Public health nursingis a specialized nursing combining both nursing and public health principles with the primary focus of improving the health of the whole community rather than just an individual. Its documented history started in the 1800s and has evolved from home visiting to the varied settings that public health nurses find themselves working in as members of public health teams in clinics, schools, workplaces and government health departments.Public health nursing has been a critical component of the country’s health care system, uplifting of the health status of Malaysians and playing a dominant role in the fight against communicable diseases, and is set to face the challenges of the 21st century with public health nurses practising to the full capacity of their training in a restructured Malaysian health system – 1Care for 1Malaysia. The health sector reform allows for optimisation of scarce health care resources to deliver expansion of quality services based on needs, appropriateness, equity &allocative efficiency. The proposed model will be better than the current system, preserving the strengths of the current system but able to respond to increasing population health needs and expectations. There will be increased autonomy for healthcare providers with incentives in place for greater performance. Some of the implications of reform include allowing public- private integration, a slimmer Ministry of Health with a stronger governance role, enhancing the gatekeeping role of the primary care providers and the autonomous management of the public healthcare providers. In this restructured health system, the roles of the public health nurses are no less important than in the current one. In fact, with the increasing emphasis placed on prevention and primary care as the hub of community care with nurses as part of the primary care team delivering continuous comprehensive person-centered care,public health nurses in the future will be able to meet the challenge of refocusing on the true mission of public health: to look at the health problems of a community as a whole and work with the community in alleviating those problems by applying the nursing process to improve health, not just as providers of personal care only.
MeSH terms: Malaysia; Nursing Care; Primary Health Care; Public Health
Citation: Mohamad Noh K, Jaafar S. Health in all policies: The primary health care approach in Malaysia. 50-years experience in addressing social determinants of health through Intersectoral Action for Health. World Conference on Social Determinants of Health. 19-21 October 2011, Rio de Janeiro, Brazil.
At Independence in 1957, Malaysia inherited a rural urban divide and racial identification of specific economic functions. Thus, the government’s welfarist policy was on growth with equity. This entailed the formulation of national social policies to reduce poverty and at the same time to restructure society by addressing economic imbalances and eventually eliminating racial identification of specific economic functions. The poverty reduction approaches placed a strong emphasis on rural socio-economic development addressing the social determinants of health. This approach has served Malaysia well over the decades but since the 1990s Malaysia has been caught in a middle income trap. Realising that achieving a high income nation status by 2020 is not possible at the present economic trajectory, Malaysia has now embarked on a national transformation agenda based on the four pillars of inculcating the cultural and societal values under the 1Malaysia Concept and the twin commitments of people first in all policies & projects and performance now; a government transformation programme (GTP); macroeconomic policies under the economic transformation programme (ETP); and the operationalisation of these policies through the 10th Malaysia Plan. The highest political commitment is given to the implementation of these national policies by the various agencies, orchestrated and coordinated by a central planning process which cascades down to the state and district administrative levels of the government machinery. The health policies follow these national policies and the thrust of the Malaysian health care system is primary health care, supported by an inclusive referral system to decentralized secondary care and regionalized tertiary care. This model of comprehensive public primary health care delivers promotive, preventive, curative and rehabilitative care across the life course. The network of static health facilities is organized into a two-tier system which includes outreach services for remote areas. Community participation is encouraged through village health promoters, health volunteers and advisory panels. The primary health care approach has delivered increased access to health care at a relatively low-cost. This has translated into health gains for the Malaysian population comparable with countries of similar economic development. As Malaysia moves towards a high income nation status, as demographic and epidemiological transitions continue, and as new health technology develops, the demand for health care by the - Draft Background Paper 7 - 2 population will continue to rise with increasing expectations for more care of even higher quality, and at ever increasing cost. This is especially challenging as Malaysia’s open economy is yet to recover fully from the Asian financial crisis of 1997. The government transformation programme, with its focus on a whole-of-government approach, is a natural progression for the primary health care approach to addressing the social determinants of health as a vehicle for social justice to reduce health inequalities.
