exudates and Pain

Despite evidence of physical (illness) and mental (stress) health problems, there appears to be a lack of studies or concern regarding occupational safety and health among educators in Malaysia.. To review the prevalence of illness, stress, and corresponding risk factors among educators in Malaysia.. Scopus, ProQuest, PubMed, ScienceDirect, CAB, and other computerized databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies published between January 2013 and April 2019 on the prevalence and associated risk factors of illness and stress among educators (S1 Checklist). The keywords used included educator, teacher, lecturer, academic staff, teaching profession, university staff, academician, faculty, illness, injury, disease, pain, WMSD, dysphonia, hoarseness, stress, mental health, strain, health problem, disorder, and/or Malaysia. Selected studies were evaluated by quality assessment.. Twenty-two articles fulfilled the eligibility criteria. The prevalence of illness and stress was determined for low back pain (33.3-72.9%); upper back pain (33.33-56.4%); neck/shoulder pain (40.4-80.1%); upper arm discomfort (91.3%); forearm pain (89.6%); wrist pain (16.7-93.2%); hip pain (13.2-40.9%); thigh discomfort (91.8%); lower leg discomfort (90.5%); knee pain (23.7-88.0%); ankle/feet pain (19.3-87.7%); elbow pain (3.5-13.0%); voice disorder (10.4-13.0%) and stress (5.5-25.9%). Sex, education level, teaching experience, quality of life, anxiety, depression, coping styles, and others were reported as associated risk factors across the studies.. There appears to be a cause for concern regarding musculoskeletal disorders, voice disorder, and stress reported among educators in Malaysia. While most risk factors matched those reported in studies elsewhere, others such as school characteristics (school level, government or private school, and location [rural/urban]) have not been investigated.

Topics: Female; Humans; Malaysia; Male; Musculoskeletal Diseases; Pain; Prevalence; Quality of Life; Risk Factors; School Teachers; Stress, Psychological; Voice Disorders

Psychosocial interventions for patients with osteoarthritis (OA) of the knee to reduce pain and improve physical and psychological functioning are still lacking in Malaysia.. A parallel-group unblinded randomized controlled trial involving 300 patients was conducted in two hospital orthopedics clinics in Malaysia. Patients were randomly assigned to receive cognitive behavioral-based group therapy (. At 6 months, mean change from baseline in the KOOS knee pain score was 0.6 points (95% CI -1.73 to 2.94) in the control group and 8.9 points (95% CI 6.62 to 11.23) (denoting less knee pain intensity) in the intervention group (significant treatment effect. The intervention module delivered by healthcare professionals had a sustained effect on knee OA pain and functionality over 6 months, thereby leading to an overall improvement in psychological well-being, thus benefitting most of the Malaysian knee OA patients.

Topics: Activities of Daily Living; Adult; Aged; Cognition; Cognitive Behavioral Therapy; Female; Humans; Malaysia; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pain Management; Pain Measurement; Psychotherapy, Group; Treatment Outcome

This study concerns clinical characteristics and survival of renal cell carcinoma (RCC) patients in University Malaya Medical Centre (UMMC), as well as the prognostic significance of presenting symptoms.. The clinical characteristics, presenting symptoms and survival of RCC patients (n=151) treated at UMMC from 2003-2012 were analysed. Symptoms evaluated were macrohaematuria, flank pain, palpable abdominal mass, fever, lethargy, loss of weight, anaemia, elevated ALP, hypoalbuminemia and thrombocytosis. Univariate and multivariate Cox regression analyses were performed to determine the prognostic significance of these presenting symptoms. Kaplan Meier and log rank tests were employed for survival analysis.. The 2002 TNM staging was a prognostic factor (p<0.001) but Fuhrman grading was not significantly correlated with survival (p=0.088). At presentation, 76.8% of the patients were symptomatic. Generally, symptomatic tumours had a worse survival prognosis compared to asymptomatic cases (p=0.009; HR 4.74). All symptoms significantly affect disease specific survival except frank haematuria and loin pain on univariate Cox regression analysis. On multivariate analysis adjusted for stage, only clinically palpable abdominal mass remained statistically significant (p=0.027). The mean tumour size of palpable abdominal masses, 9.5±4.3cm, was larger than non palpable masses, 5.3±2.7cm (p<0.001).. This is the first report which includes survival information of RCC patients from Malaysia. Here the TNM stage and a palpable abdominal mass were independent predictors for survival. Further investigations using a multicentre cohort to analyse mortality and survival rates may aid in improving management of these patients.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Papillary; Carcinoma, Renal Cell; Combined Modality Therapy; Female; Fever; Follow-Up Studies; Hematuria; Humans; Kidney Neoplasms; Malaysia; Male; Middle Aged; Neoplasm Staging; Pain; Prognosis; Retrospective Studies; Survival Rate; Weight Loss

Topics: Antibody Specificity; Antivenins; Bandages; Blood Coagulation; Blood Transfusion; Drug Hypersensitivity; Epinephrine; Fear; First Aid; Hemoglobinuria; Humans; Malaysia; New Guinea; Pain; Placebos; Respiratory Insufficiency; Snake Bites; Tracheotomy; United States

This study aims to quantify the preferences of patients with advanced cancer for quality of life (QoL) outcomes versus survival extension in Malaysia. The secondary aim of this study is to explore the change in preferences over time.. A discrete choice experiment was developed to include 7 attributes valued in cancer management: physical, psychological and social functioning, pain control, survival, place of death, and cost. Patients were recruited via convenience sampling from 2 Malaysian public hospitals. The survey questionnaire was administered to patients within 6 months of their cancer diagnosis with a follow-up 3 months later. Conditional logit regression was used to estimate the preference weight, relative attribute importance, and willingness to pay.. One hundred valid responses were collected at baseline and 45 at follow-up. Respondents placed higher values on QoL improvements from severe to moderate or mild levels and to achieve home death over survival extension from 6 to 18 months. However, additional improvements (from moderate to mild) in some of the QoL outcomes were not valued as highly as life extension from 12 to 18 months, showing that it was vital for patients to avoid being in "severe" health dysfunction. Improving physical dysfunction from severe to mild yielded 3 times as much value as additional 1-year survival. After 3 months, the respondents' preferences changed significantly, with increased relative attribute importance of physical functioning, pain control, and cost.. As QoL outcomes are valued more than survival, palliative care should be introduced as early as possible to alleviate suffering related to advanced cancer.

Topics: Choice Behavior; Humans; Malaysia; Neoplasms; Pain; Patient Preference; Quality of Life; Surveys and Questionnaires

Dental professionals have been reported to be constantly exposed to work-related musculoskeletal disorders with symptoms often started as early as the student phase. Risk perception may play an important role in modifying risk at work.. To assess the influence of gender, academic level, and the presence of painful symptoms on the perception of risk factors at work contributing to musculoskeletal symptoms among dental students of Melaka, Malaysia.. A cross-sectional survey of 183 clinical year dental students based on a convenience sample. The data were collected using the Nordic Musculoskeletal Questionnaire and Job Factor Questionnaire for assessment of musculoskeletal symptoms and risk factors at work respectively. Study data were evaluated using percentage, median, Cochran's Q test, Bonferroni correction, multiple linear regression analysis and Mann-Whitney U Test. The analysis was interpreted considering a 95 % confidence interval and significant level at P < 0.05.. Dental students reported a high prevalence (86.9 %) of musculoskeletal symptoms mostly affected the neck, shoulder, lower and upper back body regions. No significant difference in perception was found with the gender. A significant (P < 0.05) higher perception was observed in fourth-year students. The presence of painful symptoms was significantly (P < 0.05) associated with working in the same position, prolonged duration of work and use of tools.. Priority in implementing ergonomic education throughout the training in the dental schools should be considered to improve perception and reduce musculoskeletal disorders associated with the dental profession.

