This paper explores whether middle-income Asian countries are reorienting their health services in response to non-communicable diseases (NCDs). Malaysia, Sri Lanka, and Thailand were selected as case studies of Asian societies experiencing rapid increases both in NCDs and an aging population. While NCD programs, especially those related to diabetes and stroke, are well-established in Thailand, health services struggle to respond to increasing numbers of people with chronic health problems. Health services at all levels must plan ahead for more patients with chronic and often multiple conditions who require better integrated health care.
MeSH terms: Delivery of Health Care; Diabetes Mellitus; Health Services; Humans; Income; Malaysia; Sri Lanka; Thailand; Stroke
This review aims to profile the disease of thalassemia in Malaysia and to identify the challenges that have kept Malaysia from effectively reducing the birth rate of thalassemia patients. The success of thalassemia prevention programs in some countries have shown that more than 90% of the reduction of cases were achieved by using retrospective screening method (prenatal, premarital, retrospective counselling). However, in Malaysia any impact of the prevention program is yet to be visible, and a reduction in new births of thalassemia patients remains to be seen. The number of patients in the national thalassemia registry (www.mytalasemia.net.my) is increasing over the years from 3588 in 2008 to 4990 in 2010 and to 6624 in 2015. The provision of quality care and disease management imposes a huge economic burden on national health resources, which is why an effective prevention program is urgently needed. For Malaysia to reduce the burden of new thalassemia cases, it is vital to address gaps and limitations of the existing preventive strategies. The screening program has to be integrated into existing primary healthcare settings, promoted to every party including the higher ministry bodies and designed to adapt to the highly diverse local religious and cultural backgrounds. Through continuous support by the government, health care providers and the general public, there is hope that prevention and control of this disease may be achieved in the future.
The effects of children’s exposure on high concentration of airborne pollutants at schools often associated with increased rate of absenteeism, low productivities and learning performances, and development of respiratory problems. Recent studies have found that the presence of occupants in the classroom seems to give major effect towards the elevation of concentration of airborne pollutants in indoors. In order to evaluate and further understand on the significance of occupancy factor on IAQ, this study has been designed to determine and compare the level of selected physical (particulate matter (PM)) and chemical (carbon dioxide (CO2) and temperature) IAQ parameters and biological contaminants via colony forming unit (CFUm-3 ) for bacteria and fungi inside the selected classrooms during occupied and non-occupied period (first objective). The second objective is to describe the possible sources of airborne pollutants inside the classrooms at the selected primary schools around Kuantan, Pahang. Assessments of physical and chemical IAQ were done by using instruments known as DustMate Environmental Dust Detector and VelociCalc® MultiFunction Ventilation Meter 9565.The data were recorded every 30 minutes for 8 hours during schooldays and weekend at the selected sampling point in the classrooms. For microbial sampling, Surface Air System Indoor Air Quality (SAS IAQ) was used to capture the bacteria and fungi. The data obtained were compared with the established standard reference known as the Industrial Code of Practice on Indoor Air Quality (2010) constructed by the Department of Occupational Safety and Health (DOSH), Malaysia. This study has found that some of the IAQ parameters in the selected classrooms were exceeding the established standards during occupied period in schooldays compared to non-occupied period during weekend. Findings of this study provide the insights for future research including the site selection of school, arrangement of the classrooms and numbers of students per class.
Land filling is the most common disposal method in most parts of the world and landfill site has always been the final destination in solid waste management hierarchy. Thus, the selection of landfill site is always an essential part in the management of solid waste. Selecting an appropriate site for landfill minimizes any unwarranted ecological and socio-economic effects. Hence, landfill site selection requires a detailed analysis of the area that must be able to meet the local authority requirement and criteria. The present study presents a feasibility assessment of landfill establishment for Khomeynishahr city in Isfahan, applying a multi criteria evaluation (MCE) method using GIS technique. Information layers related to topography, soil, water table, sensitive habitats, land use and geology maps were prepared and superposed using Boolean logic in GIS environment. Essential analysis and regulation, criteria and site selection assessment showed that because of many limitations khomeynishahr city doesn’t have adequate conditions for landfill site establishment. Khomeynishahr city has a dense population and limited area and is not suitable for landfill establishment. In this case consideration of adjacent cities and finding a common landfill site between two or more cities could be a viable solution of solving this problem.
