The aim of this postal survey was to assess the utilization, knowledge and attitude concerning sealants among Malaysian dentists. A pretested questionnaire was sent to all dentists (1217) who were on the Dentist Register of Malaysia of 1987. A response rate of 61.1% was obtained. The results indicate that 52.6% of the respondents have used sealants, but of these only 13.6% have used them frequently. The two "knowledge" related questions receiving the most support concerned the suitability of the first permanent molars for sealants and the loss of sealants attributable to problems at the time of application. The two "attitudinal" questions receiving the most support concerned the value of sealants in preventing dental caries and the need for the profession to expand more efforts toward increasing public demand for sealants. Only about 50% of the respondents believed that sealants are cost-effective.
In a recent epidemiological study of 249 opiate addicts in the State of Penang, Malaysia, the use of benzodiazepines, its temporal relationship to opiate addiction and the reasons for use of benzodiazepines were examined. Just over a half of the opiate addicts indicated use of benzodiazepines in their lifetime. Use of 7 different benzodiazepines was reported, among them flunitrazepam most frequently. A substantial proportion had discontinued the use of benzodiazepines after initial experimentation. Just over a quarter had used them in the last 24 hours. Benzodiazepine use starts on average 3 to 6 years later than heroin use. The most common reason cited for benzodiazepine use was to enhance the feeling of 'high' from the opiates. These findings can be explained, at least partly, by economic factors. Reasons that could be qualified as attempts to autotherapy did not exceed 20%. None of the opiate addicts had reported isolated benzodiazepine use for fun and pleasure. From the time course of use as well as from the reasons given by the addicts, it is evident that benzodiazepines are not primary drugs of abuse. Comparing their figures from Malaysia with figures from Germany and England the authors cannot explain the preferred use of flunitrazepam by Malaysian addicts by the existence of special properties of this substance.
In a study of 249 opiate (mainly heroin) addicts special attention was paid to adjunctive drug use. Generally, nicotine (cigarette smoking), alcohol and cannabis preceded the use of heroin, and continued to be used as adjunctive drugs after the establishment of heroin addiction. Nicotine was the most common substance used together with opiates. Alcohol and cannabis were used as adjunctive drugs in about two-thirds of the cases. In the late stages of heroin addiction, benzodiazepines were also used concomitantly with opiates. The most frequently reported reason for the use of adjunctive drugs was to intensify the effect of the opiate. Three-quarters or more of the addicts had used different adjunctive drugs to boost the euphoric feeling derived from the primary drug, i.e. heroin. Attempt at self-treatment of withdrawal symptoms was a less frequently reported reason for adjunctive drug use. The findings show that heroin addiction is the major problem. The use of adjunctive drugs, especially benzodiazepines, can be partly explained on economic grounds. They must be clearly distinguished from the primary drug of abuse, heroin. For policy-making decisions, it is important that the elimination of heroin abuse through effective prevention measures would ultimately wipe out the problem of adjunctive drug use, while reduction of the overall supply of heroin without reduction in actual demand might result in an increasing trend to adjunctive drug use.
Following revision of the curriculum the effectiveness of a traditional cookbook experiment, used in conjunction with an 'interpretation seminar', was evaluated. Curriculum revision had been predominantly concerned with an avoidance of overloading and provision of self-study periods. The preceding lectures were integrated with the experiment. The learning resulting from the practical experience was assessed using pre- and post-tests. The practical exercise was ineffective and did not facilitate conceptual understanding. Due to the central role of passive teaching methods the students adopted a surface approach to all learning, were teacher dependent and did not make effective use of their private study. Furthermore, owing to a broad-based entry into medical school many students lacked the basic skills essential to the achievement of meaningful learning. Clearly, for effective learning the curriculum and pedagogy must be geared to the background and educational needs of the students.
The nutritional status of 641 children between the ages of 0 to 4 years old, from 835 households in 41 randomly selected rural villages with water supply in Sarawak were determined. Based on Waterlow's classification and the National Center for Health Statistics (NCHS) standards, 61% of the children were stunted and 44.1% were wasted. Based on Gomez's classification and the NCHS standards 81.9% of the children were malnourished. There was no sex difference in nutritional status. The percentage of malnourished children increased continuously with age while the percentage of children who were wasted increased from 6 to 36 months and then it leveled off. The percentage of stunted children also increased with age but the increase was sharpest in children who were 12 to 23 months old. It is noted that the Gomez classification overestimates the prevalence of undernutrition.