Topics: Cross-Sectional Studies; Ergonomics; Humans; Malaysia; Musculoskeletal Diseases; Occupational Diseases; Pain; Perception; Prevalence; Risk Factors; Students, Dental; Surveys and Questionnaires

Knee pain is often underreported, underestimated and undertreated. This study was conducted to estimate the prevalence, burden and further identify socioeconomic factors influencing ethnic differences in knee pain and symptoms of OA among older adults aged 55 years and over in Greater Kuala Lumpur (the capital city of Malaysia). The sample for the Malaysian Elders Longitudinal Research (MELoR) was selected using stratified random sampling, by age and ethnicity from the electoral rolls of three parliamentary constituencies. Information on knee pain was available in 1226 participants, mean age (SD) 68.96 (1.57) years (409 Malay, 416 Chinese, 401 Indian). The crude and weighted prevalence of knee pain and self-reported knee OA symptoms were 33.3% and 30.8% respectively. There were significant ethnic differences in knee pain (crude prevalence: Malays 44.6%, Chinese 23.5% and Indians 31.9%, p<0.001). The presence of two or more non-communicable diseases (NCD) attenuated the increased risk of knee pain among the ethnic Indians compared to the ethnic Chinese. The prevalence of knee pain remained significantly higher among the ethnic Malays after adjustment for confounders. While the prevalence of knee pain in our older population appears similar to that reported in other published studies in Asia, the higher prevalence among the ethnic Malays has not previously been reported. Further research to determine potential genetic susceptibility to knee pain among the ethnic Malays is recommended.

Topics: Aged; Ethnicity; Female; Humans; Knee Joint; Malaysia; Male; Multivariate Analysis; Osteoarthritis; Pain; Prevalence; Risk Factors; Socioeconomic Factors

Inadequate pain management is linked to potential neurodevelopmental and behavioral problems. Sufficient knowledge in neonatal pain is required to facilitate optimal pain management. The aim of this study was therefore to assess the knowledge and perception of pain experienced by neonates requiring intensive care among pediatric doctors working in a level III neonatal intensive care unit in Malaysian hospitals.. This was a cross-sectional study conducted over a period of 18 months. A self-administered questionnaire assessing knowledge and perception regarding neonatal pain was used.. Twenty-four hospitals participated in the study, with 423 respondents. The response rate was 85%. One hundred and ninety-seven respondents (47%) were aware of tools for neonatal pain assessment, but only 6% used them in daily practice. Doctors with >4 years of experience in neonatal care had better awareness of available pain assessment tools (59.4% vs 40.9%, P = 0.001). Sixteen statements regarding knowledge were assessed. Mean score obtained was 10.5 ± 2.5. Consultants/specialists obtained a higher mean score than medical officers (11.9 vs 10.4, P < 0.001). More than 80% of respondents were able to discriminate painful from non-painful procedures.. Clinicians involved in neonatal care, especially those with longer experience were knowledgeable about neonatal pain. Gaps between knowledge and its application, however, remain. Implementation of clinical guidelines to improve the quality of assessment and adequate pain management in neonates is recommended.

Topics: Adult; Attitude of Health Personnel; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Malaysia; Male; Middle Aged; Pain; Pain Management; Pain Measurement; Physicians; Practice Patterns, Physicians'; Surveys and Questionnaires; Young Adult

One of the occupations that suffer from musculoskeletal disorders (MSD) is the teaching profession. Although teachers are known to have a variety of health and safety issues, few studies have actually been published that relate to somatic health problems of teachers, especially studies conducted in Malaysia. From this viewpoint, it is clearly important to investigate psychosocial factors, and MSD with depression as mediator among school teachers.. The study aimed to determine the incidence of MSD for school teachers in 15 primary schools in Kuala Lumpur during a 6-month period. Secondly, the study also sought to examine the relationships between psychosocial factors, depression and MSD among teachers. Thirdly, the study aimed to explore depression as mediator. The hypothesis addressed by this cross-sectional study was that depression would prove to be a mediator for the psychosocial factors affecting MSD.. The incidence of MSD during the previous 6 months was 80.1% (95% CI: 75.8-84.2%), with 80.5% of female and 77.5% of male teachers reporting symptomatic pain during that period. There were significant relationships between psychosocial factors, depression, and MSD. The results indicated that in relation to psychosocial factors, depression (r = - 0.25, p < .01) and musculoskeletal disorder (r = -.17, p < .01) were both negative. In addition, depression was positively related to musculoskeletal disorder (r = .30, p < .01). Furthermore, depression appeared to have a partially mediating effect on the relationship between psychosocial factors and MSD.. The findings in this study demonstrate that psychosocial factors and depression are significant predictors of MSD among teachers. Recognizing the relationship between these variables will help in arranging, planning or actualizing preventive intervention programs for teachers with the hope of lessening the incidence of MSD. This study also provides awareness for teachers and the Malaysian Ministry of Education regarding the issues of MSD in the workplace.

Topics: Adult; Cross-Sectional Studies; Depression; Depressive Disorder; Female; Humans; Incidence; Malaysia; Male; Musculoskeletal Diseases; Occupational Diseases; Occupations; Pain; School Teachers; Schools; Workplace

To investigate the association between potentially inappropriate medication (PIM)/potential prescribing omission (PPO) and the health-related quality of life (HRQoL) among community-dwelling hospitalized elderly patients.. This is a cross-sectional study that took place in a Malaysian tertiary hospital. Patients ≥ 65 years old with at least one medication on admission were recruited. The patients' prehospitalization medications were reviewed to identify PIMs/PPOs using version 2 of the STOPP/START criteria. HRQoL was assessed using the EuroQol-5 dimensions (EQ-5D) and EuroQol-visual analog scale (EQ-VAS). The association between the presence of PIM/PPO and the patients' HRQoL was analyzed using Chi-square and Mann-Whitney U tests. Multiple linear regression models were applied to determine the effect of exposure to PIM/PPO on the patients' HRQoL, adjusting for confounders.. Out of 517 patients who fulfilled the inclusion criteria, 502 patients (97%) accepted to be involved in the study and completed the HRQoL questionnaire. The mean (SD) age was 72.4 (5.9) years. 393 (78.3%) of the patients had problems in at least one EQ-5D dimension with pain/discomfort problem being the most reported complaint. The mean (SD) values of the EQ-5D index and the EQ-VAS were 0.734 (0.214) and 59.6 (14.2), respectively, which are lower than those seen in the general Malaysian population. PIM and PPO were found in 28.5% and 45.6% of the patients, respectively. No significant differences were found in the EQ-5D dimensions, EQ-5D index and EQ-VAS between patients who had PIM/PPO and those who did not. Age, sex, and comorbidities were significantly associated with the patients' HRQoL.. PIM and PPO are not uncommon among hospitalized elderly patients; however, it does not significantly affect their HRQoL as measured by the EQ-5D-3L instrument.

Topics: Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Humans; Inappropriate Prescribing; Linear Models; Malaysia; Male; Pain; Pain Management; Quality of Life; Surveys and Questionnaires; Tertiary Care Centers; Visual Analog Scale

The population of end-stage renal failure (ESRF) receiving dialysis treatment is increasing worldwide. For most patients with ESRF, dialysis can extend their life. However, treatment can be demanding and time-consuming. Despite dialysis treatment, many patients continue to experience various sufferings.. A qualitative study was conducted with semi-structured interviews to explore the experiences of suffering of ESRF patients on maintenance dialysis in Malaysia. The results were thematically analyzed.. Nineteen ESRF patients were interviewed. The themes and subthemes were: (I) physical suffering-physical symptoms and functional limitations, (II) psychological suffering-the emotions and thoughts of suffering, (III) social suffering-healthcare-related suffering and burdening of others and (IV) spiritual suffering-the queries of suffering.. These findings may help healthcare professionals to fill in the gaps in the delivery of best renal palliative care.

