Attitude Towards Anti-smoking Measures and Its Associated Factors Among Adults in Sub-urban Area, in Kuala Terengganu, Terengganu, Malaysia

@#Introduction: General population across different countries have shown an overall support for anti-smoking measures that vary significantly by certain population parameters. However, characteristics of the public attitude in a community who has been exposed to prolonged awareness campaigns and smoke-free area legislation is unclear. Consequently, we investigate residents who reside next to Batu Buruk beach in Kuala Terengganu city which has been gazetted as a smoke-free area since 2017. Methods: The cross-sectional study involves self-administered validated questionnaires. Multiple linear regression with forward method was applied to identify significant factors associated with the attitude towards anti-smoking measures. Results: A total of 295 residents participated. Most of them were Malays (96.6%), married (64.4%), attained up to the secondary school level (45.4%) and employed (59.7%). The mean value of the total attitude scores was 181.86 (range: 70-200). Multivariate analyses revealed those having higher monthly income had a higher total attitude scores (adjusted b: 6.91, 95% CI: 2.15, 11.66), while current daily smokers had a lower total attitude scores towards anti-smoking measures than non-smokers (adjusted b: -23.30, 95% CI: -29.55, -17.05). These findings highlight comparatively stronger and more consistent support for anti-smoking measures that may vindicate high-stake investment and legislation against smoking. Conclusion: The novel evidence may also better-inform the strategy to expand the initiatives further through profiling the target population with heightened emphasis on the economic standing and prevalence of current daily smokers. Future research may adopt experimental design to establish causality relationship between predictors and outcomes revealed in this community.

Genetics in prenatal diagnosis

The options for prenatal genetic testing have evolved rapidly in the past decade, and advances in sequencing technology now allow genetic diagnoses to be made down to the single-base-pair level, even before the birth of the child. This offers women the opportunity to obtain information regarding the foetus, thereby empowering them to make informed decisions about their pregnancy. As genetic testing becomes increasingly available to women, clinician knowledge and awareness of the options available to women is of great importance. Additionally, comprehensive pretest and posttest genetic counselling about the advantages, pitfalls and limitations of genetic testing should be provided to all women. This review article aims to cover the range of genetic tests currently available in prenatal screening and diagnosis, their current applications and limitations in clinical practice as well as what the future holds for prenatal genetics.

Do Our Diabetic Patients Ready for Safe Pregnancy? Attitude Towards Preconception Care and Its Associated Factors Among Women With Diabetes Attending Government Health Clinics in Terengganu

@#Introduction: Women with uncontrolled diabetes may conceive but will result in poor pregnancy outcomes. This study aimed to assess the level of knowledge and attitude and determine factors associated with attitude towards preconception care. Method: A cross-sectional study was conducted in various government health clinics from all districts in Terengganu by using multistage random sampling. A self-administered questionnaire was applied to assess the level of knowledge and attitude towards preconception care. Multiple logistic regressions were applied to determine factors associated with attitude towards preconception care. Results: A total of 422 respondents were involved. The prevalence of respondents with unsatisfactory knowledge and attitude were 41.7% and 84.1%, respectively. Knowledge was not significantly associated with attitude. Respondents who used contraception had a better attitude (Adj. OR: 0.44, 95% CI:0.23,0.84). Low household income was associated (Adj. OR: 2.40, 95% CI:1.10,5.26) with an unsatisfactory attitude towards preconception care. Conclusion: Attitude towards preconception care amongst diabetic women who were attending primary care clinics was unsatisfactory. A structured and focused preconception educational programme care is necessary, especially amongst low-income women.

The Frequency and Cost of Redundant Biochemistry Test in Tertiary Teaching Hospital

@#Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST, Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600 thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration among physicians and laboratory professionals can minimise test inappropriateness.

Physicians’ Attitude Towards Artificial Intelligence In Medicine, Their Expectations And Concerns: An Online Mobile Survey