A self-administered questionnaire survey was conducted among sawmill managers in Sarawak to explore certain health and safety aspects of workers in this industry. The survey reveals that many sawmills are lacking in the provision of occupational health facilities and activities for their employees.
The socioeconomic, social behaviour and dietary pattern of 100 Aborigines and Malays, aged 7 years and above from Kuala Pangsoon, Selangor Malaysia were studied by using pretested questionnaires. The individual's dietary intake was estimated using 24 hour recall for 3 days within one week which was chosen at random. The household's food consumption pattern was evaluated using food frequency questionnaires. There was no difference in the total income per month for both communities, as well as the educational attainment of the head of household and property ownership. The proportion of smokers among the Aborigines and the Malays was almost similar (33%) but the percentage of heavy smokers was higher among Aborigines compared to Malays. One third of the Aborigines regularly consume alcohol. The main energy source for both communities was rice, sugar and cooking oil whilst fish and eggs were the main sources of protein. More than 50% of the Aborigines take tapioca or tapioca leaves at least once a week compared to less than 20% among the Malays. There was no significant different in the intake of energy, protein and carbohydrate between the groups. However, the Aborigines take less fats and iron compared to the Malays. The difference in terms of smoking, drinking habit and dietary intake may determine the distribution of disease in both communities.
In a case study involving preliminary investigations for the feasibility of a beach resort complex in the west coast of Sarawak, Malaysia, since the acceptable quality of recreational water quality had not been specified, existing international standards and practices were reviewed to arrive at acceptable microbiological and physicochemical parametric levels. Water samples were collected on a weekly basis in the proposed beach complex at Tanjong Batu Coastal Reserve and also along the nearby Sungei Batang Kemena and its estuary. It was ascertained that the swimming water quality was acceptable in terms of faecal Coliforms, temperature, pH and dissolved oxygen. However E. Coli counts did indicate a potential risk of 1.68% for gastrointestinal illness and the ubiquitous presence of faecal Streptococci pointed to recent pollution of human or animal origin. Besides, grease and oil contents exceeded the WHO Guideline values. It was hence recommended that an appropriate sanitation or pollution survey should be carried out in the adjacent coastal catchment area and the beach. Also routine water sampling should be undertaken. Such action will help to pinpoint sources of pollution and lead to antipollution measures, thus helping to upgrade swimming water quality and establish swimming water quality standards.
The use of organochlorine pesticides has caused concern due to their effects on human health and the Malaysian aquatic ecosystem, particularly so in view of their persistent and bioaccumulative properties. Since the extent of organochlorine pesticide pollution in Malaysian waterways is unknown except for isolated instances, a systematic survey has now been carried out. Water samples from various rivers were extracted, cleaned up with Florisil and analysed for the individual organochlorine pesticides by gas chromatography (GC) with an electron capture detector (ECD). DDE, DDT and heptachlor were present in all the river water samples of the west coast of Peninsular Malaysia. Other organochlorine pesticides were also identified from the water samples. However, the levels of all these are still below criteria values for Malaysian aquatic life, indicating that organochlorine pesticide pollution is less of a problem than other organic or inorganic pollutants.
A questionnaire was mailed to 1217 dentists whose names appear in the Dentist Register of 1987 in order to assess their awareness and acceptance of hepatitis B vaccine and their pattern of glove usage. Almost all the respondents (99.6%) were aware of the availability of the hepatitis B vaccine yet only 44.8% have received the vaccine. This is in spite of the fact that the majority (61.2%) of the vaccine non-acceptors have no reservations concerning the vaccine. About 71% and 63% of the vaccine-acceptors and non-acceptors respectively believed that the risk of their contracting hepatitis B was high or very high. About 22% of the vaccine non-acceptors never used gloves when treating patients as compared to 9% among vaccine acceptors. Overall, about 78% of the respondents have experienced needleprick injuries in the 3 years preceding the survey.
