Impact of work environment on job satisfaction and stress among hemodialysis staff in Klang Valley

Objective:To investigate the factors contributing to satisfaction with the work environment,job satisfaction(JS),and stress among hemodialysis(HD)staff in the central region of Malaysia.Methods:A quantitative cross-sectional study was conducted on 215 HD staff working at private and non-government(NGO)dialysis centers using self-administered questionnaires.The chi-square test was used to determine factors associated with HD staff's JS,stress,and working environment.Results:The scientific proof was apparent that the working environment had an effect on JS and stress among employees at HD centers.Conclusions:This research offers useful insights into the essence and complexities of HD staff's work and will help nurses,dialysis managers,other dialysis personnel,and organizations to better understand the benefits and stresses faced by these workers.

Hypertension in low and middle-income countries: Challenges, gaps and limited resources specific strategies

In this article we aim to discuss the burden of hypertension in middle-income countries, the challenges andopportunities, identify some implementation gaps in some of the published initiatives and propose a few pillars that could benefit an upstream population health and health promotion. One billion people suffer from hypertension worldwide; however, the prevalence of hypertension in low and middle-income countries is higher than that in the industrialized countries. Hypertension affects 45% of African adults aged 25 and above, compared to the 36% North American prevalence rate; moreover, the death rate from hypertension in LMICs is higher the than that of the European countries(141 vs 93 per 10000, respectively). The association between increased systolic blood pressure and income reversed between the early 80 s and the first decade of the 20 th century; the higher the per capita income the lower the risk of hypertension. Hence, unless an effective interventions, such as improving diagnosis and treatment, lowering salt intake, enhancing access and availability of fresh fruit and vegetable, and increasing leisure time physical activities are implemented, then low income countries epidemic is inevitable. In this article we aim to discuss the global burden of hypertension in low and middle-income countries, the gaps and challenges, identify the high-risk groups and propose a prevention and cost effective treatment strategic framework.

Obesity in Relation to Ovarian Response in IVF Treatment

Introduction: The effect of Body Mass Index (BMI), which reflects the woman’s obesity, in IVF treatment cycle, remains unclear. In 1997, the World Health Organization (WHO) provided authoritative refinements to the over-weight terminology and BMI cutoffs [1]. Objective: To verify the relationship between BMI and ovarian response in IVF treatment cycle. Design: Retrospective study. Materials & Methods: The study includes 2625 IVF treatment cycles performed in our IVF center in the period of 4 years. Patients were divided into five groups using the WHO criteria according to their BMI [2]. Cancellation rate, mean last E2 before hCG administration, mean endometrial thickness, mean duration of stimulation, number of eggs retrieved, fertilization rate, pregnancy and abortion rates were analyzed. The unpaired t-test was used in statistical analysis. Results: There was statistically significant less mean oestradiol level prior to hCG, less endometrial thickness and less number of simulation days as BMI gets higher. In contrast, there was a positive relationship between cancellation rate and higher BMI except with BMI >39 which was not, possibly due to lower number of patients available. But if we look at the cause of cancellation, it was 100% due to insufficient number of follicles obtained for this group (BMI >39). Also, days of stimulation are significantly lower for the same group of patients in comparison with the other groups. Retrieval, fertilization and pregnancy rates were not significant between all groups. Abortion rate gets significantly higher as BMI increased. Conclusion: Overweight affects ovulation, if we consider the cause of cancellation being insufficient number of follicles reflects the poor response. The fertilization and pregnancy rate were not affected once oocytes retrieved. The reduction of weight is an important part of infertility treatment in obese women with regards to the ovarian response and abortion rate in IVF cycle.