Psychological and work-related factors predicting work engagement in Malaysian employees.

BACKGROUND: Past research on work engagement has focused almost exclusively on either psychological or work-related factors in almost wholly separate literature. There is therefore a need to examine how these factors collectively influence work engagement. AIMS: To determine levels of work engagement and to identify psychological and work-related characteristics predicting work engagement in employees in Malaysia. METHODS: We recruited 5235 employees from 47 public and private organizations in Malaysia who responded to an online health survey. We assessed work engagement with the 9-item Utrecht Work Engagement Scale (UWES-9) and psychological distress using the 6-item Kessler scale. We performed multiple linear regression to determine predictors of work engagement. RESULTS: Employee mean age was 33.8 years (standard deviation [SD] ± 8.8). The mean work engagement score on the UWES-9 was 3.53 (SD ± 0.94). Eleven of 18 variables on multiple regression predicted work engagement, F(18, 4925) = 69.02, P < 0.001, R2 = 0.201. Factors that predicted higher work engagement were age, marital status, education level, job type, job permanency, longer sleep duration, lower psychological distress and no history of workplace bullying. CONCLUSIONS: Key factors associated with poorer work engagement in Malaysian employees include inadequate sleep, psychological distress and a history of workplace bullying. These are modifiable factors that individuals and employers can target to improve work engagement, ideally tailored according to occupational type.

Adult Langerhans cell histiocytosis: An unusual cause of referred knee pain.

Langerhans cell histiocytosis (LCH) in adults is rare and regarded as an 'orphan disease.' The systemic symptoms of LCH can mimic many other undifferentiated diseases seen at the primary care level. Failure to diagnose and delays in referral are common pitfalls in the management of this disease. We present a case of a 34-year-old woman with referred knee pain who was eventually diagnosed with multi-system LCH 4 years after the initial presentation. The mean age of presentation of LCH symptoms in adults is 33. Bone lesions are the frequent presentation of LCH in this age group. Endocrine involvement in LCH is seen in the form of diabetes insipidus (DI), which remains the most common extraskeletal presentation of LCH in adults. In the case discussed here, a definitive diagnosis of LCH was established through tissue biopsy. The spectrum of undifferentiated symptoms underscores the difficulty and delay in making a diagnosis associated with the condition. Most GPs not only face the predicament of initial recognition but also fail to merge presenting symptoms to form a purposeful referral of this elusive disease to a tertiary care unit.

Anticoagulant management of atrial fibrillation: the influence of dosing algorithm and recall schedule on time in therapeutic range.

BACKGROUND: The quality of anticoagulation management in atrial fibrillation patients is reflected by the concept of time spent in therapeutic range (TTR). In a primary care setting, the implementation of a dose nomogram could help increase the mean TTR among these patients. OBJECTIVE: This study compares the influence of a dose algorithm with an integrated recall on TTR prior to standard care and after the implementation of the protocol. PATIENTS AND METHODS: In a purposive sample of patients with AF, an uncontrolled 'before' and 'after' study design was utilized to measure the effects of the protocol on TTR. Demographic data, TTR levels, frequency of international normalized ratio (INR) within therapeutic range, clinician adherence to dose nomogram and warfarin dose changes were captured from consultations at the anticoagulation clinic. RESULTS: A total of 152 patients with AF were entered into the final analysis. The increment in mean TTR in the 'after' intervention phase (2.9%) was not statistically significant (57.5-60.4%, P=0.252). The increase in the frequency of INR values within therapeutic range in the 'after' intervention phase was significant (50.0-56.0%, P<0.05) but with a very low effect size (r=0.04). CONCLUSIONS: The implementation of a dose nomogram has the potential of reducing unnecessary dose changes for minor fluctuations in INR levels. The findings in this study needs to be confirmed in a future study involving other indications for anticoagulation, various regional primary care clinics and a larger population size.

A review of tuberculosis research in malaysia.

