Abdul Aziz AM, Manan MM, Bahri S, Md Yusof FA, Kamarruddin Z, Said S, et al.
ISBN: 978-967-5570-45-2
Citation: Abdul Aziz AM, et al. Drug Utilization in the Treatment of Diabetes Mellitus in the Ministry of Health Facilities. Petaling Jaya: Pharmaceutical Services Division, Ministry of Health, Malaysia; 2013
Diabetes Mellitus (DM) is a costly disease to manage because of its chronic nature and severity of complications. Treatment of DM incurred high healthcare cost in both developed and developing countries. In Malaysia, treatment of DM is provided by all Ministry of Health (MOH) healthcare facilities and treatment may vary according to types of facilities. These differences may be associated with the utilization pattern and patient’s adherence to therapy and it is important to link actual medication therapy and the direct medical cost in the management of Malaysian DM patients. Thus, this study is to describe the utilization of medications in the treatment of DM in the MOH healthcare facilities and DM patient’s adherence towards their medication. This is a cross-sectional study in 94 MOH health facilities from November 2010 to December 2011. The healthcare facilities were categorized as National Referral Hospital, State Hospitals, Hospitals with Specialist, Hospitals without Specialist and Health Clinics. Patients were selected by the method of systematic random sampling and screened based on the inclusion and exclusion criteria. Face-to-face interview and retrospective data retrieval of patients’ medical record were conducted. The questionnaire and Morisky’s four questions adherence scale were utilized during the interview. A total of 2,509 (88.2%) patients were included in the study. The findings showed that variables for age, gender, race, marital status, household income, and occupation were essential components in examining its impact towards DM care. Most of the patients were between 45 to 55 years old and were burdened with co-morbidities. The observed trend in disease status showed that DM is closely related to co-morbidities such as hypertension, cardiovascular diseases, and hyperlipidaemia; more commonly in patients with more than 5 disease years. A total of 14.6% of DM patients have yet to be initiated with insulin while 84% and 78.9% of patients had poor control of HbA1c and fasting blood glucose. In terms of drug utilization and medication cost, there was no significant difference in the pattern of medication used for the first-line treatment of DM among type of facilities. Biguanides, sulphonamides, urea derivatives, and insulin are the top three DM medications. Insulin usage ranges from 25.6% at Hospitals without Specialist to 57.8% at State Hospitals and this corresponds to 2.5 to 7.0 times increment from National Health and Morbidity Survey (NHMS) III. Use of non-antidiabetic agents (ADA) corresponds with the top 10 co-morbidities. These include platelet aggregating inhibitors, ACE-inhibitors and statins. The pattern of treatment for co-morbidities showed significant differences among facilities and may be due to the degree of severity of DM patients. Also, the policies of categorizing A*/A/KK has led to these medications being less commonly prescribed in Hospitals without Specialist and Health Clinics. Adherence is an issue that DM patients need to improve. This study found that race, household income, and age were significant indicators for poor adherence. The odds ratio (OR) for age showed it contributed to almost one time lower in adherence. The OR for inter-racial differences found that both Chinese and Indian patients were about 0.7 times more likely to be non-adherence than Malays. Household income of less than RM1,000 per month similarly showed a 0.8 times less adherence compared to households earning between RM1,000 to RM3,000 per month. Pharmacists had been giving counselling to patients and the personalized approach by pharmacist had shown positive impact on Diabetic Medication Therapy Adherence Clinic (DMTAC) patients. The study findings, however, showed no improvement in adherence between those who attended DMTAC and those who have not. These findings might not be generalizable since most facilities had a very small percentage of DM patients and they are usually the problematic or difficult patients; this could have led to the rather uneventful findings. Finally, this study showed that there is no significant difference in the utilization of medication among health facilities in the treatment of DM. Adherence is still an area of concern and collaboration between healthcare professionals is vital for better treatment outcome.
MeSH terms: Adult; Ambulatory Care Facilities; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Drug Utilization; Hospitals; Humans; Insulin; Malaysia; Medication Adherence
DNA barcoding is the technique of sequencing a short fragment of cytochrome c oxidase subunit I (COI) mtDNA – a ‘DNA barcode’ - from a taxonomically unknown organism. This DNA barcode is then matched against a reference library of barcodes of known species origin to make a species identification. Since 2004 an international consortium has been promoting DNA barcoding as a global standard for taxonomic identifications (Savolainen et al. 2005). While we applaud Kumar et al. (2012) for bringing DNA barcoding to the attention of researchers in Malaysia, we have concerns about their understanding of the theory and methods of DNA barcoding.