MeSH terms: Malaysia; Primary Health Care; Social Determinants of Health
Citation: Md Gowdh NF, Sivasampu S, Lim TO, Abdullah NH. National healthcare establishments and workforce statistics (primary care) 2008-2009. Kuala Lumpur: Clinical Research Centre, Ministry of Health, Malaysia
MeSH terms: Ambulatory Care Facilities; Health Facilities*; Malaysia
The steady two-dimensional stagnation point flow of an incompressible viscous and electrically conducting fluid, subject to a transverse uniform magnetic field, towards a stretching sheet is investigated. The governing system of partial differential equations are transformed to ordinary differential equations, which are then solved numerically using a finite difference scheme known as the Keller-box method. The effects of the governing parameters on the flow field and heat transfer characteristics are obtained and discussed. It is found that the heat transfer rate at the surface increases with the magnetic parameter when the free stream velocity exceeds the stretching velocity, i.e. ε>1, and the opposite is observed when ε<1.
Ujian Alexander-Govern merupakan ujian kesamaan sukatan memusat yang teguh pada keadaan varians heterogen. Malangnya ujian ini tidak teguh pada keadaan data tidak normal. Adaptasi penganggar teguh seperti penganggar M satu langkah terubah suai (MOM) sebagai sukatan memusat menggantikan min didapati berupaya meningkatkan keteguhan ujian ini apabila dijalankan pada data terpencong. Penganggar ini mempunyai kelebihan berbanding min kerana tidak dipengaruhi oleh data yang tidak normal. Kajian ini mendapati bahawa ujian Alexander-Govern yang telah diubah suai ini berupaya mengawal Ralat Jenis I dengan baik pada data terpencong untuk semua keadaan. Kadar Ralat Jenis I yang dihasilkan kebanyakannya berada di dalam selang kriteria teguh ketat (0.045 hingga 0.055) pada aras keertian 0.05. Berbeza dengan kaedah pengujian asal yang mana pada kebanyakan keadaan, ujian teguh tetapi hanya dengan kriteria liberal (0.025 hingga 0.075), malahan ada kedaan yang mana ujian tidak teguh. Prestasi kaedah yang diubah suai ini juga setanding dengan keadah asal pada keadaan data normal. Kajian ini juga membandingkan kaedah Alexander Govern yang diubah suai dengan kaedah pengujian klasik seperti ujian-t dan ANO VA dan menyaksikan bahawa kaedah klasik tidak teguh pada keadaan varians heterogen.
A sensor incorporating a three electrodes configuration have been fabricated using low cost screen-printing technology. These electrodes couples with Square Wave Stripping Voltammetry (SWSV) has provided a convenient screening tool for on-site detection of trace levels of Pb(II), Cd(II) and Cu(II). Modification of the graphite carbon surface based on in situ deposition of mercury film has been carried out. By appropriate choice of supporting medium and optimized parameters setting such as amount of mercury used the deposition potential, deposition time, frequency and scan rate, well resolved and reproducible response for Pb(II), Cd(II) and Cu(II) were obtained. The performance characteristics of the developed mercury film screen printed carbon electrode (MFSPCE) for 120 s deposition time showed that the linear range for Cd(II), Pb(II) and Cu(II) were 10 to 200 μg L-1. The detection limit recorded for Cd(II), Pb(II) and Cu(II) were 2, 1 and 5 μg L-1 with relative standard deviation (RSD) of 6.5%, 6.9% and 7.5%, respectively. Successful applications of the sensing device to waste-water and extracted soil samples were demonstrated.
Bone formation has been associated with the presence of an enzyme called alkaline phosphatase (ALP). This longitudinal study was carried out to observe its activity in gingival crevicular fluid (GCF) during leveling and alignment stage of orthodontic fixed appliance treatment. Fourteen patients between the ages of 15 and 27 years old with moderate upper labial segment crowding were recruited from postgraduate orthodontic clinic. GCF from mesial and distal sites of upper canines were collected using endodontic paper point before the fixed appliance placement (week 0). The baseline level of ALP (week 0) acted as a control. Samplings of GCF were repeated at 1st, 2nd and 3rd week during orthodontic treatment. The activities of ALP were measured using spectrophotometer (405 nm). Paired sample t-test was used to assess the significance of difference over the 3 weeks. Although the results showed patterns of ALP activities on the test teeth throughout the 3 weeks of leveling and alignment stage, however the results were not significant (p >0.05) when compared to control. Therefore, it has been shown that there was no significant pattern of ALP activities in GCF in patients undergoing leveling and alignment stage of orthodontic treatment.
