The concept of primary health care (PHC) according to WHO has been implemented in Malaysia since 1978. The rural health centres which provide the primary health care have developed from about 47 in 1970 to about 772 in 1998. Since the implementation of the health centres there has been significant reduction in morbidity and mortality rates. However due to the emerging issues like changing demographic 'patterns, changing pattern of disease, and increasing demand from the public, the delivery of PHC is being reviewed. Newer programmes and review of the older programmes are being done to address the provision of PHC in the 21st century. The functions and roles of the existing staff in the health centres are being reviewed. This new concept is known as expanded scope of primary health care. The purpose of this paper is to explain the achievements in primary health care and the components of primary health care in the expanded scope.
Current selection guideline for CRT uses broad QRS duration (>120 ms) as a marker for ventricular dyssynchrony. However, more recent data supports mechanical marker specifically measured by Tissue Doppler Imaging (TDI) as a better criterion to predict response to CRT. Sixty seven patients with significant left ventricular dysfunction (EF less than 40%) and narrow QRS complex were prospectively enrolled. They underwent Tissue Doppler Imaging (TDI) study to evaluate intraventricular mechanical dyssynchrony. Dyssynchrony index which is defined as standard deviation of time to peak systolic velocity in twelve ventricular segments was measured. A value greater than 32.6 is taken to reflect significant ventricular dyssynchrony. Overall 38 patients (56.7%) demonstrated significant dyssynchrony. There was no significant correlation between QRS duration and the Ts-SD-12 (r = 0.14, p = 0.11). Ventricular mechanical dyssynchrony is common in patients with normal QRS duration. Therefore, QRS duration alone will miss a substantial proportion of suitable patients for CRT and therefore deny them this adjunct therapy. We propose echocardiographic parameters, specifically TDI, to be included in patient selection criteria for CRT.
Background: Cataract is the second priority eye disease in the world and this case in Indonesia occupies the third-highest position in Southeast Asia. There are two methods for cataract treatment that can be expensive, small incision method (SICS) and Phacoemulsification method, and it is important to know the cost-effective comparison of those two methods.
Objective: This study aims to conduct Cost-Effectiveness Analysis (CEA) between cataract surgery; Small Incision Cataract Surgery (SICS) and Phacoemulsification, at Undaan Eye Hospital Surabaya.
Materials and Method: A prospective study following up patients from before surgery up to 21 days’ post surgery. A total of 155 cataract patients had undergone surgery; 25 patients and 130 patients had SICS and Phacoemulsification, respectively. Quality-Adjusted Life Years (QALYs) was used as the outcome measure. The assessment of utility using ‘Visual Function 25’ (VF-25) was the quality of life regarding visual function before surgery, 7 days, and 21 days post-surgery.
Result: The average cost of Phacoemulsification technique was Rp 10,821,038 and the average cost of SICS technique was Rp 10,443,544. QALYs at day7 post-surgery of Phacoemulsification and SICS was 9.49 and 8.95, respectively. While QALYs at day21 post- surgery of Phacoemulsification and SICS was 10.37 and 10.15, respectively. ICER values for Phacoemulsification versus SICS at day7 post-surgery was Rp 696,360 (USD 49,74) while at day 21 was Rp 1,723,559 (USD 123,11).
Conclusion: Phacoemulsification and SICS are effective ways to improve the quality of life related to visual function. The incremental cost per QALYs obtained via Phacoemulsification from SICS at D7 and day21 post- surgery were less than Indonesia’s GDP per capita income of USD 3,347, means that Phacoemulsification is more cost effective than SICS technique for cataract surgery.
Systematic review is a comprehensive review of research findings in which all of the primary studies are systematically identified, appraised and summarised using an explicit and reproducible methodology. Meta-analysis is the statistical component of a systematic review in which combinable studies are drawn together via a statistical process. Systematic reviews and meta-analyses are routinely being used in the evidence-based approach to medicine. These short notes intend to highlight important terms in systematic-review and meta-analysis. It is a beginner’s guide for health care professional of any discipline involved in research or practice who seeks to gain more comprehensive understanding of important terms used in systematic review and meta-analysis.