@#The application of artificial intelligence (AI) is on the rise in the healthcare industry. However, the study on the physicians’ perspectives is still lacking. The study aimed to examine physicians’ attitudes, expectations, and concerns regarding the application of AI in medicine. A cross-sectional study was conducted in October 2019 among physicians in a tertiary teaching hospital in Malaysia. The survey used a validated questionnaire from the literature, which covered: (1) socio-demographic profile; (2) attitude towards the application of AI; (3) expected application in medicine; and (4) possible risks of using AI. Comparison of the mean score between the groups using a t-test or one-way analysis of variance (ANOVA). A total of 112 physicians participated in the study: 64.3% from the clinical departments; 35.7% from the non-clinical specialties. The physicians from non-clinical departments had significantly higher mean attitude score (mean = 14.94 ± 3.12) compared to the clinical (person-oriented) departments (mean = 14.13 ± 3.10) and clinical (technique-oriented) departments (mean = 13.06 ± 2.88) (p = 0.033). The tech-savvy participants had a significantly higher mean attitude score (mean = 14.72 ± 3.55) than the non–tech-savvy participants (mean = 13.21 ± 2.46) (p = 0.01). There are differences in the expectations among the respondents and some concerns exist especially on the legal aspect of AI application in medicine. Proper training and orientation should precede its implementation and must be appropriate to the physicians’ needs for its utilization and sustainability.

Inappropriate Positioning of Separator Gel in Blood Collection Tube: A Case Report

@#Blood collection tubes containing separator gel are widely used in many clinical laboratories because of easy to use, convenience and several other advantages. However, they are not void of limitation. We describe an unusual case with a floating separator gel in the primary blood collection tube. The blood sample was collected into a BD Vacutainer SST II Advance tube, from a 51 years old man admitted for community acquired pneumonia and had history of hyperproteinaemia. Inappropriate positioning of the separator gel was observed after centrifugation, whereby the separator gel floated above the serum. Detection of abnormal separator gel floatation pattern in this patient’s sample before analysis had prevented potential technical problem and production of erroneous result caused by aspiration of separator gel. The limitation of blood collection tube with separator gel especially in patients with hyperproteinaemia should be made aware among laboratory personnel and physicians.

The Economic Burden Of Frailty Among Elderly People: A Review Of The Current Literature

@#Life expectancy from birth is increasing dramatically. Due to this increase, the population of elderly people will increase. Consequently, geriatric related illnesses will increase leading to increased necessity to build up comprehensive and coordinated cost effective health care services appropriate for elderly people. Frailty is not a disease, but rather considered as a syndrome requiring comprehensive and multidisciplinary care approach. It is a prevalent reversible pathological transitional stage between healthy aging and disability. Frailty is associated significantly with increased health care utilization, mortality, and comorbidities such falls, hospitalizations, physical dependence, and poor perception of health. The aim of this review is to compile existing literature on the economic cost of frailty syndrome among elderly people in the recent years. Search queries were constructed to look for articles related to the economic cost of frailty in the electronic databases available at the National University of Malaysia library for articles published between the years 2011 and 2019. The accessed electronic database included New England journal of medicine, Science Direct, SCOPUS, BMJ, Cochrane, and Wiley Online Library. Articles included in this review when they were original research, participants were defined as frail elderly, manuscripts written in English language, and involved clearly described measures of frailty cost. Among the literature, twenty one articles were found to satisfy the inclusion criteria of the review process. The cost of care for frail elderly was ranging from US $ 8,620 to 29,910 per patient per year. The cost of health care was ranging from US $ 2,540 to 221,400. The health care cost was accounting for 40% to 76% of the total care cost. Hospitalization cost was the highest, it was ranging from US $ 806 to 152,726. Outpatient cost was ranging from US $ 200 to 18,000. Medications cost was ranging from US $ 7 to 3,434 per frail elderly patient per year. Home help cost was ranging from US $ 804 to 19,728 per frail elderly patient per year. In conclusion, frailty is a costly syndrome. It can be considered as a cost effective target for health promoting interventions to contain future elderly cost.

Prevalence, Associated Factors, And Help Seeking Behavior Related To Psychological Distress Among International Students At Universiti Kebangsaan Malaysia

@#Depression, anxiety, and stress are associated with decreased role functioning, productivity, and quality of life. International students are more prone to psychological distress as they face many stressors while studying abroad. The objectives of the study were to determine the prevalence and associated factors of depression, anxiety, and stress among international students, their help-seeking behavior and their awareness of the available on-campus mental support services. A cross-sectional study with a purposive sampling method was performed on 280 international students at Universiti Kebangsaan Malaysia (UKM) between the age of 18 and 35 years. The Depression Anxiety Stress Scale-21 (DASS-21) questionnaire was used anonymously to assess the mental health of students. Soci-demographic, help-seeking behavior, and awareness data were obtained. Independent sample t-test, one-way Analysis of Variance (ANOVA) test, and Multiple Linear Regression were used to explore associated factors. The overall prevalence of depression, anxiety, and stress among international students was 58.9%, 71.8%, and 53.9% respectively. Age was significantly associated with depression and anxiety. Ethnicity showed a significant association with depression and stress. No other factors were found to be significantly associated with psychological distress. Only 9.6% of the international students had sought help from on-campus mental support services. Students who were aware of the presence of such services were only 21.4% of the participants. In conclusion, the recent study showed a high prevalence of psychological distress and low help-seeking behavior among international students in Malaysia. This provided data that could be used in intervention programs to improve the mental health of the increasing number of international students in Malaysia.