Nipah virus has been identified as the causative agent responsible for an outbreak of fatal human viral encephalitis in Malaysia and Singapore in 1998 to 1999. In vitro replication assays with Nipah virus minigenome carrying CAT gene (chloramphenicol acetyltransferase) has been developed without the use of infectious virus to allow further study of the replication of Nipah virus in vitro. It has been reported that the viral RNA replication and transcription activity of paramyxoviruses are controlled by essential sequences located in the terminal regions of viral genomic and antigenomic RNAs. In this study, single base substitution was carried out on the Nipah virus minigenome separately at the three guanine residues (G) located in positions 79, 85 and 91 of the leader promoter within the 5’ non-translated region (NTR) of the nucleocapsid gene (N) mRNA region. The guanine residues of these positions were substituted with the cytosine (C) or adenine (A) residue, respectively by using the overlapping PCR-mediated mutagenesis method. The resultant mutants containing the desired point mutation were confirmed by sequencing. The mutants were analyzed to determine the effect of substitution mutation on the viral transcription activity of the minigenome. It was found that the substitution of G at positions 79 and 85 decreased the efficiency of transcription of Nipah virus minigenome while the substitution of G at position 91 did not. Our findings also showed that the effect of transition mutation gave more impact than the transversion mutation in term of suppression effect upon the transcription activity of minigenome.
A total of eight strains of Lactobacillus and two strains of Salmonella were isolated from free-range Malaysian chickens intestine. Evaluation based on in vitro studies included aggregation, co-aggregation, growth with bile salts, tolerance to acidic pH, and inhibitory activity were carried out. The isolated Lactobacillus were Lactobacillus fermentum IA, Lactobacillus fermentum IB, Lactobacillus fermentum IC, Lactobacillus fermentum ID, Lactobacillus salivarius subsp. salicinus IE, Lactobacillus salivarius subsp. salicinus IF, Lactobacillus salivarius subsp. salivarius IG, and Lactobacillus spp. IH. The corresponding isolated Salmonella were Salmonella spp. 3B21 and Salmonella spp. 1A12. The ability of aggregation and also tolerance to pH 2.5 are found in Lactobacillus fermentum ID, Lactobacillus salivarius subsp. salicinus IF, Lactobacillus salivarius subsp. salivarius IG, and Lactobacillus spp. IH. The isolate most resistance to 1% bile salts is Lactobacillus fermentum ID but observed to be weak in inhibitory activity against Salmonella spp. The best co-aggregation and strongest inhibitory activity against Salmonella spp. was observed in Lactobacillus salivarius subsp. salivarius IG. Despite being not so resistant in the presence of bile salts 0.5 and 1% (w/v), the lag time in the presence of bile salts 0.3% (w/v) of Lactobacillus salivarius subsp. salivarius IG and also for Lactobacillus spp. IH are the shortest. Based on good aggregation properties, the best co-aggregation, tolerance to acidic pH 2.5 and bile salts 0.3% (w/v) and strongest inhibitory activity against Salmonella spp., Lactobacillus salivarius subsp. salivarius IG comes out as the best candidate as probiotic for chicken.
