For any health education to succeed, the people's perception of the disease, their beliefs and cultural practices are of utmost importance as these have tremendous influence on their acceptance of new ideas. It is therefore essential to develop appropriate health education packages based on the understanding of the traditional and socio-cultural belief systems of the people. Thus on the basis of anthropological studies, health education packages were developed for the leprosy control programme in Sarawak, aimed at both adults and children. Newspaper articles, cartoon tape-slides, cartoon story books as well as posters were developed for both Chinese as well as other groups such as Malays, Ibans and Kayans. These were field tested and are now used in the Rejang Valley of Sarawak.
MeSH terms: Attitude to Health*; Culture*; Health Education*; Humans; Leprosy/ethnology*; Leprosy/prevention & control; Malaysia
A study to identify the knowledge of infected and uninfected respondents on filariasis and epidemiologic factors in one endemic community in Malaysia to determine their role in the transmission and control of filariasis was carried out. The data were collected by non-participant observations and interviews using semi-structured schedules. The majority of respondents in both groups had knowledge of filariasis. There was no marked difference between male and female respondents, and similarly, there was fair distributions of knowledgeable respondents with and without some years of schooling. On filarial transmission, 9.2% of the infected said that filariasis was contacted through mosquito bites, while among the uninfected it was 7.4%. Within the infected, 14.8% thought that filarial worms entered the human body through the consumption of unhygenically prepared foods and drinks while, among the uninfected it was 20.4%. Both groups were aware of the presence of mosquitoes in their village. However, the majority did not associate this factor with host's susceptibility to filarial infections. Rather, they were of the opinion that personal hygiene and proper meals had something to do with filariasis. The findings showed there was general awareness of filariasis in the community which might indicate that the health campaigns had reached various levels of the population. Yet, they still lacked knowledge on disease transmission. Also, they did not make direct association between environment and exposure to mosquitoes bites though they were aware of their presence but which they regarded as not directly harmful to their health.
MeSH terms: Adult; Attitude to Health*; Brugia; Culture*; Data Collection; Female; Filariasis/epidemiology*; Filariasis/transmission; Humans; Lymphedema/epidemiology*; Malaysia; Male; Middle Aged
The purpose of this study was to assess M-mode echocardiographic criteria for pulmonary artery hypertension in patients with intracardiac shunts, and to observe any signs not previously described.
Forty-seven consecutive cardiac cathetherised patients with routine M-mode echocardiogram done were reviewed. Twenty-six patients had atrial septal defect, nine had ventricular septal defect (VSD), four had patent ductus arteriosus (PDA), five had Eisenmenger syndrome and three had combined VSD and PDA.
Fifteen of 20 patients with pulmonary artery mean pressure (PAMP) of more than 50 mmHg demonstrated diminished a-dip (p < 0.001), reduced e-f slope (p < 0.01) and increased b-e slope to > 380 mm/sec (p < 0.01). The presence of systolic flutter or mid-systolic notch, or both was not observed in patients with normal PAMP, but was noted in all of the 20 patients with raised pressure(> 50 mmHg).
This study confirms the limitation of M-mode echocardiographic features in the evaluation of pulmonary artery hypertension in patients with intracardiac shunt, though clinically useful.
A retrospective study of 34 patients with supracondylar-condylar fractures of the femur admitted to the Alexandra Hospital, Singapore, from January 1979 to December 1983 was carried out. These fractures were surgically treated by AO principles and fixation, and the surgery performed mainly by the two authors. Using strict criteria adopted from Schatzker of Toronto, 1 it was found that 62% of patients had excellent/ good results. The importance of treating supracondylar-condylar fractures by AO principles and fixation is emphasised.
MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Bone Plates/adverse effects; Bone Screws; Child; Female; Femoral Fractures/radiography; Femoral Fractures/surgery*; Fracture Fixation, Internal/methods*; Humans; Male; Middle Aged; Retrospective Studies
An alarm about suspected toxic gas leakage was raised in a primary school. All the students were evacuated by the staff and the community to a district hospital in Teluk Intan, Perak, about 8 km from the school. Sixty-four primary students from the school, four secondary school students and a student’s mother, who was near the school were all examined by a team of medical officers: Perceptions and records of the incidence from the students, staff and medical officers were recorded and examined by the author who visited the school and the hospital after the incidence. Psychosomatic symptoms related to anxiety attack were predominant There was no evidence of any gas leak. Symptomatic management was given by the medical officers. The psychogenic aetiology of the subsequent physical symptoms and behaviour, and the difference from epidemic hysteria are discussed.
One hundred and forty-one Penans from three longhouses along the Melinau and Terawan Rivers, Baram, Sarawak were examined. The number of decayed, missing and filled teeth was determined for each subject. The number of Penans who wore dentures was noted likewise the number of Penans who brush their teeth was recorded. The relationship between these findings and their possible causes are discussed.
The left atrial myxoma is important not only because of its relative frequency and diagnostic difficulty but because it can be successfully removed by surgery. However, if untreated, it invariably leads to death. We report three cases seen at the Cardiology Department, General Hospital, Kuala Lumpur in 1985.
A patient with marfanoid habitus was admitted to the General Hospital, Kuala Lumpur in October 1985 for surgical closure of an atrial septal defect. He was suspected to have Marfan Syndrome but there was no involvement of the aorta nor the eye. The clinical features were intermediate between that of the Marfan Syndrome and the Ehler's Danlos Syndrome. It is suggested that this could be a separate distinct entity within the heritable disorders of connective tissue known as the Marfanoid Hypermobility Syndrome.
