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Source identification of particulate matter in a semi-urban area of Malaysia using multivariate techniques

Wahid NB, Latif MT, Suan LS, Dominick D, Sahani M, Jaafar SA, et al.

Bull Environ Contam Toxicol, 2014 Mar;92(3):317-22.
PMID: 24435135 DOI: 10.1007/s00128-014-1201-1

This study aims to determine the composition and sources of particulate matter with an aerodynamic diameter of 10 μm or less (PM10) in a semi-urban area. PM10 samples were collected using a high volume sampler. Heavy metals (Fe, Zn, Pb, Mn, Cu, Cd and Ni) and cations (Na(+), K(+), Ca(2+) and Mg(2+)) were detected using inductively coupled plasma mass spectrometry, while anions (SO4 (2-), NO3 (-), Cl(-) and F(-)) were analysed using Ion Chromatography. Principle component analysis and multiple linear regressions were used to identify the source apportionment of PM10. Results showed the average concentration of PM10 was 29.5 ± 5.1 μg/m(3). The heavy metals found were dominated by Fe, followed by Zn, Pb, Cu, Mn, Cd and Ni. Na(+) was the dominant cation, followed by Ca(2+), K(+) and Mg(2+), whereas SO4 (2-) was the dominant anion, followed by NO3 (-), Cl(-) and F(-). The main sources of PM10 were the Earth's crust/road dust, followed by vehicle emissions, industrial emissions/road activity, and construction/biomass burning.
Ionic composition of rainwater at selected sites of Kuantan, Pahang, Malaysia: a preliminary study

Tay JH, Jaafar S, Mohd Tahir N

Bull Environ Contam Toxicol, 2014 Mar;92(3):329-33.
PMID: 24435136 DOI: 10.1007/s00128-014-1203-z

A short-term investigation on the chemical composition of rainwater was carried out at five selected sampling stations in Kuantan district, Pahang, Malaysia. Sampling of rainwater was conducted by event basis between September and November 2011. Rainwater samples were collected using polyethylene containers and the parameters measured were cations (sodium, potassium, ammonium, calcium and magnesium) and anions (chlorides, nitrates and sulphates). The average pH value for rainwater samples was 6.0 ± 0.57 in which most of the sampling sites exhibited pH values >5.6. Calcium and sulphate were the most abundant cation and anion, respectively, whilst the concentrations of other major ions varied according to sampling location.
Fulltext Beneficial effects of ACE inhibitors in severe mitral stenosis

Sebastian VJ, Bhattacharya S, Ray S, Jaafar SM

Med J Malaysia, 1989 Dec;44(4):291-5.
PMID: 2562442

There are several reports of beneficial effects of ACE inhibitors in both primary and secondary pulmonary hypertension. However the effect of ACE inhibitors in mitral stenosis is not documented. The authors report three patients with severe mitral stenosis in whom surgery was delayed. They had initial symptomatic improvement with diuretics and sodium restriction, but had recurrence of their symptoms while on treatment. Enalapril not only relieved their symptoms in particular exertional dyspnoea and haemoptysis but prevented recurrence and improved their effort tolerance without causing excessive fall of blood pressure or impairment of renal function.
Fulltext A study of the nature and level of trust between patients and healthcare providers, its dimensions and determinants: a scoping review protocol

Rasiah S, Jaafar S, Yusof S, Ponnudurai G, Chung KPY, Amirthalingam SD

BMJ Open, 2020 Jan 23;10(1):e028061.
PMID: 31980505 DOI: 10.1136/bmjopen-2018-028061

