Primary aldosteronism (PA) causes a persistently elevated blood pressure (BP) due to
excessive release of the hormone aldosterone from the adrenal glands. Classically, it is called
Conn’s syndrome and is described as the triad of hypertension and hypokalemia with the
presence of unilateral adrenal adenoma. It can be cured with surgical resection of the
aldosterone-secreting adenoma leading to resolution of hypertension, hypokalemia and
increased cardiovascular risk associated with hyperaldosteronism. We present a case of a man
with previous ischemic heart disease (IHD) who presented with resistant hypertension.
Investigations for secondary causes of hypertension revealed an elevated aldosterone level
and saline suppression test confirmed the diagnosis of PA. Radiological examination revealed
a left adrenal adenoma and a normal right adrenal gland. However, adrenal venous sampling
showed lateralization of aldosterone secretion towards the right. He subsequently underwent
a laparoscopic right adrenalectomy which improved his BP control promptly. This case
highlights the importance of recognizing the need to investigate for secondary causes of
hypertension. It also underscores the importance of dynamic tests, which may not be easily
accessible to most clinicians but should pursue, to allow a definitive diagnosis and effective
treatment.
Introduction: This study aimed to determine the prevalence of Hepatitis C infection and the
level of knowledge, attitude and practice regarding Hepatitis C prevention among municipal
waste collectors in Penang Island, Malaysia. Methods: A cross-sectional study was
conducted among a convenient sample of 184 adult male municipal waste collectors in
Penang Island from January to May 2018. Respondents’ blood samples were obtained and
evaluated for antibodies to Hepatitis C virus (anti-HCV), and questionnaires administered to
them to collect information on sociodemographic variables and knowledge, attitude and
practice regarding Hepatitis C prevention. The seroprevalence of Hepatitis C virus was
estimated, and the association between sociodemographic variables and respondents’ level
of knowledge, attitude and practice regarding Hepatitis C prevention was explored using a
range of parametric and non-parametric statistical tests in SPSS version 23. Results were
considered significant at p
Introduction: Ocimum basilicum (OB), a herb known for its antihypertensive,
anticholinesterase and antioxidant properties was investigated for possible intraocular
pressure (IOP) lowering effects in rabbits with ocular hypertension (OHT). Methods: The
IOP lowering effect of a single drop of OB extract (OBE) was evaluated in oculonormotensive
rabbits using three concentrations (0.25, 0.5 and 1% w/v). The concentration showing
maximum IOP reduction was further evaluated in rabbits with water-loading and steroidinduced OHT. Results: IOP lowering effect of OBE 0.5% in oculonormotensive rabbit eyes
was significantly greater compared to OBE 0.25% (p0.05) to
OBE 1%. Therefore, 0.5% concentration was selected for further evaluation. Pretreatment
with OBE (0.5%) caused significantly lower increase in IOP after water loading amounting to
23.39% above baseline as compared to 54.00% in control eye, 15 minutes post water
loading. At 60 minutes, post water loading, mean IOP rise was 95.12% and 63.58% in
control and test eyes, respectively. Significant difference between the mean IOP of two eyes
persisted during the 2nd hr. In rabbits with steroid induced OHT, OBE 0.5% produced a
mean IOP reduction of 24.73% at the end of first hr and the mean peak IOP reduction of
31.63% was observed at the end of 2 hr. A significant difference between the IOP of test and
control eyes persisted from 1 to 6 hr. Conclusions: Ocimum basilicum seed extract showed
significant IOP lowering effect in rabbits with water loading and steroid induced OHT,
however, its utility as an effective antiglaucoma medication needs further investigations.