A case of acute appendicitis occurring in a 10- month-old infant is reported. The difficulties of an early preoperative diagnosis are highlighted. Perforation has usually occurred on presentation. However, prognosis may not necessarily be poor if active measures are instituted soon after perforation. The importance of active and aggressive preoperative resuscitation with fluids and electrolyte and intravenous antibiotics is stressed.
A total of 62 patients with vesico-urethral dysfunction were investigated at the Urodynamic Laboratory (Universiti Kebangsaan Malaysia) at the Institute of Urology and Nephrology over a period of eleven months in 1985. In most instances the results significantly influenced a change in patient management strategy. These results are analysed and the usefulness and limitations of this modality of investigations are critically alluded to.
Many operations have been described for the correction of claw hands following involvement in leprosy, from Sir Harold Stiles (1922) of Edinburgh, through Bunnell, Brand and many others in India and USA. Some of these procedures are classified "static" and attempt mainly to correct hyper-extension at the metacarpo-phalangeal joint, while the "dynamic" procedures employ a variety of tendon graft operations to restore the function of the paralysed lumbrical muscles. This study is an analysis of the four-tailed tendon graft operation of Paul Brand, carried out in the National Leprosy Con. trol Centre, Sungei Buloh, Selangor, during the period 1965·175, by a host of surgeons, mainly by Dr M.K. Bhojwani, MRCP, FRCSEd, the Director of the Centre at that time. The analysis carried out during November. December 1976, was made on 36 hands in 33 patients; it revealed an average improvement in the metacarpo. Phalangeal joint flexion of nearly 90% and in the proximal interphalangeal joint extension in nearly 80%, and an improvement in the grafted lumbrical voluntary motor tone of nearly 70%.
Fifty-one consecutive arthroscopies of the knee were reviewed after an average of eight months follow-up. Thirty-eight patients underwent arthroscopic surgical procedures as well. A meniscus tear was the commonest (68%) primary pathology noted, followed by isolated anterior eructate tears (16%). Excellent/good results were obtained in 80% of arthroscopic partial meniscectomies. Synovial biopsies and loose body removal were all successfully achieved arthroscopically: Arthroscopic knee surgery is a useful and less traumatic technique of obtaining a diagnosis and treating amenable knee lesions compared to open arthrotomy.
Infantile or developmental coxa vara is a relatively infrequent localised dysplasia of unknown etiology which usually presents in the second or third year of life soon after the child begins walking. The clinical and radiological picture is usually characteristic especially when seen early. Early surgery leads to a satisfactory outcome. However, difficulty arises in diagnosis and treatment when patients present late, three cases diagnosed in adolescence at the University Hospital, Kuala Lumpur over the last 10 years are presented to increase awareness of this condition, which may be underdiagnosed, and the difficulties in diagnosis and treatment with late presentation are stressed.
MeSH terms: Adolescent; Adult; Female; Hip Dislocation/radiography*; Hip Dislocation/surgery; Hip Dislocation, Congenital/radiography*; Hip Dislocation, Congenital/surgery; Humans; Male; Osteotomy
Fractured penis has traumatic consequenoes on the patient as both his manhood and procreation ability are threatened. 2 cases of fractured penis successfully treated at the Armed Forces Hospital, Terendak, Melaka by a combination of surgical intervention and splintage are reported and the management discussed.
It has been suggested that the 'ideal' measure of reliability of an examination is obtained by test and retest using the one examination on the same group of students. However, because of practical and theoretical arguments, most reported reliabilities for multiple choice examinations in medicine are actually measures of internal consistency. While attempting to minimize the effects of potential interfering factors, we have undertaken a study of true test-retest reliability of multiple true-false type multiple choice questions in preclinical medical subjects. From three end-of-term examinations, 363 items (106 of 449 from term 1, 150 of 499 from term 2, and 107 of 492 from term 3) were repeated in the final examination (out of 999 total items). Between test and retest, there was little overall decrease in the percentage of items answered correctly and a decrease of only 3.4 in the percentage score after correction for guessing. However, there was an inverse relation between test-retest interval and decrease in performance. Between test and retest, performance decreased significantly on 33 items and increased significantly on 11 items. Test-retest correlation coefficients were 0.70 to 0.78 for items from the separate terms and 0.885 for all items that were retested. Thus, overall, these items had a very high degree of reliability, approximately the 0.9 which has been specified as the requirement for being able to distinguish between individuals.
MeSH terms: Education, Medical, Undergraduate*; Educational Measurement/methods*; Humans; Malaysia
All singleton live births occurring in Singapore in the three years 1981-3 were computed, and birthweight was examined in the different ethnic groups (Chinese, Malay, and Indian). Overall the proportions of babies of very low birthweight (less than 1500 g) and low birthweight (less than 2500 g) were: Chinese 0.3% and 6.1%, Malays 0.4% and 8.5%, and Indians 0.5% and 10.0%. The important finding was that in all gestational periods and virtually all maternal age and live birth order groups Indians had the highest proportion of very low and low birthweight babies. However for prematurity Indians at 6.7% had a higher rate than Chinese (5.1%) but lower than Malays (9.9%). Likewise for neonatal mortality Indians at 8.7 per 1000 live births were between Chinese (7.1) and Malays (9.1). The evidence seems to indicate that the reason for Indians having a higher proportion of low birthweight babies is partly ethnic/genetic, and the cut-off point of 2500 g should perhaps be lowered for babies from the Indian subcontinent when international comparisons are being made.