cross-Sectional Studies; Female; Health Education; Hospitals, Maternity; Humans; Infant; Marriage; Medical Records; Mothers; Surveys and Questionnaires; Smoking; Tobacco; Tobacco Smoke Pollution; Workplace; Spouses; Term Birth
Plasma total homocysteine levels (tHcy) is lowered by high insulin levels, and it can be elevated in insulin-resistant states. However, it is uncertain whether plasma tHcy and insulin or any components of the metabolic syndrome has any relationship among hypertensive individuals. In this study the tHcy and insulin concentrations were measured by enzyme immunoassay techniques in samples from 41 (27 male and 14 female) participants. Components of the metabolic syndrome (insulin resistance) profiles were also evaluated. The participants’ age ranged from 31 to 67 years (mean+SEM, 52.1±1.3 years), body mass index from 20.2 to 38.3 kg/m2 (27.2±0.7 kg/m2), plasma tHcy concentration from 6.9 to 16.2 μmol/L (11.0±0.4 μmol/L), and plasma insulin 3.0 to 16.6 μIU/mL (7.3±0.5 μIU/mL). A significant negative correlation was found between tHcy concentrations and insulin levels (r=-0.358, P=0.011), but not with other variables (P>0.05). In conclusion, the tHcy concentration is significantly related to plasma insulin in hypertensive subjects. tHcy concentrations were independent of the components of the metabolic syndrome and other risk factors of coronary heart disease in hypertensive subjects.
MeSH terms: Coronary Artery Disease; Female; Humans; Hypertension; Immunoenzyme Techniques; Insulin; Insulin Resistance; Male; Risk Factors; Body Mass Index; Metabolic Syndrome X
Patient understanding and perception of diabetes control is important if clinicians were to allow diabetes patients to play a central role in management of their illness. We conducted a survey to see what diabetic patients generally thought of their understanding of disease and glycemic control; if these perceptions were accurate and related to complications.
One hundred and eight consecutive patients (mean age 52.7± 13 years, BMI 27±5.2 kg/m2, HbA1c 9.2±2.2 %) attending diabetes clinic participated including 63% women, 60% primary or no education, and 47% duration of diabetes >10 years. 54% claimed to have a good understanding although nearly half answered questions on diabetes management and targets wrongly. 32% perceived their glycemic control to be good and were found to have lower baseline HbA1c (p
MeSH terms: Blood Glucose; Diabetes Mellitus; Female; Humans; Perception; Surveys and Questionnaires; Thinking; Body Mass Index; Comprehension
This is a prospective study on infection following fixation of closed fractures done in Hospital Tengku Ampuan Afzan ,Kuantan from May 2003 to May 2005. There were 23 cases in this study. The mean age of patient was 32.9 years (range 15 to 77). Twenty one were males and 2 females. Twenty (87%) infections occurred in the lower limb and only 3(13%) occurred in the upper limbs. Twenty two patients (91%) had plating done for the fracture. Infection following internal fixation is commonly a deep seated (96%) and florid (78%) infection in which 70% occur after the surgical wound has healed. Staphylococcus aureus is the commonest organism isolated in which 43% are Methicillin resistant (MRSA). Overall infection caused by gram negative organisms is more common than gram positive organisms.
Objectives: The objectives of this study were to ascertain the prevalence of Indonesians obstetrics immigrant and to assess the fetal maternal outcome. Methodology: A prospective cohort study design was used to analyse 54 consecutive Indonesians obstetrics immigrant compared to 56 Malay women. Chi square and student t test were used where appropriate, p < 0.05 was considered to be of statistical significance. Results: There was a reducing trend in the incidence admission of Indonesians from 10.5 in 1999 to 6.5 % in 2002. The maternal mortality ratio showed an increasing trend from 1999 (40.0/100000) to 2001 (162.9/100000) but decreased to 5.8/100000 in 2002. The majority was between 20-40 years old, multiparous and booked, which was similar to the Malay population. Most Malays were in occupational class 1 to 3 and the husband has secondary and tertiary education compared to the Indonesians who were in class 4 and 5 and the husband has primary and no formal education. Significantly more immigrants were housewives compared to Malays who were working women. There was no significant difference in the antenatal complications. There were no significant difference in terms of delivery and most delivered vaginally. The perinatal outcome in terms of gestation, birth weight, Apgar score and admission to neonatal ICU were similar in both populations and there was no perinatal mortality. In conclusion, the incidence admission of Indonesian immigrant was on the decreasing trend. The outcome of these patients managed in MHKL was similar to the Malay population. Further studies with enrollment of a larger number of patients should be carried out to ascertain the significance of these findings.
