OBJECTIVES: This study aimed to determine the level and factors contributing to burnout among doctors in Sana'a City, Yemen and to determine the relationship between burnout and psychological morbidity.
METHODS: This was a cross-sectional study of 563 working doctors in the four main hospitals in Sana'a City, Yemen. The 12-item version of the General Health Questionnaire (GHQ12) was used as a measure of psychological morbidity and the 22-item Maslach Burnout Inventory (MBI) was used to measure emotional exhaustion, depersonalization, and personal accomplishment. Sources of job stress were determined using a 37-item scale questionnaire. The questionnaire elicited information about socio-demographic and work characteristics.
RESULTS: On the MBI, 356 doctors showed high emotional exhaustion (63.2%), 109 showed high depersonalization (19.4%) and 186 showed low personal accomplishment (33.0%). Sixty six doctors (11.7%) were identified as experiencing a high degree of burnout (high emotional exhaustion and depersonalization and low personal accomplishment). The prevalence of high degree of burnout was significantly higher in those with duration of work or=40 h/wk (OR=2.1, 95% CI 1.25-3.62) and in those who had psychological morbidity (OR=5.3, 95% CI 2.22-12.39). Thirteen out of 37 sources of stress were significantly associated with high degree of burnout. In multivariate analysis, the significant predictors of high burnout were: dealing with patient's psychosocial problems, feeling of isolation, disturbance of home/family life by work, not chewing khat, long working hours and psychological morbidity.
CONCLUSION: The prevalence of high degree of burnout as well as emotional exhaustion in Yemeni doctors was higher than those reported internationally and was associated with psychological morbidity and many important sources of job stress.
OBJECTIVE:
Cervical HPV is the most common sexually transmitted disease among college-age women. This study aimed to assess knowledge and attitudes towards HPV infection, HPV vaccination and cervical cancer among female university students, to provide insight into development of HPV educational information.
STUDY DESIGN:
A cross-sectional survey using a convenience sample. A total of 1083 ethnically diverse female students attending a public university were approached and 650 were interviewed.
RESULTS:
Knowledge regarding HPV, HPV vaccination, cervical screening and cervical cancer risk factors was remarkably poor. Across the sample, the mean total knowledge score (14-item) was only 3.25 (S.D. +/-2.41; 95% CI 3.07-3.44). Only 10.3% had heard of the newly released HPV vaccine. Approximately 48% of participants indicated an intention to receive an HPV vaccine. Intention to receive an HPV vaccine was significantly associated with knowledge of HPV and genital warts (OR 1.53; 95% CI 1.25-1.88), and knowledge of cervical screening and cervical cancer risk factors (OR 1.21; 95% CI 1.11-1.33). Of those who refused HPV vaccination, 50.9% doubted the safety and efficacy of the new vaccine, and 41.5% perceived themselves as not at risk of HPV infection.
CONCLUSION:
The findings suggest that providing education about the etiology of cervical cancer and the HPV link is an essential component to enhance HPV vaccine uptake.
MeSH terms: Uterine Cervical Neoplasms/virology*; Condylomata Acuminata/prevention & control; Cross-Sectional Studies; Ethnic Groups*; Female; Humans; Interviews as Topic; Health Knowledge, Attitudes, Practice*; Malaysia; Patient Acceptance of Health Care; Patient Education as Topic; Students; Papillomaviridae/immunology; Papillomavirus Infections/prevention & control*; Asian Continental Ancestry Group/statistics & numerical data; Papillomavirus Vaccines*; Young Adult
A molecular docking tool of AutoDock3.05 was evaluated for its ability to reproduce experimentally determined affinities of various sialic acid analogues toward hemagglutinin of influenza A virus. With the exception of those with a C6-modified glycerol side chain, the experimental binding affinities of most sialic acid analogues (C2, C4 and C5-substituted) determined by viral hemadsorption inhibition assay, hemagglutination inhibition assay and nuclear magnetic resonance correlated well with the computationally estimated free energy of binding. Sialic acid analogues with modified glycerol side chains showed only poor correlation between the experimentally determined hemagglutinin inhibitor affinities and AutoDock3.05 scores, suggesting high mobility of the glutamic acid side chain at the glycerol binding pocket, which is difficult to simulate using a flexi-rigid molecular docking approach. In conclusion, except for some glycerol-substituted sialic acid analogues, the results showed the effectiveness of AutoDock3.05 searching and scoring functions in estimating affinities of sialic acid analogues toward influenza A hemagglutinin, making it a reliable tool for screening a database of virtually designed sialic acid analogues for hemagglutinin inhibitors.