One hundred seventy four articles related to tuberculosis were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred fifty three articles were selected and reviewed on the basis of clinical relevance and future research implications. Topics related to epidemiology, clinical presentation, detection methods and treatment were well researched. However, limited information was available on screening and behavioural interventions. The younger population were more vulnerable to tuberculosis infection and had higher prevalence of risk factors that reactivate tuberculosis infection. Screening of tuberculosis was conducted primarily on healthcare workers, tuberculosis contacts, prisoners and foreign workers. Data on the clinical presentation of pulmonary and extrapulmonary tuberculosis was comprehensive. There was a general focus on related risk factors such as HIV and diabetes mellitus. A great degree of information was available on the treatment and various detection methods to identify tuberculosis. The efficacy and the practicality of investigative methods was analysed in this review. In conclusion, the direction of research should be aimed at novel preventive and control measures of tuberculosis. There should be emphasis on the screening of high risk groups (other than HIV) within the population namely diabetic patients, smokers and immunosuppressed individuals. The design of health policies should be guided by information gathered from research evaluation of communitybased behavioural interventions.

A Review of Tuberculosis Research in Malaysia

One hundred seventy four articles related to tuberculosis were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred fifty three articles were selected and reviewed on the basis of clinical relevance and future research implications. Topics related to epidemiology, clinical presentation, detection methods and treatment were well researched. However, limited information was available on screening and behavioural interventions. The younger population were more vulnerable to tuberculosis infection and had higher prevalence of risk factors that reactivate tuberculosis infection. Screening of tuberculosis was conducted primarily on healthcare workers, tuberculosis contacts, prisoners and foreign workers. Data on the clinical presentation of pulmonary and extrapulmonary tuberculosis was comprehensive. There was a general focus on related risk factors such as HIV and diabetes mellitus. A great degree of information was available on the treatment and various detection methods to identify tuberculosis. The efficacy and the practicality of investigative methods was analysed in this review. In conclusion, the direction of research should be aimed at novel preventive and control measures of tuberculosis. There should be emphasis on the screening of high risk groups (other than HIV) within the population namely diabetic patients, smokers and immunosuppressed individuals. The design of health policies should be guided by information gathered from research evaluation of communitybased behavioural interventions.

A review of tuberculosis research in malaysia

One hundred seventy four articles related to tuberculosis were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred fifty three articles were selected and reviewed on the basis of clinical relevance and future research implications. Topics related to epidemiology, clinical presentation, detection methods and treatment were well researched. However, limited information was available on screening and behavioural interventions. The younger population were more vulnerable to tuberculosis infection and had higher prevalence of risk factors that reactivate tuberculosis infection. Screening of tuberculosis was conducted primarily on healthcare workers, tuberculosis contacts, prisoners and foreign workers. Data on the clinical presentation of pulmonary and extrapulmonary tuberculosis was comprehensive. There was a general focus on related risk factors such as HIV and diabetes mellitus. A great degree of information was available on the treatment and various detection methods to identify tuberculosis. The efficacy and the practicality of investigative methods was analysed in this review. In conclusion, the direction of research should be aimed at novel preventive and control measures of tuberculosis. There should be emphasis on the screening of high risk groups (other than HIV) within the population namely diabetic patients, smokers and immunosuppressed individuals. The design of health policies should be guided by information gathered from research evaluation of communitybased behavioural interventions.

Influence of diabetes mellitus and risk factors in activating latent tuberculosis infection: a case for targeted screening in malaysia.

A review of the epidemiology of tuberculosis, its contributing risk factors (excluding HIV) and the role of screening latent tuberculosis infection in Malaysia was done. Despite the global and domestic decrease in prevalence rates of tuberculosis in the past decade, there is an alarming increase in the trend of non communicable diseases in the country. High prevalence rates of major risk factors leading to reactivation of tuberculosis were seen within the population, with diabetes mellitus being in the forefront. The rising numbers in the ageing population of Malaysia poses a further threat of re-emergence of tuberculosis in the years to come. Economically, screening of diabetic patients with comorbidities for latent tuberculosis infection (LTBI) using two major techniques, namely tuberculin sensitivity (TST) and Interferon gamma release assay tests (IGRA) could be a viable option. The role of future research in the detection of LTBI in the Malaysian setting might be necessary to gauge the disease reservoir before implementing prophylactic measures for high risk groups involved.