In the light of present HIV worldwide epidemic. there is a need to teach the busy general practitioners how to recognise HIV & AIDS. Due to the deadly nature of this infection and its manifold presentations from opportunistic diseases. the busy general practitioners in primary care may be misled in making the correct diagnosis. In Malaysia. the doctors in the primary care level constitute 70 to 75% of the doctors' population. The rest are specialists in secondary and tertiary care institutions. Family Physicians from the Font liners to recognise and detect early cases of HlV in all its early manifestalions on the various systems. Any doctors in primary medicine whether from private or public sector, amy be confronted by patients who present with trivial complaints. These patients may be fee-paying, or particularly those doctors involved with welfare and health of factory workers and the other forms of the main work force should well arm themselves with updates in HIV and AIDS.
MeSH terms: Acquired Immunodeficiency Syndrome; Malaysia; Physicians, Family; Primary Health Care; HIV Infections
The morbidity patterns and demographics of patients presenting to two government health centers and four private general practice clinics were studied over one week. Results showed little difference in the morbidity patterns but a significant difference in the demographics of the patients. The commonest illnesses seen were minor ones like upper respiratory tract infection and chronic ones like hypertension and diabetes mellitus. A wide spectrum of illnesses was seen in all the clinics. Both places handled few emergencies and referred only occasionally. There was an equal percentage of patients from both sexes. Ages of the patients varied from place to place and the racial distribution was influenced by several factors, including the existing patient population and the race of the doctor.
MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Diabetes Mellitus; Emergencies; Humans; Hypertension; Malaysia; Morbidity; Outpatients; Primary Health Care; Private Practice; Public Facilities; Private Facilities
1. Revised ARA criteria (1987) the diagnosis of RA requires presence of at least 4 of the following 7 features: 1) morning stiffness> 1 hour 2) swelling of 2 or more joints (of 6 weeks duration) 3) symmetrical joint involvement 4) arthritis of more than 1 hand joints (of at least 6 weeks duration) 5) positive rheumatoid factor, 6) presence of rheumatoid nodule 7) X-ray changes. 2. Use of DMARD should start early, along with pain control by non steroidal anti inflammatory drugs (NSAID) 3. Early referral to rheumatologists is the current recommendation 4. Indications for early referral include: i. Early morning stiffness (EMS) of 30 mins ;- ii. Metatarsophalangeal (MTP) / metacarpophalageal (Mep) involvement. iii. 2 or more swollen joints.
Musculoskeletal complaints are one of the most common presenting symptoms to primary care physicians. However, in Malaysia, there has been no prospective survey to look at this problem. This was a descriptive study to look at the prevalence of non-traumatic musculoskeletal complaints presenting to the primary care clinic at University Malaya Medical Center, Kuala Lumpur. Over a 3-week period, there were 408/4201 patients (9.7%) with non-traumatic musculoskeletal disorders. The most common regional problem was backache and the most commonly made diagnosis was non-specific musculoskeletal pain. In conclusion, musculoskeletal disorders form a significant proportion of primary care consultations and thus should be included in the curriculum for the primary care physician training. Keywords: musculoskeletal disorders, arthritis, primary care
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.
MeSH terms: Ambulatory Care Facilities; Arthritis; Back Pain; Cross-Sectional Studies; Hospitals, University; Humans; Malaysia; Musculoskeletal Diseases; Outpatient Clinics, Hospital; Outpatients; Pain; Primary Health Care; Prevalence; Musculoskeletal Pain
Objectives: The objectives of this study were to screen for psychiatric symptomatology in Form 4 students in Ipoh, Perak and to determine demographic characteristics, contributing factors and the key person consulted for psychiatric / emotional problems. Methods: Between December 1997 and March 1998, 84 Form 4 students selected by random sampling from 2 Ipoh schools (one co-educational - S1 and one all boys - S2) were screened using the 30-item Malay version General Health Questionnaire (GHQ-30) and a demographic questionnaire. S1 students were interviewed by a psychiatrist (second author) to assess for anxiety / depression / somatization using DSM IIIR criteria. Results: Eighty three students (98.8%) completed their questionnaires. Twenty four students (28.9%) had high GHQ scores (8 and above). There was no significant association found between GHQ scores and gender, race, parental occupation and marital status / situation, number of siblings, frequency of illness and Penialian Menengah Rendah (PMR) results. A significant association was found between the GHQ scores and the students' birth order and perceived performance in the past 6 months as compared to PMR. Fifty percent consulted their friends for emotional problems, 29.2% their parents, 4.9% their siblings. None consulted their teacher / school counselor. Conclusion: Further studies are recommended to look into the prevalence of psychiatric symptomatology amongst our Malaysian secondary school students and into the possible use of the Malay version GHQ-30 as a screening tool in this age group.
