Introduction: Occult HCV infection has a predilection for specific populations such as haemodialysis (HD) patients. The exact natural course, epidemiology, pathogenesis and clinical importance of OCI are unknown. We investigated the existence of OCI among local patients undergoing routine HD at a referral hospital in Pahang, Malaysia. Methods: Serum and peripheral blood mononuclear cells (PMBCs) were collected from peripheral venous blood samples of seropositive (anti-HCV positive) and seronegative (anti-HCV negative) HD patients as well as healthy individuals (negative control group). Inclusion criteria for the seronegative patients included elevated liver enzymes. Both conventional PCR and strand-specific PCR were used to detect the viral RNA and to indicate active viral replication in PBMCs respectively. Direct DNA sequencing was done to confirm the viral HCV RNA and their genotypes. Results: In the majority (90-100%) of seropositive chronic hepatitis C patients, viral RNA was detected in both serum and PMBCs . Meanwhile, out of 22 seronegative patients, 6 (27%) showed active viral replication in PBMCs but no detectable viral RNA presence in the serum. None of the negative control group had detectable viral RNA. All seronegative patients with OCI were infected with HCV genotype 3 and two of them (2/6) had a slight elevation of their liver enzymes. Conclusion: Seronegative OCI does exist among local hemodialysis patients, with normal or persistently abnormal liver enzyme values. Further investigation is needed to study the mode of viral transmission and clinical significance of OCI in HD setting.

Teachers face one of the highest demands of any professional group to use their voices at work. Thus, they are at higher risk of developing voice disorder than the general population. The consequences of voice disorder may have impact on teacher’s social and professional life as well as their mental, physical and emotional state and their ability to communicate. Objectives of this study are to determine the prevalence of voice disorder and the relationship between voice disorder with associated risk factors such as teaching activities and lifestyle factors among primary school teachers in Bintulu, Sarawak. A cross sectional study was conducted based on random sample of 4 primary schools in Bintulu, Sarawak between January-March 2014. A total of 100 full-time primary school teachers were invited to participate in the study. Data were collected through a self-administered questionnaire addressing the prevalence of voice disorder and potential risk factors. Descriptive analysis and chi-square test was used to measure the relationship between voice disorder and associated risk factors. The response rate for this study was 78% (78/100). The study found that the prevalence of voice disorder among primary school teachers in Bintulu, Sarawak was 13%. Chi-square test results revealed that factors significantly associated with voice disorder (p<0.05) were smoking (p=0.012), consuming alcohol beverages (p=0.012) for lifestyle factors while teaching session (p=0.049) for teaching activities. A low prevalence of voice disorder exists among primary school teachers in Bintulu, Sarawak. Smoking, consuming alcohol beverages and teaching session has proven to be significantly associated causing voice disorder among them.

Doctor-patient communication skills are important in family medicine and can be taught and learned. This paper summarizes the salient contents and main methods of the teaching and learning of doctor-patient communication, especially those applicable to the discipline.
Patients ; Communication ; Family Practice ; Educational process of instructing ; Primary Health Care

HIV/AIDS is the most devastating disease that mankind has ever faced. For being neighboring country of India, Bangladesh has been highly vulnerable to HIV infection. Although Bangladesh continues to maintain low HIV prevalence status, the infection rate is on the rise in Rajshahi Division. Some studies have been carried out on the knowledge about HIV/AIDS among some risk groups, but studies on blood donor’s awareness about HIV/AIDS are rarely found. This study aims at investigating the knowledge and awareness about HIV/AIDS among the blood donors in Rajshahi Metropolitan of Bangladesh. In this study, primary data was used. The data was collected by the authors during the period 3rd March to 28th April in 2008. Purposive sampling technique has been applied. Interview method has been used to collect information from the respondents. Data reveals that, though 89 percent blood donors knew it is transmitted through blood transfusion, only 1 percent of them had undertaken blood test before donation, which is alarming. The odds of having preliminary and preventive knowledge reduce with the increase in age of the respondents. Besides these, blood donors who were educated and who were in service were found to be more aware about the HIV/AIDS than the others. Strict rules and regulations should be maintained regarding blood screening. Overall people should be encouraged to use condoms and abide by the religious rules to avoid HIV/AIDS infection. Both Government and Non-Government organizations should augment their educational and Focused Group Discussion (FGD) programs on HIV/AIDS knowledge.
HIV ; Acquired Immunodeficiency Syndrome ; Blood Donors ; Awareness

