In this population-based study, we determined the incidence rates of hip fracture among Singapore residents aged 50 years and above. Information was obtained from a centralized database system which captured admissions with the primary diagnosis of a closed hip fracture (ICD-9 codes 820, 820.0, 820.2 and 820.8, n = 12,927) from all health care establishments in the country from 1991 to 1998 inclusive. After removing duplicates, hospital transfers, readmissions and non-acute care admissions, the total number of hip fractures was 9406. Based on the national population census 1990 (n = 464,100) and yearly population estimates, the age-adjusted hip fracture rates for 1991-1998 (per 100,000) were 152 in men and 402 in women. This was 1.5 and over 5 times higher than corresponding rates in the 1960s. From 1991 to 1998, these hip fracture rates tended to increase by 0.7% annually in men and by 1.2% annually in women. Among the three major racial groups, in men, the Chinese had significantly higher age-adjusted hip fracture rates (per 100,000): 168 (95% confidence interval (CI) 158-178) compared with 128 (95% CI 105-152) for Indians and 71 (95% CI 54-88) for Malays. A similar pattern occurred in women: 410 (95% CI 395-425), for Chinese compared with 361 (95% CI 290-432) for Indians and 264 (95% CI 225-303) for Malays. Since the 1960s, the main increases in hip fracture rates have been seen in the Chinese and Malays, with the rates in Indians appearing to decrease. Hip fracture incidence rates in Singapore have risen rapidly over the past 30-40 years, particularly in women, and are now among the highest in Asia. Significant racial differences in hip fracture rates occur within the same community. Time trends in hip fracture rates differed between races.
The primary objective of this study was to determine the mean glandular dose (MGD) during diagnostic mammography in Malaysia. The secondary objective was to evaluate some of the factors affecting MGD. A survey of standard MGD was performed, based upon quality control records for the period October 1999 to August 2001. This covered 30 mammography units from 9 manufacturers. MGD was also measured for a series of patients attending mammography examinations at three other mammography units. MGD per film was estimated from recorded radiographic factors, the compressed breast thickness (CBT) and X-ray unit calibration data. MGD per woman was calculated by summing the MGDs for all films, and averaging it over both breasts. 300 women drawn equally from three major ethnic groups, namely Malay, Chinese and Indian, took part in the study. The difference of MGD per woman between ethnic groups was tested for significance using non-parametric Kruskal-Wallis and median tests. The factors affecting MGD per woman were tested for significance using a multivariate analysis of variance. The MGD for the phantom was 1.23 mGy (range 0.22-2.39 mGy) while the mean patient based MGD per film was 1.54 mGy and 1.82 mGy for the craniocaudal and mediolateral oblique views, respectively. The mean MGD per woman was 3.37 mGy. It was also found that there is no significant difference in MGD per woman among the ethnic groups (p>0.05, Kruskal-Wallis test). However, on the multivariate test two factors, namely half value layer of the X-ray beam and (CBT), had a significant effect on MGD per woman (p<0.05). No significant relationships were seen between MGD per woman with respect to ethnicity, body mass index or age.
Solvent abuse is deliberate sniffing of an organic solvent for the intention of altering the physiological state of the individual. It is also commonly known as glue sniffing because glue is the most commonly abused substance. This form of substance abuse is widespread throughout the world and usually popular among secondary school children and young adults because of its easy availability and it is cheaper compared with most drugs of abuse. In Malaysia this problem has been recognized especially among the children in East Malaysia. In this study, 37 children and young adults from or around Kota Kinabalu, Sabah were referred to Bukit Padang Psychiatric Hospital by the Anti-drug Task force for suspected solvent abuse. These children were interviewed using questionaire and examined physically. Blood and urine were analysed for toluene and hippuric acid. 27 of the children, age ranging between 8 and 20 years, willingly admitted to sniffing glue for a period between a few months to 2 years. Most of them were children of Fillipino illegal immigrants in Kota Kinabalu. Biochemical parameters were found to be normal. Two of them were pale with low hemoglobin and 7 had eosinophilia. Haematuria and proteinuria were found in 21 children (78%). 16 blood samples with toluene levels ranging from 0.3 to 41 microg/ml and 10 urine samples have elevated urinary hippuric acid levels ranging from 1.2 to 7.4 mg/ml. Strong positive correlation was noted between mean blood toluene levels and duration of abuse.
