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1.  Adverse Health Effects and Unhealthy Behaviors among Medical Students Using Facebook 
The Scientific World Journal  2013;2013:465161.
Little is known about the relationships between adverse health effects and unhealthy behaviors among medical students using Facebook. The aim of this study was to determine the associations between adverse health effects and unhealthy behaviors with Facebook use. A cross-sectional study was conducted in a private university in Malaysia among 316 medical students. A self-administered questionnaire was used. It included questions on sociodemographics, pattern of Facebook use, social relationship, unhealthy behaviors, and health effects. Mean age was 20.5 (±2.7) years. All students had a Facebook account. The average daily Facebook surfing hours were 2.5 (±1.7). Significant associations were found between average hours of Facebook surfing and the following factors: isolation from family members and community, refusing to answer calls, musculoskeletal pain, headache, and eye irritation (P < 0.005). The average hours spent on Facebook were significantly associated with holding urination and defecation while online, surfing Facebook until midnight, and postponing, forgetting, or skipping meals (P < 0.005). The average hours spent on Facebook were associated with adverse health effects and unhealthy behaviors among medical students, as well as social isolation from the family and community.
doi:10.1155/2013/465161
PMCID: PMC3888741  PMID: 24453859
2.  Emotional Burnout, Perceived Sources of Job Stress, Professional Fulfillment, and Engagement among Medical Residents in Malaysia 
The Scientific World Journal  2013;2013:137620.
This study was the first to explore factors associated with emotional burnout (EB) among medical residents in Malaysia. A cross-sectional study was conducted in a universal sample of 205 medical residents in a Malaysian general hospital. The self-administered questionnaire used consisted of questions on sociodemographics and work characteristics, sources of job stress, professional fulfillment, engagement, and EB. EB was measured using the emotional exhaustion subscale, the Maslach Burnout Inventory (MBI). Mean (±SD) age of the respondents was 26.5 (±1.6). The most common source of job stress was “fear of making mistakes.” Most of the participants were dissatisfied with the increase of residentship period from one year to two years. A high level of EB was reported by 36.6% of the respondents. In multivariate analysis, the most important correlates of EB were sources of job stress, professional fulfillment, and engagement. A high prevalence of EB was found among medical residents. Sociodemographic characteristics, performance pressure, and satisfaction with policies were significantly associated with EB. Although this study was limited by its cross-sectional design, its findings posit a sufficient foundation to relevant authorities to construct, amend, and amalgamate existing and future policies.
Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life—the poetry of the common place, of the common man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their grief. SirWilliam Osler, Aphorisms from the Student Life (Aequanimitas, 1952)
doi:10.1155/2013/137620
PMCID: PMC3842044  PMID: 24367238
3.  Level and Determinants of Knowledge of Symptomatic Knee Osteoarthritis among Railway Workers in Malaysia 
BioMed Research International  2014;2014:370273.
Background. Symptomatic knee osteoarthritis, an ancient malady greatly impairing modern population quality of life, has stimulated global attention to find effective modes of prevention and intervention. Purpose. This study aimed to assess factors affecting knowledge of symptomatic knee osteoarthritis (knee OA) among Malaysian railway workers. Methods. A cross-sectional study was conducted among 513 railway workers involving eight major states within Peninsular Malaysia using population-based sampling. The assessment instrument was a face-validated, prepiloted, self-administered instrument with sociodemographics and knowledge items on knee OA. Results. Mean (±SD) age of the respondents was 41.4 (±10.7), with the majority aged 50 years or older (34.9%). Of the total respondents, 53.6% had low levels of knowledge of knee OA disease. Multivariate analysis found that four demographic predictors, age ≥50 years, family history of knee OA, self-awareness, and clinical diagnosis of the disease entity, were significantly associated with knowledge scores. Conclusion. The finding of a low level knee OA knowledge among Malaysian railway workers points to an urgent need for massive information to be disseminated among the workers at risk to foster primary prevention and self-care.
doi:10.1155/2014/370273
PMCID: PMC3950488  PMID: 24701573
4.  Factor Structure and Reliability of the Malay Version of the Perceived Stress Scale among Malaysian Medical Students 
Background:
The Perceived Stress Scale 10 (PSS-10) is a validated and reliable instrument to measure global levels of perceived stress. This study aims to assess the internal consistency, reliability, and factor structure of the Malay version of the PSS-10 for use among medical students.
