Provider Costs of Treating Colorectal Cancer in Government Hospital of Malaysia

@#Background: The incidence of colorectal cancer (CRC) is rapidly rising in several Asian countries, including Malaysia, but there is little data on health care provider costs in this region. The aim of this study was to estimate the cost of CRC management from the perspective of the health care provider, based on standard operating procedures. Methods: A combination of top-down approach and activity-based costing was applied. The standard operating procedure (SOP) for CRC was developed for each stage according to national data and guidelines at the University of Malaya Medical Centre (UMMC). The unit cost was calculated and incorporated into the treatment pathway in order to obtain the total cost of managing a single CRC patient according to the stage of illness. The cost data were represented by means and standard deviation and the results were demonstrated by tabulation. All cost data are presented in Malaysian Ringgit (RM). The cost difference between early stage (Stage I) and late stage (Stage II–IV) was analysed using independent t-test. Results: The cost per patient increased with stage of CRC, from RM13,672 (USD4,410.30) for stage I, to RM27,972 (USD9,023.20) for Stage IV. The early stage had statistically significant lower cost compared to late stage t(2) = −4.729, P = 0.042. The highest fraction of the cost was related to surgery for Stage I, but was superseded by oncology day care treatment for Stages II–IV. CRC is a costly illness. From a provider perspective, the highest cost was found in Stages III and IV. The early stages conserved more resources than did the advanced stages of cancer. Conclusion: Early diagnosis and management of CRC, therefore, not only affects oncologic prognosis, but has implications for health care costs. This adds further justification to develop and implement CRC screening programmes in Malaysia.

"Taking my breath away by keeping stress at bay" - an employee assistance program in the automotive assembly plant

The aim of this study was to evaluate the effectiveness of individual-focused stress management training namely Deep Breathing Exercise [DBE] on self-perceived occupational stress among male automotive assembly-line workers. A quasi-experimental study was conducted at 2 automotive assembly plants in Malaysia over 9 months, from January 2012 to September 2012. Assembly-line workers from Plant A received DBE training while Plant B acted as a control by receiving pamphlets on stress and its ill-effects. Intention-to-treat analysis was conducted among the self-voluntary respondents in Plant A [n=468] and Plant B [n=293]. The level of stress was measured using Depression Anxiety Stress Scales-21 [DASS-21] stress subscale. Significant favorable intervention effects were found in Plant A [Effect size=0.6] as compared to Plant B [Effect size=0.2] at the end of the study in those receiving DBE. Time and group interaction effects were examined using the repeated measure ANOVA test in which there was a significant group *time interaction effect [F [1, 1] = 272.45, P<0.001]. The improvement in stress levels showed the potential of DBE training as part of Employee Assistance Program in the automotive assembly plant. Future studies should be carried out to assess the long term effects of an on-site relaxation training to provide stronger evidence for the introduction of DBE among assembly-line workers as a coping strategy to alleviate occupational stress

Rota viral infection: a significant disease burden to Libya

Rotavirus is a common infection causing 450,000 deaths annually primarily in children 5 years and below. Despite the high burden of disease, little is known about the epidemiology of rotavirus in Libya. The aim of this study was to estimate the rotavirus disease burden among Libyan children. A cross-sectional study was carried out prospectively among children 5 years old and below between August 2012 and April 2013. Stool samples of children with diarrhea attending the outpatient department or admitted to the pediatric wards, at three public hospitals within the northwestern region of Libya were tested for rotavirus. The seasonality, symptomology demographics and outcomes of rotavirus cases were determined and compared to other diarrhea illnesses. An estimated incidence rate per 100,000 children aged 5 years and below was determined. A total of 545 children with diarrhea were identified for participation. Results of rotavirus immunoassays determined 57% of cases were caused by rotavirus. Inpatients were more likely to be rotavirus positive than outpatients [58% vs. 53%, P<0.05], Most rotavirus positive cases [86%] were found among children below 2 years of age. Rotaviral cases peaked in the winter, constituting 76% of diarrheal illness in February and very few rotavirus cases in the summer months. The incidence rate of rotavirus diarrhea was estimated at 640/100,000 children aged 5 years and below. Rotavirus infection poses a significant disease burden in Libya. Preventive measures such as proper hygiene should be emphasized. Introduction of vaccination against rotavirus into the national immunization program should be examined, as it would likely be a cost-effective investment