MeSH terms: Hemagglutinins/metabolism*; Humans; Influenza, Human/metabolism*; Magnetic Resonance Spectroscopy; Influenza A virus/metabolism*; N-Acetylneuraminic Acid/metabolism*; Physical Processes
Several critical factors of an influenza microneutralization assay, utilizing a rapid biotin-streptavidin conjugated system for detecting influenza virus subtypes A and B, are addressed within this manuscript. Factors such as incubation times, amount of virus, cell seeding, sonication, and TPCK trypsin were evaluated for their ability to affect influenza virus neutralization in a microplate-based neutralization assay using Madin-Darby canine kidney (MDCK) cells. It is apparent that the amount of virus used in the assay is the most critical factor to be optimized in an influenza microneutralization assay. Results indicate that 100xTCID(50) of influenza A/Solomon Islands/03/2006 (H1N1) virus overloads the assay and results in no, to low, neutralization, in both ferret and macaque sera, respectively, whereas using 6xTCID(50) resulted in significantly improved neutralization. Conversely, strong neutralization was observed against 100xTCID(50) of B/Malaysia/2506/04 virus. In this manuscript the critical factors described above were optimized and the results indicate that the described biotin-streptavidin conjugated influenza microneutralization assay is a rapid and robust method for detecting the presence of functional, influenza virus-neutralizing antibodies.
MeSH terms: Animals; Antibodies, Viral/blood*; Biotin/pharmacology; Cell Line; Dogs; Ferrets; Fluorescent Dyes; Influenza Vaccines/immunology*; Macaca mulatta; Male; Neutralization Tests/methods*; Influenza B virus/immunology*; Sensitivity and Specificity; Staining and Labeling/methods; Streptavidin/pharmacology; Influenza A Virus, H1N1 Subtype/immunology*; Antibodies, Neutralizing/blood*
OBJECTIVES: To investigate the correlations and agreements between the solute/creatinine ratios from the 24-hour and early morning spot urine samples for metabolic evaluation in stone-formers given the various pitfalls with the 24-hour urinary metabolic evaluation in stone-formers.
METHODS: 30 urinary stone-formers out of an initial 62 recruited provided a complete 24-hour urine and early morning spot urine samples for metabolic evaluation. Pearson correlation and Bland and Altman Test were used to assess the correlations and agreements.
RESULTS: Significant correlations were established between the 24-hour urinary solute excretions and the corresponding early morning spot urine solute/creatinine ratios for calcium, magnesium, urate, potassium, oxalate, citrate, and the Differential Gibb's free energy value of calcium oxalate DG(CaOx) values. However, all these solute/creatinine measurements between the 24-hour and early morning spot urine samples were judged to be not within the acceptable limits based on the estimated "limit of agreement" by the Bland and Altman Test of Agreement. Diurnal circadian rhythm and postprandial excretion surge are thought to be responsible for the disagreements.
CONCLUSIONS: Thus, the early morning spot urine is not suitable to be used interchangeably to replace the 24-hour urine collection in the evaluation of urinary metabolic abnormalities in stone-formers. A good correlation does not translate to an agreement between the 2 measurements.
Recently, the increased demand of fructooligosaccharides (FOS) as a functional food has alarmed researchers to screen and identify new strains capable of producing fructosyltransferase (FTase). FTase is the enzyme that converts the substrate (sucrose) to glucose and fructose. The characterization of complex sugar such as table sugar, brown sugar, molasses, etc. will be carried out and the sugar that contained the highest sucrose concentration will be selected as a substrate. Eight species of macro-fungi will be screened for its ability to produce FTase and only one strain with the highest FTase activity will be selected for further studies. In this work, neural networks (NN) have been chosen to model the process based on their excellent 'resume' in coping with nonlinear process. Bootstrap re-sampling method has been utilized in re-sampling the data in this work. This method has successfully modeled the process as shown in the results.