To verify the actual immunisation coverage in Kuala Lumpur, City Hall Health Department and the Malaysian Paediatric Association (NGO ) carried out a survey. The survey revealed that the immunisation coverage determined at the child's first birthday for BCG was 95%, DPT 3 94%, OPV 3 94%, and measles = 27% (59% at 2 years). These figures correspond closer to City Hall's estimated coverage rather than the rates projected by the Ministry of Health. The main reasons for immunisation failure were, child ill 31.8% (not brought = 20.1%, brought but not given vaccine 11.7%), lack of information 28.6%, lack of motivation 9.1%, mother too busy 9.1%. Measles immunisation coverage at 1 year was low because of wrong information on schedules. Tetanus toxoid immunisation coverage of pregnant women was low. Only 27% of children were protected against neonatal tetanus although 97% of pregnant women received antenatal care and 50% had attended other health facilities as well during pregnancy. Private medical practitioners were responsible for more than 40% of all immunisations but were not submitting returns to the Health Department. Recommendations to improve immunisation coverage include education and motivation of the public and also doctors and health personnel on prevention of missed opportunities, contraindictions to immunisation and correct schedules. (Copied from article).
A questionaire concerning various aspects of blood pressure measurement and hypertension was answered by 84 out of 98 (86%) doctors and 73 out of 100 (73%) nurses working in various parts of the state of Pahang. 59% and 85% of doctors and nurses respectively agreed that blood pressure should be measured routinely in all out-patients. 48% of medical staff were taught to use and 38% were actually using phase 4 as the diastolic blood pressure despite the general agreement that phase 5 should be used to denote diastolic pressure. 52% of doctors believed that hypertensive patients present with symptoms, the common symptoms cited were headache and dizziness, although it is well documented that hypertension is essentially asymptomatic. 93%, 80%, 69% and 82% of doctors believed that treatment of hypertension can prevent cerebrovascular disease, heart failure, renal failure and coronary artery disease respectively, although prevention of the last complication is yet unproven. Most doctors would begin treating a patient at rather low level of blood pressure, for example, for a man in the age group 40-49, 40% of doctors would begin drug treatment at diastolic pressure of 90 mmHg and 55% at diastolic pressure 95 mmHg. 79% of nurses and 55% of doctors were dissatisfied with the sphygmomanometer they have, the most common complaint was that the cuff-bladder 'blow up' on being inflated.
Study site: doctors and nurses at private general practice, klinik kesihatan, district hospitals, Pahang, Malaysia
Although delays in seeking dental care among patients are frequently observed in daily practice, this problem has never been investigated in other utilization studies. This study attempts to establish the magnitude and severity of the problem of delay in a delivery system where cost is not a major barrier to utilization. 555 users of Government dental services were interviewed. Only 37% of them came promptly within 6 days of perceiving a dental need. The majority (63%) had delayed their dental visit for more than 1 week. In fact, the highest frequency of delay was for more than 1 month. Prompt attendance was found to be associated with people who regularly came for asymptomatic check-ups. In contrast, more than 50% of those who thought they needed fillings and extractions had delayed their visit for more than a month. The main causes of delays were attributed to work commitments and the lack of perceived need for urgent care. Barriers related to transport or financial problems were ranked very low. The implications of these findings are discussed.
One hundred consecutive patients attending the UKM (Universiti Kebangsaan Malaysia) Cardiology Clinic completed a questionnaire enquiring about their own assessment of their knowledge about their illness, their awareness of cardiac risk factors and their expectations in their management. Only 11% of our patients had graduated from tertiary education. 59% of our patients were being treated for ischaemic heart disease. Although only 28% of our patients considered having considerable knowledge of their illness, a majority of our patients were aware of cardiac risk factors. This was independent of the formal education achieved. However this awareness did not necessarily result in appropriate behaviour; 32% of patients admitted to smoking despite being aware of the harmful effects of smoking. 74% of our patients expected a cure from their doctors; only 37% of our patients thought they required medication indefinitely. Thus, patients could be made aware of their illness regardless of their formal educational status. However this may not necessarily result in appropriate behaviour. The high expectations which the patients have of their doctors is unrealistic and may be detrimental to appropriate long-term management of their chronic illness.