Preventive Practice On Secondhand Smoke And Its Associated Factors Among Adults In A Suburban Community In Kuala Terengganu

@#Secondhand smoke (SHS) carries many health risks and is associated with diseases and premature deaths among nonsmoking adults and children. Despite many health promotions and legislative measures executed by the government to protect the public from SHS, the prevalence of SHS exposure is still high. Personal appropriate practices to avoid exposure are crucial especially at home or private area. Therefore, the current study focused on describing individual preventive practices on SHS and determining its associated factors. A cross sectional study was conducted among 250 adults in a village, Kuala Terengganu. Data were collected using self-administered questionnaires. Multiple logistic regression analysis was performed to determine the association between all independent variables and the SHS preventive practice status. The prevalence of SHS exposure was 66.0%. Majority of the respondents (77.2%) has good knowledge on SHS. Nevertheless, despite having good knowledge, a large proportion of them showed poor attitude toward SHS (77.6%) and poor preventive practices (61.2%). Poor preventive practices on SHS were significantly associated with being older (OR­adj: 1.0206, 95% CI: 1.0004, 1.0412), female (OR­adj: 2.0644, 95% CI: 1.0753, 3.9635), smoker (OR­adj: 12.1107, 95% CI: 4.0630, 36.0991), not having existing tobacco-related morbidity (OR­adj: 3.6795, 95% CI: 1.1795, 11.4786), and poor attitude towards SHS (OR­adj: 4.1871, 95% CI: 2.0955, 8.3665). The preventive practices of SHS among the villagers were poor despite showing acceptable level of knowledge. Hence, health awareness on the potential impact of SHS to the public as well as instilling appropriate behavior for them to avoid SHS and educate smokers need to be emphasized.

A Review Of Occupational Stress Prevalence And Its Predictors Among Selected Working Populations In Malaysia

@#Occupational stress is a modern epidemic. Prevalence and predictors of occupational stress in specific workforce are critical in management of occupational stress. The aim of this review is to explore the current prevalence of occupational stress and its predictors among selected Malaysian working population based on published articles between years 2008 to 2017. A systematic search of articles published between 2008 and 2017 was conducted in several databases (ISI Web of Knowledge, PubMed, Scopus, Google scholar). A total of eleven articles met the inclusion criteria, included in the review. The current prevalence of occupational stress was between 6.0% till 71.7%. Mean prevalence of stress was 29.9%. From eight job categories, most stressful job was primary teachers and least stressful job was academician in private university. Predictors of occupational stress were: 1) organizational factors: high job demand, poor workplace condition, lack of organization support, job insecurity, long working hours, burden of career development and interpersonal conflicts 2) individual (extra-organization) factors: gender, age, marital status, number of children, coping strategies. Although the predictors of occupational stress varies among different job categories, most job categories present similar risk factors such as high job demand, poor workplace condition, lack of organization support, job insecurity, long working hours, burden of career development and interpersonal conflicts. Dual approaches involving organization and individual level pertaining towards each stressor are recommended in alleviating occupational stress among those selected workforces.

General Health And Psychosocial Burden Among Women With Abnormal Pap Smear After Post Colposcopy

@# The identification of psychosocial burden and general health among women with abnormal Pap smear results was fundamentally important because women play the significant role in the family and community. The purpose of this study was to determine the level of psychosocial burden, level of general health and relationship between psychosocial burden with general health among women with abnormal Pap smear after colposcopy. This crosssectional study was done towards 218 women with abnormal Pap smear after colposcopy. Universal sampling at gynecology clinic from three tertiary hospitals in the East Coast of Malaysia was conducted. Respondents selfanswered the validated Malay version of Psychosocial Effect of Abnormal Pap smear Questionnaire and General Health Questionnaire-12 in Malay version. Data were analyzed by using statistical software IBM-SPSS version 22, descriptive statistical method, Pearson and Spearman Correlation coefficient analysis were used. The results revealed that 43.1% and 16.5% of women with psychosocial burden were having distress due to abnormal Pap smear after colposcopy. The correlation coefficient showed a significant moderate correlation between psychosocial burden and general health (r = 0.41 and p=0.000). The women are facing psychosocial burden and distress in life after being diagnosed with abnormal Pap smear, because it is related to physical and psychological aspects. This shown that psychological aspect is important in health, therefore health care needs to perform the assessment of the psychosocial burden and general health among women with abnormal Pap smear in Malaysia.