BACKGROUND: Managed care is one of the means advocated for health care reforms. The Malaysian government has proposed managed care for its citizens. In the Malaysian private health care sector, managed care is practised on a small scale with crude risk adjustment. The main determinant of an individual's health service utilization is their health status (HS). HS is used as a risk adjuster for capitation payment. Prescribed medications represent a useful source for HS estimation. We aimed to develop and validate a medication-based HS estimate and to incorporate it in the Andersen model of health service utilization. This is a preparatory step in studying the feasibility of developing a model for risk assessment in the Malaysian context.
METHODS: Data were collected retrospectively from an academic year from computerized databases in University Sains Malaysia (USM) about users of USM primary care services. A user is a USM health scheme beneficiary who made at least one visit in the academic year to USM-assigned primary care providers. Socio-demographic variables, enrolment period, medications prescribed and number of visits were also collected. Chronic illness medications and some non-chronic illness medications were used to calculate the Long-Term Therapeutic Groups Index (LTTGI) which is an estimate of the HS of users. Using a random 50% of users, weighted least square methods were used to develop a model that predicts a user's number of visits. The other 50% were used for validation.
RESULTS: Socio-demographic variables explained 15% of variability in number of primary care visits among users. Adding the LTTGI improved the explanatory power of the model to 36% (P < 0.001). A similar contribution of the LTTGI was noted in the validation.
CONCLUSIONS: The Long-Term Therapeutic Groups Index was successfully developed. Variability in number of primary care visits can be predicted by LTTGI-based models.
MeSH terms: Adult; Ambulatory Care Facilities; Child; Child, Preschool; China/ethnology; Female; Forecasting; Health Status Indicators*; Hospitals, University; Humans; India/ethnology; Infant; Infant, Newborn; Long-Term Care; Malaysia; Malaysia/ethnology; Male; Managed Care Programs; Outpatient Clinics, Hospital; Drug Prescriptions*; Primary Health Care/utilization*; Retrospective Studies; Universities; Risk Assessment; Young Adult
Candidiasis is a term describing infections by yeasts from the genus Candida, and the type of infection encompassed by candidiasis ranges from superficial to systemic. Treatment of such infections often requires antifungals such as the azoles, but increased use of these drugs has led to selection of yeasts with increased resistance to these drugs. In this study, we used allicin, an allyl sulfur derivative of garlic, to demonstrate both its intrinsic antifungal activity and its synergy with the azoles, in the treatment of these yeasts in vitro. In this study, the MIC(50) and MIC(90) of allicin alone against six Candida spp. ranged from 0.05 to 25 microg/ml. However, when allicin was used in combination with fluconazole or ketoconazole, the MICs were decreased in some isolates. Our results demonstrated the existing synergistic effect between allicin and azoles in some of the Candida spp. such as C. albicans, C. glabrata and C. tropicalis, but synergy was not demonstrated in the majority of Candida spp. tested. Nonetheless, In vivo testing needs to be performed to support these findings.
Extraribosomal functions of human ribosomal proteins (RPs) include the regulation of cellular growth and differentiation, and are inferred from studies that linked congenital disorders and cancer to the deregulated expression of RP genes. We have previously shown the upregulation and downregulation of RP genes in tumors of colorectal and nasopharyngeal carcinomas (NPCs), respectively. Herein, we show that a subset of RP genes for the large ribosomal subunit is differentially expressed among cell lines derived from the human nasopharyngeal epithelium. Three such genes (RPL27, RPL37a and RPL41) were found to be significantly downregulated in all cell lines derived from NPC tissues compared with a nonmalignant nasopharyngeal epithelial cell line. The expression of RPL37a and RPL41 genes in human nasopharyngeal tissues has not been reported previously. Our findings support earlier suspicions on the existence of NPC-associated RP genes, and indicate their importance in human nasopharyngeal organogenesis.