Topics: Adult; Aged; Female; Humans; Interpersonal Relations; Kidney Failure, Chronic; Malaysia; Middle Aged; Pain; Palliative Care; Renal Dialysis; Spirituality; Stress, Psychological; Young Adult

Topics: Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Fatigue; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Pain; Public Health Surveillance; Sleep; Stress, Psychological; Surveys and Questionnaires

Topics: Congresses as Topic; Health Promotion; Humans; Malaysia; Pain; Pain Management; Public Health; Socioeconomic Factors; Standard of Care

There are currently limited data available on the patterns of opioid prescribing in Malaysia. This study investigated the patterns of opioid prescribing and characterized the dosing and duration of opioid use in patients with noncancer and cancer pain.. This retrospective, cross-sectional study was conducted at an outpatient hospital setting in Malaysia. All prescriptions for opioids (dihydrocodeine, fentanyl, morphine, and oxycodone) issued between January 2013 and December 2014 were examined. The number of prescriptions and patients, the distribution of mean daily dose, annual total days covered with opioids, and annual total opioid dose at the individual level were calculated and stratified by noncancer and cancer groups.. A total of 1015 opioid prescriptions were prescribed for 347 patients from 2013 to 2014. Approximately 41.5% of patients (N = 144/347) and 58.5% (N = 203/347) were associated with noncancer and cancer diagnosis, respectively. Oxycodone (38.0%) was the highest prescribed primarily for the noncancer group. The majority of patients in both noncancer (74.3%) and cancer (60.4%) groups were receiving mean daily doses of < 50 mg morphine equivalents. The chronic use of opioids (> 90 days per year) was associated with 21.8% of patients in the noncancer group and 17.5% in the cancer group.. The finding from this study showed that 41.5% of opioid users at an outpatient hospital setting in Malaysia received opioids for noncancer pain and 21.8% of these users were using opioids for longer than 90 days. The average daily dose in the majority of patients in both groups of noncancer and cancer was modest.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Cancer Pain; Cross-Sectional Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fentanyl; Humans; Malaysia; Male; Middle Aged; Morphine; Neoplasms; Outpatient Clinics, Hospital; Oxycodone; Pain; Retrospective Studies; Young Adult

Endogenous and exogenous opioids are substrates of the permeability glycoprotein (P-gp) efflux transporter, which is encoded by the ABCB1 (MDR1) gene. Genetic polymorphisms of ABCB1 may contribute to interindividual differences in pain modulation and analgesic responses. We investigated the relationship between ABCB1 polymorphisms and cold pain sensitivity among healthy males.. Cold pain responses, including pain threshold and pain tolerance, were measured using the cold-pressor test (CPT). DNA was extracted from whole blood and genotyped for ABCB1 polymorphisms, including c.1236C>T (rs1128503), c.2677G>T/A (rs2032582), and c.3435C>T (rs1045642), using the allelic discrimination real-time polymerase chain reaction.. A total of 152 participants were recruited in this observational study. Frequencies of mutated allele for c.1236C>T, c.2677G>T/A, and c.3435C>T polymorphisms were 56.6%, 49.7%, and 43.4%, respectively. Our results revealed an association of the CGC/CGC diplotype (c.1236C>T, c.2677G>T/A, and c.3435C>T) with cold pain sensitivity. Participants with the CGC/CGC diplotype had 90% and 72% higher cold pain thresholds (87.62 seconds vs. 46.19 seconds, P = 0.010) and cold pain tolerances (97.24 seconds vs. 56.54 seconds, P = 0.021), respectively, when compared with those without the diplotype.. The CGC/CGC diplotype of ABCB1 polymorphisms was associated with variability in cold pain threshold and pain tolerance in healthy males.

Topics: Adolescent; Adult; Analgesics, Opioid; ATP Binding Cassette Transporter, Subfamily B; Cold Temperature; Cross-Sectional Studies; Genotype; Humans; Malaysia; Male; Middle Aged; Pain; Pain Threshold; Polymorphism, Single Nucleotide; Random Allocation; Young Adult

Pain catastrophising is defined as exaggerated negative thoughts, which can occur during an actual or anticipated painful experience, such as musculoskeletal injuries (MSI) or disorders (MSD). The aims of this study are to examine the association between pain catastrophising and MSI and MSD in Malaysian Army male recruits, and evaluate the effects of past injury.. A cohort of 611 male Malaysian Army recruits were recruited and followed up at 3 and 6 months. Pain catastrophising, MSD, sociodemographic and work factors were measured using a self-administered questionnaire, and MSI incidence was retrieved from the medical records. Multivariable fixed effects regression was used to model the cumulative incidence of MSD and MSI.. Approximately 12% of the recruits were diagnosed with incident MSI and 80% reported incident MSD. Higher pain catastrophising at baseline was associated with higher 6 month MSD risk (adjusted OR (aOR) 1.6 per 1 SD increase of Pain Catastrophising Scale (PCS) scores; 95% CI 1.2 to 2.0), and longitudinally associated with MSD incidence (aOR 1.2, 95% CI 1.1 to 1.4). Pain catastrophising was not associated with MSI incidence (aOR 1.0, 95% CI 0.8 to 1.3). The association between pain catastrophising and self-reported MSD was stronger among recruits with self-reported past injury (p for interaction <0.001).. Pain catastrophising was able to predict symptomatic MSD, and not physician-diagnosed MSI, and these findings are directly related to individual health beliefs. Pain catastrophising has a greater influence on how military recruits perceived their musculoskeletal conditions during training, and efforts to reduce pain catastrophising may be beneficial.

Topics: Adolescent; Adult; Catastrophization; Cohort Studies; Humans; Incidence; Malaysia; Male; Medical Records; Military Personnel; Multivariate Analysis; Musculoskeletal Diseases; Musculoskeletal System; Occupational Diseases; Pain; Socioeconomic Factors; Surveys and Questionnaires; Wounds and Injuries; Young Adult

Musicians from a wide range of backgrounds experience playing-related health problems including musculoskeletal disorders, hearing loss, and performance anxiety. Few studies have focused specifically on the health concerns of musicians in Malaysia.. This study aimed to investigate playing-related health problems among student musicians at a university in Malaysia as well as their knowledge and awareness of playing-related health problems.. Instrumental music students enrolled in undergraduate and post-graduate university music courses (n=98) participated in a self-report online survey which addressed aspects such as educational background, playing experience, knowledge and awareness of musicians' health issues, history of physical problems, lifestyle factors, and prevention and management strategies.. Of the total participants, 28.9% reported that they were currently experiencing playing-related pain in a body part, and 46.4% had experienced playing-related pain at some time. More than half (56.7%) felt that they have not received enough information or advice on playing-related health during their current studies. Musicians who experienced playing-related pain, tension, and discomfort reported the main problem sites to be the fingers and hands, arms, neck, and shoulders.. The study results demonstrate that Malaysian university music students are affected by similar types of playing-related physical problems as their counterparts around the world. A greater awareness and knowledge of injury prevention and management strategies is needed so that these music students can sustain healthy playing careers.

Topics: Adolescent; Adult; Anxiety; Female; Health Status; Hearing Disorders; Humans; Life Style; Malaysia; Male; Middle Aged; Musculoskeletal Diseases; Music; Occupational Diseases; Pain; Self Report; Students; Young Adult

The Malay spoken in Brunei a South East Asian country where Malay is the national language is distinctive and different from Malay spoken in Malaysia, Singapore and Indonesia. This study aimed to develop a Brunei Malay version of the 5-level EQ-5D questionnaire (EQ-5D-5L) and to assess its psychometric properties among patients with type 2 diabetes mellitus (T2DM).. The Brunei Malay EQ-5D-5L was developed by culturally adapting two existing Malay versions. A total of 154 Bruneians with T2DM completed the questionnaire in two different points of time with one week apart. Known-groups validity of the utility-based EQ-5D-5L index and visual analogue scale (EQ-VAS) was evaluated by comparing subgroups of patients known to differ in health status. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) or Cohen's kappa.. As hypothesized, patients known to have 'better' health had higher EQ-5D-5L index scores than those having 'worse' health in all 7 known-groups comparisons. The hypothesized difference in the EQ-VAS scores was observed in only 4 of the 7 known-groups comparisons. Kappa values ranged from 0.206 to 0.446 for the EQ-5D-5L items; the ICC value for the EQ-5D-5L index and EQ-VAS was 0.626 and 0.521, respectively.. The utility-based EQ-5D-5L index appears to be valid and reliable for measuring the health of Brunei patients with T2DM. The validity of the EQ-VAS in Brunei requires further investigation.