Methods:
The original English version of the PSS-10 was translated and back-translated into Malay language. The Malay version was distributed to 242 Bachelor of Medical Science students in a private university in Malaysia. Test–retest reliability was assessed in 70 students. An exploratory principal component factor analysis with varimax rotation was performed. Reliability was tested using the intraclass correlation coefficient (ICC).
Results:
All 242 students participated in the initial questionnaire study (validity and factor structure), and 70 students participated in the test–retest reliability of the study. Exploratory factor analysis yielded 2 factors that accounted for 57.8% of the variance. Cronbach’s alpha coefficients for the 2 factors were 0.85 and 0.70, respectively. The reliability test showed an ICC of 0.82 (95% CI: 0.70, 0.89).
Conclusion:
The Malay version of the PSS-10 showed adequate psychometric properties. It is a useful instrument for measuring stress among medical students in Malaysia.
PMCID: PMC3684234  PMID: 23785249
Malaysia; medical; psychological; reliability and validity; stress; students
5.  Stress and Coping Strategies of Students in a Medical Faculty in Malaysia 
Background:
Stress may affect students’ health and their academic performance. Coping strategies are specific efforts that individuals employ to manage stress. This study aimed to assess the perception of stress among medical students and their coping strategies.
Methods:
A cross-sectional study was conducted among 376 medical and medical sciences undergraduates in Management and Science University in Malaysia. Stress was assessed by a global rating of stress. Sources of stress were assessed using a 17-item questionnaire. The validated Brief COPE inventory was used to assess coping strategies.
Results:
The majority of respondents were females (64.4%), aged 21 years or older (63.0%), and were Malays (68.9%). Forty-six percent felt stress. The most common stressor was worries of the future (71.0%), followed by financial difficulties (68.6%). Significant predictors of stress were smoking (OR = 2.9, 95% CI 1.3–6.8, P = 0.009), worries of the future (OR = 2.1, 95% CI 1.3–3.4, P = 0.005), self-blame (OR = 1.3, 95% CI 1.1–1.5, P = 0.001), lack of emotional support (OR = 0.8, 95% CI 0.7–0.9, P = 0.017), and lack of acceptance (OR = 0.8, 95% CI 0.6–0.9, P = 0.010). Students used active coping, religious coping reframing, planning, and acceptance to cope with stress.
Conclusion:
Stressors reported by the students were mainly financial and academic issues. Students adopted active coping strategies rather than avoidance. Students should receive consultation on how to manage and cope with stress.
PMCID: PMC3216229  PMID: 22135602
coping skills; Malaysia; medical school; social support; stress; students
6.  Patient Satisfaction in Malaysia's Busiest Outpatient Medical Care 
The Scientific World Journal  2015;2015:714754.
This study aimed to explore factors associated with patient satisfaction of outpatient medical care in Malaysia. A cross-sectional exit survey was conducted among 340 outpatients aged between 13 and 80 years after successful clinical consultations and treatment acquirements using convenience sampling at the outpatient medical care of Tengku Ampuan Rahimah Hospital (HTAR), Malaysia, being the country's busiest medical outpatient facility. A survey that consisted of sociodemography, socioeconomic, and health characteristics and the validated Short-Form Patient Satisfaction Questionnaire (PSQ-18) scale were used. Patient satisfaction was the highest in terms of service factors or tangible priorities, particularly “technical quality” and “accessibility and convenience,” but satisfaction was low in terms of service orientation of doctors, particularly the “time spent with doctor,” “interpersonal manners,” and “communication” during consultations. Gender, income level, and purpose of visit to the clinic were important correlates of patient satisfaction. Effort to improve service orientation among doctors through periodical professional development programs at hospital and national level is essential to boost the country's health service satisfaction.
doi:10.1155/2015/714754
PMCID: PMC4306375  PMID: 25654133
7.  Psycho-Socioeconomic Factors Affecting Complementary and Alternative Medicine Use among Selected Rural Communities in Malaysia: A Cross-Sectional Study 
PLoS ONE  2014;9(11):e112124.