The stress shielding effect is an event in which the replacement implant limits the load transferred to bone and the ineffective stress in the vertebrae causes bony growth to cease. In the present study, a 3D finite element L4-L5 model was developed and subjected to a 1200 N compression preload. Five groups of muscle forces were applied on L4 under flexion-extension, lateral bending and axial rotation. Topology optimisation was employed for reducing the stress shielding effect by removing the ineffective material from the design domain. The optimised design was designed with polyaryletheretherketone (PEEK) titanium and cortical materials to encounter the shielding response. The stress responses show that the new design increased the stress magnitude by at least 17.10, 18.11 and 18.43% in 4 Nm of flexion-extension, lateral bending and axial rotation, respectively. In conclusion, the material factor did not significantly alter the stress magnitude, but volume was the key factor in reducing the stress shielding effect.
MeSH terms: Humans; Lumbar Vertebrae*; Stress, Physiological*; Prostheses and Implants*; Finite Element Analysis
It has been suggested that potassium concentrations may vary between different geographical regions, possibly reflecting ethnic differences in potassium status. This study compared the serum potassium concentrations of three Asian ethnicities in a single geographical location.
MeSH terms: China; Cholesterol/blood; Creatinine/blood; Humans; India; Malaysia; Potassium/blood*; Triglycerides/blood; Linear Models; Asian Continental Ancestry Group/ethnology*
The effects of treatment processes on estrogenicity were evaluated by examining estradiol equivalent (EEQ) concentrations in influents and effluents of sewage treatment plants (STPs) located along Yeongsan and Seomjin rivers in Korea. The occurrence and distribution of estrogenic chemicals were also estimated for surface water in Korea and compared with seven other Asian countries including Laos, Cambodia, Vietnam, China, Indonesia, Thailand and Malaysia. Target compounds were nonylphenol (NP), octylphenol (OP), bisphenol A (BPA), estrone (E1), 17beta-estradiol (E2), 17alpha-ethynylestradiol (EE2) and genistein (Gen). Water samples were pretreated and analyzed by liquid-liquid extraction (LLE) and gas chromatography/mass spectrometry (GC/MS). The results showed that the treatment processes of Korean STPs were sufficient to reduce the estrogenic activity of municipal wastewater. The concentrations of phenolic xenoestrogens (i.e., NP, OP and BPA) in samples of Yeongsan and Seomjin rivers were smaller than those reported by previous studies in Korea. In most samples taken from the seven Asian countries, the presence of E2 and EE2 was a major contributor toward estrogenic activity. The EEQ concentrations in surface water samples of the seven Asian countries were at a higher level in comparison to that reported in European countries, America and Japan. However, further studies with more sampling frequencies and sampling areas should be carried out for better evaluation of the occurrence and distribution of estrogenic compounds in these Asian countries.
MeSH terms: Asia; Benzhydryl Compounds; Environmental Monitoring; Estradiol/analysis; Estradiol/chemistry; Estrogens/analysis*; Estrogens/chemistry; Estrone/analysis; Estrone/chemistry; Ethinyl Estradiol/analysis; Ethinyl Estradiol/chemistry; Geography; Phenols/analysis; Phenols/chemistry; Waste Disposal, Fluid; Water Pollutants, Chemical/analysis*; Water Pollutants, Chemical/chemistry; Genistein/analysis; Rivers/chemistry*; Republic of Korea
The production of beta-mannanase from palm kernel cake (PKC) as a substrate in solid substrate fermentation (SSF) was studied using a laboratory column bioreactor. The simultaneous effects of three independent variables, namely incubation temperature, initial moisture content of substrate and airflow rate, on beta-mannanase production were evaluated by response surface methodology (RSM) on the basis of a central composite face-centered (CCF) design. Eighteen trials were conducted in which Aspergillus niger FTCC 5003 was cultivated on PKC in an aerated column bioreactor for seven days under SSF process. The highest level of beta-mannanase (2117.89 U/g) was obtained when SSF process was performed at incubation temperature, initial moisture level and aeration rate of 32.5 degrees C, 60% and 0.5 l/min, respectively. Statistical analysis revealed that the quadratic terms of incubation temperature and initial moisture content had significant effects on the production of beta-mannanase (P < 0.01). A similar analysis also demonstrated that the linear effect of initial moisture level and an interaction effect between the initial moisture content and aeration rate significantly influenced the production of beta-mannanase (P < 0.01). The statistical model suggested that the optimal conditions for attaining the highest level of beta-mannanase were incubation temperature of 32 degrees C, initial moisture level of 59% and aeration rate of 0.5 l/min. A beta-mannanase yield of 2231.26 U/g was obtained when SSF process was carried out under the optimal conditions described above.
