Drone versus ambulance for blood products transportation: an economic evaluation study.

BACKGROUND: Medical transportation is an essential step in health care services, and includes ground, air and water transportation. Among the important uses of medical transportation is the delivery of blood products in the event of a clinical emergency. Drone technology is the latest technological advancement that may revolutionize medical transportation globally. Nonetheless, its economic evaluation is scant and insufficient, whilst its cost-effectiveness remains controversial. The aim of this study was to compare the cost-effectiveness of drone transportation versus the ambulance. METHODS: The setting of the study was within a developing nation. An economic evaluation study of drone versus ambulance for emergency blood products transportation between the Sabah Women and Children Hospital (SWACH) and the Queen Elizabeth II Hospital (QEH2) on Borneo Island was conducted using the Cost-Effectiveness Analysis (CEA) technique. The total cost of each mode of transportation was calculated using the Activity Based Costing (ABC) method. Travel time was used as a denominator to estimate the Incremental Cost Effectiveness Ratio (ICER). RESULTS: For one clinical emergency in SWACH, a round trip of blood products transportation from SWACH to QEH2 costs RM1,266.02 (USD307.09) when using the ambulance, while the drone costs RM1,313.28 (USD319.36). The travel time for the drone was much shorter (18 min) compared to the ambulance (34 min). The Cost-Effectiveness Ratio (CER) of ambulance transportation was RM37.23 (USD9.05) per minute whilst the CER of drone transportation was RM72.96 (USD17.74) per minute. The ICER of drone versus ambulance was - 2.95, implying an increase of RM2.95 in cost for every minute saved using a drone instead of an ambulance. CONCLUSION: Although drone transportation of blood products costs more per minute compared to the ambulance, the significantly shorter transport time of the drone offset its cost. Thus, we believe there is good economic potential for drone usage for blood products transportation in developing nations particularly if the drone price decreases and its operational lifespan increases. Our limitation of a non-clinical denominator used in this study leads to the recommendation for use of clinical outcomes in future studies.

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 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.

Modifiable Risk Factors Of Cardiovascular Disease Among Adults In Rural Community Of Malaysia: A Cross Sectional Study

Cardiovascular disease (CVD) is the leading cause of death in Malaysia and many parts of the world. Potentially modifiable risk factors for CVD include diabetes mellitus, hypertension, abdominal obesity, smoking and psychosocial stress. Over the last several decades, efforts to prevent or treat CVD risk factors have resulted in significantly lower rates of CVD-related mortality. However, many patients have never achieved adequate control of CVD risk factors despite them being identified. The aims of this study were to measure the prevalence of cardiovascular diseases and to determine its associated factors. A cross sectional study was carried out in a rural area of Malaysia from March 2011 to November 2011 on 1489 respondents aged 18 and above who were selected via convenient sampling. The survey was conducted via a face-to-face interview using a standardized self administered questionnaire. Prevalence of cardiovascular disease identified was 72 cases (4.8%). Overall, the prevalence of modifiable risk factors were predominant compared to non modifiable, with abdominal obesity (51.2%) hypertension (39.5%) and psychosocial stress (33.8%) being among the highest. However, the prevalence of other modifiable risk factors was relatively low with smoking (25.2%), and diabetes mellitus (10.9%) respectively. Respondent with diabetes mellitus and hypertension were 4 times more likely to have cardiovascular disease and those who are obese had associated 2.5 risks towards cardiovascular disease. Therefore, community health intervention measures should be mobilized, specifically on prevention and control of lifestyle-related risk factors.