Topics: Adult; Aged; Anxiety; Asian People; Brunei; Cross-Sectional Studies; Depression; Diabetes Mellitus, Type 2; Female; Health Status; Humans; Language; Malaysia; Male; Middle Aged; Pain; Pain Measurement; Psychometrics; Quality of Life; Surveys and Questionnaires; Visual Analog Scale

Interventional Pain Procedures (IPPs) is a relatively new treatment modality for chronic pain in Malaysia. The Interventional Pain Service (IPS) newly set up in our institution is led by a pain neurosurgeon and provides a whole package of multimodal pain management including different range of IPPs. This clinical audit is to examine the quality of IPPs performed within the IPS in our institution since its initiation. A total of 87 IPPs were performed on 56 chronic pain patients over 3-year duration. As high as 81.8% of the procedures were effective and 81.5% of patients were satisfied. Only one minor transient complication occurred after an intradiscal procedure but none resulted in death or permanent disability. Thus, safe and effective IPPs can be provided as part of IPS in a local neurosurgical pain centre to bring more comprehensive and less fragmented care for chronic pain patients.

Topics: Clinical Audit; Humans; Malaysia; Pain; Pain Management; Patient Satisfaction

The Pain Catastrophizing Scale (PCS) is designed to assess negative thoughts in response to pain. It is composed of three domains: helplessness, rumination, and magnification. We report on the translation, adaptation, and validation of scores on a Malay-speaking version of the PCS, the PCS-MY.. Guidelines for the process of cross-cultural adaptations of assessment measures were implemented. A sample of 303 young military recruits participated in the study. Factor structure, reliability, and validity of scores on the PCS-MY were examined. Convergent validity was investigated with the Positive and Negative Affect Scale, Short-form 12 version 2, and Ryff's Psychological Well-being Scale.. Most participants were men, ranging in age from 19 to 26. The reliability of the PCS-MY scores was adequate (α = 0.90; mean inter-item correlation = 0.43). Confirmatory factor analysis showed that a modified version of the PCS-MY provided best fit estimates to the sample data. The PCS-MY total score was negatively correlated with mental well-being and positively correlated with negative affect (all ps < 0.001).. The PCS-MY was demonstrated to have adequate reliability and validity estimates in the study sample.

Topics: Adult; Catastrophization; Factor Analysis, Statistical; Female; Humans; Malaysia; Male; Military Personnel; Pain; Pain Measurement; Psychometrics; Quality of Life; Reproducibility of Results; Surveys and Questionnaires; Translations; Young Adult

This was an analysis of the impact of somatic symptoms on the severity and course of depression in Chinese patients treated for an acute episode of major depressive disorder (MDD).. Data were extracted from a 3-month prospective observational study which enrolled 909 patients with MDD in psychiatric care settings; this analysis focused on the Chinese patients (n=300). Depression severity was assessed using the Clinical Global Impression of Severity (CGI-S) and 17-item Hamilton Depression Rating Scale (HAMD-17); somatic symptoms were assessed using the patient-rated 28-item Somatic Symptom Inventory (SSI). Cluster analysis using baseline SSI scores grouped patients into three clusters with no/mild, moderate, or severe somatic symptoms. Four SSI factors (pain, autonomic symptoms, energy, and central nervous system) were defined, and regression analyses identified which factors were associated with remission at 3 months.. More than 70% of the patients had moderate or severe somatic symptoms. Baseline depression severity (HAMD-17 and CGI-S scores) was associated with more severe somatic symptoms. Remission rates differed between clusters of patients: 84.1%, 72.0%, and 55.3% for no/mild, moderate, and severe somatic symptoms, respectively (P=0.0034). Pain symptoms were the somatic symptoms more strongly associated with lower remission rates at 3 months.. Somatic symptoms are associated with greater clinical severity and lower remission rates. Among somatic symptoms, pain symptoms have the greatest prognostic value and should be taken into account when treating patients with depression.

Topics: Adult; Autonomic Nervous System Diseases; Central Nervous System Diseases; China; Comorbidity; Depressive Disorder, Major; Fatigue; Female; Follow-Up Studies; Hong Kong; Humans; Malaysia; Male; Middle Aged; Outcome Assessment, Health Care; Pain; Republic of Korea; Severity of Illness Index; Singapore; Taiwan

The influence of ethnicity on pain complicating ultrasound-guided percutaneous liver biopsy (US-guided PLB) and its clinical impact has not been reported to date.. Consecutive adults from a multiethnic background, undergoing an US-guided PLB, were independently assessed for pain up to 6 h after the procedure. Clinical and demographic parameters were analysed to determine independent predictors of significant pain after PLB. Willingness to undergo a repeat procedure was assessed 1 week after PLB.. Data from 203 patients (median age 50 years; 43.9% female; ethnicity: Malay 41.5%, Chinese 40%, Indian 18%; median BMI 27.7 kg/m; median waist circumference 92.0 cm) were analysed. Pain after US-guided PLB was experienced in 133 (61.1%) patients, with severity grades as follows: none, n=81 (39.9%); mild, n=56 (27.6%); moderate, n=51 (25.1%); and severe, n=15 (7.4%). Analgesia requirements correlated well with severity of pain. Independent predictors of significant pain after PLB (moderate and severe categories) in patients included age less than 50 years [odds ratio (OR) 3.0], female sex (OR 3.7), Indian ethnicity (OR 2.9) and Malay ethnicity (OR 2.7), but not number of needle passes, BMI and educational levels. Patients who experienced moderate/severe pain were less willing to undergo a repeat PLB compared with those who experienced mild/no pain (60.9 vs. 82.8%, P=0.001).. Ethnicity has an important role in the development of pain after US-guided PLB. This has a significant impact on willingness to repeat the procedure.

Topics: Adult; Anthropometry; Asian People; Biopsy, Needle; Female; Humans; Liver; Liver Diseases; Malaysia; Male; Middle Aged; Pain; Pain Measurement; Ultrasonography, Interventional

Out of 20,887 persons who use drugs that came into contact with the National Anti-Drugs Agency (NADA) officials in the year 2013, 3.2% were women. Because women who use drugs (WWUD) are often a hidden population, this may be an underestimate. International literature shows that women who use drugs face increased risk of HIV, intimate partner violence, and mental health issues. Similar literature in Malaysia is lacking, and thus, the objective of our study was exploratory in nature.. Thirty-eight women who use drugs were interviewed using a semi-structured topic guide in Kelantan, Penang, Johor, Kuala Lumpur, and Selangor. Locations were chosen purposively. Nineteen women were interviewed individually and the remaining 19 were in focus group discussions (FGDs). All interviews were transcribed verbatim, translated to English, and analyzed with NVivo.. Median age of respondents was 35.5 years old, 89.5% ethnic Malays, majority having married below the age of 20, and were of low socioeconomic backgrounds. Youngest age of initiation into drug use was 9 years old. Most reported is inhalation of amphetamine-type substances. Seven reported ever injecting. Three themes emerged: (a) repeating patterns of fluid family structures and instability; (b) "pain" and "difficulty" as features of home life; and (c) seeking marriage as a source of stabilization and practices of power within those marriages. Respondents often came from very fluid family environments and married to find stability, only to be drawn into a similar cycle. None of the women who had been separated from their children either institutionally, by family members, or by third parties, had accessed legal recourse for the loss of their parental rights.. Unstable familial relationships or environments contributed to earlier initiation of drug use which raised questions about support services for WWUD and children who use drugs. Respondents were drawn into unstable and/or abusive relationships, perpetuating social inequalities that marked their own familial environments during childhood. These findings support the need for additional services to support the unique needs of WWUD, including domestic violence services, financial and life skills, parental rights assistance, and empowerment programs.