Pre-pregnancy Clinic (PPC) services is one the plausible efforts towards achieving the Millennium Development Goals. However, various issues still need to be addressed for improvement of the services. Considering this view, an attempt was made to explore the barriers, strength and weakness of current practice of pre-pregnancy clinic services in Sarawak, since the programme has been implemented in this state from the year 2011. This cross-sectional study was conducted at nine selected health care facilities throughout Sarawak. A multistage sampling procedure was adapted to select the health care facilities. An unstructured open-ended questionnaire was administered to get the in-depth perceived views and current practice of pre-pregnancy clinic services. A total of 322 health care providers from nine selected health care facilities gave their feedback. In the present paper, a qualitative analysis was done for the open-ended questions to get in-depth views of barriers, strength and weakness of pre-pregnancy clinic services. The results of the study were narrated in textual form and a thematic analysis was done manually. The identified themes for perceived barriers to the provision of pre-pregnancy care were perception, attitude and acceptance of PPC services, socio-economic issues, services and client factors. The perceived weaknesses of the services are listed under two main themes: working environment and service factors, while, the strength of services produced three thematic areas which are preparation for pregnancy, prevention of mortality and morbidity and comprehensive services. Though pre-pregnancy services are beneficial for society wellbeing, various issues still need to be considered for the improvement of the quality of services. Lack of awareness, no ministerial guidelines or Standard Operating Procedures (SOP) and knowledge pertaining to the services were few of the main areas which need to be pondered upon. Promotional activities and campaigns should be geared up ensuring availability the services to the general population.
Barriers ; Perception ; Pre-pregnancy Care ; Sarawak

These days, there is a growing concern that schoolchildren are carrying too heavy school back on their backs. The use of a back pack is the most important factor causing low back pain among students. Thus, a cross sectional study was conducted on 81 schoolchildren from two different types of primary school in Kajang, Selangor. The objective of this paper is to determine the association between schoolbag weight and back pain among primary schoolchildren in Kajang, Selangor. For the method, respondents’ body weight and their schoolbag weight were measured using the electronic body composition OMRON and KERN weighing scale respectively, while the height was measured using Body Meter Seca 208cm. Back pain in the past one week was assessed using questionnaire, adapted from previous studies. This studied involving 81 primary schoolchildren from two types of school which were government and private school. 74.1% of schoolchildren had the schoolbag weight more than 10% of their body weight. 32.1% of schoolchildren reported having back pain and 21.0% of them were female respondents. Back pain was detected in 24.7% government schoolchildren and 7.4% private schoolchildren. There was significant association between back pain and; relative weight (x2=9.720, p=0.002) and types of school (x2=4.949, p=0.026). As conclusion, schoolchildren that carry schoolbag heavier than that generally recommended which is not more than 10% of body weight will experienced the back pain

The objective of study is to determine traffic noise level and non-auditory effect among shop lot workers at Kajang Selangor. This cross sectional study was carried to study traffic noise exposure with annoyance and work performance level among shop lot workers in Jalan Mendaling, Jalan Tukang and Jalan Sulaiman at Kajang town, Selangor. This study involves 120 shop lot workers that exposed to the traffic noise during their working hours where they are randomly selected. Noise exposure was estimated using the Sound Level Meter for environmental noise. The traffic volume was recorded using video recorder and calculated using tally counter. One set questionnaire consist standard questionnaire was used to assess the annoyance level and work performance level among the respondents. Respondents were predominantly by male which are 94 and female, 26 respondents. The mean age of the respondent were ranged between 41 to 60 years old. Only 12.5% of respondent are ranged 21 until 30 years old. In total of 120 respondent, 54.2% of them are Chinese while Malay and India only 30% and 15.8% respectively. The result showed that the traffic noise level at study areas are exceeded the permissible sound limit of commercial and business area during daylight which is 70 dB(A). Regarding work performance, 94 respondents are having low work performance level and 82% of respondent high annoyance level during the exposure of traffic noise from four different sources which are noise from the traffic, speeding vehicle, high traffic volume and exhaust system. There is a significant relationship between traffic noise level with work performance level (p=0.001) and annoyance level (p=0.026). The average traffic noise (Laeq) level at Jalan Mendaling, Jalan Tukang and Jalan Sulaiman is 71.19 dB(A) which were high and exceeds permissible sound level from road traffic, commercial and business place at day time, 70 dB(A). The exposure from the traffic noise effect the annoyance level and work performance level among the shop lot worker. In order to reduce traffic noise exposure towards the shop lot workers, some recommendation are needed to control the traffic noise such as build a noise barrier, plant trees and also enforcement of legal requirement in noise level.