MeSH terms: Adolescent; Anxiety; Cross-Sectional Studies; Depression; Humans; Malaysia; Mass Screening; Primary Health Care; Schools; Students; Prevalence; Sex Distribution
Between 2/10/2000 and 30/1/2001, the organizational structure and management in 4 general practice (GP) clinics & 2 health centers (HC) in Kinta District were studied by 14 Level 4 medical students of Perak College of Medicine. Data collected from work process files and staff interviews / shadowing showed that GPs in the study had more working experience with postgraduate qualifications than HC doctors. All HC nurses but only one GP clinic nurse had formal training. HC organization was more complex with documentation. GP organization was simple and lacked documentation. HC management was by a group while GPs handled all management aspects. This study enhanced students' understanding of Malaysian primary care system.
MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Humans; Malaysia; Outpatients; Primary Health Care; Private Facilities
To investigate crown development patterns, branch architecture, branch-level light interception, and leaf and branch dynamics were studied in saplings of a plagiotropically branching tree species, Polyalthia jenkinsii Hk. f. & Thoms. (Annonaceae) in a Malaysian rain forest. Lengths of branches and parts of the branches lacking leaves ('bare' branches) were smaller in upper branches than in lower branches within crowns, whereas lengths of 'leafy' parts and the number of leaves per branch were larger in intermediate than in upper and lower branches. Maximum diffuse light absorption (DLA) of individual leaves was not related to sapling height or branch position within crowns, whereas minimum DLA was lower in tall saplings. Accordingly, branch-level light interception was higher in intermediate than in upper and lower branches. The leaf production rate was higher and leaf loss rate was smaller in upper than in intermediate and lower branches. Moreover, the branch production rate of new first-order branches was larger in the upper crowns. Thus, leaf and branch dynamics do not correspond to branch-level light interception in the different canopy zones. As a result of architectural constraints, branches at different vertical positions experience predictable light microenvironments in plagiotropic species. Accordingly, this pattern of carbon allocation among branches might be particularly important for growth and crown development in plagiotropic species.
A shared experience in Health and Education are essential ingredients of nationhood. In healthcare, it is constructive to think in terms of the characteristics of a healthcare system that a substantial majority of our people would be enthusiastic to claim ownership. It is useful to think in terms of the elements of a 'charter for health for all Malaysians towards 2020' a) Healthcare for all Malaysians, that is equitable, accessible, and comprehensive. b) Care of quality given with courtesy and respect for patients and their families, with no financial barriers at the time of need. c) A commitment to healthcare of a quality that is appropriate to a Malaysia as a developed country by the Year 2020. Each Five-Year Plan should move in that direction, guided by extensive consultation with the community on priorities and preferences. We have to overcome the 'colonial hangover' that still leaves its mark. Health investment is still concentrated in the capital city, Kuala Lumpur, and in other cities. It is a hospital-centred system. The colonial hierarchy persists with its apex in the Capital city. Government servants are separated from other citizens in access to healthcare. Finally, health has low budget priority. However, there is good reason for optimism. A remarkable consensus has emerged between health professionals and government experts on the shape of a future health system for Malaysia. This is a considerable achievement, in contrasts to the bitter divisions that have characterised changes in other countries. There is still a long road ahead, so it is most important that the leaders of the Malaysian community make clear their preferences and priorities. The Ministry of Health speaks of a 'transformation' of the health system, and advises the medical profession to prepare for radical changes in their behaviour, and in the delivery and funding of healthcare. Four strands of change can be discerned. One, all the professions of health will have to provide evidence of competency, and must learn to monitor the quality of service they provide. Second, the great divide between public and private sector will end, and we have to find ways to integrate our services. Third, a Health Financing Authority may be established, providing hope to all Malaysians that their basic health needs will be met. As citizens, we have the duty to ask that there will be no 'privatisation' of the Health Financing Authority, or of the health facilities of the Ministry of Health. There is a fourth change, arising from our entry into the World Trade Organisation (WTO). Foreign investors will demand access to Malaysian markets, under a so-called 'Globalisation'. All professions will be affected. More serious is the danger of commercialised health care that will damage the health of the less well-off in our country, and raise the cost of health for all of us. Health and education are most important concerns for all of us, yet it strange that as citizens we have contributed so little to shaping the sort of health system that we want for our families and for ourselves. I hope that this meeting is a new beginning.