Topics: Adult; Family; Family Conflict; Female; Humans; Interviews as Topic; Malaysia; Pain; Qualitative Research; Stress, Psychological; Substance-Related Disorders

To assess rugby players' preferences for using a mouthguard and to determine the factors contributing to the use and discontinuation of a mouthguard.. A cross-sectional study was conducted in two rugby tournaments from 2009 to 2010. Samples were selected by convenience sampling. Participants were required to complete a self-administered questionnaire, which inquired about awareness and pattern of mouthguard use, as well as reasons if discontinued.. Completed questionnaires were returned by 456 participants, with an estimated response rate of 77.8%. All participants were male (mean age = 22.73, SD = 3.98). Median duration of playing was 6 years, and median frequency was 6 h per week. Overall mouthguard use was low (31.1%, n = 142), especially for custom-fitted mouthguard (1.8%, n = 8), followed by stock mouthguard (7.7%, n = 35). Boil-and-bite type was most commonly used (21.1%, n = 96). Of those who wore a mouthguard before, only 28% continued using it. The discontinuation rate for each type was as follows: stock, 57.1% (P = 0.032); boil-and-bite, 80.2% (P = 0.002); and custom, 37.5% (P = 0.04). Age was a significant factor for mouthguard use (P = 0.007, OR = 1.10, 95% CI = 1.03-1.17). Breathing disturbance (OR = 3.36, 95% CI = 1.17-9.72) and general discomfort (OR = 3.71, 95% CI = 1.68-8.20) were significant factors in discontinuing mouthguard use.. The use of mouthguard was low among rugby players. Custom-made was the least worn type, possibly due to limited availability. The use of mouthguard increased slightly with age but was discouraged by breathing interference and general discomfort. Therefore, preventive effort should focus on early education and reinforcement, as well as on the improvement of wearability and accessibility.

Topics: Adolescent; Adult; Age Factors; Attitude to Health; Cross-Sectional Studies; Football; Humans; Malaysia; Male; Middle Aged; Mouth Protectors; Pain; Respiration; Self Report; Speech; Sports Equipment; Time Factors; Tooth Injuries; Young Adult

Successful implementation of pain management procedures and guidelines in an institution depends very much on the acceptance of many levels of healthcare providers.. The main purpose of this study was to determine the level of knowledge and attitudes regarding pain among nurses working in tertiary care in a local setting and the factors that may be associated with this.. This cross-sectional research study used a modified version of the Nurses' Knowledge and Attitudes Survey (NKAS) regarding pain. Basic demographic data were obtained for further correlation with the level of pain knowledge.. A total of 566 nurses, 34 male and 532 female, volunteered to participate in this study. The response rate (RR) was 76%, with an overall mean percentage score of 42.7±10.9 (range: 5-92.5). The majority of participants were younger nurses below 40 years of age and more than 70% had worked for less than 10 years (6.6±4.45). Up to 92% had never had any formal education in pain management in general. The total mean score of correct answers was 58.6±9.58, with oncology nursing staff scoring a higher percentage when compared with nurses from other general and critical care wards (63.52±9.27, p<0.045). Only 2.5% out of all participants obtained a score of 80% or greater. The majority of the oncology nurses achieved the expected competency level (p<0.03).. The present findings give further support for the universal concern about poor knowledge and attitudes among nurses related to the optimal management of pain. The results indicated that neither number of years working nor age influenced the level of knowledge or attitudes of the practising nurses. Oncology nursing staff consistently scored better than the rest of the cohort. This reflects that clinical experience helps to improve attitudes and knowledge concerning better pain management.

Topics: Adult; Attitude of Health Personnel; Clinical Competence; Cross-Sectional Studies; Data Collection; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Neoplasms; Nursing Staff, Hospital; Oncology Nursing; Pain; Pain Management; Surveys and Questionnaires; Tertiary Healthcare; Young Adult

This study compared the components of sexual responses between Malaysian women with Type 2 diabetes mellitus and those without the disease.. This cross-sectional study measured sexual responses by using the validated Malay version of Female Sexual Function Index. A factor analysis with varimax rotation method was employed using principal component analysis to explore the correlation structure of the different domains of sexual responses between the two groups. Components of sexual responses were obtained using Kaiser's criteria and compared between those in the diabetic and non-diabetic groups.. A total of 353 women (178 with diabetes and 175 without diabetes) were recruited. Three components of sexual responses emerged from the analysis in the study and control groups. Sexual pain was found to form a component together with lubrication and orgasm domains among the women with diabetes, unlike those without diabetes, where pain stood on its own. Sexual desire and arousal formed one component and satisfaction formed another in both groups.. The domains in the sexual responses of Malaysian women were highly overlapping. It is concluded that the presence of pain as part of lubrication and orgasm component in women with diabetes indicates the importance of intact genital sensation, even though an adverse type of sensation, for vaginal congestion and orgasm to occur in this group of women.

Topics: Adult; Arousal; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Factor Analysis, Statistical; Female; Humans; Malaysia; Orgasm; Pain; Personal Satisfaction; Sexual Behavior

Breast cancer is the leading cause of cancer-related death among women in Malaysia. A diagnosis is very stressful for women, affecting all aspects of their being and quality of life. As such, there is little information on quality of life of women with breast cancer across the different ethnic groups in Malaysia. The purpose of this study was to examine the quality of life in Malay and Chinese women newly diagnosed with breast cancer in Kelantan.. A descriptive study involved 58 Malays and 15 Chinese women newly diagnosed with breast cancer prior to treatment. Quality of life was measured using the Malay version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast-specific module (QLQ-BR23). Socio-demographic and clinical data were also collected. All the data were analyzed using SPSS version 20.0.. Most of the women were married with at least a secondary education and were in late stages of breast cancer. The Malay women had lower incomes (p=0.046) and more children (p=0.001) when compared to the Chinese women. Generally, both the Malay and Chinese women had good functioning quality-of-life scores [mean score range: 60.3-84.8 (Malays); 65.0-91.1 (Chinese)] and global quality of life [mean score 60.3, SD 22.2 (Malays); mean score 65.0, SD 26.6 (Chinese)]. The Malay women experienced more symptoms such as nausea and vomiting (p=0.002), dyspnoea (p=0.004), constipation (p<0.001) and breast-specific symptoms (p=0.041) when compared to the Chinese.. Quality of life was satisfactory in both Malays and Chinese women newly diagnosed with breast cancer in Kelantan. However, Malay women had a lower quality of life due to high general as well as breast-specific symptoms. This study finding underlined the importance of measuring quality of life in the newly diagnosed breast cancer patient, as it will provide a broader picture on how a cancer diagnosis impacts multi-ethnic patients. Once health care professionals understand this, they might then be able to determine how to best support and improve the quality of life of these women during the difficult times of their disease and on-going cancer treatments.

