The post-operatve course of amputees is poorly documented. This cross-sectional survey was unertaken to determine functional outcomes of 213 patients who had undergone either a below-knee or above-knee amputation from 2000 to 2002 in a state-hospital setting. The study comprises a self-constructed questionnaire and interview conducted by phone. Of the 213 amputees, 41 out of 61 documented telephone numbers of the patients were useful for contact. Only 30 amputees were available for the study as the remaining 11 had passed away. Included in the questionnaire was the modified Barthel Index, a measurement to assess the amputees' ability to carry out activities of daily living (ADL). It contains ten questions pertaining to ADL with a total score of 20 points. Two-thirds of the respondents (67%) use their prosthesis for less than six hours per day. The Barthel Index of 30 patients ranged from 9-20 (mean 17.7). However, the mean Barthel Index in those with and without prosthesis was 18.4 and 15.2 respectively, but this difference was not significant. Half of the respondents were unable to maintain their pre-amputation jobs, while the remaining 50% were still able to work. Forty seven percent of amputees took less than a year to return to their activities, while 33% took between one to two years. Regarding the adequacy of preamputation information provided by the doctors, 73% amputees responded in the affirmative, while 27% felt otherwise. Amputees were still facing substantial disabilities following major amputation of the lower limb. Although 80% of respondents surveyed own prosthesis, the full use of prosthesis is suboptimal due to prosthetic-related problems. Most amputees had a good functional outcome based on the modified Barthel Index. Some amputees were unhappy as they felt that they were insufficiently informed regarding post-amputation expectation prior to the amputation. Despite good support from family, the community support for amputees is still lacking.
The prevalence of pain complaints as a reason for patient-doctor encounters in the local primary care setting is unknown. We performed a cross-sectional survey of such encounters in one public primary care clinic (KK) and 17 general practice clinics (GP), from the city of Seremban, Negeri Sembilan, Malaysia. Reasons for visits were recorded by doctors in KK and medical students in GP using a structured questionnaire. Morbidity data was coded using the International Classification of Primary Care (ICPC-2). A total of 2234 encounters were recorded (80.9% from KK, 19.1% from GP). The overall prevalence of pain complaints was 31.9% with a significant difference between the two cohorts (KK 28.7% and GP 45.2%, p<0.001). Musculoskeletal pain complaints were more common in KK than GP (40.9% versus 29.7%, p<0.05). Of the 3 main ethnic groups in Malaysia (Malay, Chinese and Indian) the Indian patients at KK had the highest prevalence of pain complaints and the Chinese at the GP had the lowest. Thus pain was a common complaint in the two different primary care settings studied. Some of the differences observed are probably due to the differences in the healthcare seeking behaviour of patients consulting at these two settings as well as differences in the payment systems.
Soil-transmitted helminthiases are a public health problem in rural communities. A cross-sectional study of the prevalence and distribution of Ascaris lumbricoides, Trichuris trichiura and hookworm was conducted in 281 Orang Asli children (aborigines) aged between 2 and 15 years, from 8 Orang Asli villages in Selangor, Malaysia. All the children were infected with soil-transmitted helminthes, with 26.3% of the children infected either with A. lumbricoides, T. trichiura or hookworm and 72.6% having mixed infection. The overall prevalences of A. lumbricoides, T. trichiura and hookworm were 61.9, 98.2 and 37.0%, respectively. Approximately 19.0, 26.0 and 3.0% of the children had severe infection of ascariasis, trichuriasis and hookworm infection, respectively. The prevalences and mean egg per gram (epg) counts for A. lumbricoides and T. trichiura were not significantly dependent on age, therefore age-dependent convexity was not seen in this study. However, the results of this study reveal an age-dependent prevalence and mean epg count in children with hookworm infection. We conclude that ascariasis, trichuriasis and hookworm infection are still prevalent and therefore a public health concern in Orang Asli communities. Severe ascariasis and trichuriasis may lead to other health and medical problems.