INTRODUCTION: The aim of this scoping review is to systematically search the literature to identify the nature and or level of trust between the patient, the users of health services (eg, clients seeking health promotion and preventive healthcare services) and the individual healthcare providers (doctors, nurses and physiotherapists/ occupational therapists), across public and private healthcare sectors, at all levels of care from primary through secondary to tertiary care. It also aims to identify the factors that influence trust between patients, users of health services (clients) and providers of healthcare at all levels of care from primary care to tertiary care, and across all health sectors (public and private). The study will also identify the tools used to measure trust in the healthcare provider.
METHODS AND ANALYSIS: The scoping review will be conducted based on the methodology developed by Arksey and O'Malley's scoping review methodology, and Levac et al 's methodological enhancement. An experienced information specialist (HM) searched the following databases MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature. The search terms were both keywords in the title and/or abstract and subject headings (eg, MeSH, EMTREE) as appropriate. Search results were downloaded, imported and stored into a 'Refworks' folder specifically created for reference management. The preliminary search was conducted between 7 December 2017 and 14 December 2017. Quantitative methods using content analysis will be used to categorise study findings on factors associated with trust between patients, clients and healthcare providers. The collection of studies will be also examined for heterogeneity. Qualitative analysis on peer reviewed articles of qualitative interviews and focus group discussion will be conducted; it allows clear identification of themes arising from the data, facilitating prioritisation, higher order abstraction and theory development. A consultation exercise with stakeholders may be incorporated as a knowledge translation component of the scoping study methodology.
ETHICS AND DISSEMINATION: Ethical approval will be obtained for the research project from the Institutional Review Board. The International Medical University will use the findings of this scoping review research to improve the understanding of trust in healthcare, in its endeavour to improve health services delivery in its healthcare clinics and hospitals, and in its teaching and learning curriculum. The findings will also help faculty make evidence based decisions to focus resources and research as well as help to advance the science in this area. Dissemination of the results of the scoping review will be made through peer-reviewed publications, research reports and presentations at conferences and seminars.
Fulltext Association between genetic polymorphisms and external apical root resorption: A systematic review and meta-analysis

Nowrin SA, Jaafar S, Ab Rahman N, Basri R, Alam MK, Shahid F

Korean J Orthod, 2018 Nov;48(6):395-404.
PMID: 30450332 DOI: 10.4041/kjod.2018.48.6.395

Objective: To date, only a few studies have investigated the relationships between genetic polymorphisms and external apical root resorption (EARR). Hence, the aim of this systematic review was to explore the relationship between different gene polymorphisms and their association with EARR.
Methods: A complete literature search was conducted by two independent reviewers. The PubMed, Science Direct, and Scopus databases were searched. In addition, the bibliographies of all textbooks and relevant articles were searched manually. A meta-analysis was performed using data entered into the electronic databases until February 28, 2017.
Results: On the basis of the search, we identified 17 and 7 publications for the systematic review and meta-analysis, respectively. Odds ratio (OR) was used to evaluate the association of the interleukin 1B (+3954) polymorphism and the risk of EARR. The overall OR from the studies was used to estimate the risk of EARR. However, no association was found and no publication bias was apparent for the risk of EARR in patients receiving orthodontic treatment.
Conclusions: More research on the relationship between gene polymorphism and EARR is necessary to determine better specificity of possible interactions.
Fulltext Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme

Muhamad NA, Buang SN, Jaafar S, Jais R, Tan PS, Mustapha N, et al.

BMC Public Health, 2018 Dec 22;18(1):1402.
PMID: 30577816 DOI: 10.1186/s12889-018-6316-6