Topics: Adult; Breast Neoplasms; China; Constipation; Cross-Sectional Studies; Diarrhea; Fatigue; Female; Humans; Malaysia; Middle Aged; Nausea; Pain; Quality of Life; Sleep Initiation and Maintenance Disorders; Socioeconomic Factors; Stress, Psychological; Surveys and Questionnaires; Vomiting; Young Adult

The human skeleton is the most common organ to be affected by metastatic cancer and bone metastases are a major cause of cancer morbidity. The five most frequent cancers in Malaysia among males includes prostate whereas breast cancer is among those in females, both being associated with skeletal lesions. Bone metastases weaken bone structure, causing a range of symptoms and complications thus developing skeletal-related events (SRE). Patients with SRE may require palliative radiotherapy or surgery to bone for pain, having hypercalcaemia, pathologic fractures, and spinal cord compression. These complications contribute to a decline in patient health- related quality of life. The multidimensional assessment of health-related quality of life for those patients is important other than considering a beneficial treatment impact on patient survival, since the side effects of treatment and disease symptoms can significantly impact health-related quality of life. Cancer treatment could contribute to significant financial implications for the healthcare system. Therefore, it is essential to assess the health-related quality of life and treatment cost, among prostate and breast cancer patients in countries like Malaysia to rationalized cost-effective way for budget allocation or utilization of health care resources, hence helping in providing more personalized treatment for cancer patients.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Fractures, Bone; Health Care Costs; Humans; Hypercalcemia; Malaysia; Male; Pain; Prostatic Neoplasms; Quality of Life; Spinal Cord Compression

This study examined the health status of injured workers with musculoskeletal disorders enrolled in the Malaysian Return to Work (RTW) program. The 102 participants were categorized into three RTW groups: Off-work (n = 30, 29.4%), Re-entry (n = 44, 43.1%), and Maintenance (n = 28, 27.5%). Overall health status, as measured by the SF-36 version 2, of the workers exhibited below average compared to the internationally established normative population, with their physical health component summary rated lower than mental health. Across the different groups, significant differences were found in role-physical, vitality, bodily pain, general health, and mental health. However, the mean values of these variables were higher in the Maintenance group and were found significant. The current health status of injured workers at Off-work and Re-entry phases was significantly low and warranted to be improved by involving other health professionals such as occupational therapists, ergonomists, and psychologists.

Topics: Adolescent; Adult; Female; Health Status; Humans; Malaysia; Male; Mental Health; Middle Aged; Musculoskeletal Diseases; Occupational Injuries; Pain; Return to Work; Sick Leave; Young Adult

There is a strong association between depression and pain, which is influenced by various biological and psychological mechanisms. The objectives of this study were to assess the prevalence and severity of pain symptoms among patients with major depression; and to determine the correlation between pain with clinical variables, neurotic pathology and severity of depression.. Fifty-one Malay patients with major depressive disorder without psychotic feature enrolled for the study. They were assessed with the Hamilton Rating Scale for Depression (HAM-D), Brief Pain Inventory (BPI) and Crown Crisp Experiential Index (CCEI).. The majority (80.4%) of the subjects had experienced pain, but overall severity of the pain was mild (33.3%). There were no statistically significant differences in socio-demographic variables with the status of pain. The prevalence of pain was significantly higher in patients who were still depressed (p<0.05), had anxious depression (p<0.05) and those with prominent somatic symptoms of anxiety (SOM) (p<0.05). The severity of pain was significantly correlated with neuroticism, the severity of depression (HAM-D total score) and high scores on SOM, DEP and FFA subscales of the CCEI. Among the three, the DEP subscale had the highest correlation with severity of pain.. The somatising patients were heterogeneous group. The pain symptoms were common in severe mixed anxiety-depression, predisposed by the underlying neurotic pathology. Neuroticism and high scores on SOM, DEP and FFA subscales of the CCEI contributed significantly to the pathogenesis of depressed Malay patients with pain symptoms.

Topics: Adult; Aged; Anxiety Disorders; Cross-Sectional Studies; Depressive Disorder, Major; Female; Humans; Malaysia; Male; Middle Aged; Neuroticism; Pain; Pain Measurement; Psychiatric Status Rating Scales; Severity of Illness Index; Young Adult

Acmella uliginosa (Sw.) Cass. is a medicinal herbaceous plant that is commonly used by the Malay community in Malaysia to relieve pain often associated with mouth ulcers, toothache, sore throat, and stomach ache.. The study was carried out to investigate the antinociceptive effect of the methanolic extract of A. uliginosa (Sw.) Cass. flowers (MEAU) using murine models of chemicals and thermal nociception.. Chemicals (acetic acid-induced abdominal constriction and formalin-, capsaicin-, glutamate-induced paw licking test) and thermal models (hot plate test) of nociception in mice were employed to evaluate the MEAU analgesic effect. The extract was given via oral administration at doses of 3, 10, 30 and 100 mg/kg.. It was demonstrated that MEAU produced significant antinociceptive response in all the chemical- and thermal-induced nociception models, which indicates the presence of both centrally and peripherally mediated activities. Furthermore, the reversal of antinociception of MEAU by naloxone suggests the involvement of opioid system in its centrally mediated analgesic activity. Moreover, MEAU-treated mice did not show any significant motor performance alterations. No mortality and signs of toxicity were recorded following treatment of the MEAU.. The results from the present study appear to support the folkloric belief in the medicinal properties of A. uliginosa (Sw.) Cass. which against pain at both central and peripheral levels, in which the central antinociception is probably due to the participation of the opioid receptors.

Topics: Analgesics; Animals; Asteraceae; Flowers; Hot Temperature; Malaysia; Male; Mice; Mice, Inbred ICR; Morphine; Naloxone; Pain; Phytotherapy; Plant Extracts; Rotarod Performance Test

To determine the sensitivity and specificity of intensive empirical treatment with pantoprazole in diagnosing laryngopharyngeal reflux in adults.. This was a prospective, double-blind study.. Fifty-five patients with either a Reflux Symptom Index of more than 13 or a Reflux Finding Score of more than 7 were enrolled. All patients underwent 24-hour, double-probe pH monitoring before commencing pantoprazole 40 mg twice daily; both investigators and patients were blinded to pH monitoring results. The Reflux Symptom Index and Reflux Finding Score were reassessed during the second, third and fourth month of follow up.. The sensitivity of empirical pantoprazole treatment in diagnosing laryngopharyngeal reflux was 92.5 per cent. The specificity was 14.2 per cent, the positive predictive value 86 per cent and the negative predictive value 25 per cent. There was significant reduction in the total Reflux Symptom Index and Reflux Finding Score after the second, third and fourth month of treatment. There was no correlation between laryngopharyngeal reflux and body mass index.. Our results suggest that intensive empirical treatment with proton pump inhibitors is effective in diagnosing laryngopharyngeal reflux.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adolescent; Adult; Body Mass Index; Double-Blind Method; Endoscopy, Gastrointestinal; Esophageal pH Monitoring; Humans; Hydrogen-Ion Concentration; Laryngopharyngeal Reflux; Malaysia; Middle Aged; Pain; Pain Measurement; Pantoprazole; Prospective Studies; Proton Pump Inhibitors; Sensitivity and Specificity; Severity of Illness Index; Treatment Outcome; Young Adult

The present study was carried out to investigate the antinociceptive and anti-inflammatory activities of virgin coconut oil (VCO) produced by the Malaysian Agriculture Research and Development Institute (MARDI) using various in vivo models.. Two types of VCOs, produced via standard drying (VCOA) and fermentation (VCOB) processes were used in this study. Both VCOA and VCOB were serially diluted using 1% Tween 80 to concentrations (v/v) of 10, 50 and 100%. Antinociceptive and anti- inflammatory activities of both VCOs were examined using various in vivo model systems. The antinociceptive activity of the VCOs were compared to those of 1% Tween 80 (used as a negative control), morphine (5 mg/kg) and/or acetylsalicylic acid (100 mg/kg).. Both VCOA and VCOB exhibited significant (p < 0.05) dose-dependent antinociceptive activity in the acetic acid-induced writhing test. Both VCOs also exerted significant (p < 0.05) antinociceptive activity in both phases of the formalin and hot-plate tests. Interestingly, the VCOs exhibited anti-inflammatory activity in an acute (carrageenan-induced paw edema test), but not in a chronic (cotton-pellet-induced granuloma test) model of inflammation.. The MARDI-produced VCOs possessed antinociceptive and anti-inflammatory activities. Further studies are needed to confirm these observations.

