Introduction : Diabetes mellitus is recognized as a major public health problem worldwide. The burden of diabetes to society are morbidity, mortality and extensive usage of health care services.
Methodology : This study aimed to determine the provider’s cost in treating diabetic foot patient per day in orthopaedic ward, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in year 2006. Result : A total of 54 patients fulfilled the inclusion and exclusion criteria, only 29 were eligible for analysis. The cost of health care providers derived from cost calculation on capital and recurrent costs. Results showed that the average cost for treating diabetic foot patient per day is RM 634.57. Recurrent costs contributed 75.3% of the total diabetic foot treatment and Intensive Care Unit costs was the biggest percentage (40.5%).
Discussion : The results were comparable with findings by Case-Mix Unit of UKMMC. Treatment cost of diabetic foot is substantial and therefore avoidance of this complication must be emphasized to all diabetic patients.
The agricultural industry scenario in many industrialized countries has adopted an image processing system as a solution to automate the grading process in order to provide accurate, reliable, consistent and quantitative information in addition to the large volumes, which human graders are not able to perform. In Malaysia, the grading of palm oil Fresh Fruit Bunches (FFB) is still performed manually through visual inspection using the surface color as the main quality attribute. It is the intention here to introduce an automated grading system for palm oil FFB using a computer assisted photogrammetric methodology which correlate the surface color of fruit bunches, not the fruitlets, to their ripeness and eventually sorts the fruit to two predefined fruit categories. The methodology consists of five main phases, i.e. image acquisition, image pre-processing, image segmentation, calculation of color Digital Numbers (DN) (data manipulation) and finally the classification of ripeness. This computerized photogrammetric image processing technique using MATLAB® package which is integrated to a sorting system differs in various aspects from other digital imaging technique or machine vision system adopted for classifying fruit ripeness. A comprehensive discussion will be presented based on the results achieved through actual fruit testing on the prototype grading system. The main concern was to ensure the reliability of the computerized photogrammetric technique achievable and the system’s mechanism working as intended. The fruit classification ability of the system yields above 90% accuracy and taking not more than 25 seconds to classify and sort each fruit.
This paper outlines the past five decades of scientific interests and advances in medicinal plant research in Malaysia. Initially the prime interest of research programmes has been on phytochemical studies leading to the discovery of biologically active compounds as chemical templates to produce new drug candidates. As the Malaysian herbal medicine market experiences an extraordinary growth, the research approaches taken have recently included activities to develop herbal medicines into quality, efficacious and safe products for human consumption. Advances in chromatographic and spectroscopic techniques have had a tremendous impact on the isolation and structure elucidation of the constituents of medicinal plants. The development of a series of bioassay methodologies and utilization of bioassay-guided isolation techniques have contributed significantly to the progress of medicinal plant research in Malaysia. Research work on some medicinal plants carried out by the local scientists will be illustrated as examples.
Industrial statistics is an important part of the management system in any industry that strives to continuously improve quality and increase productivity and efficiency. That system covers supply chain management, production design and prototyping, production process and marketing. Industrial statisticians, industrial engineers and industrial leaders should work together hand in hand, in the same language, to ensure that the process and products are as expected. The system itself is never complete. Thus, the usefulness, manageability and reliability of all statistical models used in the system are to be considered as first priority, but those skills are not sufficient. Industrial statisticians should also, of course, be able to come and go between the two poles: statistics and industry. This requirement needs a good understanding about the culture of these poles and how to conduct a mutual symbiosis. One of the principal bridges between these cultures is statistical process control (SPC). This paper is to show that modern industry cannot escape from SPC, especially in a multivariate setting. This setting, which characterizes modern industry, consists of two philosophical problems: how to order data and how to measure process variability. Our recent research results sponsored by the Government of Malaysia will be presented to illustrate the challenging statistical problems in modern industry.
Human activity has ‘very likely’ been the primary cause of global warming since the start of the Industrial Revolution (18th–19th century). As a new player in industrial transformation, Malaysia can choose to ignore the warnings of global warming. blame. This may not augur well. Release of greenhouse gases have been categorically linked to climate change and global warming. In her march towards industrialization, Malaysia too has contributed to the release of greenhouse gases. Apart from those arising from natural sources, the industrial sector in Malaysia also releases other types of gases such as the fluorocarbons. This is evident from the worsening air quality in some of our cities. (Copied from article).