This study aims to describe the pattern of sexual behaviour among methamphetamine and heroin users. It describes the pattern of sexual behaviour based on aspects of sex such as desire, interest, drive and obsession in relation to the drug use. A cross-sectional study was carried out among attendees of drug rehabilitation programmes in Kota Kinabalu, Kota Bharu and Kuala Lumpur. All subjects were living in the community with satisfactory psychosocial functioning. This study was primarily based on a validated sexual behaviour self-rated questionnaire followed by face-to-face interview. A total of 227 subjects were included with 124 (54.6%) using methamphetamine while 103 (45.4%) using heroin. Majority (218; 96%) were heterosexuals with 104 (45.8%) reported having been involved in high risk sexual behaviour. More methamphetamine than heroin subjects agreed that their sexual thoughts, feelings and behaviours were often associated with the drug (p<0.05). Methamphetamine subjects agreed that the use of methamphetamine caused them to be more obsessed with sex and they found themselves to be preoccupied with sexual thoughts while being under the influence of the drug (p<0.05). Heroin subjects mainly reported on negative effects of the drug on their sexual behaviour. Methamphetamine subjects reported that the use of drug had positively affected their sexual interest and drive (p<0.05). Methamphetamine subjects were also 1.97 times more likely than heroin subjects to be involved in risky sexual behaviour. The results of this study can be utilized to improve the drug treatment and rehabilitation programme. Methamphetamine subjects were more likely than heroin subjects to be involved in risky sexual behaviour.
MeSH terms: Cross-Sectional Studies; Heroin; Emotions; Methamphetamine; Obsessive Behavior; Surveys and Questionnaires; Risk-Taking; Sexual Behavior; Substance-Related Disorders; Heterosexuality
Working environmental conditions in automotive industry are very challenging to the human workers. Meanwhile, products quality is very much dependent on workers’ health, safety and comfort in their working environment. Environmental factors, such as temperature, illuminance and humidity levels have significant effect on workers’ performance at the production line. In this experiment, temperature, humidity, illuminance levels and productivity rate were observed in a control room. An automotive manufacturing firm production line was chosen to be simulated in the control room to observe the temperature, relative humidity, illuminance and worker’s productivity rate. The experimental data collected was analyzed using Response Surface Method (RSM). RSM is an analysis technique, which combined statistical systems and mathematical methods. It can be applied for research and development, reform and optimize a process, which involves several design variables. As a result, the combined effect of temperature, illuminance and humidity toward productivity can be clearly seen. Optimum environmental factor cannot be predicted using first order RSM analysis because it gives low reliability for obtaining the optimum level. Thus, a second order RSM analysis was generated for obtaining the optimum level of environmental factors.
The control of the Casimir force between two parallel plates can be achieved through inducing the optical Kerr effect of a nonlinear material. By considering a two-plate system which consists of a dispersive metamaterial and a nonlinear material, we show that the Casimir force between the plates can be switched between attractive and repulsive Casimir force by varying the intensity of a laser pulse. The switching sensitivity increases as the separation between plate decreases, thus providing new possibilities of controlling Casimir force for nanoelectromechanical systems.
The effect of corrosion inhibition of low carbon steel in water based medium containing lignin was investigated via weight loss method. The evolution of surface morphology has been carried out for 7 to 42 days via optical microscopy (OM), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX) and X-ray photoelectron microscopy (XPS). Immersion of metal specimen without lignin shows that significant increase in the surface roughness. The longer the immersion time, the more the oxide crust formed. The surface degradation of metal specimen was well protected by immersion in lignin solution. A protective layer containing of lignin was formed on the surface of metal specimens after 7 and 21 days immersion. The corrosion inhibition gives about 13 and 53% inhibition for both 7 and 21 days immersion, respectively. The protective layers were spalling and separated from the metal surface after 42 days immersion in lignin solution possibly due to the increase in corrosion attack after long time immersion according to the increase in dissolved oxygen and may also due to the thermal mismatch between oxide and substrate. The adsorption of protective layer containing lignin was temporary adsorbed on the surface.
Moldability of metal injection molding (MIM) is dependent on the outward appearance of the resultant feedstock. Properties of the binders used will influence the properties of the feedstock. Stainless steel powder 316L with mean size 22 μm and the binder system consists of three major fractions of paraffin wax, thermoplastic natural rubber and stearic acid with a powder loading of 65 vol. % was investigated. Comparison was also made with existing palm stearin in the binder system replacing the paraffin wax. Kinetic solvent extractions were done to determine the differences between the binder systems. The feedstock was then injected into tensile bar using vertical injection machine. The results showed that there is a slightly time extension during the solvent extraction as a comparison. The feedstock has been successfully injection molded at 190-200°C. Study of thermal analysis such as DSC and TGA has been done as a preparation for the thermal debinding and sintering process. This study demonstrated that a backbone polymer; thermoplastic natural rubber performs best in term of flow stability and compact quality and also saves in processing time.