Post-Traumatic Stress Disorder And Its Associated Factors Among School-Going Children Exposed To A Tsunami Disaster In Malaysia

Posttraumatic stress disorder (PTSD) is a psychiatric diagnosis made when someone including children who experiences traumatic stressor. Those who are exposed to a more severe trauma have highest level of PTSD. The aim of this study was to measure the prevalence of PTSD and its associated factors among 219 children who were affected by a form of natural disaster which is the tsunami waves in a rural area in Malaysia. A cross sectional study was carried out among children aged 10-12 years 6 months after the traumatic event. Child Posttraumatic Stress Disorder –Reaction Index (CPTSD-RI) was used as a screening instrument which was answered by the affected children through a self-administered questionnaire. Forty six percent of these children had PTSD symptoms; 31.1% of these children had mild, 11.4% had moderate, 3.7% had severe PTSD and none had very severe PTSD. Result also showed that 91.8% had re-experiencing symptoms, 28.3% had numbing/avoidance symptoms and 49.3% had hyperarousal symptoms. Children with low social support (Adj OR = 2.3 (95% CI: = 1.3- 4.2)), and children who experienced deaths among someone close to them (Adj OR = 3.7 (95% CI =1.2 - 11.5)) were more likely to have symptoms of PTSD. This showed that children are at higher risk of developing PTSD as early as 6 months after the event and thus early intervention should be offered to them. Future longitudinal study can be carried out among affected children to assess whether these PTSD symptoms persist over time.

Cost Analysis Of Hypertension Management In An Urban Primary Medical Centre Kuala Lumpur

Hypertension is one of the commonest health problems in Malaysia and its cases are on a rise. In conjunction with the above statement, it is predictable that the cost of healthcare services will further increase in the future. Therefore, cost study is necessary to estimate the health related economic burden of hypertension in Malaysia. A cross sectional study was carried out to quantify the direct treatment cost of hypertension. Three hundred and ninety one hypertensive patients’ data from Bandar Tasik Selatan Primary Medical Centre in year 2010 were collected and analysed. The direct treatment costs were calculated. The result showed that out of 391 hypertensive patients, 12.5% was diagnosed hypertensive without any co-morbidity, 25.3% with 1 co-morbidity dyslipidemia only; 4.3% with diabetes mellitus type 2 only; 0.5% with chronic kidney disease only and none with ischaemic heart disease. Patients with 2 co-morbidities (dyslipidemia and diabetes mellitus type 2) were 42.2%; with 3 co-morbidities (diabetes mellitus type 2, dyslipidemia and chronic kidney disease) was 4.3%. The mean cost of direct treatment of hypertension per visit/ year was RM289.42 ±196.71 with the breakdown costs for each component were medicines 72.2%, salary 14.6%, laboratory tests 5.0%, administration 4.4% and radiology tests 3.8%. Dyslipidemia is by far the commonest co-morbidity among hypertensive patients. Direct costs of treating hypertension are mostly dependent on present of co-morbidity and numbers of drugs used. Thus, the annual budget could be calculated precisely in the future especially for drugs.

Do Elderly Women In Malaysia Go For Mammogram Screening?

Despite the debates of the benefits of continuing mammography screening among elderly women, studies in Malaysia have shown that the prevalence of breast examination declines after age 45 years and for mammogram per se, the prevalence of examination increases until age of 64. This study aims to determine the prevalence of mammogram screening among elderly women in Hulu Langat, Selangor and its relationship with factors such as demographic factors, family history of breast cancer, perceived health status, perceived general psychological factor and lifestyle factors. Data used were from a cross sectional study of health status among community in Hulu Langat area by the Department of Community Health, Universiti Kebangsaan Malaysia carried out from the year 1998 till 2002. However this paper focused on the database involving elderly women age 60 and above. The sample population was 652. The mean (standard deviation) age was 67.17 (5.995). Only 8.3% of the elderly women claimed to ever had mammogram screening done. Hence, the prevalence of mammogram screening is still low among elderly women in Hulu Langat. Having family history of breast cancer (p < 0.001) and perceived positive psychological status (p=0.003) had shown significant associations with mammogram screening among them. It is therefore important for researcher to further look into the reasons behind this and qualitative exploration is highly recommended.

