seconds ; therapeutic aspects ; Chronic Disease ; Back

There has been a change in the lifestyles of populations, including reduced physical activity and consumption of foods high in calories. Overweight and obesity are now replacing the more traditional public health concerns such as under-nutrition and infectious diseases as some of the most significant contributors to ill health. Determination of the body mass index (BMI) profile and nutritional status of adults of two rural coastal villages in Northern Malaysia was part of a community diagnosis in a community survey. Height and weight were measured and BMI calculated. Blood pressure was measured using a manual sphygmomanometer according to WHO guidelines. A standardized questionnaire was used to interview the villagers concerning their health. Out of the total population, 504 were above 20 years of age. Data was available for 441 persons for analysis. There were 210 (47.6%) males and 231 (52.4%) females. The prevalence of underweight was 9.8% (n=43), overweight 25.9% (n=114) and obesity 17% (n=75). The problem of over-nutrition was significantly higher among females, especially housewives. (p< 0.05). Those in ages 41-70 years were the majority with problems of over-nutrition (p=<0.05). More than half (52.9%; n=39) of those who were obese had hypertension (p=<0.05). Results show that a higher number of women especially housewives were obese and more than half of those obese subjects had hypertension. A more thorough nutritional profile using waist, hip and body fat measurement as well as an assessment of the dietary intake and activity regime of these villagers is needed. Interventions need to be carried out before more serious complications of obesity become rooted in this community.
Nutritional status ; Obesity ; Body Mass Index ; Lower case en ; lower case pea

Background: The six item Confusion, Hubbub and Order Scale (CHAOS-6) has been validated as a reliable tool to measure levels of household disorder. We aimed to investigate the goodness of fit and reliability of a new Malay version of the CHAOS-6. Methods: The original English version of the CHAOS-6 underwent forward-backward translation into the Malay language. The finalised Malay version was administered to 105 myocardial infarction survivors in a Malaysian cardiac health facility. We performed confirmatory factor analyses (CFAs) using structural equation modelling. A path diagram and fit statistics were yielded to determine the Malay version's validity. Composite reliability was tested to determine the scale's reliability. Results: All 105 myocardial infarction survivors participated in the study. The CFA yielded a six-item, one-factor model with excellent fit statistics. Composite reliability for the single factor CHAOS-6 was 0.65, confirming that the scale is reliable for Malay speakers. Conclusion: The Malay version of the CHAOS-6 was reliable and showed the best fit statistics for our study sample. We thus offer a simple, brief, validated, reliable and novel instrument to measure chaos, the Skala Kecelaruan, Keriuhan & Tertib Terubahsuai (CHAOS-6), for the Malaysian population.

Clinical coding creates a rich database that can be used for administrative functions including planning for health service programmes and preparing budget of hospitals with appropriate use of disease and procedure classification system. Clinical coding errors may occur in the diagnoses or procedure codes. The errors can be happen at any of the digits use in the classification codes. Errors in clinical coding can give a huge implication on hospital’s income if the coding system is used for reimbursement. This study aims to determine incidence of clinical coding errors among 464 patient’s medical records (PMR). An independent senior coder was appointed to review the selected PMRs and the clinical codes. Post-audit evaluation shows that 89.4%(415/464) of the records contained at least one coding error in the assignment of diagnosis or procedure codes. Error in secondary diagnosis code was the highest comprising 81.3% (377/464) of the records. Coding errors were particularly found in O&G discipline comprising 94.8% (110/116) of the selected records. These errors caused a potential loss of RM 666,461 for the hospital. The highest pre-and post audit variance of potential income was RM 568,403 for paediatric discipline. The hospital should carry out regular monitoring of quality of clinical coding in order to prevent loss of income in the future when the reimbursement of services is linked to coding of diagnosis and procedures.

Background and Objectives: Unmet need for contraception is the gap between women's reproductive intentions and their contraceptive behavior. This community based interventional study was carried out to determine the unmet needs for contraception, the reasons for this and to assess the impact of interventional measures on acceptance of contraception. Subjects and Methods: This study was conducted in 52 villages in the state of Maharashtra, India, among 363 married women selected by cluster sampling. Data was collected using an interview guide. An intervention was done for the women who had an unmet need and an assessment of the change was done subsequently. Data was analyzed by using SPSS. Results The prevalence of contraceptive usage was 59.2% and the prevalence of unmet need for contraception was 44% (160). The unmet need for spacing births was 53.8%, 38.7% for limiting births and 7.5% women were dissatisfied with the current contraceptive method. The reasons ranged from side effects to contraceptives to source of obtaining contraceptives. Age of the respondents, education and number of living children showed statistically significant association with unmet needs. Post intervention, the contraceptive prevalence rate increased significantly 85.7% and there was a significant reduction in the unmet needs for spacing and limiting births, equally there was a significant reduction of dissatisfaction with using contraception. Conclusion: Improvement in the use of contraception and addressing the unmet need for contraception requires community involvement and ongoing, sustained efforts by health workers to ensure quality care to the beneficiaries.

