Enhancing diabetic care in the community in Malaysia: need for a paradigm shift

Efforts towards improving the management of diabetes mellitus has grown and progressed. Clinical studies and new drug discoveries have led to better treatment for patients. Most healthcare budgets devote an enormous amount of expenditure for the treatment of diabetes. However, despite all these efforts, the disease continues to grow and has been predicted to be unmanageable in the near future. Thus, there is a dire need to relook the current approaches and policies. “Prevention is better than cure” is definitely the precise solution to this catastrophe. A paradigm shift in strategies for the prevention of diabetes and treatment of its risk factors is an imperative

A community-based study on the prevalence and factors affecting smoking in Terengganu state, Malaysia, 2004

Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live. Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence. Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire. Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%. Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001)

Novel method to estimate the length of palmaris longus tendon

Palmaris longus is tendon of choice in reconstructive, plastic and cosmetic surgeries. Thus, a suitable length is required and it would be more convenient if the length of the tendon of the palmaris longus could be estimated before harvesting. This study was carried out to determine the relationship between the length and width of the palmaris longus tendon and the length of forearm and hand, the relationship between the length and the width of the palmaris longus tendon and wrist width and wrist circumference, as well as to identify a technique to estimate the length of the tendinous part of palmaris longus before harvesting it. A standardized proforma was used to collect the data of each of the 31 cadavers upper limbs. These data were analysed using SPSS software version 17. It is important to note that p value less than 0.05 is considered as statistically significant in this study. Out of the 31 upper limbs, palmaris longus tendon was absent in 3 (9.68%). Meanwhile, the mean length and width of the palmaris longus tendon was found to be 16.20 cm and 0.48 cm, respectively. The mean length of the forearm and hand was 26.6 cm and 21.2 cm, respectively. The mean width of the wrist and wrist circumference was 8.2 cm and 14.82 cm, respectively. These indicate a significant and moderate relationship between the length of palmaris longus tendon and the length of forearm (r = 0.49, r2=0.24, p < 0.01). In addition, there was also a significant relationship between the length of palmaris longus tendon and the length of hand (r = 0.56, p < 0.01). This paper presents the technique used to estimate the length and width of the tendinous part of palmaris longus before harvesting. The length of palmaris longus can be estimated pre-operatively by measuring the length of the hand by using the technique explained in this paper

A national study on the prevalence and factors associated with smoking amongst Malaysians aged 18 years and above

A cross-sectional study was conducted in Malaysia with the objectives of determining the prevalence of smoking in Malaysia, reasons for starting to smoke, age first started to smoke, duration of smoking and to determine the relationship between smoking and age, sex, race, education level, peer influence and parental smoking status. Methods: All residents aged 18 years and above from selected households were included in this study. A standardised pre-tested structured questionnaire was used in this study. Results: The results showed that the overall mean age of the 17, 246 respondents was 38.8 (95% CI= 38.5 - 39.2) years with a range of 18 - 100 years. The majority were Malays (55.5%) followed by Chinese (21.2%) and Indians (11.2%). The age, sex and ethnicity adjusted prevalence of ever and current smokers were 32.0% and 24.9% respectively. The prevalence of ever and current smokers for males was 59.3% and 47.2% respectively. For the females, the prevalence of ever and CUlTentsmokers was 4.8% and 2.7% respectively. The highest ethnicity adjusted prevalence of current smokers was in Malays (28.9%), followed by the Chinese (18.7%). The lowest prevalence was amongst the Indians (16.8%). The highest prevalence of current smokers was found in Kelantan (30.2%), Terengganu (29.7%), Pahang (28.7%) and Kedah (26.9%); the lowest prevalence was in Kuala Lumpur, Federal Teritory (20.4%). The overall mean initiation age of current smokers was 19.2 years (95% CI = 19.1, 19.4 years). The mean initiation age of male current smokers was significantly lower (18.9 years) compared to female current smokers (24.1 years). The mean duration of smoking amongst the current smokers was 18.6 years. Males smoked significantly more cigarettes than the females ( p < 0.00 I). D isc u ssio n : Multivariate logistic regression analysis showed that smoking was significantly associated with age, sex, ethnicity, educational level and peer and family influence

A population-based study on the prevalence and factors associated with obesity in Selangor

