CROSS-SECTIONAL STUDY ASSESSING FACTORS ASSOCIATED WITH PERCEIVED DENIAL AMONG POST-MYOCARDIAL INFARCTION SURVIVORS IN A MALAYSIAN CARDIAC HEALTH FACILITY

Objectives: The aim of this study was to determine the factors associated with perceived denial among post-myocardial infarction (post-MI) survivors in Malaysia. Methods: This descriptive-analytical single-hospital cross-sectional study was conducted between July and September 2016 among 201 post-MI survivors aged between 24 and 96 years old at the outpatient cardiac clinic in a Malaysian public hospital. A self-administered questionnaire that consisted of the validated 8-items Verbal Denial of Myocardial Infarction Questionnaire, and items on socio-demographic, health attributes and social support characteristics based on the OSLO-3 Social Support Scale (OSS-3) was utilized. Descriptive, bivariate and multivariate analyses were conducted. Results: The average total score of perceived denial in post-MI survivors was 22.1 (SD ± 6.1) and ranged between 8 and 37. At multivariate level, greater denial score was more prevalent in singles, those with time-to-event of ≤ 1 year, those sustained arrhythmias, those who perceived good health, and those received a lot of other people’s concern. These associations were statistically significant (p<0.05). Conclusion: Perceived denial was significantly associated with socio-demographics, health attributes and social support in post-MI survivors. Early screening is crucial to prompt primary caregivers to initiate potential coping mechanisms for better prognosis and improved quality of life. Â

Patient Satisfaction in Malaysia’s Busiest Outpatient Medical Care

This study aimed to explore factors associated with patient satisfaction of outpatient medical care in Malaysia. A cross-sectional exit survey was conducted among 340 outpatients aged between 13 and 80 years after successful clinical consultations and treatment acquirements using convenience sampling at the outpatient medical care of Tengku Ampuan Rahimah Hospital (HTAR), Malaysia, being the country’s busiest medical outpatient facility. A survey that consisted of sociodemography, socioeconomic, and health characteristics and the validated Short-Form Patient Satisfaction Questionnaire (PSQ-18) scale were used. Patient satisfaction was the highest in terms of service factors or tangible priorities, particularly “technical quality” and “accessibility and convenience,” but satisfaction was low in terms of service orientation of doctors, particularly the “time spent with doctor,” “interpersonal manners,” and “communication” during consultations. Gender, income level, and purpose of visit to the clinic were important correlates of patient satisfaction. Effort to improve service orientation among doctors through periodical professional development programs at hospital and national level is essential to boost the country’s health service satisfaction

Emotional Burnout, Perceived Sources of Job Stress, Professional Fulfillment, and Engagement among Medical Residents in Malaysia

This study was the first to explore factors associated with emotional burnout (EB) among medical residents in Malaysia. A cross-sectional study was conducted in a universal sample of 205 medical residents in a Malaysian general hospital. The self-administered questionnaire used consisted of questions on sociodemographics and work characteristics, sources of job stress, professional fulfillment, engagement, and EB. EB was measured using the emotional exhaustion subscale, the Maslach Burnout Inventory (MBI). Mean (±SD) age of the respondents was 26.5 (±1.6). The most common source of job stress was “fear of making mistakes.” Most of the participants were dissatisfied with the increase of residentship period from one year to two years. A high level of EB was reported by 36.6% of the respondents. In multivariate analysis, the most important correlates of EB were sources of job stress, professional fulfillment, and engagement. A high prevalence of EB was found among medical residents. Sociodemographic characteristics, performance pressure, and satisfaction with policies were significantly associated with EB. Although this study was limited by its cross-sectional design, its findings posit a sufficient foundation to relevant authorities to construct, amend, and amalgamate existing and future policies

Mild Joint Symptoms Are Associated with Lower Risk of Falls than Asymptomatic Individuals with Radiological Evidence of Osteoarthritis

Osteoarthritis (OA) exacerbates skeletal muscle functioning, leading to postural instability and increased falls risk. However, the link between impaired physical function, OA and falls have not been elucidated. We investigated the role of impaired physical function as a potential mediator in the association between OA and falls. This study included 389 participants [229 fallers (≥2 falls or one injurious fall in the past 12 months), 160 non-fallers (no history of falls)], age (≥65 years) from a randomized controlled trial, the Malaysian Falls Assessment and Intervention Trial (MyFAIT). Physical function was assessed using Timed Up and Go (TUG) and Functional Reach (FR) tests. Knee and hip OA were diagnosed using three methods: Clinical, Radiological and Self-report. OA symptom severity was assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The total WOMAC score was categorized to asymptomatic, mild, moderate and severe symptoms. Individuals with radiological OA and ‘mild’ overall symptoms on the WOMAC score had reduced risk of falls compared to asymptomatic OA [OR: 0.402(0.172–0.940), p = 0.042]. Individuals with clinical OA and ‘severe’ overall symptoms had increased risk of falls compared to those with ‘mild’ OA [OR: 4.487(1.883–10.693), p = 0.005]. In individuals with radiological OA, mild symptoms appear protective of falls while those with clinical OA and severe symptoms have increased falls risk compared to those with mild symptoms. Both relationships between OA and falls were not mediated by physical limitations. Larger prospective studies are needed for further evaluation