Assessing The Service Quality Of Physiotherapy Services: A Cross Sectional Study At Teaching Hospitals In Klang Valley, Malaysia

The physiotherapy services have played major roles as a part of rehabilitation components and emerging in most hospitals throughout Malaysia as well as internationally. As such, there is still a lack of scientific research and reporting about the finding of service quality studies in physiotherapy services at teaching hospitals settings in Malaysia. This study was to assess the level of patients' satisfaction and its contributing factors as well as to assess the quality of physiotherapy services at teaching hospitals in Klang Valley. The cross sectional study was conducted from March until July 2011 among outpatients (311 patients) who has been referred to the Physiotherapy Clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and Universiti Malaya Medical Centre (UMMC) in Klang Valley. Patients were recruited using simple random sampling technique and data were collected by using the validated self-administered Service Quality (SERVQUAL) Questionnaire. About 62.4% respondents in teaching hospitals have met their expectation. ‘Assurance’ showed the highest satisfaction score and ‘Caring Services’ showed the lowest satisfaction score among the entire dimension studied. The factors which significantly influence patient satisfaction include age, education status, working status and number of visit. There are relationships between patient satisfaction with SERVQUAL, Outcome and Corporate Culture components. However, the predictors contributed for overall patient satisfaction at Physiotherapy Clinics at teaching hospitals was not influenced by factors studied (p>0.05). The levels of satisfaction that met patients’ expectation is ‘Moderate’ for teaching hospitals and the ‘Caring Services’ should be focus in order to improve the level of patient satisfaction.

Remeasurement, Evaluation And Comparison The Health Services Utilization Among Women Staff At Universiti Kebangsaaan Malaysia After Eleven Years Period

A cross-sectional study was carried out in July-October 2012 in UKM to remeasure, evaluate and compare the changes in health services utilization level among women staff in UKM with a previous study done in 2001 and its influencing factors. The services studied were blood pressure (BP) measurement and Pap smear test. A total of 234 respondents aged between 18 and 55 were selected using stratified random sampling from Bangi, Kuala Lumpur and UKMMC, Malaysia. Data was collected via self-administered questionnaire and was analyzed by using SPSS version 17.0. Majority 85.9% of the respondents were found to have utilized at least one BP measurement which is higher compared to previous study. The Pap smear test, 64.5% of women have had a Pap smear test done also higher compared to previous study. Multivariate analysis shows the factors associated with BP measurement are age (OR 2.7, CI 95% 1.2, 6.3), family history of general health problems (OR 3.4, CI 95% 1.5, 7.6), and health staff influence (OR 5.2, CI 95% 1.1, 25.5). The factors associated with Pap smear test are marital status (OR 62.8, CI 95% 7.2, 546.4), general health problems (OR 2.3, CI 95% 1.2, 4.5), family planning (OR 6.9, CI 95% 3.0, 16.5) and self-interest (OR 3.3, CI 95%, 1.3, 8.6). The level of health services utilization on BP measurement and Pap smear test in 2012 is higher than 2001. For both BP measurement and Pap smear test the determinant factors are differed in the aforesaid years.

Caregivers' satisfaction of healthcare delivery at paediatric clinics of Universiti Kebangsaan Malaysia Medical Centre in 2009.

Patient's satisfaction has become increasingly important as patients evaluate healthcare services for both medical cost and quality. The purpose of this study was to measure the prevalence and the factors influencing caregivers' satisfaction. A cross sectional study of 262 respondents using universal sampling method was conducted at the paediatric clinics of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Overall, 90.5% were satisfied with the services provided. Satisfaction rates based on various healthcare delivery domains were: 95.0% for communication skills, 88.5% for interpersonal aspect, 83.6% for technical quality, 82.1% for financial aspect, 72.9% for time spent with doctors and 64.9% for ease of contact. This study shows that the caregivers (an unpaid person who helps a person cope with disease) were highly satisfied with the communicational aspect delivered by the clinic. However, there is still room for improvement on ease of contact domain and waiting time in order to produce high quality service.