The aim of this study was to evaluate the levels of C-reactive protein (CRP) and
interleukin-6 (IL-6) in the gingival crevicular fluid (GCF) among stroke survivors in relation to
the oral hygiene status and stroke characteristics. Methods: A multi-centre cross-sectional
study was conducted among hospitalised stroke survivors. Socio-demographic data were
collected. Oral clinical assessment (dental plaque scores) and functional dependency levels
scores were carried out. Gingival Crevicular Fluids were collected, using absorbent papers
and analysed using ELISA kit. Descriptive statistic and correlation analyses were performed
using proportion and Spearmen correlation coefficient test. Results: A total of 53 patients were
recruited from five public hospitals. There was a significant correlation between CRP and IL-6
levels of GCF (P=0.021, r=0.21). A significant correlation was also observed between CRP
levels in GCF with dental plaque scores and functional dependency levels. There was no
statistically significant correlation found between IL-6 levels in GCF with dental plaque scores
and functional dependency levels. Dental plaque scores were associated with high levels of
CRP in GCF (P=0.014), and swallowing problem was associated with high levels of IL-6 in
GCF (P=0.002). Conclusions: IL-6 levels in GCF were correlated with the levels of CRP in
GCF. High CRP and IL-6 levels in GCF were significantly associated with dental plaque scores
and swallowing condition (presence of dysphagia), respectively. Thus, this pilot study suggests
that CRP level in the oral cavity respond to the oral health conditions and may not be a
predictor factor of stroke outcomes. Further studies are warranted to compare the level of
inflammatory biomarkers from the oral cavity and serum in relation to the stroke conditions and
outcomes.
Mental illness is expected to become the second biggest health problem affecting Malaysians by 2020. Doctors and medical students are more prone to mental illness compared to the general population. However, they are often reluctant to and resist seeking help because of stigma and a (strong) sense of shame. This can lead to detrimental consequences for themselves and their patients. That said, a doctor with a mental illness receiving appropriate treatment and who is in a stable condition may still be permitted to practise provided patient safety is not compromised. Determining this is a key responsibility of a healthcare regulator like the Malaysian Medical Council (MMC). Using some prominent cases to illustrate this point, this article reviews the MMC guideline on ‘Managing Impaired Registered Medical Practitioners’. In the absence of similar local guidelines for medical students, we also allude to the UK General Medical Council’s guideline on ‘Supporting Medical Students with Mental Health Conditions’. The article recommends that doctors and medical students with mental illness should seek help; outlines a number of factors to consider in deciding whether a doctor should continue practising; and explores alternative career paths in instances where they should not. The article concludes that appropriate support goes a long way for doctors and medical students who grapple with mental health issues in that there is hope and a way through a seemingly devastating situation.
MeSH terms: Mental Disorders; Delivery of Health Care; Health Personnel; Humans; Mental Health; Physicians; Shame; Students, Medical; Social Stigma; Patient Safety
A strong and robust Primary Health Care system is essential to achieving universal health
coverage and to save lives. The Global Conference on Primary Health Care 2018: from Alma-Ata towards achieving Universal Health Coverage and the Sustainable Development Goals at
Astana, Kazakhstan provided a platform for low‐ and middle‐ income countries to join the
Primary Health Care Performance Initiative (PHCPI). At this Global Conference, Malaysia has
declared to become a Trailblazer Country in the PHCPI and pledged to monitor her Vital Signs
Profiles (VSP). However, the VSP project requires an honest and transparent data collection
and monitoring of the Primary Health Care system, so as to identify gaps and guide policy in
support of Primary Health Care reform. This is a huge commitment and can only be materialised
if there is a collaborative partnership between Primary Care and Public Health providers.
Fundamental to all of these, is the controversy concerning whether or not ‘Primary Care’ and
‘Primary Health Care’ represent the same entity. Confusion also occurs with regards to the role
of ‘Primary Care’ and ‘Public Health’ providers in the Malaysian Primary Health Care system.
This review aims to differentiate between Primary Care, Primary Health Care and Public Health,
describe the relationships between the three entities and redefine the role of Primary Care and
Public Health in the PHCPI-VSP in order to transform the Malaysian Primary Health Care
system.
