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.
general population & ; Orang Asli ; cultural believe & ; practice

Numerous health issues can arise from improper domestic waste management. Uncollected wastes provide food and breeding sites for insect, bird and rodent which can expose the community to vector borne disease. Therefore, this study aims to investigate the community awareness towards domestic waste management. This study is a cross-sectional study conducted at Bandar Baru Sungai Buloh, Selangor, Malaysia. The questionnaire consists of five sections with a total of 57 questions. The questionnaire consists of four parts: Socio-demographic, knowledge, attitude and practice. The data were analysed using SPSS version 22.0. T-test, ANOVA test, Chi-squared test were used according to the type of variables and significance level will be taken at 95% or p-value of less than 0.05. A total of 355 respondents participated in this study. The mean age was 40.52 ±14.94. The majority of them were male (52.1%), Malay (71.0%), married (71.3%), with secondary educational (81%) and employed (41.1%). The majority of respondents mentioned that inappropriate waste management can cause dengue fever and leptospirosis (98.0%, 97.2%; respectively). Property type, education, occupation, ethnicity, religions and household income were significant influenced the knowledge of the participants towards domestic waste management. For attitude, gender, education, ethnicity, religion and income significantly influenced the attitude of the participants towards domestic waste management. For practice, ethnicity, religion and occupation were significantly influenced the practice of the participants towards domestic waste management. In conclusion, the community has moderate awareness of domestic waste management. Awareness of waste management should also be taught in school so that the next generation of people will have a better understanding and eventually have better practice in domestic waste management. It is also hoped that a carefully thought-out strategy can be developed to further improve the community awareness towards domestic waste management which will shed a new light on tackling this issue.
Waste Management ; Health ; Knowledge ; Attitude ; Practice ; general population

Bilateral breast cancer is not a common clinical problem, and its occurance is not suprising in this paired organ. Bilateral breast cancer is categorized as synchronous or metachronous. We propose to evaluate clinical and biological characteristics in bilateral breast cancer. Previous cancer in one breast is the strongest known risk factor for cancer to develop in the second breast, and a young age at dignosis of a breast cancer and lobular type of tumor are additional risk factors related to bilaterality. Seventeen cases of bilateral breast cancer have been admitted to the department of General surgery, Samsung Cheil general Hospital from 1980 till 1995. We report the analysis of these cases with the references. The incidence of bilateral breast cancer among all case of total breast cancer was 2.1%(17/827). Synchronous breast cancer was 3 cases(0.4%) and metachronous breast cancer was 14cases (1.7%). The median age was 41 years. The mean age at diagnosis of the primary tumor in the metachronous group was 40 years. Among metachronous cases, the mean interval between the treatment of the primary cancer and the detection of secondary cancer was 37months. The clinical stage was 0-I in 12%, II in 50%, III in 32%, and IV in 6% of tumors. The majority of patients (88%) were clinically node positive. Out of a total of 34 tumors, the clinical tumor size Tis-T1 in 8 tumors, T2 in 21 tumors, and T3 in 5 tumors. Histopathologic type of the pimary tumor was the same with the second in 70%(12/17). The location of secondary breast cancer was in the upper outer quadrant in 9 cases, and in the upper medial quadrant of breast in 2 cases. The premenopausal primary cancer was in 50% of the patients, and postmenopausal primary cancer was in 50% of patients for whom this information was available. Median survival period was 57 months, and 5 year survival rate was 80%. Bilateral breast cancers have similar biological features to unilateral breast cancer more freqently than would be predicted by chance alone. The similarity in clinical aspects of unilateral and bilateral breast cancers should be considered in clinical management of patients with breast cancer. Further investigation is required to know these similaritics and differences between unilateral and bilateral breast cancer.
Breast Neoplasms* ; Breast* ; Diagnosis ; Hospitals, General ; Humans ; Incidence ; Population Characteristics ; Risk Factors ; Survival Rate

The purpose of this study is to analyze degree of geographic maldistribution of physicians and changes in the distributional pattern in Korea over the years 1980-1985. In assessing the degree of distribution and in identifying changes in the distribution pattern, the Gini index of concentration was used. The geographical units selected for computation of the Gini index in this analysis are districts (Gu), cities (Si), and counties (Gun). Locational data for 1980 and 1985 were obtained from the population census data in the Economic Planning Board and regular reports of physicians in the Korean Medical Association. The rates of physician located countries to whole physicians were 10.4% in 1980 and 9.6% in 1985. In term of the ratio of physicians per 100,000 population, rural area had 9.18 physicians in 1980 and 12.95 in 1985, 7.13 general practitioner in 1980 and 7.29 in 1985, and 2.05 specialists in 1980 and 5.66 in 1985. Only specialists of general surgery and preventive medicine were distributed over 10% in county and distribution of every specialists except chest surgery in county increased in 1985, comparing with that rates of 1980. The Gini index computed to measure inequality of physician distribution in 1985 indicate as follows; physicians 0.3466, general practitioners 0.5479, and specialists 0.5092. But the Gini index for physicians and specialists fell -15.40% and -10.42% from 1980 to 1985, indication more even distribution. The changes in the Gini index over the period for specialists from 0.3639 to 0.4542 for districts, from 0.2510 to 0.1949 for cities, and 0.5303 for countries indicate distributional change of 24.81%, -22.35%, and 10.65% respectively. The Gini indices for specialists of neuro-surgery, chest surgery, plastic surgery, ophthalmology, tuberculosis, preventive medicine, and anatomical pathology in 1985 were higher than Gini indices in 1980.
Censuses ; General Practitioners ; Humans ; Korea ; Ophthalmology ; Pathology ; Preventive Medicine ; Rural Population ; Socioeconomic Factors ; Specialization ; Surgery, Plastic ; Thorax ; Tuberculosis

