Citation: Savedoff WD, Smith AL. Achieving Universal Health Coverage: Learning from Chile, Japan, Malaysia and Sweden. Maine, United States: Result for Development Institute; 2011
Over the last hundred years, most countries have made substantial progress toward universal health coverage. The shared trends includes rising incomes, increasing total health expenditures and an expanding role for government in improving access to health care. Despite this, countries vary significantly in their particular routes to universal health coverage. These routes are shaped by prominent leaders and strong popular movements and framed by particular moral claims and world views. They are affected by unpredictable events related to economic cycles, wars, epidemics and initiatives in other public policy spheres. They are also influenced by a country’s own institutional development and experiences in other countries. As a result of these highly contingent paths, countries reach universal health coverage at different income levels and with disparate institutional arrangements for expanding health care access and mitigating financial risk. This paper examines the histories of attaining universal health coverage in four countries – Sweden, Japan, Chile and Malaysia. It shows that domestic pressures for universalizing access to health care are extremely varied, widespread, and persistent. Secondly, universal health coverage is everywhere accompanied by a large role for government, although that role takes many forms. Third, the path to universal health coverage is contingent, emerging from negotiation rather than design. Finally, universal health coverage is attained incrementally and over long periods of time. These commonalities are shared by all four cases despite substantial differences in income, political regimes, cultures, and health sector institutions. Attention to these commonalities will help countries seeking to expand health coverage today.
In the past decade, numerous studies on mood problems following stroke have emerged with an emphasis on posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD). This systematic review is intended to investigate the relationship between stroke and PTSS. We searched the following databases: SCOPUS, ISI Web of Knowledge, EMBASE, MEDLINE, CIHANL, AMED and PsyhINFO and retrieved the relevant titles and abstracts. Cross-sectional, longitudinal and predictive studies were included. These studies included patients of any age and of either gender with a diagnosis of stroke who were screened for PTSD or PTSS and must be written in English. A total of 108 articles were retrieved from the search. After reviewing the titles and abstracts, 104 were excluded for not meeting the predetermined inclusion criteria. A total of four studies were considered for this review. The results showed that 21%-31% of stroke patients experienced PTSS and 9.8% met the criteria for PTSD. Therefore, it is important to study PTSS in stroke patients since its would be interesting to define its role in the prediction of recovery from stroke.
This study aimed to investigate the usage of behavioural cognitive approach in group counselling on social anxiety among adolescents in Malaysia. This study also identified social anxiety sympthoms and social situations that cause anxiety among them. A total of 72 secondary school students of one of the secondary schools in Terengganu participated in this experiment study. Data was analysed using descriptive statistics and ANOVA test. Results revealed that there was a significant difference in the mean score of Social Anxiety Scale for Adolesence – SAS-A in the post test between the control and treatment group, F(1,70) =1.068, p
The aim of this study is to measure the validity and reliability standard of Basic Needs questionnaire designed by William Glasser. This study also attempts to determine if the Basic Needs questionnaire has the high validity and reliability criteria suitable to be applied in Malaysia. Five expert panels from the counseling discipline and 119 students from two different schools were chosen for group sampling. The instrument used in this study was the questionnaire with 85 items among 5 subscale category. The data was analyzed using cronbach alpha and test-retest analysis. The result showed that half of the items in this instrument were of significantly higher quality. In the first phase, the needs coefficient scores .885. and the second phase the coefficient scored is .899. In general, the result proves that this instrument possesses a high validity and reliability standard for application in Malaysia. Several implications and suggestions are also proposed.
MeSH terms: Counseling; Humans; Malaysia; Surveys and Questionnaires; Schools; Students; Reproducibility of Results
The aim of this study was to examine the expectations about counselling among the Orang Asli students in secondary schools in the Cameron Highlands district of Malaysia. Data was collected using the Expectations about Counselling Questionnaire which was distributed to 436 respondents. The findings showed that the expectations of counselling sessions among the Orang Asli students were high (mean= 4.605, 79%). The counsellor expertise factor was the most dominant (mean=4.84, 69.14 %). It was found that the expectations about counselling among the Orang Asli students were significant between the expectation dimension (personal commitment, facilitative conditions, counsellor expertise, and counsellor nurturance) and the variables of gender, age and client status. There was no significant relationship between their expectations and the religion and residence variables. In conclusion, this study was successful in giving a general picture about the students’ expectations of counselling sessions.