MeSH terms: Data Collection; Delivery of Health Care; Goals; Kazakhstan; Malaysia; Primary Health Care; Public Health; Health Care Reform; Vital Signs; Policy
Starting peace-building in early childhood is crucial as this is the best time to model a harmonious personality as well as exposure to value-based curriculum. Peace-building helps in preventing conflict and violence among peers, at home and in the community. In Malaysia, the elements of moral values such as tolerance, respect and unity are integrated across the National Preschool Curriculum in order to instill the awareness of maintaining peace and unity. This qualitative study aimed to explore the perspectives of the children, parents and teachers regarding peace and peace-building. Instruments in the form of questions were sent to various kindergarten teachers from public and private setting including those from urban and rural areas. Seven preschools responded. Interview of children, parents and teachers were conducted and transcribed through a focal point from each school and sent back to the researchers for analysis. Constant comparative method analysis was used where categories were created. Based on the analysis, children’s perception of peace is predominantly linked to love and orderliness and is within the environment they live in; whereas parents and teachers have more comprehensive and complicated views of peace which is related to harmony and tolerance in a bigger perspective. Children perceived peace-building pragmatically, to them peace-building just happened in everyday living. They perceived cleaning up, helping each other, sharing happiness, listening and cooperating as actions for peace-building. Parents and teachers understood their roles in creating peace for the young children; and unanimously agreed that they must be the role model for the children in creating peace. Parents and teachers believed that the immediate environment children live in must be harmonious, caring, and loving so that they can build up the character of their children who will love and practice peace in their own life. Methodology of peace building adopted by parents and children were mainly dialogue, negotiation and situational learning.
This paper discusses methodological dilemma that arise in qualitative research, specifically in education field. It outlines the broad principles that underpin good qualitative research and the aspects of practice that qualitative researchers should consider when designing, conducting, and disseminating their research. Two primary methodological dilemma are (i) lack of objectivity, and (ii) issue of generalizability in qualitative research. The aim of this paper is to argue the dilemmas and encourage researchers to examine the relevance of qualitative issues to their own research. These dilemmas could be taken as important consideration for others who wish to conduct qualitative research in education.
MeSH terms: Educational Status; Humans; Research Personnel; Problem-Based Learning; Qualitative Research
The issue in research ethics has been a long-standing problem in the academic world. In qualitative research, most of the studies carried out involve human subjects and require awareness of ethical issues that may arise, such as misconduct in research, plagiarism and authorship disputes. However, the emphasis on this issue has been given little exposure mostly among postgraduate students in Malaysia. This paper will highlight the most common ethical issues that arise in qualitative research studies, why this has happened, and how to overcome these important issues across institutions. In order to discover these issues, the databases Scopus, Google Scholar and Google Search were queried in the searching. The databases were assessed through the criteria of research ethics, research misconduct, and ethical issue in qualitative research from the year 1995 to 2019. The results revealed that there are studies on ethics in qualitative research especially in health and business area but insufficiently addressed in education. Besides, there are also several types of ethical problems in qualitative researches being identified which are commonly engaged by students despite research classes or courses that have been provided. Finally, it is concluded that not only does the research ethics component needs to be clearly addressed in the teaching among postgraduate students when conducting qualitative research, but there is also an urgent need to improve the institution curriculum in the research subject.
MeSH terms: Authorship; Curriculum; Humans; Malaysia; Students; Bibliometrics; Plagiarism; Scientific Misconduct; Ethics, Research; Dissent and Disputes; Research Subjects; Qualitative Research
Student athletes represent a unique segment of society, having to manage a set of expectations and challenges that are distinct and psychologically demanding. They are expected to achieve the highest level of sporting excellence while also performing well academically. A basic qualitative study was used to gain an understanding of the nature and type of psychological challenges faced, and ways the student athletes successfully managed or was currently managing those challenges. The results entailed two overlapping groups of challenges; internal and external, where internal consisted of emotional strain, expectations from one’s self, balance between sports and studies, and present feelings of regret, while external consisted of issues with their coach, perception of others, and transition to tertiary education. Additionally, there were three ways of managing those challenges namely through problem-focused coping, emotion-focused coping, and experiential learning. Those three domains are further explored and discussed, with consideration to the local context and the role of individual differences.