In December 2009, at the UN Climate Change Conference COP 15 in Copenhagen, the Prime Minister of Malaysia, the Rt. Hon. Mohd Najib Abdul Razak, had announced that “Malaysia is adopting an indicator of a voluntary reduction of up to 40% in terms of emissions intensity of GDP by the year 2020 compared to 2005 levels. This indicator is conditional on receiving the transfer of technology and finance of adequate and effective levels from Annex 1 partners, that correspond to what is required in order to achieve this indicator”. Malaysia also needs to decouple its GDP from its current relatively high carbon-based energy demand. In trying to meet both these targets, we need to intensify our research efforts in energy-based areas. As government funding in R&D is limited as the aim is for research to be private-sector driven, and with the grim global economic scenario today, it is most unlikely that Malaysia will get any assistance financially or technologically from Annex 1 nations. It is therefore proposed that Malaysia considers implementing a dedicated carbon cess on petroleum products to fund R&D in the country. (Copied from article).
The purpose of this study was to determine the quality of counter service at the Ministry of Health hospitals as perceived by patients. This was a cross sectional study using selfadrninistered questionnaires distributed to patients at the outpatient departments in all Ministry of Health Hospitals. By the end ofthe data collection period, 118 of 121 hospitals (total number of MOH Hospitals) participated with 93.2% response rate., The hospitals were divided into four categories, for the purpose of this study 1000 sample size were needed in each category, the number of sample size were obtained using Epi Info Program based on assumption that 30% Of patients were dissatisyded with the services provided and with a precision of 10%. In this study the quality were based on clarity and provision of services based on Client Charten deliverance of clear infomation by the healthcare personnel, priority treatment given to urgency of the cases, cleanliness of the facilities and teamwork among the staff This study revealed about 64% of patients perceived that the hospitals had provided quality services at the counter: Only about 11% of patients were not happy with the quality of the services given at the counter. The proportion of happy patients increased from the smaller to the bigger hospitals. In terms of delivering services according to the Client Charter; only about 15% said that service was not provided by the counter staff according to the Client’s Charter On the aspect of priority on the urgent cases, about 64% of the patients perceived that urgent cases were not seen immediately. About 64% of the respondents felt that the hospitah do provide quality services. Strategies should focus on the bigger hospitals because non conformance to quality occurs more frequently there. The post of Counter Supervisor should be created to ensure that quality services are delivered.
Study site: outpatient departments in all Ministry of Health Hospitals
A cost-utility analysis was performed desferrioxamine treatment in thalctssaemia patients at two tertiary hospitals in Malaysia in 2004. A hundred and twelve transfusion dependent thalassaemia patients were grouped according to the status of desferrioxamine; optimum and sulwptimum. Cost analysis was from a patient and hospital perspectives while Quality Adjusted Life Years (QALYs) was the health outcome of choice. Incremental Cost·Effectiveness Ratio (ICER) was also stipulated to show the difference in cost for an additional QALY if patient currently on suboptimum desferrioxamine to switch using optimum desferrioxamine. Results on cost analysis showed the mean cost of treatment for thalassaemia patients on optimum desferrioxamirie was higher than those on sub·optimum desferrioxamine; (RM14, 775.00+SDRM4,737.00 and RM10,780+RM3,655, respectively). QALYs were 19.186+6.591 and 9.859+5275 in the optimum and suboptirnum group, respectively. Costutility analysis showed the cost per QALYs in optimum desferrioxamine group was RM59,045.00 compared to RM44,665.00 in suboptimum desferrioxamine group. ICER of patients on sub-optimum desferrioxamine switching to optimum desferrioxarnine was only RM420.39. Sensitivity analysis showed that the results were robust in the best and worst scenarios. In conclusion, although it is expensive for thalassaemia patients to use optimum desferrioxamine compared to sub-optimum desferrioxamine, the cost per QALYs gained was undoubtedly low.