Undoped zinc oxide (ZnO) thin films were prepared by a sol-gel method. The effect of annealing temperature from 500 to 700°C on the structural and optical properties of the fi lms was studied. The films nanostructure characterized by the X-ray diffraction method showed that the films were single phase ZnO with wurtzite structure. The surface morphology studied using the field emission scanning electron microscope showed that the thickness of the films increased with the increment of annealing temperature. The grain size of the films increased with the increment of the annealing temperature. The film surface roughness measured using the atomic force microscope showed that the surface roughness of the film decreased (from 2.3 to 1.02 nm ), when the annealing temperature increased from 500 to 600°C then it increased to 3.06 nm at 700°C. The optical properties were studied by the UV-Vis spectrophotometer. The results showed that the films had high transmittance (above 80%) in the visible range and the exciton absorption occurred at a wavelength of 379 nm. The energy gap decreased with the increment of annealing temperature.
In this study, the effect of Fe addition on the phase stability and corrosion resistance of Ti-15%Cr alloys was investigated. The alloying phenomenon in the specimens was also investigated to determine the effectiveness of the application of pure metallic powders as raw materials for the powder metallurgy method. Ti-15%Cr-1%Fe alloys exhibited needle-like structures within equiaxed structures, while Ti-15%Cr-5%Fe and Ti-15%Cr-10%Fe alloys only showed equiaxed grains. XRD results showed that the β phase could be stabilized by the addition of 5% or more Fe to the alloy. Although the pure powders were used as raw materials, the designated chemical composition, i.e. Ti-15%Cr-(1~10)%Fe can be achieved during sintering. The alloying phenomenon occurred upon sintering due to the high diffusivity of Cr and Fe within the β Ti matrix. The corrosion resistance of the newly developed Ti-15%Cr alloys was significantly improved compared with a commercial Ti-6%Al-4%V alloy.
In this work, the effects of backbone polymer in the binder system mixed with pre-alloyed NiTi powder, on impurity contents, phase transformation temperatures and microstructures were investigated. A spherical gas-atomised pre-alloyed NiTi powder (50.3 at. %Ni) with a mean particle size of less than 22 μm and powder loading of 69.5 vol. % was used. The binder consisted of a water soluble binder system, mainly polyethylene glycol (PEG), with two different backbone binders, namely polyethylene 520 (PE 520) and poly-methyl- methacrylate (PMMA). The latter was used in the form of a powder and as an emulsion. Green parts were prepared by warm-press the feedstock into a cylindrical shape. The samples were then leached in warm water, thermally debound in Argon and finally, vacuum sintered at 1240°C for 10 h. The experimental results indicate that the oxygen content in the as-sintered condition increased to almost double than that of the powder state (from 0.08 to 0.14 - 0.16 wt. %) and the carbon increased by one third to half (from 0.06 to 0.08 - 0.09 wt. %). This consequently resulted in a shift of the phase transformation temperature to lower values and consequently broadened the reversible austenite to martensite transformation. The uptake of oxygen and carbon during the process led to the formation of the well-known Ti4Ni2Ox and TiC precipitate phases which were evident from grey-scale images of back-scattered SEM.
This paper reports on the effects of HAP addition and sintering temperature on the microstructure and properties of the F-75/HAP composites fabricated by powder metallurgy. Co-Cr-Mo (F-75) is used in orthopedics because of its excellent biocompatibility when implanted to human or animal body. Hydroxyapatite (HAP) powders have been used as fillers because HAP is the one of the most effective biocompatible materials with similarities to mineral constituents of bones and teeth. HAP powders (chemical formula Ca10(PO4)6 (OH)2) have been added to Co-Cr-Mo alloys in composition of 0 to 10 wt. %. The mixtures were then milled, cold compacted at 550 MPa, before sintered at 1100 and 1200°C in a tube furnace. The density, porosity, microhardness and compressive strength were measured. The composites that have been sintered at temperature 1200°C showed better physical and mechanical properties than those produced at 1100°C. After sintering at 1200°C, the samples show higher density, compared with the sample sintered at 1100°C. The sample with no HAP which have been sintered at 1200°C has the highest microhardness (208.9 HV), compared with the same sample sintered at 1100°C (194.3HV). As the temperature is increased from 1100 to 1200°C, the value of compressive strength increased from 184.538 to 341.086 MPa. Microstructural analysis for line scan showed that, as the sintering temperature was increased, there was good interface bonding between HAP particles and matrix F-75.