The purpose of this study was to report on the estimates and distribution of body mass index in a sample of Malaysian adolescents. The study utilized a cross-sectional design and multi-stage random sampling of secondary schools to select 5 urban and 9 rural schools in Kedah and Penang. A total of 6555 male and female adolescents (11-15 years old) of Malay, Chinese and Indian ethnic groups were measured for weights and heights for body mass index calculation. Information on household demographic and socioeconomic were obtained from parents through self-administered questionnaires. Analyses of body mass index distribution by location, ethnicity, gender and age were conducted using Chi-square test of SPSS 11.5. More of the rural (12.1%) and urban (19.4%) adolescents were underweight and overweight, respectively. While in all ethnic, gender and age groups, rural adolescents were more likely to be underweight, more of the urban adolescents were overweight. The prevalence of underweight was highest among the Indians (19.2%) and lowest in Chinese (7.2%). The prevalence of overweight in the three ethnic groups was in the range of 18-19%. More male than female adolescents were underweight (15% vs 7.8%) and overweight (19.5% vs 16.7%). Consistent patterns were also observed across location, ethnic and age groups. As age increased, the prevalence of overweight decreased across the ethnic and gender groups. The reported findings can serve as current reference on body mass index distribution of Malaysian adolescents and a basis for future efforts in health and nutrition interventions for Malaysian children and adolescents.
Smoking and alcohol intake patterns may persist from adolescence to adulthood. The aims of this study are to determine the prevalence and factors associated with smoking and drinking habits among Form Six students. This was a cross-sectional study conducted in January 2003 among Form Six students from government schools in the Petaling District, Selangor. A hundred and thirty six self-administered questionnaires were distributed to students selected through multistage stratified sampling. Response rate in this study was 90.1% (136/151). The respondents were mainly Chinese 60 (44.1%) and female 88 (64.7%). The prevalence of smoking was 22.8%, whereas the prevalence of alcohol intake was 47.8%. Only 33.1% of the respondents practiced undetermined activities and 1.5% have undetermined characters. There were significant associations between smoking and males (Adjusted OR 2.56, 95% CI 1.02-6.43) and smoking and alcohol intake (Adjusted OR 2.74, 95% CI 1.11-6.78). Alcohol intake has significant negative association with Malays (Adjusted OR 0.83, 95% CI 0.03-0.27). Smoking habits among adolescents were associated with males and alcohol intake. However, only alcohol intake was negatively associated with Malays. Program interventions to reduce behavioral problems, particularly smoking and alcohol intake should be emphasized.
An audit of hypertension management was done in October 2004 in nine general practice (GP) clinics. Two structure, ten process and two outcome indicators were assessed. Results showed that targets were achieved in only four indicators, i.e., weight recording (89%), BP monitoring (85.8%), follow-up interval not exceeding 6 months (87.9%) and mean diastolic BP (73.9%). The other indicators (hypertension registry, reminder mechanisms for defaulters, recording of smoking, height, fundoscopy, monitoring of lipid profile, blood sugar, ECG, renal function and achievement of target mean systolic pressure) showed adequacy percentages varying from 22.1 to 68.7. Out of the 1260 patients assessed, 743 (59%) achieved a mean BP < or = 140/90 (or < or = 130/80 mmHg with diabetes mellitus / renal insufficiency) in the last 3 recorded readings. There was a vast difference between individual clinics. Reasons for not achieving targets were discussed and remedial measures for implementation were recommended.
The objective of this study was to determine the prevalence of diabetic retinopathy in a primary care setting using digital retinal imaging technology and to quantify the degree of diabetic retinopathy using internationally accepted severity scales. Two hundred patients with type 2 diabetes were evaluated clinically followed by fundus photography. The prevalence of retinopathy and maculopathy was 47.4% and 59.2% respectively (both retinopathy and maculopathy 34.7%). The high prevalence of retinal abnormality in this study is a cause for concern as most patients had diabetes for only 5 years or less.