We describe the distribution of blood pressure (BP) by age, sex and ethnicity in Malaysian adults. A national sample of 21,391 individuals aged 30 or older had usable data. They were selected by stratified 2-stage cluster sampling. BP was measured using an automated oscillometric device, Visomat. Percentile tables and curves by age, sex and ethnicity are presented. The systolic and diastolic BP distribution was right skewed and showed the expected increase with age. This was markedly so in Malay and other indigenous women; as a result they had most severe hypertension.
Study name: National Health and Morbidity Survey (NHMS-1996)
One of the objectives of this short communication was to add to the literature on the prevalence of oral recurrent aphthous stomatitis (ORAS). This research is based on a total of 11,697 randomly selected Malaysian subjects with an age range of 25-115 years and a mean age of 44.5 +/- 13.9 years who were examined for oral mucosal lesions (ORAS). The prevalence of ORAS detected during the oral examination (average point prevalence) was found to be 0.5% (64 subjects). ORAS formed 5.7% of all lesions detected during the survey. The average point prevalence of ORAS was highest in the indigenous people of Sabah and Sarawak (1.2%), followed by the Chinese (0.7%), the Malays (0.5%) and the Indians (0.1%). This difference was statistically significant (p < 0.001). A review of the English literature on the prevalence of ORAS revealed different prevalence types used by different researchers, namely average point prevalence (APP), self reported life-time prevalence (SLP) and self reported two-year prevalence (STP). The other objective of this paper was to present the different types of prevalence that have been reported in the literature and to discuss the usefulness of such prevalence types in relation to using epidemiology in deriving certain possible etiological associations.
A survey was conducted in December 1995 to study car occupant restraint usage in Selangor. A total of 1082 car occupants were observed in 536 cars. The results of the study shows that only 57.3% of the car occupants observed were protected by any form of restraints. Most of the cars (99.8%) examined had front seat belts but only 44.2% had rear seat belts. Only 0.6% of the cars were found to have child restraints in the cars. 80.2% of drivers used restraints and only 65.4% of front seat passengers used any forms of restraints. In the case of the rear seat passengers, only 0.42% used an available restraint. More people in the urban areas (84.42%) than in the rural areas (66.51%) used seat belts. Usage of seat belts by car drivers influenced the use of seat belts by front seat passengers. Type of seat belts fitted was associated with usage rate. It is sad to note that 21.9% of the drivers used seat belts incorrectly.
The Gibbs canonical ensemble of statistical mechanics is used to describe the probability distribution of the age classes of mothers of new-borns in an age-structured population. The Malthusian parameter emerges as a Lagrange multiplier corresponding to a generation time constraint, while a new perturbation parameter appears as the Lagrange multiplier corresponding to a maternity constraint. Classical Lotka stability reduces to the unperturbed case of the more general canonical ensemble model. The model is used in a case study of the female (peninsular) Malaysian population of 1970. The Malthusian parameter and perturbation are calculated easily by linear regression. Use of the model identifies an anomaly in the population due to the effects of World War II.
To obtain the profile of periodontal conditions in West Malaysian adults, five small scale surveys were carried out on selected occupational adult groups, 20-54 years old, between 1987 to 1990. Periodontal assessment was made using the CPITN index. In all, 779 subjects were examined. Results indicated that only 16% of the adults examined had healthy gingivae. Bleeding of the gingivae was limited to the younger (20-24 years) age group. Calculus is highly prevalent in at least 65.5% of all the subjects examined. Periodontal pockets were limited to mostly shallow pockets and the risk of developing pockets increased with increasing age. Both navy personnel and factory workers showed a higher number of healthy sextants across all ages as compared to the other three occupational groups; viz., rubber tappers, villagers and government workers. The rubber tappers were the only group with deep pockets, with the prevalence ranging between 8 to 25%. Implications of the findings to the Malaysian dental delivery system are discussed.
A clinical analysis of 304 cases of pyogenic granuloma (excluding pregnancy tumour) were obtained from the clinical evaluations submitted by clinicians while sending specimens for biopsy. The average age of the patients with pyogenic granuloma was 28.9 years with a peak age incidence in the second decade. More female patients were affected and the lesions present mainly in the Chinese. The majority of the lesions were ulcerated and pedunculated. The lesions had a mean diameter of 10.8 mm with a mean lesion duration of 6.0 months. The gingiva was the prevalent site for these lesions with a greater number being located in the maxilla. The recurrence rate was found to be 14.1%.