BACKGROUND: In 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were developed for Malaysia's HPV school-based immunisation programme. It was approved for nationwide school base implementation for 13-year-old girls or first year secondary students in 2010. This paper examines how the various strategies used in the implementation over the last 7 years (2010-2016) that unique to Malaysia were successful in achieving optimal coverage of the target population.
METHODS: Free vaccination was offered to school girls in secondary school (year seven) in Malaysia, which is usually at the age of 13 in the index year. All recipients of the HPV vaccine were identified through school enrolments obtained from education departments from each district in Malaysia. A total of 242,638 girls aged between 12 to 13 years studying in year seven were approached during the launch of the program in 2010. Approximately 230,000 girls in secondary schools were offered HPV vaccine per year by 646 school health teams throughout the country from 2010 to 2016.
RESULTS: Parental consent for their daughters to receive HPV vaccination at school was very high at 96-98% per year of the programme. Of those who provided consent, over 99% received the first dose each year and 98-99% completed the course per year. Estimated population coverage for the full vaccine course, considering also those not in school, is estimated at 83 to 91% per year. Rates of adverse events reports following HPV vaccination were low at around 2 per 100,000 and the majority was injection site reactions.
CONCLUSION: A multisectoral and integrated collaborative structure and process ensured that the Malaysia school-based HPV immunisation programme was successful and sustained through the programme design, planning, implementation and monitoring and evaluation. This is a critical factor contributing to the success and sustainability of the school-based HPV immunisation programme with very high coverage.
Fulltext Stem cells from childrens' teeth

Mohd Hilmi, A.B., Fazliah, S.N., Siti Fadilah, A., Asma, H., Siti Razila, A.R., Shaharum, S., et al.

Archives of Orofacial Sciences, 2008;3(1):29-31.
MyJurnal

The aim of this study was to isolate stem cells from dental pulp of primary molars and incisors to be used as possible source for tissue engineering. Human primary molars and incisors were collected from subjects aged 4-7 year-old under standardized procedures. Within 24 hours, the tooth was cut at the cemento-enamel junction using hard tissue material cutter. The dental pulp tissue was extracted, digested and then cultured in Alpha Modified Eagles's Medium (α-MEM) supplemented with 20% FCS, 100 mM L-ascorbic acid 2-phosphate, 200 mM L-glutamine and 5000 units/ml Penicillin/Streptomycin. The cells were observed daily under the microscope until confluence. Children's tooth pulp- derived progenitor cells were found positive for stem cell markers CD105 and CD166, which are consistent with the finding for mesenchymal stem cells (MSCs) from bone marrow.
Fulltext 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

Mohamad Noh K, Jaafar S

World Conference on Social Determinants of Health, 2011.

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.
Fulltext Diagnostic Implication and Clinical Relevance of Ancillary Techniques in Clinical Pathology Practice

Makki JS

Clin Med Insights Pathol, 2016;9:5-11.
PMID: 27042154 DOI: 10.4137/CPath.S32784

Hematoxylin-eosin-stained slide preparation is one of the most durable techniques in medicine history, which has remained unchanged since implemented. It allows an accurate microscopic diagnosis of the vast majority of tissue samples. In many circumstances, this technique cannot answer all the questions posed at the initial diagnostic level. The pathologist has always been looking for additional ancillary techniques to answer pending questions. In our daily histopathology practice, we referred to those techniques as special stains, but nowadays, they are more than stains and are collectively called ancillary tests. They include a wide range of techniques starting from histochemical stains and ending in one or more advanced techniques, such as immunohistochemistry, immunofluorescence, molecular studies, cytogenetic studies, electron microscopy, flow cytometry, and polymerase chain reaction.
Fulltext Recurrent re-expansion pulmonary oedema complicating rapid decompression of large pneumothoraces

Liam CK, Jaafar S

Med J Malaysia, 1991 Jun;46(2):199-202.
PMID: 1839427

A young male who developed ipsilateral pulmonary oedema on two occasions as a complication of treatment of pneumothoraces involving the left lung is reported. The importance of large pneumothoraces, the rapidity of decompression and the application of suction to the pleural space as factors predisposing to the development of re-expansion pulmonary oedema is well demonstrated by this case. The re-expansion pulmonary oedema was more severe on the second occasion when the lung had collapsed for a longer duration compared to the first pneumothorax which was of more recent onset.
Fulltext Bibliography of primary care research in Malaysia

Khoo EM, Teng CL, Ng CJ, Jaafar S

ISBN: 978-983-100-450-0

Citation: Khoo EM, Teng CL, Ng CJ, Jaafar S. Bibliography of primary care research in Malaysia. Kuala Lumpur: University of Malaya; 2008
Fulltext Morbidity profiles at three primary care clinics in Perlis, Malaysia

Kamarudin MF, Mohamad Noh K, Jaafar S

Med J Malaysia, 2012 Aug;67(4):363-8.
PMID: 23082442 MyJurnal
Facilitating equity and efficiency in Malaysian primary health care through the application of the ACG® case mix system. [Abstract]

Kamaliah MN, Jaafar S, Ehsan FZ, Safiee I, Ismail F, Mohd Saleh N, et al.