In this study, injection molding parameters, including green strength, surface quality and green part density, were optimized using the L18 Taguchi orthogonal array. The L25 Taguchi method was used to optimize the green density of solvent debinding parameters. The feedstock consisted of stainless steel powder (SS316L), with powder loading fractions of 63, 63.5 and 64 v/o. The binder compositions used in the study were polyethelene glycol (PEG-73 wt. %), polymethyl methacrilate (PMMA-25 wt. %) and stearic acid (2 wt. %). The Taguchi method was used to optimize the injection parameters. The obtained optimum parameters were as follows: mold temperature of 65oC, injection temperature of 145oC, injection pressure of 650 bar, injection flow rate of 20 m3/s, holding time of 5 s and powder loading of 64% v/o. Analysis of variance results showed that mold temperature has the greatest influence in the production of good green part surface quality and that powder loading gave the best green part strength. Immersion time and temperature were used to optimize for solvent debinding parameters. By optimizing the solvent debinding parameters, an immersion temperature of 61oC and immersion time of 5 h produced the highest density which is the optimum value gain in this study.
Tool life of the cutting tools is considered as one of the factors which has effects on machining costs and the quality of machined parts. The topic of tool life prediction has been an interesting and important research topic attracting the attention of a wide number of researchers in this particular area. In terms of the suitable methods used in this research topic, it is stated that both statistical and artificial intelligence (AI) approaches can be employed to model tool life. For further justifying the capability of the ANN model in predicting tool life, the current study was based on conducting experimental work for collecting the experimental data. After carrying out the experiment, 17 data sets were collected and they were divided into two subsets; the first one for training and the second for testing. Since the data sets seemed to be lower than the number of data sets used in previous studies, we attempted to make verification of the ability of the ANN model in learning and adapting with low training and testing data. Diverse topologies accompanied with single and two hidden layers were created for modeling the tool life. For choosing the best and most effective network, the study adopted the mean square error function as criteria for the evaluation of the network selection. Thus, based on the data generated from the same experiment, a regression model (RM) was constructed employing the SPSS software. A comparison between the ANN model and RMs in terms of their accuracy was carried out and the findings revealed that the accuracy of the ANN was higher than that of the RM.
MeSH terms: Artificial Intelligence; Attention; Research; Research Personnel; Software
Invention of milling combined laser sintering system (MLSS) is able to reduce the mould manufacturing time and improve the mould accuracy. Thus, more study is needed to increase the understanding for the laser sintered material machining characteristic to gain benefit from the invention of MLSS. This paper clarified the analysis of laser sintered material machinability with the application of Finite Element Method (FEM). Mild steel AISI1055 was applied in developing the Finite Element model in this study due to its popularity in machinability test and adequate level of data availability. 2D orthogonal cutting was employed on edge design tools with updated Lagrangian coupled thermo mechanical plane strain model. Adaptive meshing, tool edge radius and various types of friction models were assigned to obtain efficient simulations and precise cutting results. Cutting force and cutting-edge temperature estimated by Finite Element Method are validated against corresponding experimental values by previous researchers. In the study, cutting force increases when radial depth increases and lowest error acquired when the shear friction factor of 0.8 was applied. Machining simulation for laser sintered materials estimated lower cutting force compared with mild steel AISI1055 due to lower Young modulus. Higher cutting temperature estimated for machining simulation laser sintered material compared with machining simulation mild steel AISI1055 due to its low thermal conductivity.
MeSH terms: Hot Temperature; Lasers; Paper; Radius; Steel; Temperature; Thermal Conductivity; Friction; Finite Element Analysis; Elastic Modulus; Mechanical Phenomena; Inventions
This paper presents the tool life of the end milled Inconel 718, which is part of a material that is difficult to be machined. Previous researchers found that tool life in machining aged Inconel 718 is shorter compared with other materials. However, this observation required further investigation. Thus, a raw grade Inconel was proposed in this experiment. The experiments were performed using TiAlN-coated carbide. The studied milling parameters were the cutting speed, Vc, from 90 to 150 m/min; feed rate, fz, from 0.15 to 0.25 mm/rev; depth of cut, ap, from 0.3 to 0.5 mm; and radial depth of cut, ae=1 mm. The application of the cutting fluid used in this experiment was a minimum quantity lubricant, which had the advantage of cooling effectiveness and low consumption of cutting fluid. The results showed that the feed rate, fz, was the primary factor controlling the tool life. The combination of Vc=115 m/min, fz=0.15 mm/tooth, as well as ap=0.5 mm and ae=0.15 mm gave the longest tool life that served 95.38 min in operation.