The resistance to various insecticides from 4 major groups (organochlorine,
organophosphate, carbamate and pyretroid) was investigated in a field strain of Culex
quinquefasciatus from Baan Suan community, Nonthaburi province, Thailand by using a
standard World Health Organization susceptibility test. The Baan Suan strain was completely
resistant to DDT and highly resistant to deltamethrin, permethrin, fenitrothion and propoxur
but this strain was still found to be highly susceptible to malathion. This strain displayed high
resistance to cypermethrin since the result revealed that the resistance ratio of the 50% lethal concentration value (RR50) between the field and the laboratory strains (NIH strain) was 16. The study indicated that mosquitoes were resistant to almost all insecticide tested except malathion and this should be an alternative for Cx. quinquefasciatus control in this area. Moreover, Aedes aegypti, which is a main dengue vector in Baan Suan community was also tested with deltamethrin, permethrin and fenitrothion. The results showed that dengue
mosquitoes are clearly resistant to permethrin and tolerant to deltamethrin, but was 100%
susceptible to fenitrothion. The cause of insecticide resistance in Cx. quinquefasciatus may
be due to the continuous use of insecticide for dengue vector control programme in Baan
Suan community.
A study on causes of lung condemnation in 25 abattoirs from peninsular Malaysia for a period of seven years (1998-2004) was conducted by examining the records at the Department of Veterinary Services headquarters in Kuala Lumpur. A total of 5.3% of lungs from 233,417 cattle and buffaloes were condemned from 1998 to 2004. The main cause of condemnation was congestion (2.98%). The percentage of lungs that were condemned due to parasitic infection among the total population slaughtered was low (0.11%). Parasitic infection contributed to 2.1% of all lungs condemned. It was also found that the prevalence of parasitic infection in the lungs was generally much higher in buffaloes than in cattle.
Childhood obesity is an established problem in many countries and emerging in others.
Epidemiological data on obesity in children is essential in order to plan public health policy and services. A study was conducted to determine the prevalence of obesity in school children in the fifth grade of elementary school (10-12 years old) in the district of Kuala Selangor. Ten schools of which five are in urban and five in rural areas were selected consisting of 699 eleven year old schoolchildren from the three major ethnic groups. Using international cut-off points for obesity, we report an overall prevalence of obesity of 7.2%. Prevalence of obesity in urban children is 7.2% whereas in rural children it is 7.0 %. Analysed by gender, there were 8.9% obese boys and 5.3% obese girls. Among the 3 major ethnic groups, the Malays had the highest prevalence of obesity at 9.3% followed by the Chinese with 6.6% while among Indians 3.0%. The data obtained from this study suggests that obesity in Kuala Selangor children is a cause for concern in urban and rural areas.
A field study on foraging activity and proteinacous food preference was performed on
the tropical fire ant (Solenopsis geminata) (Fabricius) at the School of Biological Sciences and Desasiswa Bakti Permai, Universiti Sains Malaysia (USM), Penang. Foraging activity studies of 4 colonies of S. geminata were conducted in the field for 24 hours. Foraging activity significantly increased 4 hours before sunset and maximum foraging occurred at midnight until early morning. Three types of proteinacous food; anchovy, meat and egg yolk were tested among the five colonies of S. geminata in the field. The egg yolk was the most preferred food (100%) followed by meat (31%) and anchovy (15%).
The population of the world is ageing and Malaysia is no exception. The proportion of those above 60 will be 9.5% by the year 2020. Cognitive impairment and depression are two common problems in this age group. The objective of this study was to determine the prevalence of cognitive impairment and depression and their associated factors in the elderly population in a rural community in Kedah. The study design was descriptive cross sectional study. A standardized questionnaire was used in two villages in Mukim Kota Kuala Muda. Barthels index, geriatric depression scale and elderly cognitive assessment questionnaire were also used. The prevalence rate of cognitive impairment was 18.5%. Cognitive impairment was higher among females (22.6%) than males (12.8%). 34.8% of the widowed were cognitively impaired and it increases with age 15.1% within age groups 60 to 69 years, 42.9% in age groups 80 to 89 years and the one and only participant above 90 years was cognitively impaired. Among those with disability, the only one with very severe disability had cognitive impairment, 40% among the severely disabled and 33. 3% among the moderately disabled (p<0.05). Those with cognitive impairment were living with some functional disabilities involving feeding (p<0.05), bathing (p<0.05), grooming (p<0.05), dressing (p<0.05), bladder control (p<0.05), toilet use (p<0.05), transfer from bed to chair (p<0.05), mobility on level surfaces (p<0.05) and climbing stairs (p<0.05). The prevalence of depression was found to be 46.4%. Higher among males (48.4%) as compared to females (44.7%). Depression was 50.0% among the age groups 80 to 89 and 52.4% among the age groups 70 to 79. 63.6% of those living alone were depressed as were 54.8% of the unemployed. 43.8% of those depressed had functional disability. The only one with severe disability was depressed and 66. 7% of those with severe disability were depressed. 47.5% of those with hypertension were depressed. It is a matter of concern that even in a small population the rate of cognitive impairment and mental depression is very high. Health screening is an important aspect of health promotion and disease prevention in people over 60 years. Although screening for many conditions cannot conclusively prove benefit, special attention to these factors can decrease morbidity and improve quality of life in aging population.