Topics: Abdomen; Analgesics; Animals; Anti-Inflammatory Agents; Coconut Oil; Disease Models, Animal; Edema; Granuloma; Malaysia; Male; Mice; Mice, Inbred BALB C; Muscle Contraction; Pain; Pain Measurement; Phytotherapy; Plant Oils; Rats; Rats, Sprague-Dawley

The objective of this paper is to test and correct for systematic differences in reporting of pain severity among older adults by age, gender, ethnic group and socio-economic status using anchoring vignettes. Data from a national survey of community-dwelling older Singaporeans (aged 60 years and over) conducted in 2009 was used. Respondents were asked to rate the severity of their own pain as well as that of others described in the vignettes on a five-point scale ranging from none to extreme. An ordered probit model was used to estimate the coefficients of the independent variables (age, gender, ethnic group, education, housing type) on self-reported pain. Reporting heterogeneity in pain severity was then corrected using a Hierarchical Ordered Probit model. The results showed that before correcting for reporting heterogeneity, women, those older, and those of Malay ethnicity reported greater severity of pain, while there was no association of reported pain severity with housing type and education. However, after correcting for reporting heterogeneity, while women and those older were found to have an even greater severity of pain than what they had reported, Malays were found to have a lower severity of pain than what they had reported. We conclude that there are systematic differences in reporting pain severity by age, gender and ethnic group. We propose that pain management may be improved if medical professionals take into account reporting heterogeneity for pain severity among various population sub-groups in Singapore.

Topics: Aged; Female; Humans; Malaysia; Male; Middle Aged; Pain; Prevalence; Self Report; Severity of Illness Index; Singapore

The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access.. The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC.. The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from <200 g in 1993 to >1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect.. The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Delivery of Health Care; Female; Health Knowledge, Attitudes, Practice; Home Care Services; Humans; Malaysia; Male; Middle Aged; Morphine; Neoplasms; Pain; Palliative Care; Patient Acceptance of Health Care; Workforce

Within Malaysia's otherwise highly accessible public healthcare system, palliative medicine is still an underdeveloped discipline. Government surveys have shown that opioid consumption in Malaysia is dramatically lower than the global average, indicating a failure to meet the need for adequate pain control in terminally ill patients. Indeed, based on daily defined doses, only 24% of patients suffering from cancer pain receive regular opioid analgesia. The main barriers to effective pain control in Malaysia relate to physicians' and patients' attitudes towards the use of opioids. In one survey of physicians, 46% felt they lacked knowledge to manage patients with severe cancer pain, and 64% feared effects such as respiratory depression. Fear of addiction is common amongst patients, as is confusion regarding the legality of opioids. Additional barriers include the fact that no training in palliative care is given to medical students, and that smaller clinics often lack facilities to prepare and stock cheap oral morphine. A number of initiatives aim to improve the situation, including the establishment of palliative care departments in hospitals and implementation of post-graduate training programmes. Campaigns to raise public awareness are expected to increase patient demand for adequate cancer pain relief as part of good care.

Topics: Analgesics, Opioid; Developing Countries; Drug Utilization; Health Knowledge, Attitudes, Practice; Health Policy; Health Services Accessibility; Humans; Malaysia; Neoplasms; Pain; Palliative Care; Practice Patterns, Physicians'; Terminally Ill

The aim of this project was to develop an oral health related-quality of life measure for the Malaysian adult population aged 18 and above by the cross-cultural adaption the Oral Health Impact Profile (OHIP).. The adaptation of the OHIP was based on the framework proposed by Herdman et al (1998). The OHIP was translated into the Malay language using a forward-backward translation technique. Thirty-six patients were interviewed to assess the conceptual equivalence and relevancy of each item. Based on the translation process and interview results a Malaysian version of the OHIP questionnaire was produced that contained 45 items. It was designated as the OHIP(M). This questionnaire was pre-tested on 20 patients to assess its face validity. A short 14-item version of the questionnaire was completed by 171 patients to assess the suitability of the Likert-type response format. Field-testing was conducted in order to assess the suitability of two modes of administration (mail and interview) and to establish the psychometric properties of the adapted measure.. The pre-testing revealed that the OHIP(M) has good face validity. It was found that the five-point frequency Likert scale could be used for the Malaysian population. The OHIP(M) was reliable, where the scale Cronbach's alpha was 0.95 and the ICC value for test-retest reliability was 0.79. Three out four construct validity hypotheses tested were confirmed. OHIP(M) works equally well as the English version.. OHIP(M) was found to be reliable and valid regardless of the mode of administration. However, this study only provides initial evidence for the reliability and validity of the measure. Further study is recommended to collect more evidence to support these results.

Topics: Activities of Daily Living; Adolescent; Adult; Attitude to Health; Comprehension; Cross-Cultural Comparison; Disabled Persons; Health Status; Humans; Language; Malaysia; Oral Health; Pain; Quality of Life; Reproducibility of Results; Self Concept; Stress, Psychological; Surveys and Questionnaires

Topics: Education, Continuing; Gingiva; Humans; Malaysia; Male; Middle Aged; Pain; Pain Management

Effective cancer pain management is influenced by the attitudes and knowledge of treating physicians. A survey was conducted among the total population of government hospital doctors of Sarawak to study the barriers to cancer pain management. Two hundred and fifty-three respondents (83%) completed the survey. The study results highlight that knowledge about cancer pain management was low and barriers to morphine prescription were high. A majority of doctors were deterred from using morphine because of fear of addiction (36.5%) and respiratory depression (53.1%). Only 16.2% of the doctors chose the oral mode of administration to treat pain, furthermore 25% prescribed morphine on "PRN" basis. Doctors with undergraduate study in oncology consistently answered better suggesting that the situation can be improved by education. This study showed that barriers to morphine prescription and knowledge deficit amongst government doctors in Sarawak are strong but similar to those reported in western countries few years ago.

Topics: Adult; Analgesics, Opioid; Attitude of Health Personnel; Drug Administration Routes; Drug Utilization; Female; Humans; Malaysia; Male; Morphine; Neoplasms; Opioid-Related Disorders; Pain; Practice Patterns, Physicians'; Respiratory Insufficiency

The prevalence of pain complaints as a reason for patient-doctor encounters in the local primary care setting is unknown. We performed a cross-sectional survey of such encounters in one public primary care clinic (KK) and 17 general practice clinics (GP), from the city of Seremban, Negeri Sembilan, Malaysia. Reasons for visits were recorded by doctors in KK and medical students in GP using a structured questionnaire. Morbidity data was coded using the International Classification of Primary Care (ICPC-2). A total of 2234 encounters were recorded (80.9% from KK, 19.1% from GP). The overall prevalence of pain complaints was 31.9% with a significant difference between the two cohorts (KK 28.7% and GP 45.2%, p<0.001). Musculoskeletal pain complaints were more common in KK than GP (40.9% versus 29.7%, p<0.05). Of the 3 main ethnic groups in Malaysia (Malay, Chinese and Indian) the Indian patients at KK had the highest prevalence of pain complaints and the Chinese at the GP had the lowest. Thus pain was a common complaint in the two different primary care settings studied. Some of the differences observed are probably due to the differences in the healthcare seeking behaviour of patients consulting at these two settings as well as differences in the payment systems.

Topics: Adolescent; Adult; Child; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Pain; Pain Measurement; Prevalence; Primary Health Care; Retrospective Studies

This survey was intended to gauge the management of pain in palliative cancer patients by the doctors in Melaka Hospital. It also sought to identify possible barriers to adequate pain management among doctors and gauge their response to the adequacy of medical school teaching on cancer pain issues. A 39 item survey was used to cover the issues involved. Overall, the doctors displayed a lack of systematic approach to cancer pain management with inadequate knowledge of analgesia handling. Medical school exposure to cancer pain issues was lacking. Formulation of accepted clinical practice guidelines and new education strategies can improve cancer pain management.

