A study was conducted to compare the blood lead levels of 97 pregnant women warded at the Kuala Lumpur Hospital, according to their ethnicity, residence and place of work. The lead content of venous blood samples was determined with a graphic furnace atomic absorption spectrometer. Blood lead levels of Klang Valley women seem to have decreased from 17.3 micrograms/dl in 1982 to 7.71 micrograms/dl in the present study most probably attributed to the phasing out of leaded gasoline. This level is below the 10 micrograms/dl recommended by the United States Environmental Protection Agency for the public, even though 27.8% of them still have blood lead levels that are equal to or in excess of 10 micrograms/dl. The study shows that certain segments of the population such as Indians (geometric mean = 9.35 micrograms/dl) and housewives (geometric mean = 9.55 micrograms/dl) may still experience blood lead levels that are slightly elevated than the rest of the population.
The first systematic observation of a general flowering, a phenomenon unique to lowland mixed-dipterocarp forests in Southeast Asia, is presented. During general flowering, which occurs at irregular intervals of 3-10 yr, nearly all dipterocarp species together with species of other families come heavily into flower. We monitored reproductive phenology of 576 individual plants representing 305 species in 56 families in Sarawak, Malaysia. Observations continued for 53 mo from August 1992 and covered one episode of a general flowering cycle. Among 527 effective reproductive events during 43 mo, 57% were concentrated in the general flowering period (GFP) of 10 mo in 1996. We classified 257 species into flowering types based on timing and frequency of flowering. The most abundant type was "general flowering" (35%), which flowered only during GFP. The others were "supra-annual" (19%), "annual" (13%), and "sub-annual" (5%) types. General flowering type and temporal aggregation in reproductive events were commonly found among species in various categories of taxonomic groups, life forms, pollination systems, and fruit types. Possible causes for general flowering, such as promotion of pollination brought about by interspecific synchronization and paucity of climatic cues suitable for flowering trigger, are proposed, in addition to the predator satiation hypothesis of Janzen (1974).
The medical radiation usage for diagnostic radiology in Malaysia (a Level II country) for 1990-1994 is reported, enabling a comparison to be made for the first time with the United Nations Scientific Committee on the Effects of Atomic Radiation Report. In 1994, the number of physicians, radiologists, x-ray units, and x-ray examinations per 1,000 population was 0.45, 0.005, 0.065, and 183, respectively. (Level I countries had averages of 2.6, 0.072, 0.35, and 860, respectively). In 1994, a total of 3.6 million x-ray examinations were performed; the annual effective dose per capita to the population was 0.05 mSv, and the collective effective dose was 1,000 person-Sv. Chest examinations contributed 63% of the total. Almost all examinations experienced increasing frequency from 1990 to 1994 except for barium studies, cholecystography, and intravenous urography (-23%, -36%, -51%). These decreases are related to the increasing use of ultrasound and greater availability of fiberoptic endoscopy. Notable increases during the same period were observed in computed tomography (161%), cardiac procedures (190%), and mammography (240%). In order to progress from Level II to Level I status Malaysia needs to expand and upgrade radiological service in tandem with the health care development of the country.
When a doctor is required to go to court, he does so with some amount of trepidation. The degree of trepidation increases in direct proportion as to whether he is required to be a witness or a defendant. The practice of medicine on the other hand requires the patient to have full confidence and open out his secrets to the doctor. If you hold back vital information, the diagnosis may be entirely different to the disease that you have. Lawyers who enter hospitals may also do so with some trepidation, maybe even more so than doctors who enter courts, as their lives are at stake. There is a perception that medico-legal matters are on the rise. We may put forward a few reasons for this: 1. A better educated and increasingly assertive public with greater awareness of the medical and legal systems; 2. Rising expectations of medical results; 3. Commercialization of medical care with erosion of the doctor-patient trust relationship. This paper will discuss the reasons for and the ways to address medical errors as well as explore the reasons for defensive medicine. The argument is put forward that public education programs on the risks inherent in some of the new advances in treatment modalities and surgery and professional education programs on the need for obtaining the patient's informed consent to such treatment is needed. Public advocacy programs to demonstrate the problems in medicine and the delivery of health care resulting from strict cost containment limitations should be carried out. There is also the need to enhance the level and quality of medical education for all physicians, including improved clinical training experiences. Doctors' must manage their clinical affairs in a professional manner without being dictated to by the legal system. However, it would be wise to take note of the views expressed by learned counsel and judges in their courts. The middle road is always the best and we must never be extreme in our viewpoints. We must always remember the patient is why we are here and the patient must never suffer in the process while we formulate our responses to the medico-legal challenges that lie ahead.
Nursing in Malaysia is still developing as a profession. Issues such as using nursing conceptual models or frameworks in the delivery of nursing care have not been addressed by the majority of nurses. One reason for this has been the level of education and preparation of nurses, while another reason lies with the origins of existing nursing conceptual models. Most nursing conceptual models have their origins in North America. Their utility by nurses of different cultures and academic preparations might not be appropriate. Nursing is a social activity, an interaction between the nurse and the patient. It is carried out in a social environment within a particular culture. Conceptual models developed in one culture might not be readily implanted into another culture. This paper discusses how a conceptual model developed in North America; that is, the Neuman Systems Model, can be adapted into the Malaysian nursing context.