MeSH terms: Health Services*; Malaysia; Primary Health Care*
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 108-111
A cross-sectional comparative study was conducted to determine the nutritional status among physically active groups in Kota Bharu. The study population comprised 83 adult male athletes from 8 different types of sports (athlete group), 80 active men who exercised a minimum of 30 min per day for at least 3 times per week (exercise group), and 80 inactive men (sedentary group). All the respondents were aged between 18 to 44 years. Measurements taken from the respondents were anthropometric measurements, systolic (SBP) and diastolic (DBP) blood pressure, and serum total cholesterol (TC). The results showed that the combined prevalence of pre-obese (BMI 25.0-29.9) and obese (BMI ¡Ã30.0) was 21.7% in athletes, 29.9% in exercise group, and 47.5% in sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower compared to the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The incidence of waist-to-hip ratio above 0.9 in athlete, exercise and sedentary groups was 9.6%, 18.7% and 31.3%, respectively. The incidence of hypertension (SBP ¡Ã140 and/or DBP ¡Ã90 mmHg) was 13.2% in athletes, 17.5% in exercise group and 42.5% in the sedentary group. The TC values showed that the prevalence of “high risk†individuals (TC ¡Ã6.20 mmol/l) was also lower in athletes (20.5%), compared to the exercise (36.2%) and sedentary (47.5%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities have better nutritional status compared to sedentary people. However, the nutritional status in the athlete and exercise groups was still unsatisfactory. The incidence of poor health status related to over nutrition in the active groups was rather high and needs attention from health professionals. Further studies are needed to determine nutritional practices among physically active groups.
As consumer interest in organically grown vegetables is increasing in Malaysia, there is a need to answer whether the vegetables are more nutritious than those conventionally grown. This study investigates commercially available vegetables grown organically and conventionally, purchased from retailers to analyse â-carotene, vitamin C and riboflavin contents. Five types of green vegetables were selected, namely Chinese mustard (sawi) (Brassica juncea), Chinese kale (kailan) (Brassica alboglabra), lettuce (daun salad) (Lactuca sativa), spinach (bayam putih) (Amaranthus viridis) and swamp cabbage (kangkung) (Ipomoea aquatica). For vitamin analysis, a reverse-phase high performance liquid chromatography was used to identify and quantify β-carotene, vitamin C and riboflavin. The findings showed that not all of the organically grown vegetables were higher in vitamins than that conventionally grown. This study found that only swamp cabbage grown organically was highest in β-carotene , vitamin C and riboflavin contents among the entire samples studied. The various nutrients in organically grown vegetables need to be analysed for the generation of a database on nutritional value which is important for future research.
Ambulatory blood pressure monitoring (ABPM) devices are increasingly being used in the assessment of hypertension. The purpose of the study was to investigate patient’s diurnal BP variation and to further determine the differences of BP readings between male and female patients and the effects of age in patients who attended the clinic with essential hypertension. In addition, evidence of relationship between the parameters recorded by 24-hour ABPM was also investigated. This study was conducted in an outpatient specialist clinic. Two indices were used to demonstrate the diurnal BP variation. Firstly, the diurnal systolic blood pressure (SBP) and diastolic blood pressure (DBP) variations which were calculated as night / day BP ratio for SBP and DBP respectively. Anyone scoring less than 100% were categorised as dippers. Secondly, nocturnal falls in SBP and DBP were calculated as (awake SBP-sleep SBP)/awake SBP x 100 and (awake DBP-sleep DBP)/awake DBP x 100 respectively. The results showed that there was no significant difference in the mean BP between male and female patients. In general, the study sample were categorised as dippers and non dippers. There were more male dippers than female dippers. Finally correlation analysis revealed that age is related to SBP variables whilst night HR showed positive correlation with night time BP. It is concluded that ABPM was shown to be a useful tool to analyse the variation and prevalence of cardiovascular risk markers in hypertensive patients and can easily be done in an outpatient set-up.