Research examining whether psychological eating style is related to healthy or unhealthy eating patterns is required to explain the mechanisms underlying non-communicable diseases and obesity. The purpose of this study was to investigate whether eating style predicts the nature of food consumption. This was a cross-sectional study of 588 adults (males = 231 and females = 357). Eating style (i.e. restrained, emotional, external eating) was measured using the short version of the Dutch Eating Behaviour Questionnaire (DEBQ). The nature of food consumption was assessed using self-reports of consumption of fruits and vegetables, sweet foods, junk food, and snacks.The results revealed that restrained eating was higher in females and overweight participants. External eating,a higher frequency of snacking,and a higher frequency of junk food consumptionwere more prevalent among the younger participants. Consistent with previous Western studies, emotional eating was found to be the main predictor of consumption of less healthful foods (sweet foods, junk food, and snacks), whereas external eatingpredicted the intake of sweet foods. The intake of fruits and vegetableswas associated with restrained eating. In light of the significant associations between eating style and the nature of food consumption, acknowledging individuals’ eating styleshas implications for tailoring effective nutritional programs that address obesity and the chronic disease epidemic.
Khat leaves chewing/use, which imparts amphetamine like effects on the user, is widely practiced in parts of Africa, the Arabian Peninsula, and among the diaspora communities from these regions. Basic clinical and epidemiological studies from different settings have reported associations of acute coronary syndrome, heart failure, and cardiomyopathy, with khat chewing /use. This review aims to analyse the current evidence of the impact that khat, or its active constituent, cathinone, has on the cardiovascular system (CVS), particularly in two parameters, heart rate (HR) and blood pressure (BP). Subsequently, the possible mechanism of actions of how khat impacts these cardiovascular parameters is discussed, and different studies’ findings are summarised appropriately. The analysis of literature suggests that khat could influence HR and BP by most likely causing tachycardia and hypertension and the impacts might be dose-dependent and time-dependent. However, most of the studies involved different species and study designs, and had different limitations. Additionally, the underlying mechanisms of khat effects on these CVS parameters remain unclear. Therefore, more studies are needed to further support the current evidence of the impacts that khat has on the CVS parameters of HR and BP.
The objective of this study is to explore physician’s perception toward clinical pharmacy services and role of clinical pharmacists in governmental hospitals at Al-Qassim region. An observational cross-sectional survey was conducted. Results: 150 males and 39 females participated giving 75.5% (189 of 250) response rate. Physicians perceptions were found to be high (equal or more than 90% of frequency) in some clinical pharmacy services such as patients’ education and counselling, monitoring of patients’ responses to drug therapy including toxicity/side effects and provision of drug information to healthcare professionals. The physicians showed low perception (less than 76%) in the taking of patients’ medication history on admission, by clinical pharmacists. Conclusion: Physicians’ perception toward clinical pharmacy services and the role of clinical pharmacists was not found to be completely favourable. The reason of this mixed responses and to the accommodating feelings of clinical pharmacy services in clinical setting appear to relate to the state of infrastructure and environments of hospitals. The infrastructure and environments of hospitals need to be updated for an improved accommodation clinical pharmacy services.
MeSH terms: Cross-Sectional Studies; Hospitals; Humans; Pharmacists*; Physicians; Saudi Arabia
Clinical coding creates a rich database that can be used for administrative functions including planning for health service programmes and preparing budget of hospitals with appropriate use of disease and procedure classification system. Clinical coding errors may occur in the diagnoses or procedure codes. The errors can be happen at any of the digits use in the classification codes. Errors in clinical coding can give a huge implication on hospital’s income if the coding system is used for reimbursement. This study aims to determine incidence of clinical coding errors among 464 patient’s medical records (PMR). An independent senior coder was appointed to review the selected PMRs and the clinical codes. Post-audit evaluation shows that 89.4%(415/464) of the records contained at least one coding error in the assignment of diagnosis or procedure codes. Error in secondary diagnosis code was the highest comprising 81.3% (377/464) of the records. Coding errors were particularly found in O&G discipline comprising 94.8% (110/116) of the selected records. These errors caused a potential loss of RM 666,461 for the hospital. The highest pre-and post audit variance of potential income was RM 568,403 for paediatric discipline. The hospital should carry out regular monitoring of quality of clinical coding in order to prevent loss of income in the future when the reimbursement of services is linked to coding of diagnosis and procedures.
Breast Self-Examination (BSE) is a process whereby women examine their breasts regularly to detect any abnormal swelling or lumps in order to seek prompt medical attention. The purpose of this study was to investigate the knowledge and practice of BSE among female non-medical students in UKM, Bangi. A cross-sectional study was conducted using self-administered and validated questionnaire among 364 students. The results showed that only 37.1% performs BSE and 45% of the students have good knowledge. Age, marital status, using internet and pamphlets as source of information, personal, and family history of BC, were significantly associated with knowledge level of students. Practice of BSE was significantly associated with knowledge level. From multivariate analysis, BSE was more likely to be done among students with family history, students who using internet and pamphlet as sources of information, also among students with good knowledge. As conclusions, the practice of BSE is inadequate among the respondents in spite of most of them had heard about BSE. The results suggest the need of providing continuing educational programs to increase the knowledge level on BSE which in turn will have a positive effect on students to practice and motivate to perform BSE.