Obesity is a main public health problem predisposes many to the obesity-related health problems worldwide. Malaysia was ranked as sixth in Asia with high prevalence of obesity by the World Health Organisation in 2010. It is multifactorial origin and depends on many internal and external interactions; between human beings and the environment. In this review article, the focus will be on the example of chemical obesogens that present silently in the daily diet, pharmaceutical or industrial compounds that predispose people to obesity through altering and disrupting normal bodily metabolic processes
Introduction: School vision screening program is a scheduled program under the Ministry of Health, Malaysia for 7, 12 and 15 years-old children in the government schools. The aim of this study was to review the school vision screening program from the perspective of the personnel involved as the screener. Methods: The evaluation of the performance of the screener was based upon the accurate referrals' outcome from the school health database of Betong Division in Sarawak, Malaysia in the year of 2008. Results: The total accuracy of the referrals was 50.7%. Lower accuracy of the referrals was found significantly associated with Grade 1 [χ2 (2.N=304) = 28.810, p
Background: This paper examined the importance and influence of post-transplantation follow-up visits on the quality-of-life (QoL) of living kidney donors in Malaysia.
Methods: Based on data collected from 80 living kidney donors, the relationship between QoL and the frequency of follow-up visits was examined. QoL was measured using standard SF-8 questions to capture its different dimensions.
Results: Donors in the 1991–1998 donation cohort have low QoL, especially in the domains of physical and vitality, compared with the other two cohorts (1999–2005 and 2006–2012). The mean scores showed that donors who never went for any follow-up activities visits experience low QoL in most of the categories, particularly those related to physical activities, implying the importance of follow-up activities visits in influencing the donors’ QoL. Lower QoL was recorded for respondents that never received post-transplant treatment.
Conclusion: Although this study found no serious post-transplant QoL issues in Malaysia, it is still important to set up a donor registry and provide free and mandatory follow-up visits for all donors in order to adequately monitor their health.
Organ transplantation is a new treatment for end-stage organ failure. However, the total number of transplants performed in Malaysia in 2012 was only 94. Rates of deceased and living donors in Malaysia for 2012 were chronically low (0.55 and 1.87 per million population, respectively). A sample of 350 respondents in mosques, hospitals, and universities in various places in the Klang Valley, Kelantan and Pahang were collected between October and December 2013 to investigate the level of knowledge of health care professionals (HCPs), religious leaders (RLs), and academics (ACAs) and their stand on two issues on brain death. The result on the first issue (procuring organs from brain dead donors for transplantation) revealed that 52.8%, 23.7%, and 23.4% of HCPs, RLs, and ACAs, respectively, were in support of it; 30.2%, 31.8%, and 45.2% were uncertain about it; and 17%, 44.5%, and 31.5% were against it. On the second issue (terminating the life support machine of a brain dead person), 60.4%, 35.7%, and 25% of HCPs, RLs, and ACAs, respectively, were in support of it; 26.4%, 36.4%, and 38.7% were uncertain about it; and 13.2%, 27.7%, and 36.3% were against it. The lack of knowledge on Islam brain death-related issues should be addressed by educational efforts targeting these three groups of professionals. Special emphasis should be paid to educating RLs as they can channel their knowledge and perception to the other groups and to the Muslim public.
Introduction: An arteriovenous malformation (AVM) is an abnormal collection of blood vessels in which arterial blood flows directly into the draining vein without the normal interposed capillaries. The Spetzler-Martin grading system has been widely accepted worldwide to estimate the pretreatment risks and predict the outcome of patients with intracranial AVM. In Malaysia, we still do not have the baseline data of this grading system. Methods: A total of 33 patients from a tertiary referral hospital diagnosed with intracranial AVM based on neuroimaging findings over a 4-year period were studied. Medical
records were traced and neuroimaging findings were analysed. The AVMs were graded according to the Spetzler-Martin grading system and Fisher’s exact test was used to assess statistical difference between the grades of the AVM and management plan for the patients. Results: Four patients were graded as Grade 1, 9 patients as Grade II, 10 patients as Grade III, 6 patients as Grade IV and 4 patients as Grade V. Ten patients were treated conservatively; six patients underwent surgery and embolisation respectively. Four patients underwent radiosurgery and a combination of embolisation while surgery and radiosurgery were given to 5 patients and 2 patients respectively. Statistically significant difference (p=0.016) was found between the Spetzler-Martin grading system and the management of intracranial AVMs. Conclusion: The management decision was not made based on the
grading of the AVMs. It is recommended that all AVM patients be routinely graded according to this system prior to treatment.