Aim: To reevaluate the psychometric characteristics of the Malay version of the Edinburgh Postnatal Depression Scale among a sample of postpartum Malay women attending the Bakar Bata Health Center in Alor Setar, Kedah, North West of Peninsular Malaysia. Materials and methods: 64 women between 4 to 12 weeks postpartum were recruited for there validation study. They were given questionnaires on socio-demography, the 21-item Malay version of the Beck Depression Inventory II (BDI-II) and the 10-item Malay version of the Edinburgh Postnatal Depression Scale (EPDS). All the participants were later interviewed using the Hamilton Depression Rating Scale (HDRS-17) and the Composite International Diagnostic Interview (CIDI). All diagnoses were made based on the Tenth Edition of the International Classification of Diseases (ICD-10) Results: 9 women (14.1%) were diagnosed to have significant depression (7 mild depressive episodes and 2 moderate epressive episodes according to ICD-10). EPDS was found to have good internal consistency (Cronbach alpha =0.86) and split half reliability (Spearman split half coefficient = 0.83). The instrument also showed satisfactory discriminant and concurrent validity as evidenced by the statistically significant difference in EPDS scores between the depressed group and their nondepressed counterparts (Mann Whitney U test: 2 tailed p value
MeSH terms: Demography; Depression; Depressive Disorder; Female; Humans; Malaysia; Psychiatric Status Rating Scales; Psychometrics; Surveys and Questionnaires; Reproducibility of Results; Statistics, Nonparametric; Depression, Postpartum; International Classification of Diseases; Postpartum Period
Quality of life measures are designed to enable patients’ perspectives on the impact of health and healthcare interventions on their lives to be assessed and taken into account in clinical decision-making and research. This paper discusses some approaches, methodological as well as interpretative issues of health related quality of life research.
MeSH terms: Clinical Decision-Making; Paper; Quality of Life; Research
The characteristics of foveal suppression (FS) in fixation disparity (FD) due to visual stress were investigated and their relationship’s between, age, symptoms, and the effect of temporary elimination of FD using prisms on the degree of the FS were analysed. Forty-five presbyopic subjects (15 without FD and 30 with stress related FD) participated in the study. The subjects underwent comprehensive optometric examination prior to the study. Their FS and FD were measured. The FD was later corrected with ophthalmic prisms, the power of which was equally divided between the eyes, and the FS was later verified. Age and FS had no significant correlation for subjects without FD (Spearman’s rs = 0.17, p = 0.55,NS) and in subjects with FD (rs = 2.49, p = 0.19, NS), respectively. Correlation between the degree of FS and FD was weak (rs=0.38, p=0.07), however the magnitude of FD significantly increased with age (r=0.27, p=0.04). Subjects with FD had significantly larger degree of FS compared with subjects without FD (Wilcoxon’s Z =-0.25, p=0.01). There was no significant difference in the magnitudes of FD (t = -0.38, p=0.07) and in their degrees of FS (Mann-Whitney U = 1.5, p=0.71) between subjects with and without symptoms. Correcting the FD with prisms generally reduced the degree of FS (Wilcoxon’s Z =1.96, p=0.04), however, significant change in FS only occured in subjects with symptoms (Z=-1.97, p=0.03), but was not significant in subjects without symptoms (Z=-0.70, p=0.48).