With the increase of consumers’ privacy concerns and the government-enforced regulations on data protection, it is necessary for organizations to implement Privacy Enhancing Technologies (PETs) to protect consumers’ personal data. PETs refer to any protection in the form of technology. Since employees are the main stakeholders who are directly involved in the PETs implementation and execution process, it is important to understand employees’ perceptions especially those daily tasks involving the process of collecting and processing consumers’ data. Prior literature showed limited research on the effects of PETs implementation through employees’ work process and their perception on the implementation in protection personal data. Hence, the purpose of this research is to explore how PETs adoption affects employees’ work process and their perception. A qualitative single case study was adopted in a telecommunications company in Malaysia. Data were collected through in-depth interviews from nine respondents who were involved in data collecting, data processing and data controlling in their daily tasks. The results showed that employees experience difference levels of change depending on their work nature. The affected areas of change in implementing PETs are workload, communication level and data access. Employees also raised their concerns on vendors’ accountability. This research provides an insight into employees’ perception towards personal data protection based on their experience in implementing PETs. Continuous awareness, updates, monitoring and evaluating of system are perceived as the key to successful PETs implementation in protecting personal data.
MeSH terms: Personally Identifiable Information; Communication; Government; Malaysia; Perception; Surveys and Questionnaires; Social Responsibility; Technology; Telecommunications; Computer Security; Workload; Privacy
The purpose of this case study is to look at how “Lean Techniques and Principles” can be successfully introduce and implement in the higher education institution or university context. In the last two decades, Lean techniques and principle has been applied to improve production system in manufacturing processes. Lean was introduced in the 1950s by Womack and Jones known as the Toyota Production System (TPS) by the legendary car manufacturer Toyota, the world’s most profitable automaker and have spent decades perfecting lean practices in the production. The method used was to produce more productivity while using fewer resources and identifying activities which creates value for customers, activities which do not create value but are required and actions which do not create value and can be eliminated. This case study demonstrates how “Lean Principles” can be adopted to the administration services particularly in the registration process for new student intake in USIM. The objective of this case study includes : to identify the needs of improving the registration process by eliminating the waste (Muda) such as time wastage, human resource wastage, to introduce the apparatus required to reduce and eliminate waste, to redesign the process using the lean techniques and principles to eliminate waste and to continually improve the process with the goal to achieve perfection for customer satisfaction and university’s reputation. How Lean Principles can transform the work process in the registration procedure, process efficiency, the reasons for implementing Lean in the process, minimize the lead time, minimize the financial cost and the role of management. This paper contains a comprehensive discussion and findings of the development of Lean principles and management through one of the models, namely; Value Stream Mapping (VSM) process which can enhance the operational process in the university environment to improve the process, particularly in the new student registration process.
With advances in medicine, more and more premature infants who require round-the-clock nursing care due to one or more complex medical conditions are able to survive after receiving intensive treatment in the neonatal intensive care unit (NICU). The increased survival rate has resulted in a higher incidence of morbidity that may impose emotional and financial burdens on families, society and the healthcare system. This paper explores the experiences of mothers with premature babies who were admitted to a NICU. A generic qualitative approach was used to gain insights into the effects of the premature baby admission to a NICU through tape recorded semi structured open-ended questions interviews with 17 mothers whose premature babies were admitted to a NICU. Inductive thematic analysis was used to identify, analyse, and report themes and patterns within the data. Qualitative analysis of the descriptive data obtained from 17 mothers identified four major themes and 13 sub themes relating to avoidance, effects of the separation, ceremonies and inadequate preparation. The findings have several implications for practice by care professionals. It can help nurses to develop interventions to prepare mothers to cope with new situations, decreasing stress and psychological problems regarding the admission of their infants to the NICU.