BMC Health Serv Res, 2009;9:A7.
DOI: 10.1186/1472-6963-9-S1-A7

Introduction. Malaysian health care is a parallel system with both public and private sectors. The MOH (Ministry of Health) is the main provider of health services in the country, delivering comprehensive medical, health, dental and pharmaceutical services at primary, secondary and tertiary levels of care. The public health services are heavily subsidized by the government. The practice of financial distribution within the Ministry of Health of Malaysia has traditionally been dependent on historical information, i.e., looking at past performance. Any additional increment has been based on arbitrary predictions of the consumer index or inflation. A more appropriate distribution would be based not only on the volume of patients, but also on the morbidity profiles of these populations. Because of the development of the TPC (Tele-Primary Care) electronic system, considerable data is now collected, and there exists a vast potential for data-mining. One potential area of study is to account for the differences in the health status of populations and their anticipated need for healthcare services. An earlier project demonstrated that the TPC dataset provides viable data that can be used for understanding differences in case mix and resource need by various population sub-groups. This was the first step in a multi-stage process to demonstrate the benefits of integrating case mix into the Malaysian healthcare system. As a result of the first project, an increased understanding of the TPC database was gained, which is providing usable data. However, to make full and effective use of TPC, a resource-use measure based on micro-costing information needed to be developed and validated. This project evaluated the plausibility of recently developed cost measures. This new resource-use measure would enable a clearer understanding of the resource consumption based on the morbidity profile of populations across regions, as well as individual clinics.
Methods. The primary sources of data for this project came from public, primary care clinics using the TPC system; an alternative electronic system; a small group practice of private primary care clinics using a separate electronic system; and the network of a private medical insurance group with nationwide enrollees. The objective of the project was, first, to take the analyses a step further by incorporating new data input streams from private providers, and then to validate that the newly developed micro-costing information was meaningful. In addition, the project sought to assess the ability to link patient information across different providers, re-analyze the results from Phase 1 using the new resource measure, and then develop a program targeted at improving data quality. Lastly, the aim was to compare differences in service delivery patterns between TPC facilities and providers to assess the efficiency of resource use.
Results. a) The success of the coding-quality training programs to ensure continually improved data quality in TPC over time was demonstrated. The data quality is sufficiently high to create more sophisticated models. Models to identify "high risk" patients or "high cost" patients are already possible.
b) The ACG system has been proven to work with Malaysian TPC data, and the micro-costing data works for the TPC population and allows us to better understand differences in resource allocation/need. The 2008 Total Visits model is extremely predictive. However, the cost data for health clinics needs to be improved before the Total Cost can be used to predict costs with the same predictive ability as the Total Visit models.
c) The analyses of the UPIN's (Unique Patient Identification Number) ability to link data to better capture the services being provided from multiple providers show that existing challenges are surmountable. A better understanding of the differences in service delivery in public vs. private sectors is imperative before a national capitation scheme is possible.
d) The profiling of providers on a regional basis as the initial step to determining the viability of a morbidity-based capitation formula was successful.
Conclusions. The initial project successfully demonstrated the ability of Malaysia to apply readily available diagnostic and other clinical information to develop state-of-the-art case-mix measures relevant to medical and fiscal management activities using the TPC database. It also offered an example of how risk adjustment tools can be used to monitor the TPC data collection process. The ACG system has been proven to work with Malaysian data, and it works very well for Total Visits where they can now be used to predict Total Visits with a very high certainty. Where the data quality has improved, the predictive modeling has improved in tandem. The data quality is sufficiently high to create more sophisticated models. Models to identify “high risk” patients or “high cost” patients are already possible.
Effects of varying degrees of doneness on the formation of heterocyclic aromatic amines in chicken and beef satay

