In the present study, researchers explored attitudes toward midlife crises, experience with midlife crises, help-seeking, and needs among multi-ethnic Malaysian women. A total of 14 focus group discussions were conducted with 89 Malaysian women of different ages and socioeconomic backgrounds. Women expressed concern over physical aging and decline in their physical functional health. Having a midlife crisis was frequently reported. Issues that were frequently reported to trigger a midlife crisis, such as empty nest syndrome, impact of aging on sexual and reproductive function, extended parenthood, caring for aging or ill parents, and career challenges were noted by the study participants (listed here in order of most to least frequently reporting of these themes across the group discussions). Overall, these issues were associated with attitudes about aging. A comparatively less open attitude toward sexual attitudes and help-seeking for sexual problems were found among the Malay and Indian women. This may imply that intervention to increase positive attitudes concerning both sexuality and help-seeking intentions should be culturally specific. The use of religious coping for comfort and consolation was frequently reported; therefore, those providing midlife crisis prevention and intervention programs should consider involving faith-based interventions in the Malaysian setting.
Physicians' experiences in providing human papillomavirus (HPV) immunization were assessed by mailed questionnaire. Response rate of 41.4% was achieved. Malay Muslim physicians were more likely to agree that cultural sensitivity is an issue when recommending HPV vaccines. Pediatricians and family physicians were more likely to agree that acceptance is better if vaccines were recommended to prevent cervical cancer than to prevent a sexually transmitted disease. Near 70% rated success of HPV vaccines recommendation in their practice as very poor with the majority patients preferred to postpone immunization. Physicians reported cultural disparities in vaccine uptake and perceived high vaccination cost limits its use.
Epidemiological and demographic transitions are shifting the burden of modifiable risk factors for chronic and end-stage kidney disease to low- and middle-income countries (LMIC). This shifting burden of disease--combined with economic transitions and health system reforms--has led to the rapid growth of dialysis populations in LMIC including Malaysia, Tunisia, Turkey, Chile, Mexico, and Uruguay. Yet, compared to 1.5 million on dialysis in LMIC, only approximately 33,000 kidney transplants were performed in 2012. Reasons include health system factors (personnel, infrastructure, system coordination, and financing) and cultural factors (public and professional attitudes and the legal environment). The size of the dialysis populations, however, is generally a poor indicator of the potential need for kidney transplantation in LMIC. Population needs for kidney transplantation should instead be assessed based on the epidemiology of the actual underlying burden of disease (both treated and untreated), and the costs and benefits of treatment as well as prevention strategies relative to existing service provision. Here, we review current data on the global burden of end-stage kidney disease and the distribution of major risk factors, and compare this to access to kidney transplantation in 2012.
INTRODUCTION: There have been limited multiregional studies in Asia examining the parameters of men's general and sexual health and quality of life in the general population vs. those in clinical cohorts of patients with erectile dysfunction (ED).
AIMS: The aims of the Asian Men's Attitudes to Life Events and Sexuality (Asian MALES) study were to investigate the prevalence of ED, associated health conditions, and ED treatment-seeking patterns in the general male population in five regions of Asia (China, Japan, Korea, Malaysia, and Taiwan).
MAIN OUTCOME MEASURE: Standardized questionnaire previously used in a similar multiregional study and modified to ensure culturally appropriate content for Asia.
METHODS: Phase I of the study involved 10,934 adult men, aged 20-75 years, who were interviewed using the standardized questionnaire. Phase II of the study involved men with self-reported ED recruited from Phase I and via physician referral, invitations in general practitioner offices, and street interception (total Phase II sample, N = 1,209).
RESULTS: The overall prevalence of self-reported ED in the Phase I study population was 6.4%. ED prevalence varied by region and significantly increased with age (P < 0.01). Men with ED reported significantly greater rates of comorbid illness (P < 0.0001) and a reduced quality of life (P = 0.0001), compared with men without ED. Phase II of the study revealed that fewer than half of men with self-reported ED had sought treatment for their problem. Men were more likely to seek help for erection difficulties from Western doctors than from traditional medicine practitioners (P = 0.0001). A man's partner/spouse was the most common influencer of treatment seeking in all regions except Malaysia.
CONCLUSION: The findings confirm those of existing research on ED in both Asian and non-Asian males: ED is a prevalent condition; the prevalence of ED increases with age and is strongly associated with comorbid conditions; and the majority of men have never sought treatment for their condition. This study highlights a substantial need for the evaluation and treatment of ED in Asian men.