Key words: elderly, cognitive impairment, depression, rural community, Malaysia
Study site: Two villages in Mukim Kota Kuala Muda, Kuala Muda District, Kedah, Malaysia
Device, Questionnaire & Scale: Barthels index; Geriatric Depression Scale (GDS-30); Elderly Cognitive Assessment Questionnaire
Despite awareness of the detrimental effects of smoking, many adolescents initiate or continue to smoke. One possible explanation for smoking 13 the belief that it can control body weight. The objective of this study was to determine the association between Body Mass Index and smoking among Malay adolescents in Kota Bharu, Kelantan. A cross·sectional study was conducted between January to June 2005 among 1364 students selected from ten co»educational government secondary schools in Kota Bharu using stratified multistage cluster sampling. Guided self-administered questionnaire and anthropometric measurement were taken. Data was entered using SPSS 12.0 and analysed using STATA 8.0. The overall prevalence of smoking was 6. 7%. The prevalence of smoking among boys was 13.8% and among girls was 1.1%. There was no association between Body Mass Index and smoking. However, the findings may not be generalized to out-of·school youth and other ethnic groups in this country. The study was not conducted anonymously and the use of questionnaire to report smoking status can lead to measurement bias. Strategies aimed at correcting the belief that smoking can reduce weight should be included as one of the components in the prevention of smoking.
MeSH terms: Adolescent; Body Weight; Cross-Sectional Studies; Ethnic Groups; Female; Humans; Malaysia; Male; Surveys and Questionnaires; Schools; Smoke; Smoking; Students; Body Mass Index; Prevalence
There is concern that shift workers are at higher risk for metabolic syndrome (MS) . The syndrome is characterized by a constellation of metabolic risk factors in one individual. A cross-sectional study of 148 workers in one factory in Kota Bharu, Kelarttan was conducted to examine relationships between shift work and five of the MS rnk factors namely high blood pressure, hyperglycemia, hypertriglyceridaemia, hypo·I·IDL-cholesterolaemia and high body mass index (BMI) . Data was collected through a questionnaire on psychosocial and life-style factors, anthropometric and blood pressure measurements, fasting blood sugar and fasting lipid profile. The National Cholesterol Education Program’s Adult Treatment Panel III Report (NCEPATP III) with some modifications was used to determine the presence of risk factors for the metabolic syndrome, The prevalence of high blood pressure, hypertriglyceridaemia and high BMI were significantly higher among shift workers compared to day workers. There was no difference in the prevalence of hyperglycemia and hypo-HDL-cholesterolaemia. When the shift workers were compared with the
day workers, the proportion of workers having three or more risk factors for the syndrome was higher among shift workers which were 15.8% and 5.6% respectively.