MeSH terms: Attention; Breast; Cross-Sectional Studies; Female; Humans; Motivation; Pamphlets; Surveys and Questionnaires; Students; Multivariate Analysis; Breast Self-Examination; Marital Status; Internet
Increasing physical activity level during and after treatment is recommended by the American Cancer Society because of the many benefits namely reducing fatigue and improves psychological distress which leads to an improvement in the quality of life. This study is aimed to compare physical activity level and body composition between oncology patients who are still undergoing treatment and those on medical follow-up. Patients were recruited based on convenience sampling from the Oncology Outpatient Clinics of Universiti Kebangsaan Malaysia Medical Center (UKMMC). Anthropometric measurements and body compositions were measured using calibrated tools while physical activity level were assessed using Global Physical Activity Questionnaire (GPAQ). Medical treatment history was obtained from patients medical records. A total of 53 patients (n=38 were undergoing treatment and n=15 was on follow-up) consisting of Malays (54.7%) and Chinese (45.3%) and with mean age of 55.3 ± 9.3 years. Most patients were previously diagnosed with ovarian cancer (39.6%) and colon cancer (18.9%) patients and they were at cancer stage III (18.8%). Body mass index (BMI) and percent fat mass were significantly different (p<0.05) between patients undergoing treatment (22.8 ± 2.7 kg/m2, 28.7 ± 7.2%) and on follow-up (26.2 ± 5.5 kg/m2, 37.1 ± 11.9%). Majority of the patients undergoing treatment were categorized under low physical activity compared to those on follow-up (p<0.05). Physical activity level measured as METS-minutes/week is also found to be significantly different (p<0.05) between patients on treatment and follow-up. As a conclusion, cancer patients undergoing treatment have low physical activity, with lower BMI and fat mass compared to those on follow-up. This is consistent with their nature of living where during treatment the patients will resting while coping with side effects of treatments.
The main objective of the study was to determine the factors associated with blood cholesterol level among staff in Universiti Sains Malaysia (USM). The study was a cross-sectional. One-hundred staff between 23 and 59 years of age were recruited in this study using convenient sampling at USM Health Campus. A questionnaire which includes sociodemographic characteristics, medical history, and red meat intake was used in the study. Anthropometric and biochemical assessment were measured. Blood cholesterol level was divided into two categories which were known as healthy range (<5.2mmol/L) and slight risk/high risk range (≥5.2mmol/L). The gender distribution of respondents for this study comprised of 40 male and 60 female. The age group (18 to 39) years and (40 to 59) years had a total of 40.3% and 63.2% of slightly risk or high risk blood cholesterol respectively; with the significant association between age group and blood cholesterol level (χ²=4.916,p=0.027). Besides, normal BMI group had 66.7% of respondents achieved healthy blood cholesterol level whereas underweight, overweight and obese group had 39.7% achieved healthy blood cholesterol with the significant association between BMI and blood cholesterol level (χ²=7.112,p=0.008). Moreover, daily or weekly intake of red meat showed that 65.0% of total respondents had a healthier blood cholesterol level compared to 51.0% of monthly, rarely, or none red meat intake group which achieved healthy blood cholesterol level. The result also showed a significant association between red meat intake and blood cholesterol (χ²=5.229, p=0.022), which indicating less red meat consumption is linked to high level of blood cholesterol level. Therefore, further investigation and future studies are needed to gain a clearer understanding of the association between these variables and blood cholesterol level.