In a multiracial country like Malaysia, ethnicity may influence the measurement of health-related quality of life (HRQL) in asthmatic patients. We invited 131 adult patients [44 Malays, 42 Chinese and 45 Indians; mean (95% CI) age: 43 (40.2-45.7) yrs; 28.2% male] with moderate-to-severe persistent asthma followed up in an urban-based hospital outpatient clinic to complete a disease-specific HRQL questionnaire [St Georges' Respiratory Questionnaire (SGRQ)] and to provide socio-demographic and asthma-related data. Indians reported significantly worse SGRQ total score, compared to Malays [mean (95% CI) difference: 10.15 (0.51-19.78); p = 0.037] and SGRQ activity score, compared to Malays [13.50 (1.95-25.05); p = 0.019] and Chinese [11.88 (0.19-25.05); p = 0.046]. Further analysis using multivariate linear regression showed that Indian ethnicity remained independently associated with SGRQ scores. Our finding highlights the relevance of ethnicity in assessing HRQL of asthmatic patients in a multiracial country such as Malaysia.
Study site: chest clinic of an urban-based
university teaching hospital
The aim of this study is to highlight the baseline characteristics of the results of a screening test for anaemia among infants in a village in Okinawa, Japan. The groups were classified into two; infants with and without anaemia. A total of 201 infants were screened at 3-4 months, 9-10 months and 18 months. The study showed that gestational age and BMI were predictive of anaemia at 3-4 months of age. At 9-10 months, types of feeding and weight ratio were the only factors that were found to be significantly predictive of anaemia. However, no factor was found to be predictive of anaemia at 18 months. Anaemia cases were found to occur at 3-4 months and 9-10 months. Most of the anaemia cases have successfully undergone treatment.
OBJECTIVE: To assess the pharmaceutical sector to know whether people have access to essential medicines.
SETTING: The study was conducted in 20 public health clinics, five public district drug stores and 20 private retail pharmacies selected randomly in five different areas randomly selected (four states and a federal territory).
METHOD: The methodology used was adopted from the World Health Organization study protocol. The degree of attainment of the strategic pharmaceutical objectives of improved access is measured by a list of tested indicators. Access is measured in terms of the availability and affordability of essential medicines, especially to the poor and in the public sector. The first survey in the public health clinics and public district drug stores gathered information about current availability of essential medicines, prevalence of stock-outs and affordability of treatment (except drug stores). The second survey assessed affordability of treatment in public health clinics and private retail pharmacies.
MAIN OUTCOME MEASURE: Availability, stock-out duration, percent of medicines dispensed, accessibility and affordability of key medicines.
RESULTS: The average availability of key medicines in the public health clinics for the country was 95.4%. The average stock-out duration of key medicines was 6.5 days. However, average availability of key medicines in the public district drug stores was 89.2%; with an average stock-out duration of 32.4 days. Medicines prescribed were 100% dispensed to the patients. Average affordability for public health clinics was 1.5 weeks salary and for the private pharmacies, 3.7 weeks salary.
CONCLUSIONS: The present pharmaceutical situation in the context of essential medicines list implementation reflected that the majority of the population in Malaysia had access to affordable essential medicines. If medicines need to be obtained from the private sector, they are hardly affordable. Although the average availability of essential medicines in Malaysia was high being more than 95.0%, in certain areas in Sabah availability was less than 80.0% and still a problem.
Apart from the mean 24 hour ambulatory blood pressure (ABP), the blood pressure variability (BPV) also bears an independent relationship with target-organ damage in hypertension. A reduction in arterial compliance has been demonstrated in hypertension but its relation to BPV is still unknown. The aim of the study is to compare BPV and arterial compliance between hypertensive and normotensive subjects. Eighteen hypertensives and 18 controls were enrolled. Noninvasive 24-hour ABP monitoring was performed with BR-102 monitor (Schiller Inc. Germany). Arterial compliance was determined by the HDI/Pulsewave Research Cardiovascular Profiling Instrument (Hypertension Diagnostic Inc. USA). There were significantly higher systolic, diastolic and mean arterial BPV in hypertensives as compared to normotensive group. Only systolic BPV remained significantly high in hypertensives during night time. There were lower arterial compliances in hypertensive as compared to normotensive group. No significant relationship however was found between BPV and arterial compliance in hypertensive subjects. In conclusion, there were higher BPV and lower arterial compliances in hypertensive subjects as compared to normotensive subjects.