Medical professionalism from a socio-cultural perspective: Evaluating medical residents communicative attitudes during the medical encounter in Malaysia

Context: The practice of medicine requires good communication skills to foster excellent rapport in doctor patient relationship. Reports on communication skills learning attitude among medical professionals are key essentials toward improving patient safety and quality of care. Aims: We aimed to determine factors affecting communication skills learning attitudes among medical residents in Malaysia. Settings and Design: Cross-sectional survey, in a Malaysian public health hospital. Materials and Methods: A total of 191 medical residents across medical and surgical based rotations were included. We assessed the validated communication skills attitude scale among medical residents from different rotations. Statistical Analysis: Statistical Package of Social Sciences (SPSS®) (version 16.0, IBM, Armonk, NY) was used. Cronbach′s alpha was used to test the internal consistency of the scale. Descriptive analysis was conducted for all variables. Bivariate analysis was employed across the socio-demographic variables. Results: Majority of the residents believed that communication skills training should be made compulsory in Malaysia (78.5%). Medical residents agreed that acquiring good communication skills is essential to be a good doctor. However, the majority cited time pressures for not being able to learn communication skills. Significant differences in communication skills learning attitude scores were found between Malays and Chinese. Conclusion: The majority of medical residents had a positive attitude toward communication skills learning. Socio-demographic factors influenced communication skills learning attitude among medical residents. Incorporating communicative skills modules during hospital Continuous Medical Education for medical residents is essential to cultivate communicative skills attitudes for effective doctor-patient relationship during the routine medical encounters

The prevalence of medication nonadherence in post-myocardial infarction survivors and its perceived barriers and psychological correlates: a cross-sectional study in a cardiac health facility in Malaysia

Kurubaran Ganasegeran, Abdul Rashid Department of Public Health Medicine, Penang Medical College, George Town, Malaysia Background: Although evidence-based practice has shown the benefits of prescribed cardioprotective drugs in post-myocardial infarction (MI) survivors, adherence rates remain suboptimal. The aim of this study was to determine the prevalence and factors associated with medication nonadherence among post-MI survivors in Malaysia.Materials and methods: This cross-sectional study was conducted from February to September 2016 among 242 post-MI survivors aged 24&ndash;96 years at the cardiology outpatient clinic in a Malaysian cardiac specialist center. The study utilized an interviewer-administered questionnaire that consisted of items adapted and modified from the validated Simplified Medication Adherence Questionnaire, sociodemographics, health factors, perceived barriers, and novel psychological attributes, which employed the modified Confusion, Hubbub, and Order Scale and the Verbal Denial in Myocardial Infarction questionnaire.Results: The prevalence of medication nonadherence was 74%. In the multivariable model, denial of illness (AOR 1.2, 95% CI 0.9&ndash;1.8; P=0.032), preference to traditional medicine (AOR 8.7, 95% CI 1.1&ndash;31.7; P=0.044), lack of information about illness (AOR 3.3, 95% CI 1.1&ndash;10.6; P=0.045), fear of side effects (AOR 6.4, 95% CI 2.5&ndash;16.6; P&lt;0.001), and complex regimen (AOR 5.2, 95% CI 1.9&ndash;14.2; P=0.001) were statistically significant variables associated with medication nonadherence.Conclusion: The relatively higher medication-nonadherence rate in this study was associated with patient-, provider-, and therapy-related factors and the novel psychological attribute denial of illness. Future research should explore these factors using robust methodological techniques to determine temporality among these factors. Keywords: medication nonadherence, myocardial infarction, perceived barriers, psychology&nbsp

Factors Associated with Perceived Life Chaos among Post-Myocardial Infarction Survivors in a Malaysian Cardiac Care Facility

Background and objectives: Survivors of chronic life-threatening conditions like myocardial infarction (MI) are often confronted with multiple physical and psychological stressors as a consequence of elevated demands of lifestyle adjustments and modifications. Such stressors, collectively known as &#8220;life chaos&#8222;, cause disruption to one&#8217;s lifestyle equilibrium of having organized, calm, and regular routines. The objective of the current study was to determine the level of life chaos and its associated correlates among post-myocardial infarction (post-MI) survivors in Malaysia. Materials and Methods: An analytical cross-sectional study was conducted among 242 post-MI survivors in a Malaysian cardiac health facility from July to September 2016. A self-administered questionnaire in Malay that consisted of items on socio-demographics, health attributes, validated OSLO-3 Social Support Scale (OSS-3), and the Modified Confusion, Hubbub, and Order Scale (CHAOS-6) was utilized in this study. Descriptive, bivariate, and multivariate analyses were conducted. Results: The sample constituted of 208 (86%) men and 34 (14%) women. The average age was 55 years (SD = 11), and the age ranged between 24 and 96 years. Overall, 128 (52.9%) of the total post-MI survivors had highly chaotic lives. In multivariate analysis, younger age, lower household income, perceived financial insecurity, poor health status, and multiple comorbidities were related to the high chaos score, and these associations were statistically significant (p &lt; 0.05). Conclusions: Highly chaotic lifestyles were prevalent in post-MI survivors. Demographic, health attributes, and socio-economic factors were important correlates of life chaos