MeSH terms: Adult; Anthropometry; Blood Glucose; Blood Pressure; Cholesterol; Cross-Sectional Studies; Fasting; Humans; Hyperglycemia; Hypertension; Surveys and Questionnaires; Risk Factors; Hypertriglyceridemia; Body Mass Index; Prevalence; Metabolic Syndrome X
Cervical cancer is preventable by detecting precancerous states through Pap smear screening, followed by appropriate treatment. In Malaysia, even with a high incidence of cervical cancer and accessible screening program, the uptake of Pap smear screening was still low. Lack of knowledge, embarrassment, fear for the test and results are the factors reducing participation. The aim of this study was to determine the change in knowledge and attitude regarding the Pap smear screening as well as knowledge on cervical cancer among women in Mukim ]aya Setia after educational intervention. A community trial was conducted in August 2005 where 80 women were randomly selected. The women were interviewed for assessment prior to the intervention, using a set of structured questionnaire. The women underwent educational intervention programmes on cervical cancer and Pap smear screening. After a week, the women were re-assessed using the same set of questionnaire for their post intervention knowledge and attitudes. Scores were given for each answer, which were totaled and analyzed. The mean (SD) age was 41.1 (10.37) years. Most were housewives (87.5%), within the low income group (91.2%), of less than RM 1000.00 income per household. Most of the women received their education up to the secondary level only (97.5%). Despite their poor economic status, most of them had more than three children (68.8%). There was a significant improvement in knowledge of Pap smear (mean difference= 4.3, 95% CI= 3.55, 5.10) and cervical cancer (mean difference= 10.7, 95% CI= 10.03, 11.37) as well as attitude to Pap smear (mean difference= 7.1, 95% CI= 5.72, 8.47) after educational intervention. The knowledge and attitudes towards Pap smear screening as well as knowledge on cervical cancer among rural women in Mukim ]aya Setia, Kota Bharu improved after educational intervention.
MeSH terms: Attitude; Uterine Cervical Neoplasms; Family Characteristics; Fear; Female; Humans; Malaysia; Mass Screening; Surveys and Questionnaires; Socioeconomic Factors; Vaginal Smears; Incidence; Papanicolaou Test
Two hundred and sixty four samples of ready -to-eat foods (RTE) were obtained over a period of six months (April to September 2005) from 33 school hostel kitchens and canteens previously implicated in food poisoning outbreaks from 2000 to 2004. Sampling was done by food technologists and assistant environmental health ofhcers from various districts in Pahang while microbiological analysis was carried out at the Mentakab Food Quality Control Laboratory. The objective of the study was to obtain a comprehensive picture on the microbiological status of the foods that may have accounted for food poisoning outbreaks at school hostels and canteens in Pahang. Each food sample was analyzed for Total Plate Count (TPC), Salmonella, Coliform, Escheria coli, Staphylococcus aerus and Bacillus cereus. lt was found that none of the ready-to-eat foods sampled contained Salmonella although hve samples contained Bacillus cereus , four samples contained Staphylococcus aerus. High Coliform Counts were found in 15 food samples while Escheria coli was detected in two samples. Overall, it was found that 10.2 % of the samples had unsatisfactory counts.
Employee motivation affects productivity and need to be channeled towards the accomplishment of organizational goals. A cross sectional study was conducted among Public Health Specialists (PHS) in the Ministry of Health Malaysia to study their motivation level and the factors influencing this. The respondents were from the Association of Public Health Specialists of Malaysia working in the Ministry of Health. Quantitative Technique self-administered questionnaires were used in this study and the questionnaires were mailed to the respondents. The response rate for this study was 72.3%. In measuring the motivation level, five (5) aspects were studied. The social aspect, self -achievement aspect and autonomy aspect were found to be the main aspects that motivated the respondents. With regard to motivation level, 55.8 % respondents had low motivation level. In order to improve the motivation level among PHS, the aspect of self actualization and autonomy required serious attention. In the future, PHS are expected to play a major role in controlling, promoting, preventing, maintaining, restoring and solving problems in order to enhance the health of the Malaysian population.
MeSH terms: Achievement; Attention; Cross-Sectional Studies; Malaysia; Motivation; Organizational Objectives; Play and Playthings; Postal Service; Problem Solving; Public Health; Surveys and Questionnaires; Specialization
Hospital UKM is the first hospital to implement case·mix system in Malaysia. The objective of the programme is to utilise case-mix system as a tool in improving efficiency and quality of care. From July 2002 to June 2004, a total of 35,568 cases were grouped using IRDRG-Version 1.1 case-mix grouper. Out of these, 3,622 cases or 10.2 % were cardiology cases in MDC 05 (Diseases and Disorders of the Circulatory System). Medical Cardiology cases consist of 86.5% and the remaining 13.5% were Surgical Cardiology. Most of the cases were in severity level one (43.4%), 29.5 % in severity level two and 27.1% in severity level three. The mortality rates for severity level one, two and three were 1.0%, 2.6% and 11.5% respectively. Top three cardiology cases were Acute Myocardial Infarction Without Comorbidity and Complication (IRDRG 05331) (8.4%), Acute Myocardial Infarction With Major Comorbidity and Complication (IRDRG 05333) (7.6%) and Cardiac Catheterization for Ischemic Heart Disease Without Comorbidity and Complication (IRDRG 05311) (7.4%). Step-down costing was carried out to obtain the cost for each DRG group. The mean cost per episode of care for Medical Cardiology cases was RM 3,562 (SD= RM 2, 1 19) with average LOS of 6.4 days (SD= 3 .8days) . For the Surgical Cardiology cases, the mean cost per episode ofcare was RM 6,526 (SD= RM 4,585) and average LOS of5.8 days (SD= 4.1 days). The main components of cost for Medical Cardiology cases are ICU cost (28.8%), pharmacy (17.3%) and Ward Services (15.3%). In Surgical Cardiology, the biggest component of cost was for Operation Theatre (27.9%), followed by Ward Services (25 .4%) and pharmacy (8.5%). Multivariate analysis using multiple linear regression showed that factors which significantly influence the treatment cost of cardiology cases were length of stay, age of the patient, discharge outcome, case type ('surgical partition') and severity level.