Topics: Analgesics; Clinical Competence; Health Care Surveys; Humans; Malaysia; Medical Staff, Hospital; Neoplasms; Pain; Pain Measurement; Palliative Care; Patient Education as Topic; Practice Patterns, Physicians'

A cross-sectional survey of semiconductor factories was conducted to identify the ergonomic risk factors in the work processes, the prevalence of body pain among workers, and the relationship between body pain and work processes. A total of 906 women semiconductor workers took part in the study. In wafer preparation and polishing, a combination of lifting weights and prolonged standing might have led to high pain prevalences in the low back (35.0% wafer preparation, 41.7% wafer polishing) and lower limbs (90.0% wafer preparation, 66.7% wafer polishing). Semiconductor front of line workers, who mostly walked around to operate machines in clean rooms, had the lowest prevalences of body pain. Semiconductor assembly middle of line workers, especially the molding workers, who did frequent lifting, had high pain prevalences in the neck/shoulders (54.8%) and upper back (43.5 %). In the semiconductor assembly end of line work section, chip inspection workers who were exposed to prolonged sitting without back support had high prevalences of neck/shoulder (62.2%) and upper back pain (50.0%), while chip testing workers who had to climb steps to load units had a high prevalence of lower limb pain (68.0%). Workers in the assembly of electronic components, carrying out repetitive tasks with hands and fingers, and standing in awkward postures had high pain prevalences in the neck/shoulders (61.5%), arms (38.5%), and hands/wrists (30.8%).

Topics: Cross-Sectional Studies; Ergonomics; Female; Humans; Industry; Malaysia; Occupational Exposure; Pain; Prevalence; Semiconductors

This study examined the effects of treatment of lower urinary tract symptoms (LUTS) on the health-related quality of life (physical/functional, mental, social and global aspect), pain and prostatic symptoms.. The study consisted of 123 LUTS patients on medical treatment (alpha blockers) and 52 who underwent surgical treatment (TURP). The patients were assessed one week before and three months after medical and surgical treatment by using the Health-Related Quality of Life (HRQOL-20), the Visual Analogue Scale of Pain (VAS), the Present Pain Intensity (PPI) and the International Prostate Symptom Score (I-PSS) inventories and questionnaires.. Prior to treatment, the surgically treated patients were found to suffer more pain, severe prostatic symptoms, bothersomeness and deterioration in health-related quality of life than the medically treated patients. Postoperatively, the surgical group showed a significant reduction and improvement in all aspects of pain, prostatic symptoms, bothersomeness and overall health-related quality of life, as compared with the medication group. The mean ages of the surgical and medical treated groups were 69.56 years (SD=7.94 years) and 64.62 years (SD=7.94 years) respectively.. The result showed that operative procedure had significantly improved the overall health-related quality of life of LUTS patients compared to those on medical treatment.

Topics: Adrenergic alpha-Antagonists; Aged; Aged, 80 and over; Health Status; Humans; Malaysia; Male; Middle Aged; Pain; Prostatic Hyperplasia; Quality of Life; Surveys and Questionnaires; Time Factors; Transurethral Resection of Prostate; Urination Disorders

A prospective study of patients with acute aortic occlusion (AAO) admitted to the Vascular Unit, Hospital Kuala Lumpur was carried out over a 12 month period. There were a total of 11 patients admitted with a clinical diagnosis of AAO. There was a male preponderance with 10 patients. The median age was 58 years (40-70 years). Hypertension was the commonest underlying medical illness (n = 7). All patients had painful lower limb paraparesis or paraplegia with bilateral absent limb pulses from the groin downwards on admission to the vascular unit. The majority of patients (10 patients) were referred from other hospitals, of which 6 patients came from outside the Klang Valley. Only eight (8) patients underwent an operative procedure with seven (7) having an initial bilateral balloon catheter thromboembolectomy. There was one (1) aorta-bifemoral bypass after failed embolectomy. An aneurysectomy with inlay-graft was done as the initial procedure in one (1) patient. Mortality was 82% (9/11). The two survivors were in the group that had vascular reconstructive surgery. Acute aortic occlusion is an uncommon but catastrophic event with a high mortality. Clinicians must have a high index of suspicion in patients who present with painful paresis or paraplegia. Clinical examination of peripheral pulses in these patients is mandatory. Early diagnosis and treatment is important to improve the outcome of this disease.

Topics: Acute Disease; Adult; Aged; Aortic Diseases; Arterial Occlusive Diseases; Female; Humans; Incidence; Leg; Malaysia; Male; Middle Aged; Pain; Paralysis; Paraplegia; Prospective Studies

To study the distribution of presenting features and their prognostic significance in neuroblastoma treated in a single institution in Malaysia. A retrospective study was made of 78 neuroblastoma cases diagnosed and treated in the University Hospital, Kuala Lumpur, Malaysia between June 1982 and February 1997. Diagnosis was established by standard histological criteria. The presenting features were evaluated for their distribution and prognostic influence. Disease-free survival from diagnosis was the outcome variable of interest. The ages ranged from 0.1 to 11 years old (median: 3 years old). The tumor originated from the adrenal glands in 83% and the majority of cases presented in advanced stage (stage III 22%, stage IV 66%). Bone marrow was the commonest site of distant metastasis occurring in 45% of patients. The main presenting signs and symptoms in decreasing order were pallor, fever, abdominal mass, weight loss, and bone/joint pain. Univariate analysis conferred age, initial stage and Hb level as significant prognostic factors. No influence in disease-free survival was found for sex, race, primary site, urinary vanillylmandelic acid level, white cell count and platelet count. Overall 2-year disease-free survival was achieved in 27 (39%) patients. Four patients underwent bone marrow transplant, three of whom achieved 2-year disease-free survival. The results suggest that age, initial stage and hemoglobin level are significant prognostic factors based on univariate analysis. In addition, more Malaysian children presented with adrenal primary site and advanced disease compared to previous reported studies.

Topics: Adrenal Gland Neoplasms; Age Distribution; Analysis of Variance; Child; Child, Preschool; Combined Modality Therapy; Disease-Free Survival; Female; Fever; Hemoglobins; Humans; Infant; Malaysia; Male; Neoplasm Staging; Neuroblastoma; Pain; Pallor; Prognosis; Retrospective Studies; Treatment Outcome; Weight Loss

The objective of the study was to determine whether discriminant analysis of characteristics of dyspepsia can differentiate peptic ulcer from non-ulcer dyspepsia in a Malaysian population. Two hundred and twenty six patients with dyspepsia were interviewed using a standard history questionnaire before undergoing upper gastrointestinal endoscopy. Forty seven patients had peptic ulcer while 149 others were classified as having non-ulcer dyspepsia. Stepwise logistic regression analysis was done on 25 variables. The study showed that only five of these variables could differentiate peptic ulcer from non-ulcer dyspepsia, namely, nocturnal pain, pain before meals or when hungry, absence of nausea, age and sex. A scoring system was devised based on these discriminant symptoms. At a sensitivity of 51%, the specificity for peptic ulcer was 83%, but only prospective studies will determine if this scoring system is of actual clinical value.

Topics: Circadian Rhythm; Diagnosis, Differential; Discriminant Analysis; Dyspepsia; Female; Humans; Malaysia; Male; Pain; Peptic Ulcer; Prospective Studies; Regression Analysis

Topics: Adolescent; Adult; Age Factors; Aged; Child; Eosinophilia; Eosinophils; Female; Filariasis; Filarioidea; Humans; Leg; Leukocyte Count; Lymph Nodes; Lymphangitis; Malaysia; Male; Middle Aged; Nematoda; Nematode Infections; Pain; Parasite Egg Count; Skin Manifestations; Skin Tests