Study site: Cardiology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
This study investigated knowledge, attitudes, and preventive efforts of Malaysian college students regarding health risks associated with passive smoking, as well as possible directions for intervention and health education programs. Students responded anonymously to a structured written questionnaire. Statistical analyses were conducted to examine (1) differences in knowledge, attitudes, and preventive efforts between smokers and nonsmokers and between men and women; (2) the relationship between smoking by parents, siblings, and friends, and students' knowledge, attitudes, and preventive efforts; and (3) relationships between knowledge, attitudes, and preventive efforts. Peer groups and siblings had a substantial influence on students' attitudes toward passive smoking and their preventive efforts when exposed to passive smoke. A regression analysis revealed a statistically significant linear dependence of preventive efforts on knowledge and attitudes, with the attitude component playing the dominant role. This research suggests that educational efforts on passive smoking, directed toward young college students in developing countries such as Malaysia, should concentrate heavily on changing attitudes and reducing the effects of peer group and sibling influences.
Study site: Institut Teknologi Mara, Shah Alam; Stamford College, Petaling Jaya; Selangor, Malaysia
A questionnaire survey of student nurses and nurses at a premier hospital in Malaysia reveals that the majority of nurses support the use of corporal punishment on schoolchil-dren. Malay nurses who had received corporal punishment were more likely to endorse corporal punishment than those who had not received it. The number of non-Malay nurses was too small for comment. These findings reveal that nurses need to re-examine their attitudes and their training with respect to child discipline and child rearing practices. Nurses need to be educated on the cycle of violence and the root causes of child abuse in the community. Nurses need to change their attitudes to violence on children and to condemn any such acts, whether it be in the home or at school.
A retrospective survey was carried out in a neonatal unit to identify babies who required oxygen for more than the first 28 days of life and to determine the cause of their oxygen dependency. A total of 9173 neonates were admitted over a three year period. Approximately 750 were ventilated. Fifteen required oxygen for more than the first 28 days. Ten (67%) of these were due to bronchopulmonary dysplasia. 2 had upper airway complications of mechanical ventilation, one had recurrent apnoea, one had recurrent pneumonia, and one who did not require ventilation had chronic oxygen dependency of unknown cause. Bronchopulmonary dysplasia was the commonest cause of chronic oxygen dependency. The incidence was 1.5% of ventilated babies.
The optimization and development of an ELISA-disc procedure for the detection of antibodies to whole cell surface antigens and purified exotoxin ofPseudomonas pseudomallei is described. Comparison of the serum agglutination test (SAT), the serum based enzyme-linked immunosorbent assay (ELISA) and the ELISA-disc procedures used on goat and human sera demonstrated a high correlation in their ability to detect antibodies specific forP. pseudomallei antigens. A serological survey using the ELISA-disc method was carried out on a normal human population in Sabah, Malaysia, an area known to be endemic for melioidosis. The prevalances of antibodies towards cell surface antigens and exotoxin ofP. pseudomallei were 28% and 8%, respectively. As a procedure, the ELISA-disc technique reported here is technically simple and provides savings in costs and is thus deemed suitable for seroepidemiological surveillance of melioidosis in remote areas of South-East Asia.
This is a study of the prevalence of dementia in elderly Malays living in the Eunos district of Singapore. The subjects included all Malays 65 years and more living in public housing, and they were first interviewed and screened for any cognitive deficit using the Malay version of the Elderly Cognitive Assessment Questionnaire (ECAQ). All those who scored 5 or less in the ECAQ were assessed again with a more detailed questionnaire called the Geriatric Mental State (GMS) schedule. This is the preliminary results of 149 subjects interviewed--77 men and 72 women. Data from the GMS were analysed by a computer diagnostic programme, AGECAT. There were only 6 cases of dementia and the overall prevalence of dementia in the sample was estimated as 4.0%. In the age group 65 to 74 years the rate was 2.5% and this increased to 10.3% in those 75 years and more. The prevalence of dementia in elderly Malays is higher than elderly Chinese in Singapore, but it is similar to the results of studies in New York and Liverpool. All the subjects with dementia were living with their families and they had good social resources.
This study establishes the prevalence rate for alcoholism among the inpatients of the General Hospital, Kuala Lumpur, as 11%, but as 25% among the drinking population. It also describes the demographic profile of the alcoholic as compared to the non-alcoholic drinker and the non-drinker and suggests that certain vulnerability factors could contribute to the development of alcoholism. A trend noted is also the changing racial trends in the use of alcohol.