INTRODUCTION: Otitis media with effusion (OME) is an inflammation of the middle ear in which a collection of liquid is present in the middle-ear space while the tympanic membrane is intact. The association between adenoid inflammation and OME has long been noted but the exact mechanism is still much debated. We studied the role of adenoid mast cells in the causation of OME.
OBJECTIVE: To study the distribution and role of adenoid mast cells in the causation of OME.
METHODOLOGY: A cross-sectional, prospective study was carried out in the otorhinolaryngologic clinic, department of otorhinolaryngology (ORL), Science University of Malaysia, from June 1999 to September 2001. A total number of 50 cases were studied. Twenty-five of these patients underwent adenoidectomy, while another 25 patients underwent adenoidectomy and myringotomy with ventilation tube insertion. The adenoid specimens from all patients were examined for the number of adenoid mast cells present, using light microscopy and toluidine blue as the staining agent. The results were analysed using SPSS version 10.0 computer software.
RESULT: The population of adenoid mast cells in children with OME was significantly greater than that in children without OME (p=0.000).
CONCLUSION: The increased number of adenoid mast cells in patients with OME suggests that inflammation may play a role in this condition.
Sinusitis is an important cause of morbidity and one of the major sources of income loss. Anatomical variations of the nose have been reported to predispose to sinusitis. These variations include concha bullosa, nasal septal deviation and oversized bulla. The aim of this study was to determine the proportion and the distribution of concha bullosa in patients with chronic sinusitis and to determine the relationship between concha bullosa and age, sex, ethnicity. A cross-sectional study was conducted at the Department of Ear, Nose and Throat in Kuala Lumpur Hospital (HKL). Data was collected retrospectively using a pretested proforma. All patients who underwent Sino nasal surgery between January 1999 and December 2000 and whose preoperative CT scans were available were included in the study. The CT scans were reviewed. Analysis was carried out using Statistical Package for Social Sciences. Out of 146 patients who underwent sinonasal surgery between January 1999 and December 2000, 101 (69.2% preoperative CT scans of these patients were available and these were reviewed. The proportion of patients with concha bullosa was 49.5%. The results showed that there was significant relationship between presence of concha bullosa and age and sex. The overall mean age of patient with concha bullosa was 35.7 years (95% CI 12.1-39.3) and ranged from 11-years to 56-years. The mean age of respondents with concha bullosa was significantly lower than patients without concha bullosa 41.98 (95% CI 37.6-46.3; t-test = 2.221; df=99; p < 0.05). Concha bullosa was significantly more in females (66.0%) compared to males (chi2 = 4.465, df=1, p < 0.05). There was no significant relationship between presence of concha bullosa and ethnicity.
Red rice is a fermented product of Monascus spp. It is widely consumed by Malaysian Chinese who believe in its pharmacological properties. The traditional method of red rice preparation disregards safety regulation and renders red rice susceptible to fungal infestation and mycotoxin contamination. A preliminary study was undertaken aiming to determine the occurrence of mycotoxigenic fungi and mycotoxins contamination on red rice at consumer level in Selangor, Malaysia. Fifty red rice samples were obtained and subjected to fungal isolation, enumeration, and identification. Citrinin, aflatoxin, and ochratoxin-A were quantitated by ELISA based on the presence of predominant causal fungi. Fungal loads of 1.4 × 10(4) to 2.1 × 10(6) CFU/g exceeded Malaysian limits. Monascus spp. as starter fungi were present in 50 samples (100%), followed by Penicillium chrysogenum (62%), Aspergillus niger (54%), and Aspergillus flavus (44%). Citrinin was present in 100% samples (0.23-20.65 mg/kg), aflatoxin in 92% samples (0.61-77.33 μg/kg) and Ochratoxin-A in 100% samples (0.23-2.48 μg/kg); 100% citrinin and 76.09% aflatoxin exceeded Malaysian limits. The presence of mycotoxigenic fungi served as an indicator of mycotoxins contamination and might imply improper production, handling, transportation, and storage of red rice. Further confirmatory analysis (e.g., HPLC) is required to verify the mycotoxins level in red rice samples and to validate the safety status of red rice.