Jinap S, Mohd-Mokhtar MS, Farhadian A, Hasnol ND, Jaafar SN, Hajeb P

Meat Sci, 2013 Jun;94(2):202-7.
PMID: 23501251 DOI: 10.1016/j.meatsci.2013.01.013

The study was carried out to determine the effect of cooking method on Heterocyclic Aromatic Amines (HAs) concentration in grilled chicken and beef (satay). Six common HAs were investigated: 2-amino-3-methylimidazo[4,5-f]quinolone (IQ), 2amino 3,4dimethylimidazo [4,5f]quinoline (MeIQ), 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), 2-amino-3,4,8 trimethylimidazo[4,5-f]quinoxaline (4,8-DiMeIQx), 2-amino-3,7,8trimethylimidazo [4,5-f]quinoxaline (7,8-DiMeIQx), and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP). Chicken and beef satay samples were grilled to medium and well done level of doneness. Charcoal grilled (treatment A), microwave pre-treatment prior to grilling (treatment B), and microwave-deep fried (treatment C) were applied to beef and chicken satay samples. The satay samples which were microwaved prior to grilling (B) showed significantly (p<0.05) lower HAs concentration as compared to those charcoal grilled (A). Both medium and well done cooked beef and chicken satay samples that were microwaved and deep fried (C) as an alternative method to grilling were proven to produce significantly lesser HAs as compared to charcoal-grilled (A) and microwaved prior to grilling (B).
Fulltext Public health nursing in 1Care

Jaafar S, Mohd Noh K, Suhaili MR, Kiyu A, Ong F, Wong M

Int J Public Health Res, 2011;1(Special Issue):1-8.

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.
Fulltext Remembering M K Rajakumar

Jaafar S

Malays Fam Physician, 2008;3(3):125.
Fulltext Primary Health Care: Key To Intersectoral Action For Health And Equity

Jaafar S, Suhaili MR, Mohd Noh K, Zainal Ehsan F, Lee FS

Citation: Jaafar S, Suhaili MR, Mohd Noh K, Zainal Ehsan F, Lee FS. Primary Healh Care: Key To Intersectoral Action For Health And Equity. World Health Organization; 2007
Fulltext Malaysia Health System Review

Jaafar S, Mohd Noh K, Abdul Muttalib K, Othman NH, Healy J, Maskon K, et al.

ISBN: 978-92-9061-584-2

Citation: Jaafar S, Mohd Noh K, Abdul Muttalib K, Othman NH, Healy J, Maskon K, et al. Malaysia Health System Review. Geneva: World Health Organization; 2013