Road accident is ‘a global tragedy’ with ever-rising trend. The goal of this article includes review of the causes and nature of accidents, statistical data regarding road accidents and the economical impact. 1.17 million deaths occur each year worldwide due to road accidents 70 % of which occur in developing countries. 65% of deaths involve pedestrians, 35 % of which are children. Estimates suggest that 23-34 million people are injured worldwide every year in road crashes - a value almost twice that previously estimated. It is estimated that more than 200 U.S. citizens die each year due to road accidents abroad. Every year in Europe, more than 50,000 peoples are killed in road accidents, and more than 150,000 remain disabled. It is a sad fact that the total number of road accidents in Malaysia exceeded 223,000 in 1999. On the average, 16 persons died from these road accidents, every single day in 1999. Lack of attention, reckless driving, lack of proper protection, speeding, bad personal habits, social and behavioral misconduct and inconsiderate drivers of larger vehicles are some of the problems that cause accidents. In Malaysia, motorcycle fatal accidents (60%) warrant a high degree of concern. Young children and senior citizens are found to be in the vulnerable age group. In Malaysia, in 1999 alone, general insurers paid RM1.67 billion or an average of RM4.6 million a day on motor claims. It is now recognized that road traffic accidents represent a major public health problem, because of the high number of victims involved and because of the seriousness of the consequences for themselves and for their families.
Diabetes mellitus is the commonest cause of neuropathy worldwide. Diabetic neuropathy (DN) develops in about 4-10% of diabetic patients after 5 years and in 15% after 20 years.Four main mechanisms have been postulated to underlie the pathogenesis of DN. Diabetic neuropathy can be divided into symmetrical and asymmetrical neuropathies. Diabetic Autonomic Neuropathy (DAN) parallels the severity of DSN, and affects primarily the cardiovascular, gastrointestinal, genitourinary and integumentary systems. The cornerstone of treatment of diabetic neuropathy is optimization of glycaemic control. Future treatments for diabetic neuropathy should address the underlying pathogenesis.
MeSH terms: Blood Glucose; Diabetic Neuropathies; Humans; Integumentary System
Major sporting events in Asia are commonly staged in hot environments where the average daytime temperature is generally 29-31°C with the average relative humidity ranging from 80-95%. Exercise capacity and exercise performance are reduced when the ambient temperature is high and it has major implications for competitors as well as for spectators and officials. Prolonged exercise leads to progressive water and electrolyte loss from the body as sweat is secreted to promote heat loss. The rate of sweating depends on many factors and increases in proportion to work rate and environmental temperature and humidity. Sweat rates are highly variable and can exceed 2L.h-1 for prolonged periods in high heat. Since dehydration will impair exercise capacity and can pose a risk to health, the intake of fluid during exercise to offset sweat losses is important. Carbohydrate-electrolyte fluid ingestion during exercise has the dual role of providing a source of carbohydrate fuel to supplement the body’s limited stores and of supplying water and electrolytes to replace the losses incurred by sweating. The composition of the drinks to be taken will be influenced by the relative importance of the need to supply fuel and water which, is in turn depends on the intensity and duration of exercise activity, the ambient temperature and humidity. Carbohydrate-electrolyte solutions appear to be more effective in improving performance than plain water. There is no advantage to fluid intake during exercise of less than 30-minute duration. Complete restoration of fluid balance after exercise is an important part of the recovery process and becomes even more important in hot, humid conditions. If a second bout of exercise has to be performed after a elatively short interval, the speed of rehydration becomes of crucial importance. Rehydration after exercise requires not only replacement of volume losses, but also replacement of some electrolytes, primarily sodium. Studies show that rehydration after exercise can be achieved only if sweat electrolyte losses as well as water are replaced. Drinks with low sodium content are ineffective at rehydration and they will only reduce the stimulus to drink. Addition of small amount of carbohydrate to the rehydrating drinks may improve the rate of intestinal uptake of sodium and water and will improve palatability. The volume of the rehydration beverage consumed should be greater than the volume of sweat lost to provide the ongoing obligatory urine losses and palatability of the beverage is a major issue when a large volume of fluid has to be consumed.
MeSH terms: Asia; Beverages; Body Temperature Regulation; Carbohydrates; Dehydration; Drinking; Fluid Therapy; Hot Temperature; Humidity; Sodium; Sweat; Sweating; Temperature; Water; Water-Electrolyte Balance