MeSH terms: Adaptation, Psychological; Delivery of Health Care; Emotions; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Medicine; Morbidity; Mothers; Incidence; Survival Rate
This paper describes the Malaysian car owners’ preference to purchase their car through car lease swap arrangement. Since owning a car nowadays is a necessity for most individuals, people will try to find the easiest and fastest way to own a car. Hence, the aim of this paper is to describe the issues of car lease swap businesses conducted in Malaysia, in particular to understand the reasons, business mechanism, and benefits of buying a car via this method. Due to limited empirical studies on car lease swap arrangement in Malaysia, the research adopted a qualitative approach, which utilises the snowball method to identify its participants. Interviews were conducted with relevant parties, who were directly involved in car lease swap business, which include the car lease dealers, the car owners and third parties (buyers). The findings indicate that the car lease dealers were the most to gain out of this business, meanwhile the car owners were worse off. Compared to the third parties, the car owners benefited from the convenient arrangement of the business. Nevertheless, due to its vague legality, it is possible to have negative implications on all parties involved. As such, future research should look at all parties involved in investigating the issues of this car lease swap business, such as relevant government agencies and all other stakeholders.
MeSH terms: Automobiles; Commerce; Consumer Behavior; Government Agencies; Humans; Malaysia; Ownership; Empirical Research
The learning curve for doing a good qualitative study is steep because qualitative methodologies are often vague and lack explicit steps. We detail the formulation of the grounded theory approach in a study of patients with type 2 diabetes mellitus who made decisions while strategizing their treatment types. This undertaking is to demonstrate how this systematic and yet flexible methods contributed to the understanding of the issue we were investigating. The process from deciding on research objectives and research questions, follow with systematic process for data collection and analysis allows us to generate a substantive theoretical model. By paying critical attention to theoretical saturation, grounded theory approach enabled us to construct all possible explanatory concepts related to decision making in strategizing diabetes treatment. We also describe the challenges throughout the whole research journey, including getting permission to interview patients, gaining the trust of research participants and staying open to the participants’ views.
MeSH terms: Attention; Data Collection; Decision Making; Diabetes Mellitus, Type 2; Humans; Models, Theoretical; Trust; Qualitative Research; Physical Phenomena; Learning Curve; Grounded Theory
The research interview is a common method of choice for collecting data, particularly within the qualitative research tradition. This is because it lends well to the emergent nature and exploratory aims of qualitative research. Detailed accounts of what and how things happened, and who was involved, that is elaborate stories, can be located in interview responses. This is irrespective of whether or not the stories were deliberately elicited or regardless of the methodological stance adopted by the researcher. The ubiquity of stories therein signals the need for researchers using qualitative interviews to be cognizant of the narratives surrounding these stories and the analytical value they hold in their research. This paper presents the philosophical underpinnings and strategy of narrative inquiry, and illustrates how methods of collection and analysis can be shaped in concert with the methodology
MeSH terms: Data Collection; Research Design; Narration; Qualitative Research
Simulated Patient (SP) is defined as a layperson that simulates to portray the role of a patient with health-related conditions based on varying levels of training. International Medical University (IMU) has been utilising SP for more than 10 years for simulation activities including learning sessions and examination. Due to a series of complex interaction within the SP programme, the aim of the study was to explore the experience of lecturer, student and SPs towards the interaction within the SP programme. The findings of the research were aimed to improve the teaching sessions and examination through the improvement of the SP programme. A total of 17 participants were recruited for 6 interviews, including both focus group and one-to-one interview session. The researcher used a list of guide questions to explore both positive and negative experiences. Manual transcribing and coding technique were used for data analysis, while Qualitative Data Analysis (QDA) was used for data management and additional analysis. The themes for the lecturer group were: SP resemble a real patient, The making of scenario, and SP feedback; while the themes for the students group were: Simulated patient as an effective learning tool, Fairness, and Feedback from simulated patient; whereas Effective learning session, Motivation and Preparation prior class were the themes for the SP group. SPs’ contribution was valuable if the SP is able to resemble a real patient and able to demonstrate effective feedback skills. Standardisation of the character portrayal and SP feedback influenced the fairness along the students’ journey. Lecturers, SPs and students influenced the success of an SP-based simulation session.