Malaysia is a federation of 13 states and 2 territories in a parliamentary democracy, with the Prime Minister the head of government and a constitutional monarch elected by the Sultans. Malaysia is a multicultural society and a secular state with Sunni Islam as the official religion. Classified by the World Bank as an upper middle-income country, its society and economy were transformed by rapid economic growth in the latter half of the 20th century. Malaysia’s population (now numbering over 28 million with 70% living in urban areas) has benefited from a well developed health care system, good access to clean water and sanitation, and strong social and economic programmes. Life expectancy at birth is 73 years. Noncommunicable diseases now account for most mortality and morbidity but communicable diseases remain a concern. Section 2 describes the organization and governance of the health system. Health care services consist of tax-funded and governmentrun primary health care centres and hospitals, and fast-growing private services mainly located in physician clinics and hospitals in urban areas. Public sector health services are administered by the Ministry of Health through its central, state and district offices. The Ministry of Health regulates the private sector, pharmaceutical industry and food safety and plans and regulates its own health care services. Legislation governing health care professionals requires them to register with statutory professional bodies. Section 3 reports on health care financing. Malaysia’s public health system is financed mainly through general revenue and taxation collected by the federal government, while the private sector is funded principally through out-of-pocket payments from patients and some private health insurance. Spending on health reached 4.6% of GDP in 2009 with the majority from public spending, reaching 56% of total health expenditure (THE) in 2009. The main sources of THE in 2008 were the Ministry of Health (42%), followed by household out-of-pocket expenditure at nearly 34%. The Ministry of Health funds public facilities through line item budgets and patients pay private physicians and private hospitals on a fee-for-service basis. Physical and human resources are described in Section 4. The number of public primary care facilities (currently 802 centres and over 2000 small community clinics) and dental clinics were expanded steadily in earlier decades, particularly to reach people in under-served rural areas. Secondary care is offered in smaller public hospitals and more complex tertiary care, in regional and national hospitals (including university teaching hospitals run by the Ministry of Higher Education). Growth has slowed in recent years, however, and public services in urban areas have not kept pace with rapid urbanization, while the population ratio of hospital beds has declined slightly. Private clinics and hospitals in urban areas have grown rapidly over the last decade. The supply of health professionals remains seriously below the required number, although the government has increased the number of training places. Section 5 looks at provision of services. National health policies stress public health and health promotion, that is, ‘a wellness’ as well as a ‘disease’ perspective. The Ministry of Health has developed an extensive network of public primary care centres and also dental services especially for children, but these services are under strain and have staff shortages, so patients often encounter long waits. Primary care exerts only a limited gatekeeper function since people can bypass a referral from a general practitioner and for a small additional fee (if in the public sector) can go directly to specialists and hospitals. Government services increasingly serve the poor and private services the better-off people who live in urban areas. Hospital policy currently has three main thrusts: strengthening specialty care in large public hospitals; increasing the number of day surgery centres; and expanding top-end private hospital care to cater to the medical tourism market (with 35 participating hospitals in 2010). Malaysia has a large pharmaceutical manufacturing sector that exports to other countries and also supplies 30% of domestic demand. The principal health care reforms are discussed in Section 6. The government has stepped up its surveillance and early response to infectious disease outbreaks as a result of recent pandemics such as SARS and avian flu, which had a major impact on the country’s economy. The Ministry of Health has maintained its extensive vaccination programmes, has consolidated its primary health care clinics and upgraded its hospitals, and is slowly introducing information communication technology into its public facilities. The government has increased training places to counter shortages of health professionals, has strengthened food and drug safety regulation, is considering price xv regulation of pharmaceuticals, and is positioning the country as a medical tourism destination. Section 7 provides an assessment of the health system. Malaysia has a strong population health tradition and well-established and extensive health care services. Although total health expenditure at 4.6% of GDP in 2008 is in the range for middle-income countries, the government is concerned about future sustainable financing. Successive administrators have prioritized the provision of cost-effective, preventative and mainly free primary health care in public clinics. The rapid growth of private health care means that private spending has risen faster than public spending, including out-of-pocket payments by the public, with the government share (from general revenue) just above half (56%) of health expenditure in 2009. In conclusion, Malaysia has achieved impressive health gains for its population with a low-cost health care system funded through general revenue that provides universal and comprehensive services. Like many other countries in the region, Malaysia has struggled to produce an adequate supply of health professionals, and to integrate and regulate its rapidly growing private health sector. Public services have not kept pace with population growth in urban areas and those with higher purchasing power use private rather than public doctors and hospitals, which leaves the public sector with more poorer and sicker patients. The Malaysian Government recently revived the debate over options for a national social health insurance scheme. The financing challenge is to agree on a scheme for fair and sustainable funding and its respective contributions from general revenue and private payments. The regulatory challenge for the Malaysian Government is to strengthen its governance of both public and private health services in order to ensure high quality and safe services and fair charges. The structural challenge is to determine the balance between public and private sector delivery and to engage in a more productive partnership between public and private sectors. The administrative challenge is to consider whether the community would be better served by more decentralized and responsive services. As Malaysia seeks to attain high income country status, and as demographic and epidemiological transitions continue and new technology expands the possibilities for intervention, the demand for xvi health care by the population will continue to rise. The government will need to address growing concerns about equity, efficiency and budgetary constraints and balance conflicting policy principles. Pressures are building up for health system reform in Malaysia looking towards the year 2020 and beyond.
Fulltext Information technology for patient safety

Huckvale C, Car J, Akiyama M, Jaafar S, Khoja T, Bin Khalid A, et al.