A balanced dietary intake plays an important role in the prognosis of breast cancer and is one of the modifiable factors in preventing cancer recurrence. This study aims to determine the dietary intake among breast cancer survivors in East Coast of Peninsular Malaysia. A total of 125 breast cancer survivors, aged 37 to 72 years, with mean duration of survivorship of 6.1 ± 3.9 years were recruited from two main referral hospitals in Terengganu and Kelantan. Majority of the respondents were Malay (94.4%) with a mean BMI of 27.7 ± 5.07 kg/m², and were diagnosed with stage II cancer (66.0%). Dietary intake was estimated using a semi-quantitative food frequency questionnaire (FFQ). The results show that the mean daily intake of energy was 1764 ± 378 kcal/day, protein was 72.38 ± 33.6 g/day (16.5% of energy), carbohydrate was 243.0 ± 62.2 g/day (55% of energy) and fat was 55.8 ± 15.6 g/day (28% of energy). Overall, breast cancer survivors in this study had an adequate daily intake of vitamins and minerals according to Malaysian Recommended Nutrient Intakes (RNI) except for dietary fibre (10.6 ± 4.2 g/day), monounsaturated fatty acids (20.7 ± 5.7 g/day), polyunsaturated fatty acids (8.0 ± 2.2 g/day), calcium (561.0 ± 257.1 mg/day), iron (18.3 ± 7.2 mg/day) and potassium (1813.4 ± 531.1 mg/day) which was lower than the recommendation. Meanwhile, intake of sodium (2592 ± 1697 mg/day), protein (80.4 ± 33.6 g/day), saturated fatty acids (26.9 ± 14.2 g/day), vitamin B2 (1.9 ± 1.1 mg/day) and vitamin C (151.1 ± 149.3 mg/day) exceeded the recommendation by 135.0%, 139.0%, 166.9%, 154.6% and 152.0%, respectively. There was no significant difference in dietary intake between cancer survivors who were diagnosed in the past five years and those who were diagnosed more than five years ago (p>0.05) except for fat (p<0.001), saturated fatty acid (p=0.006), monounsaturated fatty acid (p=0.005) and polyunsaturated fatty acid (p=0.003). As a conclusion, breast cancer survivors in East Coast of Peninsular Malaysia had an adequate intake of most nutrients except for dietary fibre, monounsaturated fatty acids, polyunsaturated fatty acids, calcium, iron and potassium which was below the recommendation and sodium, protein, saturated fatty acids, vitamin B2, vitamin C which was above the recommendation. The intakes between long-term and short-term survivors were also comparable showing sustained dietary intake throughout survivorship.
Obese children had impaired psychosocial status as they generally tend to be socially isolated, have poor self-esteem, anxiety, mood disorder (depression and bipolar disorder) and eating disorder. The aim of this study was to investigate the child-report and parent-report of HRQoL among 9-11 years old obese school children in Malaysia and to determine the associated factors of HRQoL among obese children in Malaysia. This study was a cross-sectional study involving 101 obese Malay primary school children aged 9-11 years old from eleven primary schools in Kuala Terengganu which were selected via convenience sampling. Height and weight of the respondents were measured and their BMI was calculated. Health-related quality of life (HRQoL) was measured using PedsQL version 4.0. The mean age of the respondents was 10.02 ± 0.82 years old with mean BMI z-score was 3.01 ± 0.60. There were significance differences between boys and girls in; 1) emotional domain score for child-report QoL (p=0.019) using paired t-test and 2) psychosocial domain score for parent-report QoL (p=0.025). Regression analysis found that age and gender were the associated factors for Psychological Health for obese children (p<0.005). Being obese had negative effects on children’s quality of life. Various strategies interventions should be done to improve the HRQoL of these obese children. A multidisciplinary approach in schools must be organized to encourage a healthy lifestyle as part of routine among the school children.
Interleukin 31 (IL-31)is one of the cytokines which appears to be an important regulator of Th2 responses. Previous study has been done to determine IL-31 serums levels in atopic dermatitis (AD). However, the serum levels of IL-31 in allergic rhinitis (AR) and atopic asthma (AA) is not many reported and still unclear. The objective of this cross sectional study is to determine an association between IL-31 and other predisposing factors with allergic diseases in HRPZ II (Hospital Raja PerempuanZainab II) and HUSM (Hospital UniversitiSains), Kelantan, Malaysia. This study involved 70 patients of AD, 70 patients of AR, 70 patients of AA and 70 healthy controls from staffs and people in HUSM.Five milliliters of blood were withdrawn and centrifuged for 5 minutes at 2000 rpm to obtain the serum and analyzed for IL-31 levels by using enzymelinked immunosorbent (ELISA) kits (Human IL 31 Duoset, R&D System). Simple and multiple logistic regressions were used to analyze the association between IL-31 levels and predisposing factors among allergic diseases. The levels of IL-31 and other predisposing factors showed significant associations in smoking status, occupational exposure and area of living for AD and AR, however in AA, the significant association only found in smoking status and occupational exposure. In conclusion, we found that there were associations between IL-31 serum levels and other predisposing factors with AD, AR and AA. The findings can be the pilot study to determine IL-31 levels in allergic diseases in Malaysia.