Introduction
The use of complementary and alternative medicine (CAM) as a source of cure has gained much spectrum worldwide, despite skeptics and advocates of evidence-based practice conceptualized such therapies as human nostrum.
Objective
This study aimed to explore the factors affecting CAM use among rural communities in Malaysia.
Methods
A cross-sectional study was carried out on 288 occupants across four rural villages within the District of Selama, Perak, Malaysia. A survey that consisted of socio-economic characteristics, history of CAM use and the validated Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) were used.
Results
The prevalence of self-reported CAM use over the past one year was 53.1%. Multiple logistic regression analyses yielded three significant predictors of CAM use: monthly household income of less than MYR 2500, higher education level, and positive attitude towards CAM.
Conclusion
Psycho-socioeconomic factors were significantly associated with CAM use among rural communities in Malaysia.
doi:10.1371/journal.pone.0112124
PMCID: PMC4223045  PMID: 25375256
8.  Family Context and Khat Chewing among Adult Yemeni Women: A Cross-Sectional Study 
BioMed Research International  2014;2014:505474.
Khat chewing is associated with unfavourable health outcomes and family dysfunction. Few studies have addressed the factors associated with khat chewing among Yemeni women. However, the family and husband effects on chewing khat by women have not been addressed. This study aimed to determine the prevalence of khat chewing among Yemeni women and its associated factors, particularly husbands and family factors. A cross-sectional study was conducted among 692 adult Yemeni women in the city of Sana'a in Yemen using structured “face to face” interviews. Mean (±SD) age of women was 27.3 years (±6.10). The prevalence of chewing khat by women was 29.6%. Factors associated with chewing khat among women were chewing khat by husbands (OR = 1.8; 95% CI: 1.26, 2.53), being married (OR = 2.0; 95% CI: 1.20, 3.37), frequent family social gatherings (OR = 1.5; 95% CI: 1.06, 2.10), high family income (OR = 1.57; 95% CI: 1.12, 2.21), larger house (OR = 1.63; 95% CI: 1.16, 2.31), and age of women (OR = 0.64; 95% CI: 0.44, 0.92). It is concluded that khat chewing by women in this study was significantly associated with family factors and with khat chewing by their husbands. Urgent action is needed to control khat chewing particularly among women.
doi:10.1155/2014/505474
PMCID: PMC4055061  PMID: 24982886
9.  Factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia: a descriptive cross-sectional single-centre study 
BMJ Open  2014;4(4):e004794.
Objective
To determine the prevalence and factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia.
Design
Descriptive, cross-sectional single-centre study with universal sampling of all patients with type 2 diabetes.
Setting
Endocrinology clinic of medical outpatient department in a Malaysian public hospital.
Participants
All 169 patients with type 2 diabetes (men, n=99; women, n=70) aged between 18 and 90 years who acquired follow-up treatment from the endocrinology clinic in the month of September 2013.
Main outcome measures
The validated Hospital Anxiety and Depression Scale (HADS), sociodemographic characteristics and clinical health information from patient records.
Results
Of the total 169 patients surveyed, anxiety and depression were found in 53 (31.4%) and 68 (40.3%), respectively. In multivariate analysis, age, ethnicity and ischaemic heart disease were significantly associated with anxiety, while age, ethnicity and monthly household income were significantly associated with depression.
Conclusions
Sociodemographics and clinical health factors were important correlates of anxiety and depression among patients with diabetes. Integrated psychological and medical care to boost self-determination and confidence in the management of diabetes would catalyse optimal health outcomes among patients with diabetes.
doi:10.1136/bmjopen-2014-004794
PMCID: PMC4010817  PMID: 24760351

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