Age, Education and Depression Among Older Adults: The Mediating Role of Physical Activity.

OBJECTIVES: Past geriatric studies related to the mediating role of physical activity in depression are scarce. This is perhaps the first study to examine the mediating effects of physical activity on the associations between depression and age, and education among older adults. METHODS: Statistical analyses of cross-sectional data from a nationally representative survey on Malaysian older adult health were conducted. Structural equation modeling was used to assess the extent to which physical activity mediated the relationships between depression and age, and education. Associations between variables were explored using multivariable logistic regressions. RESULTS: Analyses were based on a sample of 3974 older adults (aged ≥60 years). Only 12.2% of older adults had depression. Age was positively associated with the odds of depression. Better educated older adults were less likely to experience depression than less educated older adults. Physical activity fully mediated the association between depression and age, whereas it partially explained the depression-education relationship. CONCLUSIONS: Older age and low educational levels were risk factors for depression, and physical activity was identified as a mediator. CLINICAL IMPLICATIONS: Older and less-educated older adults should be encouraged to participate in physical activity, and those at risk of depression should be given special attention.

Effect of Lean Six Sigma on quality performance in Malaysian hospitals.

PURPOSE: The purpose of this paper is to investigate the effects of Lean Six Sigma (LSS) and workforce management on the quality performance of Malaysian hospitals. This paper also investigates the direct and indirect relationships between top management commitment and quality performance of the healthcare organisations in Malaysia. DESIGN/METHODOLOGY/APPROACH: This study applied stratified random sampling to collect data from 15 different hospitals in Peninsular Malaysia. The self-administered survey questionnaires were distributed among 673 hospital staff (i.e. doctors, nurses, pharmacists, and medical laboratory technologists) to obtain 335 useful responses with a 49.47 per cent valid response rate. The research data were analysed based on confirmatory factor analysis and structural equation modelling by using AMOS version 23 software. FINDINGS: The research findings indicated that LSS and workforce management have a significant impact on quality performance of the Malaysian hospitals, whereas senior management commitment was found to have an insignificant relationship with quality performance. The research findings indicate that senior management commitment has no direct significant relationship with quality performance, but it has an indirect significant relationship with quality performance through the mediating effects of LSS and workforce management. RESEARCH LIMITATIONS/IMPLICATIONS: This research focussed solely on healthcare organisations in Malaysia and thus the results might not be applicable for other countries as well as other service organisations. ORIGINALITY/VALUE: This research provides theoretical, methodological, and practical contributions for the LSS approach and the research findings are expected to provide guidelines to enhance the level of quality performance in healthcare organisations in Malaysia as well as other countries.

Sociodemographic, Lifestyle, and Health Factors Associated With Depression and Generalized Anxiety Disorder Among Malaysian Adults.

Objectives: Lowering the prevalence of mental health illness is one of the main public health concerns. The objective of the present study was to examine factors associated with depression and generalized anxiety disorder (GAD) among adults in Malaysia. Methods: Data were extracted from the National Health and Morbidity Survey 2011 (NHMS 2011), which is a nationally representative sample collected using a 2-stage stratified sampling method. A bivariate probit model was utilized to examine the influences of sociodemographic, lifestyle, and health factors on the likelihood of suffering from depression and GAD. Results: Age, gender, ethnicity, education, marital status, and self-rated health were significantly associated with depression and GAD. In particular, there were positive relationships between depression and GAD, and younger adults, females, Indian ethnic group, lower level of education, being unmarried, and self-rated poor health. Conclusions: Sociodemographic and health factors were associated with determining the risks of depression and GAD in Malaysia. With this information, future policies (eg, screening and treatment) could be targeted at those at most risk to develop depression and GAD.

Sociodemographic factors associated with consumption of confectionery among obese and non-obese adults: A secondary analysis.

The objective of the present study is to examine sociodemographic factors associated with consumption of confectionery among obese and non-obese adults in Malaysia. Secondary analysis of the Malaysian Adult Nutrition Survey (MANS) 2014 was performed. The survey was conducted in urban and rural areas in the 14 states of Malaysia, including the Federal Territory of Kuala Lumpur. Adults aged 18 years and above (n = 2696) were interviewed. The dependent variable was the total servings of confectionery consumed per week. An ordered logistic regression model was used to examine the associated sociodemographic factors in the decision of people to consume 0, 1-2, 3-5 and ≥6 servings of confectionery. Marginal effects of sociodemographic variables on confectionery consumption were calculated. Analyses stratified by bodyweight group were conducted. The results showed that income, education, gender, ethnicity, and employment status were significantly associated with consumption of confectionery. In particular, income, education, gender, ethnicity and employment status affected confectionery consumption, but not the other way around. However, no relationship was evidenced between age, marital status, household location and confectionery consumption. In conclusion, sociodemographic factors were related to consumption of confectionery. Policies aimed at discouraging consumption of confectionery should focus primarily on high income earners, well-educated individuals and Bumiputera.

Sociodemographic, lifestyle and health determinants of suicidal behaviour in Malaysia.

Suicide has become a serious matter in both developed and developing countries. The objective of the present study is to examine the factors affecting suicidal behaviour among adults in Malaysia. A nationally representative data which consists of 10,141 respondents is used for analysis. A trivariate probit model is utilised to identify the probability of having suicide ideation, suicide plan and suicide attempt. Results of the regression analysis show that to ensure unbiased estimates, a trivariate probit model should be used instead of three separate probit models. The determining factors of suicidal behaviour are income, age, gender, ethnicity, education, marital status, self-rated health and being diagnosed with diabetes and hypercholesterolemia. The likelihood of adopting suicidal behaviour is lower among higher income earners and older individuals. Being male and married significantly reduce the propensity to engage in suicidal behaviour. Of all the ethnic groups, Indian/others displays the highest likelihood of adopting suicidal behaviour. There is a positive relationship between poor health condition and suicide. Policies targeted at individuals who are likely to adopt suicidal behaviour may be effective in lowering the prevalence of suicide.

Country perspective on medical tourism: the Malaysian experience.

PURPOSE: The study seeks to explore the perception of international patients on Malaysia as a medical tourism destination country, as well as overall patient satisfaction, perceived value and future intention for repeat treatment and services. DESIGN/METHODOLOGY/APPROACH: Self-administered questionnaire was the main method of data collection. The survey covered major private hospitals in medical tourists' states in the country, namely, Penang, Melaka, Selangor and Kuala Lumpur. Convenience sampling was used due to the condition of patients as respondents. FINDINGS: Indonesian patients formed the largest majority of international patients in the country. Five dimensions of medical tourism in Malaysia was identified, namely, hospital and staff, country factor, combining tourism and health services, cost saving and insurance and unavailability of treatment. Of these, hospital and staff was found to be the most important factor for the patients. Perception of value, overall satisfaction and intention for future treatment was also found to be high. This indicates that Malaysia is on the right footing in this burgeoning industry. PRACTICAL IMPLICATIONS: Findings from the study will enable policy-makers to better position Malaysia as a medical tourist destination country. ORIGINALITY/VALUE: Medical tourism is a recent phenomenon and very little empirical research has been carried out at the patient level. This study is one of the first few studies which seek to explore medical tourism from the perspective of the patients themselves.