Background: Many nurses are leaving for various destinations and leaving intention was found to be the immediate precursor for actual turnover, but studies examining the different forms of leaving intention (unit, hospital, country, and profession) and exit destinations are scarce. Objectives: To determine the different forms of nurses’ leaving intention (i.e., leaving the unit, hospital, country, and profession), exit destinations and associations of demographic variables on the different forms of leaving intention and exit destinations. Methods: The study design was a cross-sectional survey. Private hospital nurses in the Peninsular Malaysia were the study population and a total of 942 (73% response rate) nurses participated in the study. A self-reported questionnaire was used for data collection. Results: The results revealed that intention of leaving the organisation (M = 2.81, SD = 1.33) was the highest and followed by intention of leaving the unit (M = 2.54, SD = 1.31). In terms of exit destinations, advancing nursing qualification (M = 2.95, SD = 1.31) and practising nursing in another country (M = 2.55, SD = 1.31) were the most preferred exit destinations among the nurses. Conclusions: Nursing managers play a significant role in retaining nurses within the units and organisations. The findings on nurses’ exit destinations are crucial because they serve as the direction for nurses’ retention strategies which include professional development opportunities through training, education and staff mobility.
Hospitals, Private ; Education, Nursing ; Nurses

Background: The escalating rate of private hospital nurses leaving their workplace raised serious concern among the stakeholders. Past studies had found that nursing practice environment was the key influence on nurses’ leaving intention, but studies examining the quality of nursing practice environment of private hospital settings was scarce and therefore warrant investigation to provide direction for interventions in addressing nursing turnover. Objectives: To determine nurses’ perceptions towards nursing practice environment and whether there is any significant associations with nurses’ demographic variables. Methods: Cross-sectional inferential survey study was conducted at four private hospitals in the Peninsular Malaysia using the Practice Environment Scale of the Nursing Work Index (PES-NWI) and 885 nurses participated in the study. Results: Nurses rated their practice environment as favourable. However, items stated in “staffing and resource adequacy” subscale warrant serious attention because nurses rated poorly on item related to “enough staff to get the work done” (M = 2.37, SD = .81) and “enough registered nurses to provide quality patient care” (M = 2.41, SD = .82). Furthermore, t-test analyses found that nurses with educational sponsorship bond (p < .001), higher educational qualifications (p < .05), and have been working in the hospital since graduation (p < .001) were more likely to rate their practice environment lower. Conclusion: Hospital administrators play significant role in sustaining and creating positive nursing practice environment in order to ensure steady supply of nurses to meet the challenging healthcare needs.
Nursing

Managing a patient with a huge intraoral mass is always challenging. Manipulation or even a simple biopsy of the mass may lead to hemorrhage and further compromise the airway. An examination under anesthesia is not without risk. The method of securing the airway itself may become an issue if the mass is fully occupying the airway before intubation. Usually a tracheostomy is indicated. We share a gentleman presented with a huge intraoral mass occupying the oropharynx, which initially necessitates tracheostomy. We utilized the ultrasonic scalpel-assisted instrument to biopsy by debulking the tumour, thus avoiding the tracheostomy while waiting for the definitive treatment.
Oropharynx