Prevalence and signs and symptoms of menopause have been extensively studied among Malaysian women but no one had investigated the level of knowledge and perception of menopause. This study aimed to examine the knowledge and perception of menopause among young to middle aged women (15 to 49 years old). A cross-sectional survey using 20-items questionnaire was conducted in three randomly chosen districts in Federal Territory, Kuala Lumpur. Women in this survey were aware of the meaning of the term menopause and its symptoms. However, the majority lacked comprehensive understanding about the health risks associated with menopause. Commonly cited sources of knowledge were magazines and family members. Lack of official sources for accurate information on menopause was reported. Communication with health care personnel regarding menopause was uncommon. An exploration into respondents' perceptions on menopause revealed that the majority displayed positive thinking towards menopause. Young respondents seemed to have better perception regarding menopause compared to middle aged women. Although the women had good knowledge about menopause, they expressed feelings of sadness and nervousness upon the approach of their own menopause. Our data provides insight on the knowledge and perception of menopause that will guide future public health initiatives for premenopausal women in order for them to cope better when approaching this stage of life cycle.
Malaysia, like many aspiring developing countries, is undergoing a health transition that has seen the concomitant decrease in communicable diseases and increase in chronic diseases due to urbanization, modernization and ageing population. Health in the Malaysian society will thus increasingly focus on emerging problems that are both chronic and infectious in nature, such as, heart disease, diabetes, cancer, mental health, hepatitis and HIV/AIDS. Re-emerging diseases previously well-controlled, such as, tuberculosis for instance is another addition to these immediate health issues facing Malaysian society today. Despite the tremendous health gains and above average health status that Malaysians now enjoy, we are compelled to take stock of these urgent issues as well as to anticipate and handle serious challenges to our health in the 21st century. In this paper, we review the changing trends and discuss related challenges in disease pattern, environmental health, demographic impacts on health, migration influxes and health, effects of globalization on health, mental health and wellness as well as fundamental access and equality in health care. Being proactive, resilient and innovative, Malaysian society would forge ahead towards our Vision for Health in this new era. KEYWORDS: Society and health, health trends and issues, Vision for Health, Malaysia
The majority of migrant workers studied in this survey were males Muslims from Bangladesh. The mean age was 30 and the majority were aged between 21-30 years. Although almost all of them had 7-13 years of schooling, the majority were working in the service industry. More than two thrids of the migrant workers were provided with various forms of housing by their employers. Majority of them stated that they had better amenities, such as piped drinking water and sanitary toilets, in Malaysia compared to those in their home countries. From their reports, it appears that the majority did not engage in risk behaviours such as, smoking, alcohol and drug abuse.
The majority of migrant workers studied in this pilot survey were male, from Bangladesh and Muslim. The mean age was 30 years and the majority were aged between 21-30 years. Although almost half of them had 7-13 years of schooling, or an equivalent to secondary education, the majority were work- ing in the Service industry, predominantly in cleaning services. It is noted that this enlployment trend varied from the national situation, whereby majority of legal migrant workers (Indonesian and Thai) are found in the agricultural sector. More than two thirds of the migrant workers were provided with various forms of housing by the employer. However, it is not known if such acconunodation was adequate or not, as there were no questions about housing structures aod extent of overcrowding. Majority of them stated that they had better amenities, such as piped drinking water and sanitaly toilets, here in Malaysia compared to those in their home countries. Yet, the real extent of better sani- tation is difficult to assess since verification of such amenities could not be done. From their self- reports, it appears that the majority did not engage in risk behaviours, such as smoking, alcohol and drug abuse. It is pertinent, however, to include other risk behaviours in the study, particularly the area of sexual behaviour. The pilot study yielded 28 female Indonesian migrant workers. More than two thirds of them were married. Although none of the married women reported that they were pregnant at the time of the survey, more than two thirds of then1 had betweenl-3 children in Malaysia. Since the age range of these children would be an important indicator of the need for preventive health care, it is proposed that age range of the accompanying children and their immunisation status be included in the questionnaire. Just below half of them were currently practising family planning, and more than two thirds were using modern methods, such as, pill, Norplant and IUD. It is recotnmended that in addition to pregnancy and family planning information, the study could also collect data on gynaeco- logical health and the health seeking behaviour for these problems.
A review of the questionnaire was carried out basically to assess the relevance of the questions to the objectives of the study, to identify weaknesses of the questions particularly in terms of the wording in order to make them as clear as possible to the respondents and to minimize ambiguity and thus the problems of getting the questions across to the respondents. Based on the review a new set of questionnaire would be proposed. The review thus focuses on two major aspects namely the structure and the content of the questionnaire. From the structural aspects each question was reviewed in terms of the language, wording, sequencing and continuity between one another. Basically, not much problems have been identified except in certain cases of ambiguity largely due to language and words used and some cases lack of continuity due to improper sequencing of the questions In terms of the content, for each questions, the purpose of asking, and what is expected of the questions was thoroughly examined and then the relevance assessed. Based on the analysis, three group of questions were identified i.e., the irrelevant questions, the partially relevant and most inlportant non-existence of many relevant questions. It is recommended that the irrelevant questions be omitted, those partially relevant to be modified and new questions added.