MeSH terms: Adolescent; Counseling*; Cross-Sectional Studies; Humans; Malaysia; Schools; Asian Continental Ancestry Group
Artikel ini memerihalkan pembelajaran tingkah laku usahawanan di Malaysia dalam konteks kognitif sosial untuk transformasi negara bagi memungkinkan kesejahteraan psikologi, meningkatkan kualiti hidup dan menjayakan pembangunan negara yang mampan. Dengan demikian, sorotan literatur ini, menggambarkan kesesuaian kognisi sosial untuk membekalkan satu kerangka konsep bagi memupuk individu ke arah menjadi usahawanan yang berkemampuan. Selain itu, cabaran yang dihadapi dalam mendidik usahawanan dan saranan berkaitan juga dibincangkan dalam konteks kognitif sosial .
Personal ups and downs are appropriate responses to the ups and downs of life. However, some experiences emotional extremes in moods and disturbed their normal life. Individuals who have depression at times and mania or hypomania at others are called manic-depressive; and the combination is known as manic-depressive psychosis (MDP). This paper attempts to look at manic-depressive psychosis (MDP) from the western approaches as well as from the Islamic point of view. The treatments proposed by both streams are also provided.
This initial study was conducted from September to February 2009 to examine predictors of general well-being among academic college residents at a higher learning institution. A set of questions was sent to 150 students who identified themselves as residents of the academic college, Universiti Kebangsaan Malaysia. The Eysenck Personality Questionnaire - short version was used to measure personality traits.The Rosenberg Self-esteem Questionnairewas used to measure self-esteem and Satisfaction with Life Scale to measure life-satisfaction. The general well-being scale was used to measure general well-being. Inter-correlation analysis has shown that extraversion was significantly correlated to self-esteem, life-satisfaction and general well-being whilst life-satisfaction was significantly correlated to general well-being. Multiple regression analysis showed that three factors significantly contributed to general well-being with a 24% explained variance. No significant differences were found between gender and general well-being.
Citation: National Health Morbidity Survey 2011. Kuala Lumpur: Institute for Public Health, Ministry of Health, Malaysia, 2011
Study name: National Health and Morbidity Survey (NHMS-2011)
Volume I: Methodology and General Findings.
http://iku.gov.my/images/IKU/Document/REPORT/NHMS2011-VolumeI.pdf
Volume II: Non-Communicable Diseases
http://iku.gov.my/images/IKU/Document/REPORT/NHMS2011-VolumeII.pdf
Volume III: Healthcare Demand and Out-of-pocket Health Expenditure http://iku.gov.my/images/IKU/Document/REPORT/NHMS2011-VolumeIII.pdf
MeSH terms: Cross-Sectional Studies; Health Surveys; Humans; Malaysia
INTRODUCTION: Tobacco smoking is a leading cause of premature death and disability, and over 80% of the world's smokers live in low- or middle-income countries. The objective of this study is to assess demographic and socioeconomic determinants of current smoking in low- and middle-income countries.
METHODS: We used data, from the World Health Survey in 48 low-income and middle-income countries, to explore the impact of demographic and socioeconomic factors on the current smoking status of respondents. The data from these surveys provided information on 213,807 respondents aged 18 years or above that were divided into 4 pooled datasets according to their sex and country income group. The overall proportion of current smokers, as well as the proportion by each relevant demographic and socioeconomic determinant, was calculated within each of the pooled datasets, and multivariable logistic regression was used to assess the association between current smoking and these determinants.