Hysterectomy and tubal sterilisation are two commonly performed gynaecological procedures in Malaysia. Little has been published about the psychological impact on sexuality of such operations in the Far East. Many Malaysian patients believe that surgery to the pelvic organs may be detrimental to the sexual health and needs of women. There is a widespread belief that the uterus is essential for the libido and sexual wellbeing of women. It is also believed that tubal sterilisation may result in the loss of libido and thus of sexual desire for her husband. Despite counselling to dispel these misconceptions, patients frequently refuse surgical management for fear of losing their libido and sexuality. Inability to satisfy and consummate marriage is a valid reason for the partner to find another wife (Muslims in Malaysia are legally allowed to have four wives). This fear of ultimately losing the husband to another woman due to lack of libido and loss of sexuality often causes women to refuse appropriate surgery. The recent availability of the levonorgestrel intra-uterine system (IUS) in Malaysia provides a suitable medical alternative to surgery in managing some of these patients. There is good evidence to suggest the effectiveness of the levonorgestrel IUS in the treatment of menorrhagia. The use of the levonorgestrel IUS in women whose cultural beliefs/misconceptions are not amenable to counselling, may help in the psychological preservation of their libido and sexuality.
Men's health has gained prominence over the past few years but it is still not on par with the attention or funding that women and child health is getting. In Asia, this issue is even more conspicuous. With westernization of lifestyle, Asian men's problems emulate their Western counterparts but there are certain issues unique to Asian men due to cultural differences. This review will discuss the health issues affecting Asian men and suggest measures that can be taken to overcome them.
Various key aspects needing consideration in primary health care services for children are described. These include the need for basic curative facilities, a dyodic approach, concentration on major issues, use of appropriate technology and cultural appropriateness.
A morbidity survey was carried out on a sample of eight longhouses in the Entabai area of the Sixth Division, Sarawak. Of the 645 respondents interviewed, only 148 (22.9%) had experienced at least one spell of illness during the one month prior to the survey.A total of 161 spells of illness was reported, giving a rate of three spells per person per year for the community. Most of the complaints were mild in nature, with fever and aches being the commonest reported. About two thirds of the illnesses were seen by the village aide or at the klinik desa, while the remaining preferred to be treated by the manang. A sub-sample of 49 heads of household were interviewed on their views of the causation, prevention and spread offive common conditions. About 14-43% of the respondents had no knowledge of the causes of fever, cough, diarrhoea or worms. Among those who mentioned some causative factors, only a portion had correct concepts of the various aspects of diseases. Food taboos associated with the five conditions were not too numerous or extensive enough to affect dietary intakes. However, this is not so during the post-partum period where the mother is not allowed to eat many vegetables and meat which are common items in their everyday diets.
This scale is constructed to meet the need for an efficient, rapid and economical method of
measuring change in schizophrenic patients during the course of psychotropic medication (drug trial) in a multi-cultural, multi-lingual population of low educational level. Items are included only if (1) they can be elicited objectively, (2) they are important symptoms of schizophrenia and (3) they are frequent maniJestatz'on of the schizophrenic syndrome as recorded in Woodbridge Hospital. It could be used by a single rater but its reliability should be further improved if two raters are involved.
Sixty four percent (104 patients) of Malay patients attending the Psychiatric Clinic for the first time were interviewed. A similar number from the general Out-patients Department (O.P.D.) randomly chosen, served as the control group. Seventy six (73.1%) psychiatric patients had consulted a bomoh prior to their visit to the clinic as compared to 26 (25%) O.P.D. patients. The number of bomohs consulted was significantly higher among the psychiatric patients than the O.P.D. patients. The strength of social support, the availability of a bomoh and the belief of the patients, friends and/or relatives in the bomoh have been suggested as the main factors that influenced the Malay patients in seeking bomoh treatment. The belief that mental illness is due to supernatural causes is firmly held by bomohs who reinforce this notion in those who seek their advice. The importance of understanding the patient's cultural background in treating psychiatric patients is highlighted.
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Latah is a culture-bound syndrome from Malaysia and Indonesia. Persons exhibiting the Latah syndrome respond to minimal stimuli with exaggerated startles, often exclaimning normally inhibited sexually denotative words. Sometimes Latahs after being startled obey the commands or imitate the actions of persons about them. Most episodes of Latah are intentionally provoked for the amusement of onlookers. Similar sets of interactive behaviors have been reported from genetically and culturally unrelated populations (e.g., Bantu, Ainu, and French Canadians). Since competent anthropological investigators have shown Latah to be intimately tied to specific factors in the cultural systems of the Southeast Asian societies in which it is found, its occurrence elswhere has been considered paradoxical. New data, including films and videotapes of hyperstartling persons from Malaysia, the Philippines, Japan, and the United States, suggest a model capable of resolving the apparent paradox by showing how the various forms of latah are culture-specific exploitations of a neurophysiological potential shared by humans and other mammals. Latah provides an especially revealing example of the complex ways in which neurophysiological, experiential, and cultural variables interact to produce a strongly marked and phenomenon.