Qual Saf Health Care, 2010 Aug;19 Suppl 2:i25-33.
PMID: 20693213 DOI: 10.1136/qshc.2009.038497

BACKGROUND: Research on patient care has identified substantial variations in the quality and safety of healthcare and the considerable risks of iatrogenic harm as significant issues. These failings contribute to the high rates of potentially avoidable morbidity and mortality and to the rising levels of healthcare expenditure seen in many health systems. There have been substantial developments in information technology in recent decades and there is now real potential to apply these technological developments to improve the provision of healthcare universally. Of particular international interest is the use of eHealth applications. There is, however, a large gap between the theoretical and empirically demonstrated benefits of eHealth applications. While these applications typically have the technical capability to help professionals in the delivery of healthcare, inadequate attention to the socio-technical dimensions of their use can result in new avoidable risks to patients.
RESULTS AND DISCUSSION: Given the current lack of evidence on quality and safety improvements and on the cost-benefits associated with the introduction of eHealth applications, there should be a focus on implementing more mature technologies; it is also important that eHealth applications should be evaluated against a comprehensive and rigorous set of measures, ideally at all stages of their application life cycle.
Screening of Transforming Growth Factor Beta 3 and Jagged2 Genes in the Malay Population With Nonsyndromic Cleft Lip With or Without Cleft Palate

Ghazali N, Rahman NA, Kannan TP, Jaafar S

Cleft Palate Craniofac J, 2015 07;52(4):e88-94.
PMID: 26151095 DOI: 10.1597/14-024

OBJECTIVE: To determine the prevalence of mutations in transforming growth factor beta 3 (TGFβ3) and Jagged2 genes and their association with nonsyndromic cleft lip with or without cleft palate (CL±P) patients.

DESIGN: Cross-sectional study on nonsyndromic CL±P and noncleft patients.

SETTING: Reconstructive clinic and outpatient dental clinic, Hospital Universiti Sains Malaysia.

PATIENTS: Blood samples of 96 nonsyndromic CL±P and 96 noncleft subjects.

MAIN OUTCOME MEASURE: Prevalence and association of mutations in TGFβ3 and Jagged2 genes with nonsyndromic CL±P.

RESULTS: Most of the nonsyndromic CL±P patients (53.1%) had left unilateral CLP. There were slightly more females (56.6%) compared with males. The prevalence of the mutations in the TGFβ3 gene was 17.7% (95% confidence interval [CI]: 9.5, 24.5) and in the Jagged2 gene was 12.5% (95% CI: 5.5, 18.5), which was higher compared with the noncleft group. For the TGFβ3 gene, there was no mutation in the coding region in either of the groups. All variants were single nucleotide polymorphisms located within the intronic flanking region. Two variants were identified (g.15812T>G and g.15966A>G) in both nonsyndromic CL±P and noncleft patients. However, the association was not significant (P > .05). Three variants (g.19779C>T, g.19547G>A, and g.19712C>T) were identified in the Jagged2 gene among nonsyndromic CL±P and noncleft patients. Only g.19712C>T showed a significant association with nonsyndromic CL±P patients (P = .039).

CONCLUSION: g.19712C>T might play a crucial role in the development of cleft lip and palate. To the best of our knowledge, this is the first report of the mutation found within intron 13 of the Jagged2 gene among nonsyndromic CL±P Malay patients.

Study site:Reconstructive and outpatient dental clinic, Hospital Universiti Sains Malaysia (HUSM)

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