RESULTS: The odds of smoking were not equal in all demographic or socioeconomic groups. Some factors were fairly stable across the four datasets studied: for example, individuals were more likely to smoke if they had little or no education, regardless of if they were male or female, or lived in a low or a middle income country. Nevertheless, other factors, notably age and wealth, showed a differential effect on smoking by sex or country income level. While women in the low-income country group were twice as likely to smoke if they were in the lowest wealth quintile compared with the highest, the association was absent in the middle-income country group.
CONCLUSION: Information on how smoking is distributed among low- or middle-income countries will allow policy makers to tailor future policies, and target the most vulnerable populations.
Study name: World Health Survey (Malaysia is a study site)
MeSH terms: Adolescent; Adult; Aged; Female; Health Surveys/statistics & numerical data*; Humans; Male; Middle Aged; Smoking/economics*; Smoking/epidemiology*; Socioeconomic Factors*; Global Health*; Age Distribution; Young Adult
The present study aimed to examine and compare results from two questionnaire pretesting methods (i.e., behavioral coding and cognitive interviewing) in order to assess systematic measurement bias in survey questions for adult smokers across six countries (USA, Australia, Uruguay, Mexico, Malaysia and Thailand). Protocol development and translation involved multiple bilingual partners in each linguistic/cultural group. The study was conducted with convenience samples of 20 adult smokers in each country. Behavioral coding and cognitive interviewing methods produced similar conclusions regarding measurement bias for some questions; however, cognitive interviewing was more likely to identify potential response errors than behavioral coding. Coordinated survey qualitative pretesting (or post-survey evaluation) is feasible across cultural groups, and can provide important information on comprehension and comparability. Cognitive interviewing appears a more robust technique than behavioral coding, although combinations of the two might be even better.
Noninvasive imaging of coronary artery disease is rapidly replacing angiography as the first line of investigation. Multislice CT is the non-invasive modality of choice for imaging coronary artery disease and provides high speed with good spatial resolution. CT coronary angiography in addition to detecting and characterising atherosclerotic coronary artery disease is also a good imaging tool for evaluating anomalies of coronary arteries. Superdominant right coronary artery with absent left circumflex artery is one such rare coronary artery anomaly which is well evaluated with multislice CT angiography. The authors report one such case of superdominant right coronary artery with absent left circumflex artery imaged with 64-slice MDCT.
Knowledge of muscular, vascular, and neural variations in the axilla is of great clinical importance, especially in mastectomies, breast reconstruction, and axillary bypass operations. In the present paper, we report unilateral variations observed in the axillary region of a male cadaver. A fibromuscular axillary arch was observed on the right side. On the same side, there was a bifurcated axillary vein; a medial cutaneous nerve of the arm passed through and later ran beneath this axillary vein. In addition, the intercostobrachial nerve was absent on the right side. The clinical significance of the variations observed and their embryological basis are discussed in this paper.
Foreign bodies are a common problem seen in otolaryngological practice. Of the reported foreign bodies, metallic foreign bodies are a rare entity. One of the least common complications of foreign body ingestion is penetration and migration. We describe a case of a migrating metallic foreign body in a 50-year-old woman with a history of accidental ingestion causing odynophagia. In the present case, the foreign body migrated extraluminally into the carotid sheath. Our review of literature revealed that few such cases have been reported.
Inflammation of the gallbladder without evidence of calculi is known as acute acalculous cholecystitis (AAC). AAC is frequently associated with a poor prognosis and a high mortality rate. Thus, early diagnosis and prompt surgical intervention has been recommended to improve the outcome of AAC. Herein, I present a case report of AAC complicating laparoscopic appendicectomy. Unlike previous studies that have reported the need for urgent intervention in patients with AAC, in this study, our patient responded to conservative management. Therefore, the management of AAC after laparoscopic appendicectomy should be individualised.