We performed a vision screening of 1883 Chinese schoolchildren from 4 schools around Kuala Lumpur in June 1990. The group contained 1083-males and 800 females. Visual acuity, refractive error, oculomotor balance, and axial length were measured. The prevalence of myopia in Chinese schoolchildren was found to be 37% in the 6- to 12-year age group and 50% in the 13- to 18-year age group. Approximately 63% of the sample had unaided visual acuity of 6/6 or better and 24% had unaided acuity of 6/12 or worse. Six hundred twenty-five students (33%) failed the vision screening test and were referred for further examinations. The group which failed the vision screening test and had the highest rate of referral (46%) was the 11- to 12-year-old age group. The most common visual disorder was uncorrected myopia, accounting for 38% of the referrals (235 students). Only 26% of the sample were wearing a spectacle correction.
A cross-sectional study was carried out to determine the prevalence of hypertension in the Chinese elderly and to examine its relationship with various behavioural and nutritional risk factors. This study involved 243 Chinese aged 55 years and older in 2 randomly selected Chinese Villages in Seberang Prai Tengah, Penang. The study included an interview, anthropometric assessment and blood pressure measurement. The prevalence of hypertension was 48.1% and out of this, 65 (55.6%) were on anti-hypertensive treatment. There was a significant rise in the prevalence with age. Hypertension was found to be inversely related to per capita income and physical activity (p < 0.05). Hypertension was significantly more common in smokers than non-smokers. Alcohol intake in the elderly was low and not related to hypertension. Obesity was significantly associated with hypertension only among the elderly aged 55-64 years. The dietary intake of sodium, potassium and calcium did not differ significantly between the hypertensive and normotensive elderly.
Two hundred and six patients attending an urban general practice were surveyed using a self-rating questionnaire, the 30-item version of the General Health Questionnaire. At a cut-off score of 6/7, 34.5% of the respondents were found to be high-scorers which gives a corrected estimate of psychiatric morbidity of 29.9% in this clinic. Among those who presented with general complaints, such as aches and pains for which no organic cause was found, a significant proportion (70%) were high-scorers. There were no significant differences in the sex and age distribution of the high-scorers. However the mean score of Malays was significantly higher than that of Chinese.
All post-neonatal children with acute non-traumatic coma admitted over an 8-month period were analysed and followed up for 18-24 months to determine the aetiology and outcome of their coma. One hundred and sixteen children, 72 boys and 44 girls, were recruited. Half the children were under 1 year of age and only 16 (14%) were more than 6 years of age. Eighty cases (69%) were due to infection, 15 (13%) to toxic metabolic causes, six (5%) to hypoxic ischaemic insults, four (3.5%) had intracranial haemorrhage, nine (7.8%) were due to miscellaneous causes and in two (1.7%) the cause was unknown. Seven cases were lost to follow-up. Of the remainder, 39 (35.7%) died, 32 (29.3%) developed permanent neurological deficit, and 38 (35%) were discharged well. The outcome was worst in the infectious group. Age of onset and sex did not significantly affect outcome. Our findings are similar to experience in Japan, where infection accounts for 74% of non-traumatic coma, but differ considerably from Western data on childhood coma where only a third of cases are due to infection.
AIM: To study the aetiology and clinical course of children with brainstem death in a paediatric intensive care unit (ICU) and to determine whether current the practices that are used to declare brainstem death conform to accepted criteria.
METHODS: A retrospective review chart of all patients with brainstem death (n = 31) admitted to the paediatric ICU between January 1995 and December 1998 was drawn up.
RESULTS: Mean age of the patients was 51.9 +/- 54.5 mo with the main diagnoses being head trauma in 11 children, anoxic encephalopathy in 7, brain tumour in 5, drowning in 4, CNS haemorrhage in 3 and CNS infection in 1 child; 32.3% of the children were given pre-ICU admission cardiopulmonary resuscitation. The average time from insult to suspected brainstem death was 27 h and suspected brainstem death to confirmation was 25 h, with an average of 1.6 examinations performed. EEG was done in 14 patients, with electrocerebral silence in 8 after the first examination and in a further 5 after repeat testing. Cerebral blood-flow scans were done in 3 children and evoked potentials in 1 child.