Majority of doctors show no interest in research although research is now a requirement and is being done in every field of medicine. The objective of this survey was to describe the involvement in research activities among doctors in Penang and Seberang Jaya hospitals in Penang. A self-administered questionnaire was used. A total of 302 doctors participated in the survey. The differences in age (p=<0.001), years since graduation (p=0.001), occupation (p=<0.001), post graduate qualification (p=0.001) and career focus (p=0.005) were statistically significant for the involvement in research activities. Respondents who had additional training in statistics (OR 2.86 95% CI 1.76; 4.67), who read journals regularly (OR 3.79 95% CI 2.29; 6.27), who were confident in interpreting medical literature (OR 3.08 95% CI 1.84;5.17), interested in a career in research (OR 7.35 95% CI 4.26;12.68) and who had knowledge in the use of statistical packages (OR 11.10 95% CI 6.29;19.60) were more likely to be involved in research. By hierarchy, having knowledge in statistical packages (aOR 11.57 95% CI 5.49; 24.42), interested in a career in research (aOR 8.54 95% CI 3.99; 18.28) and having a post graduate qualification (aOR 1.48 95% CI 1.01;2.16) were significant associated factors. It is imperative that doctors be given ample opportunity to attend research methodology training programmes to increase their participation in research activities.

Enterobacter gergoviae is a gram negative rod-shaped opportunistic organism reported to cause urinary and respiratory tract infections, but peritonitis caused by this organism is unknown. We report a case of 50-year-old patient on peritoneal dialysis (PD) presented with Enterobacter gergoviae peritonitis with septic shock. Despite Intraperitoneal (IP) cloxacillin 250mg qid and IP ceftazidime 1gram q24h and subsequent escalation with IP amikacin 2mg/kg q24h and IP vancomycin 15mg/kg q24h within the next 48 hours, his peritonitis remained refractory and required catheter removal. Although Enterobacter gergoviae is naturally sensitive to aminoglycosides, carbapenems and quinolones, it reacts differently to the beta lactam antibiotics. Their resistance to third-generation cephalosporins is fast emerging and treatment with third-generation cephalosporins may cause AmpC-overproducing mutants. The majority of Enterobacteriaceae, including Extended-spectrum beta-lactamases producers, remain susceptible to carbapenems. Our report provides an unfavourable course of E. gergoviae peritonitis likely due to acquired secondary drug resistance during the therapy period.

Introduction: Currently, there is a dearth of research into the elderly in Malaysia. More data is needed in order to plan services for them. Hypertension is an illness whose prevalance of hypertension among the elderly population of fourteen villages in Kedah. Methods: A descriptive cross-sectional study was conducted on all elderly persons who consented to participate, in fourteen villages in the district of Kuala Muda in Kedah. A questionnaire was used for the data collection. Blood pressure was measured and participants were assessed for their activities of daily living using Barthel Index, cognitive impairment using Elderly Cognitive Assessmnet Questionnaire (ECAQ) and depression using Geriatric Depression Scale. Descriptive analysis, using SPSS version 11.0. was done to explore the data. Results: The total population of the villages was 3095 and 336 were 60 and above. A total of 240 elderly individuals agreed to participate giving a response rate of 71.4%. There were 138 females (57.5%) and 102 (42.45) males. Ninety-eight percent of the respondents were Malays (n=236) of which 57.2% were females and 42.8% males; the remaining 4 (1.7%) were Indians, of which 3 were females and 1 male. The prevalence of hypertension was 58.3% (n=140) in the villages. 138 (58.5%) of the Malays were hypertensive compared to 2 (50%) of the Indians. Half (51.4%) of those diagnosed as hypertensive were unaware of their condition and half (48.6%) of those known to have hypertension,the blood pressure was not controlled (p<0.05). Discussion:The results of the study are similar to the National Health and Morbidity Survey, 1996. Though the data is from an opportunistic sample and may not represent a larger population especially by race, the findings offer data for a pooled analysis. It is also very worrying to note that 48.6% of the people knew of their condition but did not do anything to control their blood pressure.

Ever since Universiti Kebangsaan Malaysia (UKM) signed the memorandum of agreement with Niigata University (NU) in 2009, several undergraduate and postgraduate students from both universities has been visiting NU and UKM through the student exchange programs. This year, three Doctor Of Public Health (DRPH) postgraduate candidates were fortunate enough to be chosen to conduct field attachment in Niigata Prefecture from 23rd November 2013 until 13th November 2013, which was organized by the International Health Division, Graduate School of Medical and Dental Sciences, Niigata University School of Medicine. These three weeks program covers various program involving governmental departments, hospitals, nursing homes and health centers.​
Delivery of Health Care ; Education ; Japan

Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning.
Bone Wires