Phaeohyphomycosis consists of a heterogeneous group of fungal infections caused by more than 80 genera and species. Subcutaneous infection usually follows traumatic implantation of a fungus by a wooden splinter that the fungus inh abits as a saprophyte. The growth of the fungus forms verrucous plaques or a painless subcutaneous abscess. We report a subcutaneous cyst (phaeomycotic cyst) in the leg of a 60-year-old woman that developed after a thorn prick at that site. With the provisional diagnosis of an epidermoid cyst, she was treated with a simple excision of the cyst. However, histopathological examination of the cyst revealed the typical features of fungus, and a definitive diagnosis of a phaeomycotic cyst was made. As the infective aetiology was not considered clinically, the specimen was not sent for microbiological culture, and hence the exact species was not identified. As the lesion was localised, simple excision was sufficient treatment, and no recurrence was observed during 12 months of follow-up.
Respiratory fungal infections are usually found in immunocompromised individuals who have received either long-term steroid therapy or broad-spectrum anti-microbial therapy or have a non-resolving underlying chronic disease. These infections are seen as a part of bronchopulmonary fungal infections, and their isolated and primary occurrence as laryngeal diseases is highly uncommon. Laryngeal fungal infections can also mimic various diseases, such as gastroesophageal reflux disease, granulomatous diseases, leukoplakia, and carcinoma, thereby misleading the treating team from correct diagnosis and management. It is therefore important to identify the lesion at the earliest point possible to avoid morbid or life-threatening consequences. We report a case of isolated laryngeal candidiasis in an immunocompetent Indian male with an unusual presentation mimicking laryngeal carcinoma. The clinical and histological features are highlighted with a review of relevant literature to demonstrate the possibility of such an isolated fungal lesion, even in an immunocompetent individual.
This short case report discusses the various aspects of penile fracture, which is a rare entity. Nevertheless, the incidence of penile fractures is on the rise due to the increased use of performance-enhancing drugs. An individual with a penile fracture should seek immediate medical referral. Prompt diagnosis and management is necessary to prevent undesirable after-effects as discussed. Emphasis is made on how imaging with ultrasound enables a quick and complete assessment of this mishap.
Cosmos caudatus Kunth. (Asteraceae), commonly known as ulam raja, is widely grown as an herbal aromatic shrub. In Malaysia, its young leaves are popularly eaten raw as salad with other greens and have been reported to possess extremely high antioxidant properties, which may be partly responsible for some of its believed medicinal functions. In early 2010, a suspected powdery mildew was observed on ulam raja plants at the Agricultural Park of Universiti Putra Malaysia. Initially, individual, white, superficial colonies were small and almost circular. Later, they enlarged and coalesced to cover the whole abaxial leaf surface. With development of the disease, all green parts (leaves, stems, and petioles) became covered with a continuous mat of mildew, giving a dusty appearance. Newly emerged leaves rapidly became infected. Diseased leaves ultimately senesced and dried up, making them aesthetically unattractive and unmarketable. The pathogen produced conidia in short chains (four to six conidia) on erect conidiophores. Conidiophores were unbranched, cylindrical, 125 to 240 μm long, with a slightly swollen foot cell. Individual conidia were hyaline, ellipsoid, and 25 to 30 (27.5) × 15 to 20 (17.5) μm with fibrosin inclusions. Morphological descriptions were consistent with those described for Sphaerotheca fuliginea or S. fusca, which has lately been reclassified as Podosphaera fusca (1). From extracted genomic DNA of P. fusca UPM UR1, the internal transcribed spacer (ITS) region was amplified with ITS1 (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 (5'-TCCTCCGCTTATTGATATGC-3'). A BLAST search of GenBank with an ITS rDNA sequence of this fungus (GenBank Accession No. HQ589357) showed a maximum identity of 98% to the sequences of two P. fusca isolates (GenBank Accession Nos. AB525915.1 and AB525914.1). To satisfy Koch's postulates, the pathogenicity of fungal strain UPM UR1 was verified on 4-week-old plants. Inoculation was carried out by gently rubbing infected leaves onto healthy plants of C. caudatus. Ten pots of inoculated plants were kept under a plastic humid chamber and 10 pots of noninoculated plants, placed under another chamber, served as controls. After 48 h, the plants were then placed under natural conditions (25 to 28°C). Powdery mildew symptoms, similar to those on diseased field plants, appeared after 7 days on all inoculated plants. The white, superficial colonies enlarged and merged to cover large areas within 2 weeks. The infected leaf tissues became necrotic 6 to 8 days after the appearance of the first symptoms. Sporulation of P. fusca was observed on all infected leaves and stems. No symptoms were seen on the control plants. To our knowledge, this is the first report of P. fusca causing powdery mildew on C. caudatus in Malaysia. This pathogen has also been reported previously to be economically important on a number of other hosts. With ulam raja plants, more attention should be given to prevention and control measures to help manage this disease. Reference: (1) U. Braun and S. Takamatsu. Schlechtendalia 4:1, 2000.