Cervical screening uptake and its predictors among rural women in Malaysia

<p><b>INTRODUCTION</b>Cervical cancer is the third most common cancer among Malaysian women. However, the uptake of cervical cancer screening--Pap smear--by women in Malaysia has been low and remains a challenge. This study was conducted to assess the cervical screening practices of rural women in Malaysia and to examine the factors associated with such practices.</p><p><b>METHODS</b>A cross-sectional survey was conducted in five rural districts in Perak, Malaysia. 1,000 households were selected through multistage random sampling. Women aged 20-64 years were interviewed by trained enumerators using structured questionnaires. Binomial logistic regression was used to identify predictors of cervical screening through univariate and multivariate analyses.</p><p><b>RESULTS</b>Among the 959 respondents, only 48.9% had undergone Pap smear at least once in the past three years. Women in the age group 40-49 years (odds ratio 3.027, 95% confidence interval 1.546-5.925; p < 0.005) were found to be significantly more likely to attend cervical cancer screening as compared to those in the age group 20-29 years. Other significant predictors were being married with children, having knowledge of cervical cancer symptoms, receiving relevant information regarding cervical cancer from health personnel or campaigns, being engaged in family planning and receiving encouragement from husbands.</p><p><b>CONCLUSION</b>Efforts to boost the uptake of Pap smear screening among the rural population should be targeted toward the predictors of positive uptake.</p>

Determinants of sexual intercourse initiation among incarcerated adolescents: a mixed-method study

<p><b>INTRODUCTION</b>This study aimed to investigate the determinants of sexual intercourse initiation among incarcerated adolescents aged 12-19 years in Malaysia.</p><p><b>METHODS</b>This was a sequential mixed-method research project that was conducted in two phases. Quantitative and qualitative methods were used in the first and second phases, respectively. Data was collected via a survey using self-reported questionnaires from 1,082 adolescents, and from in-depth interviews and the written essays of 29 participants. The participants were recruited from 22 welfare institutions in peninsular Malaysia.</p><p><b>RESULTS</b>Among the study participants, 483 were male and 599 were female. Overall, 62.3% of the incarcerated adolescents had initiated sexual intercourse at least once. The mean age at first sexual intercourse for both genders was 14.0 years. Individual factors found to be associated with previous sexual intercourse were the female gender (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.11-2.74), previous alcohol use (OR 1.80; 95% CI 1.10-2.94), previous illicit drug use (OR 1.85; 95% CI 1.07-3.22), permissive attitude toward premarital sex (OR 4.34; 95% CI 2.17-8.70), and sexual abuse during childhood (OR 5.41; 95% CI 3.52-8.32). Qualitative findings revealed that the reasons for initiation of sexual intercourse among these adolescents were partner influence, inability to control sex drive, family issues, and the perception of sex as an expression of love.</p><p><b>CONCLUSION</b>The determinants of sexual intercourse initiation among incarcerated Malaysian adolescents are comparable to those of developed countries. However, in Malaysia, sexual and reproductive health programmes for such adolescents should be tailored to address their specific needs.</p>

Long-term socioeconomic impact of the Nipah Virus encephalitis outbreak in Bukit Pelanduk, Negeri Sembilan, Malaysia: A mixed methods approach

Background and Objective: In 1998/99, an outbreak of Nipah virus encephalitis occurred in several pig-farming communities in Malaysia. It was associated with a high mortality rate and persistent neurological defi cits among many survivors. This mixed method study aimed to examine the longterm socio-economic consequences of the illness on affected pig farmers and their families in Bukit Pelanduk, Negeri Sembilan. Methods: A quantitative cross sectional survey was conducted in 2008 on 78 former patients or their kin from 61 households (46.2% males, mean age = 48.7 years) in Bukit Pelanduk via face-to-face interviews. This was followed by qualitative in-depth interviews with 20 respondents. Results: The immediate treatment costs were not a major burden to most households. Majority of the patients (92%) required inpatient care and most obtained free care from public hospitals. Households relied mainly on savings and support provided by the public and family members during the outbreak. However, many former patients found their low educational qualifi cations prevented them from obtaining good alternative employment after their recovery. This had negatively affected their households’ living standards. As a result, there had been a renewed appreciation of the value of education for their young, and one of their main concerns was the fi nancial burden of educating their children. Conclusion: Free public health care protected most households from high medical costs. However, household living standards had dropped due to limited alternative employment opportunities. Education has been identifi ed as a key to improving the long term welfare of affected households.