MeSH terms: Diagnosis-Related Groups; Cardiac Catheterization; Humans; Intensive Care Units; Length of Stay; Malaysia; Myocardial Infarction; Pharmaceutical Services; Pharmacies; Pharmacy; Comorbidity; Multivariate Analysis; Linear Models; Health Care Costs; Episode of Care; Myocardial Ischemia
The knowledge, attitude and practice of breastfeeding among young mothers during pre-Baby Friendly Hospital Initiative implementation was conducted at seven private hospitals in Malaysia. A structured interviewer administered questionnaire was given to all mothers (n=Z52) visiting the antenatal/postnatal clinic of the hospitals. The main respondents were Malays (57.5%) and Chinese (35%) . For most mothers, breastfeeding was combined with supplementary feeds of formula milk, with only 30% breastfed exclusively. The majority of mothers knew that breast-milk contained antibodies and can prevent illness, however many were unaware of breastfeeding's contraceptive effect if practised exclusively. Most mothers did not relate breastfeeding as being environmental friendly. Generally, there was no knowledge gained from the experience of having more children with reference to breastfeeding. Most mothers were influenced by their own beliefs regarding choice of feeding method. Therefore, a mother was empowered with the knowledge of all practical aspects of breastfeeding, it would encourage her to breastfeed her baby.
Study site: seven private hospitals in Malaysia
This study was conducted to determine the patterns of disease and treatment at two disaster sites. Studies prior to this have shown that all natural disasters are unique in that each affected region of the world have different social, economic and health backgrounds. However, similarities exist among the health effects of different disasters which if recognized can ensure that health and emergency medical relief and limited resources are well managed. This study found that although Aceh and Balakot were two totally different areas with reference to locality and climate it was noticed that the patterns of disease two months post disaster are similar the commonest being respiratory conditions followed by musculoskeletal conditions and gastrointestinal conditions. For the treatment patterns it was observed that the two areas prescribed almost similar, types of medicine mainly for gastrointestinal and respiratory systems. However in Aceh, there were more skin treatment and in Balakot there was more usage of musculoskeletal drugs.
A cross sectional survey was conducted in Kampung Datuk Kerarnat, an urbanized residential area in Kuala Lumpur from August to November ZOO5 to assess knowledge, attitude and preventive practices on dengue among its residents. A two stage sampling strategy was used to select survey household. An adult aged at least 21 years old was identified from each selected household and interviewed using a standardized questionnaire. Data was collected on demographics, dengue related KAP and house-types. Knowledge, attitude and practice were assessed using a scoring system. Each appropriate answer was given a point and the points for each section of the questionnaire were totalled. Knowledge was assessed as ‘good' or ‘moderate to poor’ based on arbitrary cut-off point. Out of 133 respondents interviewed, 78.2% were able to identify at least one clinical sign of dengue, 73% knew that dengue fever was caused by the bite of dengue infected Aedes mosquitoes, 71 % correctly identified breeding sites, 69.2% correctly identified the Aedes mosquito and 42% correctly reported biting times ofthe mosquito vector. Overall, knowledge
was categorized as poor, attitude was good and dengue control and prevention practices was moderately poor. There was a weak but significant positive correlation between knowledge and practice (r=0.271, p=0.002) but there was no significant correlation between attitude with practice and between attitude with knowledge (p>0.05) . The results suggested that inspite of good attitude l
on dengue fever, it did not correlate with good practices and good knowledge in dengue prevention. We conclude that there is a need to increase health promotion activities to increase knowledge which forms the basis for preventive practices as part of the strategy to control dengue. Preventive strategies are the only means of controlling the disease.
MeSH terms: Adult; Aedes; Animals; Breeding; Cross-Sectional Studies; Dengue; Family Characteristics; Health Promotion; Humans; Surveys and Questionnaires