The cranial suspensory ligament (CSL) is a fibromuscular structure anchoring the embryonic gonad to the posterior abdominal wall in male and female mammals. Its persistence in females is believed to be responsible for retaining the ovaries within the abdomen, while its regression in males permits testis descent. Embryonic loss of the CSL in males is believed to be an androgen-dependent event, and failure of this process has been proposed as a cause of cryptorchidism. The present study demonstrates that the nuclei of mesenchymal cells in the caudal part of the CSL are immunoreactively positive for androgen receptor. We examined the effects of exposure of the non-steroidal antiandrogen flutamide during the period from gestational day 10 to birth on the development of the CSL and on testis descent. Exposure of male Albino Swiss rats to the antiandrogen flutamide during this period resulted in feminization of the external genitalia and the suppression of growth of the testes and male reproductive tracts. In adulthood, testes were found to be located in diverse positions including normal scrotal (50%), intra-abdominal (10%) and ectopic suprainguinal (40%). The CSL of the testis persisted into adulthood in all flutamide-treated males, regardless of testis location. In all cases, the ligament consisted of bundles of smooth muscle fibres in the retroperitoneal fat of the posterior abdominal wall. These findings suggest that androgen blockade during embryonic development interferes with testicular descent, but that maldescent cannot be correlated with either the persistence of the CSL of the testis or its structure.
This paper examines the factors that might influence recycling behaviour of the households in Dhaka city, Bangladesh. Information on recycling activity, socio-economic characteristics, and attitudes of the households towards recycling were obtained from interviews with 456 households in Dhaka. Logistic regression analysis was used to determine the dominant factors that might influence the recycling behaviour of the households. The results showed that environmental consciousness, the availability of storage space, and age (25-35 years) are significant positive predictors of recycling behaviour (at the 1% level). Another variable Income 2 (TK3,000-15,000) is also positively correlated with recycling (at the 5% level). Establishment of a recycling programme could be an effective strategy in implementing sustainable waste management in Bangladesh. For this strategy to succeed, however, active partnership between households and the waste management service department is required. The households' attitudes toward recycling should, therefore, be taken into consideration as should the results of this study, which are important indicators of households' positive attitudes toward sustainable waste management in Dhaka.
Neonatal neoplasms are rare tumours notorious for their atypical presentation and unpredictable behaviour. Their optimal treatment remains uncertain, a dilemma compounded by the deleterious effects of adjuvant chemo- or radiotherapy during this vulnerable period of growth. This paper examined the relatively high incidence of these tumours and its impact on paediatric surgery in Malaysia.
Objective: To determine the prevalence of dysmenorrhea, its impact, and the treatment-seeking behavior of adolescent Asian girls.
Method: A cross-sectional study with 1092 girls from 15 public secondary schools and 3 ethnic groups in the Federal Territory of Kuala Lumpur, Malaysia.
Results: Overall, 74.5% of the girls who had reached menarche had dysmenorrhea; 51.7% of these girls reported that it affected their concentration in class; 50.2% that it restricted their social activities; 21.5% that it caused them to miss school; and 12.0% that it caused poor school performance. Ethnicity and form at school were significantly associated with the
poor concentration, absenteeism, and restriction of social and recreational activities attributed to dysmenorrhea. Only 12.0% had consulted a physician, and 53.3% did nothing about their conditions. There were ethnic differences in the prevalence, impact, and management of dysmenorrhea.
Conclusion: There is a need for culture-specific education regarding menstruation-related conditions in the school curriculum.
MeSH terms: Adolescent; Cross-Sectional Studies; Dysmenorrhea/ethnology; Dysmenorrhea/psychology*; Dysmenorrhea/therapy; Female; Humans; Malaysia/epidemiology; Menstruation/psychology; Patient Acceptance of Health Care; Premenstrual Syndrome/ethnology; Premenstrual Syndrome/psychology; Prevalence; Asian Continental Ancestry Group; Young Adult
In Penang, Malaysia, the Oriental and Afrotropical Megaselia curtineura (Brues) and the Oriental and Japanese Megaselia spiracularis Schmitz are reported from human corpses, these being the first reports of these species in such forensic cases.