Objective: This study was conducted to determine prevalence and factors associated with obesity in Selangor, Malaysia. Methods: A population-based cross-sectional study was conducted in all districts of Selangor State. All individuals, 15 years and above in the selected households, were included. A pre-tested structured questionnaire was used to collect the data. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. Statistical analysis was performed using Stata 8.2 taking into account the complex survey design. Results: The overall mean age of the 2219 respondents was 36.6(95% CI 35.7 – 37.6) years. There was no significant difference in the mean age of the males and females (p=0.697). The majority of the respondents were Malays (52.9%), followed by Chinese (30.9%), Indians (15.4%) and other races (0.9%). The overall mean BMI was 24.1 kg/m2 (95% CI=23.8- 24.4). The overall prevalence of obesity was 12.2% (95% CI 10.6%, 14.0%). There was no significant difference in the prevalence of obesity in the males compared to females (p>0.05). The prevalence of obesity increased with age up to the ages of 40-59 years and then decreased after 60 years. The highest prevalence of obesity was in the 40-59 years age groups in both sexes. The overall prevalence of obesity was significantly higher amongst the Malays (15.2%) compared to the Indians (11.6%) and Chinese (7.3%). Multivariate logistic regression analysis showed that only age and ethnicity were associated with obesity. Sex and educational level were not associated with obesity

The prevalence and factors associated with obesity among adult women in Selangor, Malaysia

<p>Abstract</p> <p>Introduction</p> <p>The prevalence of obesity in developing countries especially among women is on the rise. This matter should be taken seriously because it can burden the health care systems and lower the quality of life.</p> <p>Aim</p> <p>The purpose of this study was to determine the prevalence of obesity among adult women in Selangor and to determine factors associated with obesity among these women.</p> <p>Methods</p> <p>This community based cross sectional study was conducted in Selangor in January 2004. Multi stage stratified proportionate to size sampling method was used. Women aged 20–59 years old were included in this study. Data was collected using a questionnaire-guided interview method. The questionnaire consisted of questions on socio-demographic (age, ethnicity, religion, education level, occupation, monthly income, marital status), Obstetric & Gynaecology history, body mass index (BMI), and the Patient Health Questionnaire (PHQ-9).</p> <p>Results</p> <p>Out of 1032 women, 972 agreed to participate in this study, giving a response rate of 94.2%. The mean age was 37.91 ± 10.91. The prevalence of obesity among the respondents was 16.7% (mean = 1.83 ± 0.373). Obesity was found to be significantly associated with age (p = 0.013), ethnicity (p = 0.001), religion (p = 0.002), schooling (p = 0.020), educational level (p = 0.016), marital status (p = 0.001) and the history of suffering a miscarriage within the past 6 months (p = 0.023).</p> <p>Conclusion</p> <p>The prevalence of obesity among adult women in this study was high. This problem needs to be emphasized as the prevalence of obesity keeps increasing, and will continue to worsen unless appropriate preventive measures are taken.</p

Prevalence, awareness, treatment and control of hypertension in Malaysia: A national study of 16,440 subjects.

Study design: A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used. Methods: Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure 4140 mmHg, diastolic blood pressure490 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of o0.05 was considered to be statistically significant. Results: The overall prevalence of hypertension for subjects aged X15 years was 27.8% (95% confidence interval (CI) 26.9–28.8). The prevalence of hypertension was significantly higher in males (29.6%, 95% CI 28.3–31.0) compared with females (26.0%, 95% CI 25.0–27.1). Multivariate logistic regression showed that the odds of having hypertension increased with increasing age, in males, in subjects with a family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged X30 years has increased from 32.9% in 1996 to 40.5% in 2004. Conclusion: In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians

Prevalence of job stress and its associated factors among Universiti Putra Malaysia staff

Stress in the work place is a global major risk factor to worker’s health, which triggers the workers to be poorly motivated and less productive. Objectives: The objective of the study was to determine the prevalence of job stress and its associated factors among Universiti Putra Malaysia staff. Methods: This is a cross sectional study involving 511 academic and non-academic staff of Universiti Putra Malaysia in Serdang. Probability proportionate to size was used for calculating the required sample size. Results: The overall prevalence of stress was 21.7% (21.0% among male and 23.0% among female). The variables found to be significantly associated with stress were: Job demand, coworker support, depression, anxiety, focus and venting of emotion and self-blame (p<0.05). The findings revealed that UPM staffs are exposed to a range of specific stressors such as work stressor: job demand, lack of social support such as co-worker support and supervisor support, psychological stressors such as depression and anxiety, coping such as focus and venting of emotion and self-blame. Work stressor such as job demand was the main predictor of stress (p value = 0.001). Conclusion: The overall prevalence of job stress was 21.7%. The predictors job stress were job demand, lack of support from co-worker and supervisor, depression, anxiety and use of avoidance focused coping