A study on organizational factors that influence job stress among medical laboratory technologists in klang valley hospitals.

A cross-sectional study on organizational factors that influences job stress was carried out among Medical Laboratory Technologists (MLT) in Klang Valley's Hospitals. There were three organizational factors that were measured, interpersonal factor, job condition and career development. A total of 249 respondents participated in this study, 126 were from the private hospitals and 123 from the government hospitals. The prevalence of stress was found higher in the private hospitals with the percentage of 16.7% compared to the government hospitals of 15.4%. All three organizational factors were significantly associated with job stress (interpersonal factor p <0.001, job condition p<0.001 and career development p < 0.001). Management team in hospitals as well as the laboratory managers should introduce stress prevention programmes to assist MLTs in stress management.

Comparing extracorporeal shock wave lithotripsy and ureteroscopy for treatment of proximal ureteric calculi: a cost-effectiveness study.

Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) are two main methods of treating proximal ureteric stones. Success rates and cost-effectiveness of the two methods were compared. A total of 67 patients who underwent treatment between January 2007 and July 2007 at a state general hospital were included in the study. The success rate for ESWL group was 81.8% and for URS group was 84.6%. ESWL technique produced a significant higher overall cost per patient than URS (RM930.02 versus RM621.95 respectively). There was no significant difference in quality of patient's life. Cost-effectiveness ratio was lower for URS. The analysis suggested that URS was more cost-effective than ESWL.

Factors influencing physical activity level among secondary school adolescents in Petaling District, Selangor.

Physical activity is the first line approach and one of the main factors in preventing chronic diseases. Currently there is the increasing percentage of sedentary life style or lack of exercise among adolescents. The main objectives of the study were to determine the prevalence of inactivity and the factors influencing physical activity in adolescents. A cross sectional study was carried out among secondary school students aged 14 and 16 in Petaling District, Selangor, Malaysia. A total of 519 respondents participated in this study. Their physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). The active group was classified as those having levels of equal or more than 600 met-min per week while less than 600 met-min per week was considered inactive. Response rate in this study was 95.4%. The prevalence of inactive in adolescents was 20.8%. Female adolescents, non-working mother, time constraint, exercise only when having ample time and stretching before exercise are predictor factors for being inactive among adolescents. Steps need to be taken to persistently ensure that the physical activity among adolescents be increased continuously.

Stress and Coping Styles: The Experience of Nursing Staff Working At Two Public Hospitals in Klang Valley, Malaysia

Although stress among nursing staff is common, adopting effective coping styles helps in minimizing the problem. The objectives of this study were to compare stress level among nursing staff working in the above disciplines, to identify common coping style used and to determine the relationship between stress and coping styles. This cross-sectional study involved 106 nursing staff who were universally sampled from psychiatric wards and emergency departments in two public hospitals in the Klang Valley. Self-rated questionnaires i.e. Stress Arousal Checklist (SACL) and Coping inventory for Stressful Situations (CISS) were used to assess stress levels and coping styles respectively. There was insignificant difference in terms of stress level between the two nursing staffs. Stress dimension of SACL between the psychiatry (6.53 + 3.18, p=0.372) and emergency (6.02 + 2.67, p=0.372) nursing staffs were insignificant. Arousal dimension of SACL was also insignificant between psychiatry (8.60 + 1.70, p=0.372) and emergency (9.19 + 1.61, p=0.07) nursing staff. Task coping was the most commonly used coping styles among the psychiatry (55.36 + 9.85) and emergency (57.73 + 9.87) nursing staff in this study. Stress dimension of SACL showed weak significant relationship with task coping (r=-0.313, p=0.001) and emotion coping (r=0.292, p=0.001). Arousal dimension of SACL was also found to have weak significant relationship with task coping (r=0.271, p=0.003) and emotion coping (r=-0.251, p=0.005). While nursing was found to be a stressful profession, a significant relationship between stress and coping styles allows intervention to enable better adaptation to the stressful working environment.