The study attempts to use multivariate analysis to evaluate the profile of male player for developments of Long-Term Talent in Sports (LT-TiS) model based on anthropometric and motor fitness components. Data of anthropometric and motor fitness included power, flexibility, coordination and speed were obtained from 2019 respondents aged 7.32±0.52 year. Data interpretations were carried out using multivariate analysis of Principle Components Analysis (PCA) and Discriminant analysis (DA). The adequacy of sampling has been measured using Bartletts tests on sphericity and Kaiser-Meyer-Olkin (KMO) has been used, with this conformance of running the Principal Component Analysis (PCA). Then, Discriminant Analysis (DA) were used to validate the correctness of group classification by LT-TiS model. Then, Discriminant Analysis (DA) were used to validate the correctness of group classification by LT-TiS. As a result, two factors with eigenvalues greater than 1 were extracted which accounted for 55.00% of the variations present in the original variables was found. The two factors were used to obtain the factor score coefficients explained by 27.86% and 27.21% of the variations in player performance respectively. Factor 1 revealed high factor loading on motor fitness compared to factor 2 as it was significantly related to anthropometrics. A model was obtained using standardized coefficient of factor 1. Three clusters of performance were shaped in view by categorizing; LT−TiS≥65%, 40%≤LT−TiS
MeSH terms: Anthropometry; Male; Surveys and Questionnaires; Sports; Exercise; Multivariate Analysis; Discriminant Analysis; Principal Component Analysis
Pap smear screening is proven to be an effective tool for the early detection of cervical cancer. Public Health Laboratory of the Ministry of Health Malaysia (MOH) reported that Pontian Health District achieved only 69.4% out of the 4,112 targeted Pap smear screening performed in 2014. Pontian District Health Office conducted a Quality Assurance (QA) project, aiming to increase the percentage of Pap smear screening uptake among women in Pontian district to 100%.
A cross-sectional study using questionnaires was conducted in January 2015 involving 256 women to measure their knowledge, attitude, and practice towards Pap smear screening. The results showed 93.8% of respondents have a good knowledge of Pap smear. However, only 72% agreed to do Pap smear screening while 28% refused to do the screening. The 72 women declined the Pap smear screening for various reasons, such as time constraint (27%) feeling shy (27%), perceived the procedure as painful (23%), afraid to know the result (19%) and perceived the screening as unimportant (4%). The results also revealed only 44% of the respondents received information about Pap smear screening from health staff.
Several strategies were identified to overcome the reasons; the expansion of Pap smear screening to the workplace and residences overcome time constraint issue, an innovative tool known as “Sisih Malu” to combat the shyness feeling of doing Pap smear screening, while “Celik Servik” demonstrates the procedure as simple and painless. Active promotion of Pap smear screening was also conducted by the clinics’ staff who emphasised on cervical cancer early detection, which is more treatable at an early stage. These improvement strategies were conducted from February until December 2015.
Post-intervention saw Pap smear screening in Pontian district increased to 4,936 (118.9%), exceeding the 4,152 target set for 2015 and increased 130.5% in 2016. Another survey among 99 women in January 2016 showed that a 100% willingness to undergo a Pap smear screening
MeSH terms: Uterine Cervical Neoplasms; Cross-Sectional Studies; Female; Humans; Laboratories; Malaysia; Mass Screening; Public Health; Surveys and Questionnaires; Shyness; Vaginal Smears; Workplace; Early Detection of Cancer; Papanicolaou Test