MicroRNAs (miRNAs) are short, single-stranded non-coding RNAs that control gene expression by annealing to complementary sequences in mRNAs. They are estimated to regulate at least one third of human transcripts and hence, manipulation of these miRNAs can profoundly affect the proteome and ultimately cellular phenotypes. A substantial amount of work has shed light on the crucial roles of miRNAs in diseases. miRNA expression profiles between normal and diseased tissues have identified miRNA signature patterns that correlate to disease development and progression. This review discusses some of the important miRNAs that are involved in endothelial cell senescence and dysfunction that contribute to the development and progression of cardiovascular diseases.
Meta-analysis is a method of review that summarises the results of previous research of the same particular issue in a systematic and quantitative way. A meta-analysis that properly combines results from different studies will average out differences caused by random variation and produce a more precise estimate of the true effect. It may also detect and investigate heterogeneity among studies thus providing a deeper understanding of clinical dilemmas and guidance on resolving them, in this way a meta-analysis will be a better guide to practice than an individual study. Meta-analysis also has its limitations as it is largely dependent on the quality of published data and requires careful planning and execution of a valid protocol, together with cautious interpretation of the results. KEYW'ORDS: Quantitative Review, CritinJ Appraisal, Overall Effect, Publintion Bias.
From August 1999 to January 2001, twelve chemotherapy naive patients with locally advanced and metastatic non-small cell lung cancer (NSCLC) in our hospital received vinorelbine and cisplatin. Ten patients had stage IV disease while two had stage HI disease. Patients' performance status (PS) were as follows: four had PS 1, six had PS 2, and one each PS 3 and 4. A total of 46 cycles were given as scheduled. Only major haematological toxicities were noted; one patient each with Grade 3 anaemia, Grade 3 and Grade 4 leucopenia, two had Grade 3 neutropenia and 5 had Grade 4 neutropenia without associated mortality. Three patients had Grade 3 alopecia and one had Grade 3 phlebitis. After three cycles, three patients demonstrated partial response and two had stable disease. For the four patients who completed 6 cycles, two demonstrated stable disease and two partial response. Symptom improvement was reported in all but one patient. Performance status was better in four, stable in six but declined in two patients. In conclusion, in patients with locally advanced and metastatic NSCLC, vinorelbine/cisplatin is a well-tolerated and active regimen, offering symptom palliation and improved performance status in a significant proportion of patients. KEYWORDS; Vinorelbine, lung cancer, chemotherapy.
The objective of this study was to determine the factorial validity of the Chinese version of the General Family
Functioning subscale (GF-12) and to assess parents’ perceived family functioning of children with or without
chronic respiratory disease in Malaysia. Thirty two parents of children with chronic respiratory disease and
30 parents of healthy children were recruited. The GF-12 was administered at baseline and 2 weeks later.
Confirmatory factor analysis showed that our instrument was a 1-factor model assessing general family
functioning. Cronbach’s α value was 0.950. Test-retest reliability coefficient ranged from 0.490-0.790. The overall
mean (standard deviation) score was not significantly different between parent’s perceived family functioning
of children with or without respiratory disease [1.83(0.63) versus 1.65(0.46), p=0.385]. The Chinese version
of the GF-12 was found to be a valid and reliable instrument to assess family functioning in Malaysia. Parents
in the present study showed healthy perceived family functioning (total score >2.00).
Comparison and evaluation of physicochemical properties of the six betamethasone·17-valerate creams available locally were studied. Tests that were conducted include stiffness/hardness, grittiness. colour, odour, homogeneity (phase separation), pH, weight of loss, tackiness (stickiness) and microscopic examination. A point grading system was used 10 assess and compare the products. Results revealed that BetnovateT and CamnovaleT to be the most superior followed by BeavateT, SetrosoneT, BetasoneT and UniflexT
Background: Hepatitis C Virus (HCV) is a major public health problem worldwide. About 130- 200 million people
are infected with HCV worldwide leading to 500,000 deaths annually (WHO 2014). Healthcare workers (HCWs)
have played an important role in the transmission of HCV infection, either as victims or as sources of infection.
Objectives: To determine the prevalence of HCV, antibodies (Abs) RNA and genotypes among the female HCWs
in Baghdad and to identify whether HCWs were infective or only infected.