Cabbage (Brassica oleracea L. var. capitata L.) is one of the most important vegetables cultivated in Pahang and Kelantan, Malaysia. Pectobacterium carotovorum can cause soft rot on a wide range of crops worldwide, especially in countries with warm and humid climates such as Malaysia. Cabbage with symptoms of soft rot from commercial fields were sampled and brought to the laboratory during the winter of 2010. Disease symptoms were a gray to pale brown discoloration and expanding water-soaked lesions on leaves. Several cabbage fields producing white cultivars were investigated and 27 samples were collected. Small pieces of leaf samples were immersed in 5 ml of saline solution (0.80% NaCl) for 20 min to disperse the bacterial cells. Fifty microliters of the resulting suspension was spread on nutrient agar (NA) and King's B medium and incubated at 30°C for 48 h. Purification of cultures was repeated twice on these media. Biochemical and phenotypical tests gave these results: gram negative, rod shaped, ability to grow under liquid paraffin (facultative anaerobe); oxidase negative; phosphatase negative; positive degradation of pectate; sensitive to erythromycin; negative to Keto-methyl glucoside utilization, indole production and reduction sugars from sucrose were negative; acid production from sorbitol and arabitol was negative and from melibiose, citrate, and raffinose was positive. Hypersensitivity reaction on tobacco leaf with the injection of 106 CFU/ml of bacterial suspension for all strains was positive. Four representative strains were able to cause soft rot using cabbage slices (three replications) inoculated with a bacterial suspension at 106 CFU/ml. Inoculated cabbage slices were incubated in a moist chamber at 80% relative humidity and disease symptoms occurred after 24 h. Cabbage slices inoculated with water as a control remained healthy. The bacteria reisolated from rotted cabbage slices on NA had P. carotovorum cultural characteristics and could cause soft rot in subsequent tests. PCR amplification with Y1 and Y2 primers (1), which are specific for P. carotovorum, produced a 434-bp band with 15 strains. PCR amplification of the 16S-23S rRNA intergenic transcribed spacer region (ITS) using G1 and L1 primers gave two main bands approximately 535 and 580 bp and one faint band approximately 740 bp when electrophoresed through a 1.5% agarose gel. The ITS-PCR products were digested with RsaI restriction enzyme. According to biochemical and physiological characterictics (2), PCR-based pel gene (1), and analysis by ITS-PCR and ITS-restriction fragment length polymorphism (3), all isolates were identified as P. carotovorum subsp. carotovorum. This pathogen has been reported from Thailand, Indonesia, and Singapore with whom Malaysia shares its boundaries. To our knowledge, this is the first report of P. carotovorum subsp. carotovorum in cabbage from Malaysia. References: (1) A. Darraas et al. Appl. Environ. Microbiol. 60:1437, 1994. (2) N. W. Schaad et al. Laboratory Guide for the Identification of Plant Pathogenic Bacteria. 3rd ed. The American Phytopathological Society, St. Paul, 2001. (3) I. K. Toth et al. Appl. Environ. Microbiol. 67:4070, 2001.
MeSH terms: Agar; Melibiose; Mineral Oil; Raffinose; Polymorphism, Restriction Fragment Length; RNA, Ribosomal, 23S; Sepharose; Sodium Chloride; Tobacco; United States; Vegetables; Pectobacterium carotovorum; Citric Acid