Housing Infrastructure And Quality Of Life Of Orang Asli And Non-Orang Asli Populations In Kuala Langat Selangor

@#We investigated the association between housing conditions with a primary focus on basic housing infrastructure and WHOQOL BREF score among the Orang Asli and non-Orang Asli populations. A cross–sectional study was conducted between August 2014 and May 2015 among the Orang Asli and non-Orang Asli populations in Kuala Langat, Selangor. Sampling of the population was done through multistage sampling while eligible respondents participated conveniently. The socio-demographic information collected consisted of age, ethnicity, marital status, educational level, and employment status. Basic housing infrastructure variables including the types of housing unit, wall construction material, availability and types of toilet, availability of electricity, source of water supply, and availability of garbage collection facilities were obtained. Among the Orang Asli respondents, having the pour type of toilet in the house was significantly (p=0.003) associated with a reduction in the physical health domain score by 0.36 (95% CI: -0.61,-0.12). Conversely, having no toilet in the house and living in a semi-detached house had significantly (p=0.023 and p=0.026 respectively) increased the social relationships domain score by 0.81 (CI: 0.11, 1.51) and 3.90 (CI: 0.47, 7.34) respectively. Unavailability of garbage disposal facilities was found to be significantly (p<0.001) associated with a reduction in the environmental domain score by 0.70 (95% CI: -1.05, 0.35). This study have added to the evidence that housing programs of the Orang Asli population need to be further strengthened and supported by a range of policies and practices that address the critical intervention points for more potential health gains.

Development Of Clinical Pathway For Non-Surgical Management Of Chronic Periodontitis

@#The vast range of treatment protocols available for non-surgical management of chronic periodontitis can affect the consistency of clinical decision-making for dentists. This is further compounded by the different case definitions for periodontitis used in various clinical studies. The aim of this paper is to describe the steps taken leading to an expert consensus of periodontitis case definition followed by the development of a clinical pathway for managing chronic periodontitis. To assist reaching a consensus on a standard case definition of periodontitis for clinical research, a roundtable discussion was held involving 13 dental specialists and researchers from universities and the Ministry of Health. Participants discussed clinical experiences in identifying periodontitis and related issues based on scientific evidence. A further expert panel discussion consisting of 8 periodontists was conducted at another session to review current management practices and evidence-based practices available from the literature and generated a clinical pathway for non-surgical management of periodontitis. The case definition derived from the roundtable discussion recognises differentiation of selected clinical parameters and their thresholds as well as the extent and severity of the periodontitis. As for the newly developed clinical pathway, experts collectively defined the appropriate goals to satisfy the multidimensional needs of the patients which are translated into detailed elements of care, including the sequence of events of patients at each dental visit over time. The agreed case definition will facilitate selection and recruitment of cases for clinical studies while the clinical pathway can be used to reduce variations between clinicians.

Psychometric Evaluation of the Malay Version of the Impact of Weight on Quality Of Life-Lite (IWQOL-LITE) Questionnaire

Background: The availability of obesity specific quality of life measurement tool is limited. The Malay version of Impact of Weight on Quality of Life-Lite is an obesity specific quality of life questionnaire which has been translated for use in Malaysia. The aim of this study is to evaluate the validity and reliability of this tool to measure quality of life among different body mass index (BMI) groups.Methods: One hundred and twenty subjects with different BMI categories attending an outpatient government clinic participated in this study. The translated Malay version of IWQOL-Lite was used for assessment. The validity of this questionnaire was examined using content validity, criterion validity and construct validity. Reliability analyses used in this study were internal consistencies and test-retest reliability. Results: The Malay version of IWQOL-Lite showed good psychometric properties whereby the content validity was sufficient as measured by expert panels. The mean score of all IWQOL-Lite domains were able to discriminate between different BMI groups. Good internal consistency was demonstrated by Cronbach alpha of 0.936. Test-retest reliability ranged from 0.828 to 0.932. The physical function score (IWQOL-Lite) correlated positively with Physical Component Summary of Short Form-36 questionnaire. Exploratory factor analysis found that the questions loaded on five domains. Conclusion: The results suggest that the Malay version of IWQOL-Lite is a valid and reliable tool to measure quality of life among obese and overweight subjects in Malaysia.