Subjects and Methods: A cross-sectional study involving 1001 women attending 17 health care centres in
Baghdad, Iraq, was carried out. Information on type and duration of their occupation was obtained. HCV Abs
(anti-HCV) were tested using a third generation enzyme immunoassay (EIA-3) and immunoblot assay (Lia
Tek-111). Molecular analysis using RT-PCR and DNA enzyme immunoassay (DEIA) for HCV-RNA and genotype
detections were carried out for 63 serum samples.
Results: Only 160/1001 (15.98%) were HCWs. Anti-HCV and HCV- RNA seroprevalence were significantly higher
(6.37%, p=0.0057, 88.83%, p= 0.011 respectively) among HCWs than non HCWs. HCWs were at a significantly
higher risk of exposure to HCV infection (OR=2.75, 95% C.I. =1.31-5.79). There was no significant association
between HCV genotypes and the HCWs. HCV-4 showed higher expression (62.5%) among HCWs.
Conclusion: Female HCWs were infective and infected with HCV, thus there is a need for medical equipment
to be sterilized and cleaned thoroughly.
Parasitological and serological investigations for lymphatic filariasis were performed on 450 immigrants detained at the lmmigration Centre at Semenyih, Selangor, West Malaysia. The country of origin of these immigrants were Indonesia, The Philippines, Myanmar, Bangladesh, India and Pakistan. Brugia malayi adult worm homogenate (BmAH) antigen was used for the detection of antiifilarial IgG. A monoclonal antibody-based ELISA (MAb.XC3-ELISA) specific for filarial circulating antigens and non-phosphorylcholine reactive was used to detect antigenemia in these immigrants. Parasitologically 67 (14.89 %) were positive for W. bancrofti and 54 (12.0%) for Brugia malayi. Serologically 63% had antifilarial IgG titre to the BmAH antigen. While Bancroftian filariasis is now unknown in Peninsular Malaysia, the potential of it to be reintroduced into Peninsular Malaysia by the immigrant population is discussed. KEYWORDS: Lymphatic filariasis, immigratits, antifilarial IgG, antigenemia
Background: School children are at great risk of nutrition-related chronic diseases. Their eating pattern in
school is influenced by the availability of food served within the school environment. The purpose of this
paper was to determine the effectiveness of a canteen-based food nutrition intervention, designed according
to the theory of planned behaviour, on the knowledge, perception and choices of healthy food among primary
schoolchildren.
Methods: This was a prospective intervention study using a two-group design. Six school canteens from the
ninety-eight primary schools were randomly allocated to an intervention group or a control group. All the
food handlers in the intervention group were given a twelve-week training course in food nutrition. On the
completion of the course, 293 Standard Six students from these schools, were interviewed with a nutritional
questionnaire on food in their school canteens. The training programme for the intervention group and the
questionnaire for the students were developed and validated for the study, and a power calculation made for
the sample size of students.
Results: The students in both groups were homogeneous in gender and body mass. The mean body mass
index (BMI) was 19.26 (SD: 0.38) and 19.47 (SD: 0.39) for the intervention and the control group respectively.
There were more schoolchildren in the intervention group who purchased foods in school canteens (p 0.0036)
of milk and milk products (p 0.034), and white rice (p
Peripartum cardiomyopathy (PPCM) is a life-threatening cardiomyopathy of an unknown cause that occurs in the peripartum period in previously healthy women and this article discusses the challenges that lie in diagnosing and managing this rare yet lethal disease. KEYWORDS: Peripartum, cardiomyopathy, pregnancy, cardiac failure
Peripartum cardiomyopathy (PPCM) is a life-threatening cardiomyopathy of an unknown cause that occurs in the peripartum period in previously healthy women and this article discusses the challenges that lie in diagnosing and managing this rare yet lethal disease.
Studies have found the association between hypercholesterolemia with oxidative stress and atherogenesis. Atherosclerosis has become one of the leading causes of mortality among industrial countries due to abnormal cholesterol metabolism, inflammation of arterial wall and build-up of atherosclerotic plaque. This disease has been recently linked with alpha lipoic acid (ALA), a mitochondrial compound with antioxidative effects in water- and fat-soluble mediums, in both oxidized and reduced forms: lipoic acid (LA) and dihydrolipoic acid (DHLA), respectively. This article provides a comprehensive review of the development and progression of atherosclerosis and the roles and regulations of ALA as a potent antioxidant against atherosclerosis.