BACKGROUND: QT dispersion (QT(d)) is an indirect measure of the heterogeneity of ventricular repolarization and can be used as a risk factor for complex ventricular arrhythmias. We measured the effect of remifentanil on QT(d) and heart-rate corrected QT dispersion (QT(cd)). METHODS: Sixty ASA class I and II patients, who were between 20 and 60 years old, and who were scheduled for general anesthesia, were studied. After the patient entered the operating room, a 12 lead EKG recording was taken and intravenous infusion of remifentanil was started. The infusion rate was 0.1 microg/kg/min in group 1 and 0.2 microgram/kg/min in group 2. Another EKG recording was taken 10 minutes after infusion had started. RESULTS: In both groups, QT(d) following remifentanil infusion was not significantly different than control values (76.6 +/- 23.3 ms vs 81.8 +/- 34.9 ms, P = 0.459 in group 1; 70.7 ms +/- 29.7 ms vs 73.7 ms +/- 37.1 ms, P = 0.734 in group 2). Neither was QT(cd): (83.2 ms +/- 25.2 ms vs 89.6 ms +/- 36.2 ms, P = 0.371 in group 1; 81.0 ms +/- 35.2 ms vs 83.4 ms +/- 40.9 ms, P = 0.829 in group 2). CONCLUSIONS: Remifentanil infusion at a rate less than 0.2 microg/kg/min does not change QT(d) or QT(cd).
Anesthesia, General ; Arrhythmias, Cardiac ; Electrocardiography ; Heart Conduction System ; Humans ; Infusions, Intravenous ; Operating Rooms ; Piperidines ; Population Characteristics ; Risk Factors

BACKGROUND: As transfusion service is linked directly with patient's life and is often a race against time, efforts to shorten the turnaround time (TAT) for every step of transfusion process from blood request to blood transfusion are important. We introduce our experience for analysis and shortening of the packed red blood cell delivery time through quality improvement program for 2 years. METHODS: From January 2003 to December 2004, we evaluated the mean TAT for each step of transfusion process in Bundang Jesaeng General Hospital using the computerized laboratory information system which is capable of recording the exact times of blood request (request), specimen reception (reception), crossmatch completed (preparation), and blood issue (issue). We analyzed the turnaround time of packed red blood issued and notified the obtained data to transfusion-related workers and changes in TATs during the period were evaluated according to the type and place of request. RESULTS: Mean TAT from request to issue was significantly decreased from 174.4 minutes in 2003 to 126.7 minutes in 2004 (p<0.01). TAT from request to reception and TAT from preparation to issue were significantly decreased. No significant difference was observed according to type of request. Mean TAT was different according to place of request, with the operating and recovery room showing the shortest mean TAT from request to issue. CONCLUSIONS: Our computerized TAT data helps us to understand each steps of transfusion process. Continuous monitoring of TAT and periodic publicity to clinical staff and nurse can shorten the mean TAT.
Blood Transfusion ; Clinical Laboratory Information Systems* ; Continental Population Groups ; Erythrocytes* ; Hospitals, General ; Humans ; Quality Improvement* ; Recovery Room

OBJECTIVETo perform theory construction and empirical study of the competency model of rural general practitioners.

METHODSThrough literature study, job analysis, interviews, and expert team discussion, the questionnaire of rural general practitioners competency was constructed. A total of 1458 rural general practitioners were surveyed by the questionnaire in 6 central provinces. The common factors were constructed using the principal component method of exploratory factor analysis and confirmatory factor analysis. The influence of the competency characteristics on the working performance was analyzed using regression equation analysis.

RESULTSThe Cronbach 's alpha coefficient of the questionnaire was 0.974. The model consisted of 9 dimensions and 59 items. The 9 competency dimensions included basic public health service ability, basic clinical skills, system analysis capability, information management capability, communication and cooperation ability, occupational moral ability, non-medical professional knowledge, personal traits and psychological adaptability. The rate of explained cumulative total variance was 76.855%. The model fitting index were Χ(2)/df 1.88, GFI=0.94, NFI=0.96, NNFI=0.98, PNFI=0.91, RMSEA=0.068, CFI=0.97, IFI=0.97, RFI=0.96, suggesting good model fitting. Regression analysis showed that the competency characteristics had a significant effect on job performance.