Preliminary results of curettage and cementation in the treatment of fibrous dysplasia of the proximal radius

Introduction: Fibrous dysplasia (FD)is a benign pathological condition usually observed in the first three decades of life. A single bone may be involved either wholly or partially, or multiple bones may be affected, we aimed to use curettage and cementation as a control method of FDfibrous dysplasia of the proximal radius. Methods: We describe our finding with the treatment of FDfibrous dysplasia of the proximal radius in five patients(four females and, one male), the mean age of 28.6 years (22 to –39 years). The lesions were in the metaphysis extending to the diaphysis. Persistent pain and pain after pathological fracture were the indications for surgical intervention. We used an extensile approach to expose the lesion then extended curettage using a high-speed burr and filling the cavity with bone cement. Functional outcome and radiological findings were monitored on follow-up visits. Results: The mean follow-up period was 3.2 years (ranged from 2 years to 5 years).There was were no recurrences and no patient sustained a fracture at the end of the filling cement. At the time of the last follow-up, all patients have excellent score(mean 27 points) according to the musculoskeletal tumor society scoring system. Conclusion: Extended curettage and cementation provide a safe and reliable alternative for control of FDfibrous dysplasia of the proximal radius with little morbidity with little risk of recurrence and low incidence of complications

Diabetes educators’ competencies in facilitating self-management among diabetic patients at government health care centres in Malaysia: a concept paper

Background: According to The Fourth Malaysian National Health Morbidity Survey (2011), 2.6 million adults of 18 years and above have diabetes mellitus. Diabetes education has been a major concern of the healthcare professionals. Diabetes Educators are health care providers who specialise in the provision of diabetes self-management education and care for people with diabetes. Diabetes self-management education is a speciality area of practice and is both a therapeutic and educational intervention. In Malaysia, the role of Diabetes Educators has been highlighted with the starting of post-basic Diabetes Management Course in 2000 by the Ministry of Health, Malaysian Diabetes Association and Universiti Malaya. The course was conducted by experts in the field of diabetes care. Since the year of 2003, the training was being conducted by the Training Division of Ministry of Health. The Diabetes Educators who are trained need to apply their knowledge and skills in diabetes management to provide self-management education to patients. The aim of the study is to determine Diabetes Educators’ competencies to facilitate self-management among diabetic patients in Government Healthcare Centres in Malaysia. The specific objectives of the study are to determine the socio-demographic factors of Diabetic Educators, their competencies on the five domains consisting of clinical understanding of diabetes management, culturally-competent supportive care across the lifespan, teaching and learning skills, diabetes self-management practices, and health promotion and other programs as well as the challenges faced by them in counselling diabetic patients. Other objectives are to identify the association between socio-demographic and socio-economic factors of Diabetes Educators with the five competencies studied. Materials and Methods: This is a cross-sectional study using a self-administered questionnaire adapted from American Association of Diabetes Educators Guidelines (2013) with 438 diabetes educators randomly selected using simple random sampling in five Government Primary and Secondary Healthcare Centres in Malaysia. The administration of the questionnaire will be done from October until November 2014. Descriptive analysis such as mean with standard deviation will be used to illustrate the five competencies of Diabetes Educators’ self-reported knowledge consisting of clinical understanding of diabetes management, culturally-competent supportive care across the lifespan, teaching and learning skills, diabetes self-management practices, and health promotion and other programs. The study will illustrate the challenges faced by them in carrying out their daily task. To test the differences in the mean scores for the independent variables (socio-demographic and socio economic factors), t-test and One Way Analysis of Variance (ANOVA) will be employed and the chi-square test will be used to find the association between the independent variables and dependent variables (five domains of competencies of diabetes educators). Expected result: The result of the study will yield useful information on the effectiveness of diabetes educators’ competencies on the diabetics’ self-management of the disease in Malaysia. The study will also describe the challenges faced by the Diabetes Educators in their daily task. This is a novel study and the result of the study can be generalized to the population of Diabetes Educators in Malaysia. The outcome of the study could facilitate the Training Division of Ministry of Health to review and enhance the implementation of the post-basic Diabetes Management course since there has not been any evaluation done after the course in the service site. Implication for practice and suggestions for further research will be discussed further