CONCLUSIONS: Trauma remains the most common primary diagnosis leading to brainstem death. Intensivists in this large hospital for children mainly conform to accepted guidelines for determination of brainstem death although there is a wider use of ancillary tests to aid diagnosis. The study also showed a low rate of < 10% of organ procurement for transplantation.
Study site: Paediatric ICU, Great Ormond Street Hospital, London, United Kingdom
A canonical/lognormal model for human demography is established, specifying the net maternity function and the age distribution for mothers of new-borns using a single macroscopic parameter vector of dimension five. The age distribution of mothers is canonical, while the net maternity function normalizes to a lognormal density. Comparison of an actual population with the model serves to identify anomalies in the population which may be indicative of phase transitions or influences from levels outside the demographic. Tracking the time development of the parameter vector may be used to predict the future state of a population, or to interpolate for data missing from the record. In accordance with classical theoretical considerations of Backman, Prigogine, et al., it emerges that the logarithm of a mother's age is the most fundamental time variable for demographic purposes.
A retrospective review of 33 patients with tuberculosis of the spine from January 2000 to April 2002 revealed that the mean age was 36.5 and peak incidence is in the second decade of life (27.3%). There were 24 males and 9 females. The majority of the lesions involved the thoracic spine (30.3%), followed by the lumbar spine (27.2%). Skip lesions was seen in 12.1% of cases. The erythrocyte sedimentation rate was normal in 9.1% of patients. Neurological involvement was seen in 51.5% of patients. Concomitant tuberculosis of the lung was 66.6%. The radical surgical debridement and grafting rate was 39.3%. The preferred surgical procedure was that of radical anterior debridement and fusion supplemented by anterior or posterior instrumentation if needed. Anti-tuberculous chemotherapy remained the mainstay of treatment. Surgery gives faster relief of pain and neurological recovery but is a major undertaking, and thus selection of patients is vital to avoid morbidity and mortality.
The objectives in this epidemiology review are to measure and report the extent of morbidity and mortality due to tuberculosis (TB), the proportion of new sputum smear positive cases in districts and the status of cohort analysis as of 1999. As for leprosy, the main objective is to determine morbidity and the treatment outcomes of Multiple Drug Therapy (MDT). Based on the results obtained, a comprehensive action plan for prevention, control and monitoring of tuberculosis and leprosy cases and patients is being produced and implemented throughout the state. The analysis concentrated on patients diagnosed at all out-patient units and admitted in all of the state's hospitals. The patient particulars were recorded using a standardized format based on TB and Leprosy Health Management Information System (TB HMIS). TB was the second highest by notification of communicable diseases in Malaysia in 2001. 29% or about one-third of the national TB cases are from Sabah. However, it has been noted that there was an average decline of 2.6% in annual notification since 10 years ago to date. There was also a reduction of 11.4% in 2001 as compared to annual notification in 2000. Immigrants contribute more than 24% in detection of new cases since 1990. Treatment success rate in term of completion of treatment to date is 82%. Mortality rate has steadily declined from 14 deaths to 7 deaths per 100,000 population. Leprosy in Sabah also contributes to 30% of the yearly total caseload of Malaysia and has the highest notification rate of 2 per every 100,000 population as compared to other states. The average registered leprosy cases over the past 5 years are 239 cases and the prevalence rate is 0.7/10,000 population. The state has successfully achieved its goal to decrease leprosy as per the World Health Organization (WHO) goal of yearly overall prevalence rate of less than 1 case for every 10,000 population. However, the districts of Kudat, Tawau, Lahad Datu, Kota Kinabalu and Semporna are still within the prevalence rate of more than one per 10,000 population. This review highlights some interesting findings which can be incorporated into the State and Districts action plans and strategies. It is also noted that in order to translate National Plans and Strategies into effective action at the community level, health workers need relevant up-to-date knowledge of the pattern of health and disease, and of their determinants, in each district. The Sabah Health Department continues to organize and support programs related to management and control of tuberculosis and leprosy to progressively reduce the incidence of these diseases in the community by breaking the chain of transmission of Mycobacterium tuberculosis and M. leprae, respectively.
Study site: outpatient clinics, inpatients, hospitals, Sabah, Malaysia