Development Of Clinical Pathway For Non-Surgical Management Of Chronic Periodontitis

The vast range of treatment protocols available for non-surgical management of chronic periodontitis can affect the consistency of clinical decision-making for dentists. This is further compounded by the different case definitions for periodontitis used in various clinical studies. The aim of this paper is to describe the steps taken leading to an expert consensus of periodontitis case definition followed by the development of a clinical pathway for managing chronic periodontitis. To assist reaching a consensus on a standard case definition of periodontitis for clinical research, a roundtable discussion was held involving 13 dental specialists and researchers from universities and the Ministry of Health. Participants discussed clinical experiences in identifying periodontitis and related issues based on scientific evidence. A further expert panel discussion consisting of 8 periodontists was conducted at another session to review current management practices and evidence-based practices available from the literature and generated a clinical pathway for non-surgical management of periodontitis. The case definition derived from the roundtable discussion recognises differentiation of selected clinical parameters and their thresholds as well as the extent and severity of the periodontitis. As for the newly developed clinical pathway, experts collectively defined the appropriate goals to satisfy the multidimensional needs of the patients which are translated into detailed elements of care, including the sequence of events of patients at each dental visit over time. The agreed case definition will facilitate selection and recruitment of cases for clinical studies while the clinical pathway can be used to reduce variations between clinicians.

Psychosocial Burden Among Women With Abnormal Pap Smear And Post Colposcopy In Malaysia

@#Objective: The purpose of this study was to determine the level of psychosocial burden and its associated risk factors among women with abnormal Pap smear and post colposcopy. Methods: A cross-sectional study was conducted employing universal sampling of 218 respondents with abnormal Pap smear and post colposcopy. They fulfilled the specific inclusion and exclusion criteria. Three tertiary hospitals in the East Coast of Malaysia were participated. Self-administration of validated Malay-version Psychosocial Effect of Abnormal Pap smear Questionnaire was used to assess the psychosocial burden. The General Health Questionnaire-12 (GHQ-12) was applied to assess the general health factor. Data was analyzed using IBM-SPSS of version 22. Results: The results showed that respondents with an abnormal Pap smear and post-colposcopy women (43.1%) demonstrated a high level of psychosocial burden. The significant risk factor of psychosocial burden was living in an urban and semi-urban area of residence (p = <0.001) and distress condition (p = <0.001) respectively. Conclusions: A substantial number of women with abnormal Pap smear results were experiencing psychosocial burden. Women with an abnormal Pap-smear who were living in the urban and semi-urban and distressed were more likely to experience a higher psychosocial burden.

Development And Validation Of A Questionnaire On Socio-Cultural Factors Among The Orang Asli And General Population In Selangor

@#Cultural attitudes of the societies have long been identified as one of the important determinants of Quality of Life (QoL). Yet there is a dearth of socio-culturally validated instruments for local population to assess the impact of socio-cultural practice on health. The aim of this validation study is to develop and test the validity and reliabilityof a questionnaire on culture dimensions.Respondents were asked about their engagement in socio-cultural aspects including beliefs and practice oftraditional customs and culture using a set of newly developed questionnaire.A total of 275eligible respondentsparticipatedwith150(54.5%)from the general population and 125 (45.5%)from the Orang Asli population. Kaiser-Meyer Olkin measure of Sampling Adequacy (KMO) was 0.791 and 0.677 for the general and Orang Asli population respectively. Bartlett’s test for both population was significant (p<0.001). By Principal Common Analysis, four factorswere extracted (Eigen values >1.0) that jointly accounted for 54.7% and 52.0% of the total variance among the general population and Orang Asli respectively.The Cronbach alpha value score was 0.785and 0.730 for the general population and Orang Asli population respectively. The Cronbach alpha values foreach of the four domains ranged from 0.477-0.865 and 0.543-0.758 for the general population and Orang Asli population respectively.These results suggest that the newly developed questionnaire appeared to have adequate validity and reliability in measuringsocio-cultural factors in the population.

Health labour market requirements of health professional education in Yemen

It is important to link health professional education to the health service needs of the private and public labour market so as to meet the plans of the health sector. Thus, the main focus of this study was to identify the present labour market requirements for the outcomes of health training institutes. A qualitative study was carried out among mixed healthcare professionals and various stakeholders in Sana'a City, Yemen. Six focus group discussions were formed for 42 graduates and 20 in-depth interviews were undertaken with health development partners and public and private employers. Outcomes of the health training institutes were still below the expectations of the health labour market, and did not fill the existing gaps in English-language proficiency and clinical skills. The survival of health professional education depends on future development to meet labour market demands through collaboration between key stakeholders, regular updating of the curriculum, and constant professional development of the teaching staff