Changes in species composition in two 4-ha plots of lowland dipterocarp rainforest at Danum, Sabah, were measured over ten years (1986-1996) for trees > or = 10 cm girth at breast height (gbh). Each included a lower-slope to ridge gradient. The period lay between two drought events of moderate intensity but the forest showed no large lasting responses, suggesting that its species were well adapted to this regime. Mortality and recruitment rates were not unusual in global or regional comparisons. The forest continued to aggrade from its relatively (for Sabah) low basal area in 1986 and, together with the very open upper canopy structure and an abundance of lianas, this suggests a forest in a late stage of recovery from a major disturbance, yet one continually affected by smaller recent setbacks. Mortality and recruitment rates were not related to population size in 1986, but across subplots recruitment was positively correlated with the density and basal area of small trees (10-< 50cm gbh) forming the dense understorey. Neither rate was related to topography. While species with larger mean gbh had greater relative growth rates (rgr) than smaller ones, subplot mean recruitment rates were correlated with rgr among small trees. Separating understorey species (typically the Euphorbiaceae) from the overstorey (Dipterocarpaceae) showed marked differences in change in mortality with increasing gbh: in the former it increased, in the latter it decreased. Forest processes are centred on this understorey quasi-stratum. The two replicate plots showed a high correspondence in the mortality, recruitment, population changes and growth rates of small trees for the 49 most abundant species in common to both. Overstorey species had higher rgrs than understorey ones, but both showed considerable ranges in mortality and recruitment rates. The supposed trade-off in traits, viz slower rgr, shade tolerance and lower population turnover in the understorey group versus faster potential growth rate, high light responsiveness and high turnover in the overstorey group, was only partly met, as some understorey species were also very dynamic. The forest at Danum, under such a disturbance-recovery regime, can be viewed as having a dynamic equilibrium in functional and structural terms. A second trade-off in shade-tolerance versus drought-tolerance is suggested for among the understorey species. A two-storey (or vertical component) model is proposed where the understorcy-overstorey species' ratio of small stems (currently 2:1) is maintained by a major feedback process. The understorey appears to be an important part of this forest, giving resilience against drought and protecting the overstorey saplings in the long term. This view could be valuable for understanding forest responses to climate change where drought frequency in Borneo is predicted to intensify in the coming decades.
Consumers' self-assessments of materialism and status consumption may be influenced by external economic conditions. In this study, 239 Malaysian students were asked to describe their levels of materialism using Richins and Dawson's 1992 Materialism scale and status consumption using Eastman, Goldsmith, and Flynn's 1999 Status Consumption Scale. Half the students were told to respond assuming that they were in an expanding economy, and half as if the economy was in a recession. Comparison of the groups' mean scores showed no statistically significant differences.
Community resistance to, and resilience from, perturbation will determine the trajectory of recovery from disturbance. Although selective timber extraction is considered a severe disturbance, fish communities from headwater streams around Danum Valley Field Centre, Sabah, Malaysia, showed few long-term changes in species composition or abundance. However, some species showed short-term (< 18 months) absence or decrease in abundance. These observations suggested that both resistance and resilience were important in maintaining long-term fish community structure. Resistance to perturbation was tested by monitoring fish communities before and after the creation of log-debris dams, while resilience was investigated by following the time-course of recolonization following complete removal of all fish. High community resistance was generally shown although the response was site-specific, dependent on the composition of the starting community, the size of the stream and physical habitat changes. High resilience was demonstrated in all recolonization experiments with strong correlations between pre- and post-defaunation communities, although there was a significant difference between pool and riffle habitats in the time-course of recovery. These differences can be explained by the movement characteristics of the species found in the different habitats. Resilience appeared to be a more predictable characteristic of the community than resistance and the implications of this for ensuring the long-term persistence of fish in the area are discussed.
Climatic records for Danum for 1985-1998, elsewhere in Sabah since 1879, and long monthly rainfall series from other rainforest locations are used to place the climate, and particularly the dry period climatology, of Danum into a world rainforest context. The magnitude frequency and seasonality of dry periods are shown to vary greatly within the world's rainforest zone. The climate of Danum, which is aseasonal but subject, as in 1997-1998, to occasional drought, is intermediate between less drought-prone north-western Borneo and the more drought-prone east coast. Changes through time in drought magnitude frequency in Sabah and rainforest locations elsewhere in South-East Asia and in the Neotropics are compared. The 1997-1998 ENSO-related drought event in Sabah is placed into a historical context. The effects of drought on tree growth and mortality in the tropics are assessed and a model relating intensity and frequency of drought disturbance to forest structure and composition is discussed.
The diversity of beetle assemblages in different habitat types (primary forest, logged forest, acacia plantation and oil palm plantation) in Sabah, Malaysia was investigated using three different methods based on habitat levels (Winkler sampling, flight-interception-trapping and mist-blowing). The overall diversity was extremely high, with 1711 species recorded from only 8028 individuals and 81 families (115 family and subfamily groups). Different degrees of environmental changes had varying effects on the beetle species richness and abundance, with oil palm plantation assemblage being most severely affected, followed by acacia plantation and then logged forest. A few species became numerically dominant in the oil palm plantation. In terms of beetle species composition, the acacia fauna showed much similarity with the logged forest fauna, and the oil palm fauna was very different from the rest. The effects of environmental variables (number of plant species, sapling and tree densities, amount of leaf litter, ground cover, canopy cover, soil pH and compaction) on the beetle assemblage were also investigated. Leaf litter correlated with species richness, abundance and composition of subterranean beetles. Plant species richness, tree and sapling densities correlated with species richness, abundance and composition of understorey beetles while ground cover correlated only with the species richness and abundance of these beetles. Canopy cover correlated only with arboreal beetles. In trophic structure, predators represented more than 40% of the species and individuals. Environmental changes affected the trophic structure with proportionally more herbivores (abundance) but fewer predators (species richness and abundance) in the oil palm plantation. Biodiversity, conservation and practical aspects of pest management were also highlighted in this study.