MeSH terms: Acids; Animals; Bile Acids and Salts; Biological Phenomena; Chickens; Intestines; Lactobacillus; Salmonella; Probiotics; Lactobacillus fermentum; Lactobacillus salivarius
A quantitative analysis has been conducted to determine the concentration of ammonium (NH4+) ion in solution by using Ultraviolet-visible spectrophotometry method and artificial neural network (ANN). Riegler’s reagent was used to form Riegler-NH4+ complex. The characterisations of Riegler’s reagent in solution such as photostability, pH effect, reagent concentration, dynamic range and reproducibility were conducted. The colour change of the Riegler’s reagent after reaction with NH4+ was yellow to red. The Riegler’s reagent responds linearly to NH4+ ion concentration in the range of 1-7 ppm with optimum response at pH7. Satisfactory reproducibility (2.0-2.8%) were obtained with this reagent. The effect of interfering ions that may contain in the leachate on the determination of NH4+ ion was also studied. The application of ANN enabled the extension of the useful dynamic concentration range of NH4+ ion to 1–24 ppm. The best ANN architecture for Riegler-NH4+ complex was built from 29 hidden neurons, 21,389 epochs number and 0.001% learning rate which produced sum square error (SSE) value of 0.0483 with an average calibration error of 1.4136.
The aqueous extract of Prismatomeris glabra root has been used traditionally in Malaysia by the aborigines and certain rural Malays for its ergogenic effects, to maintain wellness and to enhance physical stamina. It has also been used as an aphrodisiac for generations in the east coast of Peninsular Malaysia. Previous studies have shown that plants with ergogenic effects may also act as a stimulant and impair cognitive function. Therefore, we seek to investigate the effects of P. glabra on non-spatial memory in male Sprague Dawley rats using object recognition test. Trial rats were injected intraperitoneally with an aqueous extract of P. glabra roots at doses of 50 and 100 mg/kg for the acute (30 min) and subacute (7 days) studies. Scopolamine (0.3 mg/kg) was used as a positive control only in the acute study meanwhile control rats were injected with saline. The locomotor activity of rats was also determined in the same test. We demonstrated that groups treated with 50 and 100 mg/kg of the extract lost their ability to discriminate the novel from familiar object in choice phase and did not alter the locomotor activity in both studies. Our results also indicated that the deficits in non-spatial working memory occured at these doses were not due to impaired locomotor activity.
This study examined the genetic characteristics of twenty-six microsatellite primers developed from three cyprinid fishes (Cyprinus carpio Linnaeus, Barbus barbus Linnaeus and Barbonymus gonionotus Bleeker) in two indigenous mahseer. The Tor douronensis Valenciennes were randomly collected from two locations in Sarawak (N=52), while Tor tambroides Bleeker were obtained from Peninsular Malaysia (N=56). A total of ten and twelve primers were successfully amplified producing four and five polymorphic loci in T. douronensis and T. tambroides, respectively. The number of alleles per locus ranging from 2 to 5 in T. douronensis and 2 to 7 in T. tambroides. A significant deviation from Hardy-Weinberg equilibrium (HWE) was observed at three loci (Barb37, Barb59 and Barb62) in one or more populations in T. tambroides while two loci (Barb37 and Barb62) were deviated in T. douronensis population of Batang Ai. Population structure analysis showed low level of inter-population genetic differentiation in both mahseer. Overall, the identified microsatellite loci should be useful in analysing T. douronensis and T. tambroides natural populations.
In this paper we investigated the concentrations of Pb in seven different soft tissues (foot, cephalic tentacles, mantle muscle, gill, digestive caecum and remaining soft tissues) of 17 geographical populations of Telescopium telescopium collected from the intertidal area of Peninsular Malaysia. Two points can be presented based on the present study. First, as expected, different concentrations of Pb were found in the different soft tissues, indicating different mechanisms of bioaccumulation and regulations of Pb in these different tissues. By comparing the Pb concentrations in the similar tissues, spatial variation of Pb was found in the different sampling sites although there is no consistent pattern of Pb contamination in these sampling sites. Second, based on the correlation coefficients and multiple linear stepwise regression analysis between Pb concentrations in the different soft tissues and Pb concentrations in geochemical factions in the surface sediments, it is found that gill and digestive caecum can truly reflect Pb contamination and Pb bioavailabilities in the tropical intertidal mudflats. To our knowledge, this is the most comprehensive study on Pb in the different soft tissues of T. telescopium, in relation to the habitat sediments of the snails.