The paper is based on original empirical research into the lifestyle migration of European migrants, primarily British, to Thailand and Malaysia, and of Hong Kong Chinese migrants to Mainland China. We combine strong structuration theory (SST) with Heideggerian phenomenology to develop a distinctive approach to the interplay between social structures and the lived experience of migrants. The approach enables a rich engagement with the subjectivities of migrants, an engagement that is powerfully enhanced by close attention to how these inner lives are deeply interwoven with relevant structural contexts. The approach is presented as one that could be fruitfully adopted to explore parallel issues within all types of migration. As is intrinsic to lifestyle migration, commitment to a better quality of life is central to the East Asian migrants, but they seek an uncomplicated, physically enhanced texture of life, framed more by a phenomenology of prosaic well-being than of self-realization or transcendence. In spite of possessing economic and status privileges due to their relatively elite position within global structures the reality for a good number of the lifestyle migrants falls short of their prior expectations. They are subject to particular kinds of socio-structural marginaliszation as a consequence of the character of their migration, and they find themselves relatively isolated and facing a distinct range of challenges. A comparison with research into various groups of migrants to the USA brings into relief the specificities of the socio-structural positioning of the lifestyle migrants of the study. Those East Asian migrants who express the greatest sense of ease and contentment seem to be those who have responded creatively to the specific challenges of their socio-structural situation. Often, this appears to have been achieved through understated but active involvements with their new settings and through sustaining focused transnational connections and relationships.
To show the effectiveness of incorporating religious-sociocultural components in the management of patients with generalised anxiety disorders and major depression who have strong religious and cultural backgrounds as compared with a normal psychotherapeutic approach.
The case history, treatment and follow-up of a thirteen-year-old girl with obsessive-compulsive neurosis of six months duration are reported. Results show that behaviour modification techniques were effective though a second course of treatment was required. Her illness and its treatment by behaviour therapy in relation to the Malaysian Chinese culture is discussed.
Malaysia has a large variety of traditional medical systems that are a direct reflection of the wide ethnic diversity of its population. These can be grouped into four basic varieties, namely, traditional "native," traditional Chinese, traditional Indian and modern medicine, examples of which are described. In spite of the great inroads made by modern medicine, the traditional systems are firmly established. Patients move from one system to another or use several systems simultaneously. The integration of the traditional Malay birth attendant into the health team is described. The forces influencing the development, acceptance and integration of the medical systems is discussed.
This study uses data from the Second Malaysian Family Life Survey, conducted in 1988, to examine parents' preferences for the sex of their children within each of Malaysia's three ethnic groups. While Malay and Indian parents do not show a consistent sex preference, Chinese parents prefer to have all sons, or a combination of sons and daughters, with more sons than daughters, or at least an equal number of them. Son preference among the Chinese does not seem to be a constraint to fertility decline among that population. Since 1970, Chinese fertility has dropped rapidly; at the same time, Chinese son preference has become more pronounced. Evidence indicates that further reductions in Chinese fertility, through the reduction in sex preference, would be small.
The objectives of this article are (1) review the contribution of traditional midwives to family planning communication in several Asian countries; (2) organize knowledge gathered from various studies into general guidelines for the most effective use of traditional midwives in family planning programs; and (3) present hypotheses for future research. In certain countries where pilot projects have tested the potential performance of traditional midwives in family planning programs, results have been encouraging. In other nations, more research is needed to determine the contribution traditional midwives can make to the family planning program.
PIP: Traditional midwives are found in almost every village and in many urban neighborhoods in the developing world, delivering the majority of births in these areas. Several Asian nations have begun to recognize the potential contribution of traditional midwives to modern family planning and health programs. A total of about 17,000 traditional midwives have been trained as family planning recruiters in Indonesia, Malaysia, the Philippines, and Thailand. Because traditional midwives deliver a large number of births in Asian nations, the potential is great for them to reach large numbers of women regarding family planning -- particularly poor, illiterate women. There is much to be learned from the traditional health system and governmental health and family planning programs should join hands with these older systems.