Paddy cultivation is one of the widely planted crop in Malaysia. The growth of agricultural activity leads to the use of Organophosphate pesticide to protect the crop. This study is to determine the relationship between the levels of blood cholinesterase with the performance of motor coordination of children living in paddy farming area in Tanjung Karang, Selangor. This cross sectional study was conducted among 683 children from four schools in an agricultural area. Majority of the children have at a family member worked as farmer and was involved with pesticides. A set of questionnaire on the was given to the children to be filled by their parents. To measure their exposure to pesticide, blood cholinesterase levels were measured. Blood samples were taken through finger prick technique and were then analysed using LOVIBOND 412870 AF287. The children were administered with motor-coordination performance test using WHO Neurobehavioral Core Test Battery and McCarthy Learning Ability Scale. Young group children (6-85 years) showed a mean score of 56.66 in motor-coordination test while older group children (10-11)= years) scored a mean of 45.37. There was a significant relationship between blood cholinesterase level and motor coordination performance among the young-group children (r=0.215, p<0.001) and the older-group children (r=0.106, p=0.049). Based on the Linear Regression test results, total household income of family, and mode of transport used were found to have significant relationship with blood cholinesterase level of children in both groups. In addition, blood cholinesterase level and mothers’ occupation were found to have significant relationship with the motor-coordination performance of all children.
Safety is vital in any industry, including the offshore sector, which is classified as a major hazard industry. Health, Safety and the Environment (HSE) identified that the probability of accidents is high while working on the offshore sectors where it will exposed workers to many hazardous work activities. The appropriate measures to prevent accident in this sectors must be laid out clearly. This paper is to identify the effectiveness of safety awareness campaign and the continuity of the awareness among the workers to prevent injuries at offshore. To achieve this, we have identified the level of awareness and propose a guideline on areas of improvement. Prior of embarking to offshore, staff were exposed to safety awareness program for four weeks. After the program, we started with the pretest to all staff. They were posted offshore for 6 weeks. Within the period, the performance awareness of each staff is monitored through observation and interview. During the final week, the posttest questionnaire were administered to all staff. Two instruments were used for the quantitative data collection, which are Unsafe Act Unsafe Condition (UAUC) card; and Behavior Observation Tool (BOT) card. Questionnaire data were analyzed quantitatively. Paired-sample t-test was used for analyzing pre and post result. The results show that the mean was increased. Recent studies on the safety briefing highlighted several significant changes in terms of employee understanding toward safety. Safety awareness training has been introduced in the new safety briefing prior to offshore mobilization.
Staphylococcus aureus aregram positive cocci which colonizethe skin and mucous membranes particularly the anterior nares. Prevalence of nosocomial infections associated with methicillin resistant S. aureus have been reported in hospitals (HA-MRSA) for over five decades. Recently,community-acquired MRSA (CA-MRSA) has emerged as a cause of skin and soft tissue infections in healthy individuals. These strains are sensitive to antimicrobials, carry genes for Panton-Valentine leukocidin (PVL) toxin and belong to the staphylococcal cassette chromosome (SCC) mec type IV or V. The suspected mode of transmission involves close contact with carriers leading to skin or nasal colonization that resultin subsequent active infection. Molecular typing is used to determine the mode of transmission of CA-MRSA in the community.General typing methods such as pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) and specific methods for Staphylococci such as SCCmec typing and spa typing have the capability to characterize bacterial chromosomes and mobile genetic elements. Combination of these molecular typing methods is necessary as each method has its own advantages with respect to discriminatory power, rapidity, cost effectiveness, reproducibility, and ease of performance.
Antenatal care is a vital part of primary healthcare that is known to improve maternal and newborn outcomes. The aim of this study was to identify the factors affecting utilization of antenatal care services for women in reproductive age in Yemen. This cross-sectional community-based study was conducted in six districts of Sana’a City, Yemen. Data were collected from 460 mothers who gave birth in the past six months via face-to-face interviews at home between September to December 2010. Only 54% of mothers were found to have made four or more antenatal care visits. Almost two third of participants made their first visit during their first trimester due to presence of health problems and did not follow up when they became healthy during pregnancy. Reasons for not receiving antenatal care services due to absence of health problems, high cost of antenatal care services, long waiting time, and poor staff attitude. Sixty percent of participants were unaware of the danger symptoms of common health problems in pregnancy. The significant factors affecting utilization of antenatal services were mother education, residence place, age at first pregnancy, gravida, parity, occurrence of pregnancy without planning, and number of live children (P<0.05). The factors affecting the number of visits were mother education, place of residence, and husband work were (P<0.05). Future healthcare activities should focus on improving women’s awareness of the importance of antenatal care even in the absence of noticeable health problems and lack of education about the common danger signs and symptoms of pregnancy.