Depressive symptoms are frequent in students and may lead to countless problems. Several hypotheses associate magnesium with depression because of the presence of this mineral in several enzymes, hormones, and neurotransmitters, which may play a key role in the pathological pathways of depression. The aim of this study was to assess whether magnesium intake could modulate depressive symptoms. A cross-sectional study was conducted on a convenience sample of 402 Iranian postgraduate students studying in Malaysia to assess the relationship between magnesium intake and depressive symptoms. The mean age of the participants was 32.54 ± 6.22 years. The results of the study demonstrated an inverse relationship between magnesium intake and depressive symptoms, which persisted even after adjustments for sex, age, body mass index, monthly expenses, close friends, living on campus, smoking (current and former), education, physical activity, and marital status.
Computer-based clinical decision support systems (CDSS) are regarded as a key element to enhance decision-making in a healthcare environment to improve the quality of medical care delivery. The concern of having new CDSS unused is still one of the biggest issues in developing countries for the developers and implementers of clinical IT systems. The main objectives of this study are to determine whether (1) the physician's perceived professional autonomy, (2) involvement in the decision to implement CDSS and (3) the belief that CDSS will improve job performance increase the intention to adopt CDSS. Four hypotheses were formulated and tested.
Chronic obstructive pulmonary disease (COPD) is a systemic disease that leads to weight loss and muscle dysfunction resulting in an increase in mortality. This study aimed to determine the prevalence rate of malnutrition and nutritional status and also factors associated with nutritional status. A total of 149 subjects were involved in the cross-sectional study. The study was conducted at two medical centers in Kuala Lumpur, Malaysia. The results of the study showed that malnutrition was more prevalent (52.4%) in the subjects with severe stages of COPD as compared to mild and moderate COPD stages (26.2%) (P < 0.05). Fat-free mass depletion as assessed using fat-free mass index (FFMI) affected 41.9% of the subjects. Plasma vitamin A, peak expiratory flow (PEF), and handgrip were the predictors for body mass index (BMI) (R(2) = 0.190, P < 0.001). Plasma vitamin A and force expiratory volume in one second (FEV(1)) were the predictors of FFMI (R(2) = 0.082, P = 0.007). BMI was the predictor of respiratory factors, that is, FEV(1)% predicted (R(2) = 0.052, P = 0.011). It can be concluded that there is a need to identify malnourished COPD patients for an appropriate nutrition intervention.
Study site: outpatient clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Institute of Respiratory Medicine
There is a strong association between depression and pain, which is influenced by various biological and psychological mechanisms. The objectives of this study were to assess the prevalence and severity of pain symptoms among patients with major depression; and to determine the correlation between pain with clinical variables, neurotic pathology and severity of depression.
Breast cancer is the most common cancer and the leading cause of cancer death among women in Malaysia. Despite the campaigns undertaken to raise the awareness of the public regarding breast cancer, breast cancer screening rates are still low in the country. The community pharmacist, as one of the most accessible healthcare practitioners, could play a role in the provision of breast cancer health promotion services to the community. However, there are no documented data regarding the community pharmacists' involvement in breast cancer related health promotion activities. Hence, this study was conducted to examine self-reported knowledge, practice and perception of community pharmacists on provision of breast cancer health promotion services and to investigate the barriers that limit their involvement. This cross-sectional survey conducted between May to September 2010, included a sample of 35 community pharmacists working in the districts of Hulu Langat and Sepang in state of Selangor. A 22-item validated questionnaire that included both closed and Lickert scale questions was used to interview those pharmacists who gave their informed consent to participate in the study. The data was analysed using SPSS. Only 11.3% of the community pharmacists answered all the questions on the knowledge section correctly. The mean overall knowledge of the community pharmacists on risk factors of breast cancer and screening recommendations is 56%. None of the respondents was currently involved in breast cancer health promotion activities. Lack of time (80%), lack of breast cancer educational materials (77.1%) and lack of training (62.9%) were the top three mentioned barriers. Despite these barriers, 94.3% (33) of the community pharmacists agreed that they should be involved in breast cancer health promotion activities. Hence, there is need to equip community pharmacists with necessary training and knowledge to enable them to contribute their share towards prevention and screening of breast cancer.