CONCLUSIONSThe rural general practitioners competency model provides reference for rural doctor training, rural order directional cultivation of medical students, and competency performance management of the rural general practitioners.

BACKGROUND: Studies worldwide indicate that people with intellectual disability have high risks of physical and mental morbidities, and poor quality of health care. This study was aimed at determining general practitioners' perceptions on barriers in clinical assessment and training needs with regard to the healthcare of community-dwelling people with intellectual disability. METHODS: A survey questionnaire was developed specifically for the study through focus group discussions and a literature review. The study was conducted as a cross-sectional anonymous survey of private general practitioners practicing in Singapore. The survey contained questions on their experience and training needs in assessing and treating patients with intellectual disability. RESULTS: Forty-nine of the 272 questionnaires sent out were returned. The respondents were predominantly male general practitioners working in “solo” practices. For most general practitioners, the proportion of patients with intellectual disability ranged from 1% to 5%. Nearly 90% of general practitioners identified problems in communicating with such patients as an important barrier that affected the quality of assessment of their health conditions. Other barriers identified were behavioral issues and sensory impairments. Only one-third of the general practitioners were confident that they had sufficient knowledge of physical and mental health conditions related to patients with intellectual disability. Three-fourths of the general practitioners believed that further training in this area would be beneficial. CONCLUSION: Appropriate interventions to address barriers in assessment and management of patients with intellectual disability with further training for general practitioners may improve the standard of healthcare provided to this population group.
Anonyms and Pseudonyms ; Delivery of Health Care* ; Focus Groups ; General Practitioners ; Humans ; Intellectual Disability* ; Male ; Mental Health ; Population Groups ; Primary Health Care ; Quality of Health Care ; Singapore* ; Surveys and Questionnaires

OBJECTIVE: The pathophysiology of major depressive disorder (MDD) is still not well understood. Conflicting results for surrogate biomarkers in MDD have been reported, which might be a consequence of the heterogeneity of MDD patients. Therefore, we aim to investigate how the severity of depression and various symptom domains are related to the levels of dehydroepiandrosterone sulfate (DHEA-s) in MDD patients. METHODS: We recruited 117 subjects from a general practice. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Depressive symptoms were divided into three subdomains according to BDI items; somatic symptoms, guilt and failure, and mood and inhibition. RESULTS: In subjects with very-mild-to-moderate depression, the DHEA-s level increased as BDI score did. However, the DHEA-s levels in the subjects with severe depression were significantly lower than in subjects with moderate depression (p=0.003). DHEA-s level was correlated with the BDI subscore for guilt and failure in very-mild-to-moderate depression (r=0.365, p=0.006). CONCLUSION: The DHEA-s level appears to be indicative of MDD severity with respect to depressive symptoms, especially regarding guilt and failure. Our findings suggest that the upregulation of DHEA-s may be a part of a compensatory process in very-mild-to-moderate depression, and the failure of this compensation mechanism may underlie the development of severe depression.
Biomarkers ; Compensation and Redress ; Dehydroepiandrosterone Sulfate* ; Dehydroepiandrosterone* ; Depression ; Depressive Disorder, Major* ; Diagnosis, Differential ; General Practice ; Guilt ; Humans ; Neuroendocrinology ; Population Characteristics ; Up-Regulation

BACKGROUND: Adrenal insufficiency (AI) is a life-threatening disorder caused by the deficiency of adrenal steroid hormones. This retrospective cross-sectional study investigated the characteristics of patients with AI in Korea. METHODS: All consecutive patients with suspected AI who received care at a tertiary referral center in Korea in 2014 and underwent adrenocorticotropic hormone stimulation or insulin-tolerance testing were identified through a review of medical charts. Patients diagnosed with AI were enrolled. Their demographic, clinical, and treatment details were extracted. RESULTS: Of 771 patients with suspected AI, 183 (23.7%) received a definitive diagnosis. The most common reason for testing was the presence of suspicious AI-related symptoms (30.0%), followed by a history of steroid medications (23.5%). Their mean age was 66.7 years, and females predominated (67.8%). The most common symptoms were general weakness, anorexia, arthralgia, and fever. Approximately half (53.6%) had a history of steroid use. Hydrocortisone was the most common treatment (71.6%), with most patients taking a 30 mg dose (44.2%). The most common dose frequency was twice a day (78.6%). Fourteen patients were treated for adrenal crisis (n=10, 5.5%) or an intercurrent illness (n=4, 2.2%). CONCLUSION: AI may have been caused by steroid medication use in many of the patients included in this study. The detection of AI can be improved by careful history-taking and being alert to the possibility that a patient has used steroids.
Adrenal Insufficiency* ; Adrenocorticotropic Hormone ; Anorexia ; Arthralgia ; Cross-Sectional Studies ; Diagnosis ; Female ; Fever ; Hospitals, General* ; Humans ; Hydrocortisone ; Hypopituitarism ; Korea ; Population Characteristics ; Retrospective Studies ; Steroids ; Tertiary Care Centers