Objective: This study assesses the impact of prescribed undergraduate psychiatry training program on medical students’ attitudes to psychiatry. It is hypothesized that training may cause positive attitude changes towards the discipline and status perceptions of the profession of psychiatry. Methods: A 23 item questionnaire was administered to 89 medical students before and after prescribed training in psychiatry as per the medical curriculum. Results: Participation in psychiatry training enhanced students’ belief that it is a rapidly expanding frontier of medicine and that psychiatry can be viewed as precise and scientific. Psychiatric referrals were seen as useful to medical and surgical patients. However there was less agreement that psychiatric treatment is helpful to most people. Support for choice of psychiatry as a career was less as students were more negatively influenced by family. Poor income prospects and perceived low status among other medical disciplines were also endorsed following the completion of training.Conclusion: There is a pressing need to revise the psychiatric training for medical students. A total attitude change is difficult to achieve and hence, the curriculum has to identify focal areas for emphasis. A multidisciplinary, bio-psychosocial model through liaison with other disciplines like medicine and surgery is a definite option. Psychiatrists have to be role models to alter the image of psychiatry among other medical professionals.
Substance misuse, in particular heroin addiction contributes to health and social problems. Although effective medical treatment was available, earlier efforts confined the treatment of heroin addicts to in-house rehabilitation which required them to be estranged from the community and their families for 2 years. The in-house rehabilitative programme, implemented for at least three decades has produced low abstinence rates. On the other hand, being ‘away’ meant that many heroin addicts faced employment problems and family relationship difficulties upon completing the in-house rehabilitation. However, recently, the concerted efforts by various government and non-government organisations, and the acknowledgement that heroin addiction is a medical illness has resulted in a revamp to approaching treatment of heroin addiction. At present, methadone substitution programmes have been offered as part of treatment programme for heroin addicts in Malaysia. This new programme has been shown to be effective in treating heroin addiction and would need support and cooperation from all groups involved.
Introduction: There is an appealing need to have a validated Bahasa Malaysia (BM) questionnaire that is able to gauge stress coping styles among Malaysian population. A culturally accepted questionnaire will generate further research in the aspect of stress coping patterns in the Malaysia population. Objective: To translate the Coping Inventory for Stressful Situations (CISS) questionnaire into BM and to determine the construct validity, reliability and other psychometric properties of the translated BM version of the English CISS 48-item. Method: Two parallel forward and backward translations were done in BM in accordance to guideline and its validation was determined by using confirmatory factor analysis among 200 Malaysian subjects. Results: The BM CISS had very good Cronbach’s alpha values, 0.91, 0.89 and 0.85 respectively for Task-, Emotional- and Avoidance-oriented. The overall Cronbach’s alpha was 0.91. It also had good factor loading for most of its items where 44 items out of 48 had Confirmatory Factor Analysis values of more than 4.0. Conclusions: BM CISS had been adequately and correctly translated into Bahasa Malaysia with high psychometric properties. Minimal readjustment may be required in a few of its items to obtain excellent results.
It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.
Objective: The fact that childhood sexual abuse is associated with depression is well-known. To date, there is no proper study done on screening for depression and coping strategies among sexually abused children in Malaysia. This study aimed to determine the prevalence of depression and examine the association of depression with the socio-demographics and
coping strategies used by sexually abused children. Methods: Sixty-five sexually abused children who attended the One Stop Crisis Centre (OSCC) services at Hospital Universiti Sains Malaysia and fulfilled the study criteria were screened for depression using a validated Malay version of Children Depression Inventory (CDI).Depression was determined by a positive score of the Malay-CDI with depression being indicated in scores of more than 18.
Results: In the study sample, 16 (24.6 %) participants had been depressed and 49 (75.4 %) participants had not been depressed. Having a confidante was a protective factor against depression. Short duration of time between the abuse incident and the clinical interview was significantly associated with depression. With respect to coping strategies, 59 (90.8 %) used emotionfocused strategies and 6 (9.2 %) used problem or task-focused strategies. Among emotion-focused coping strategies, participants did the following: deciding that nothing could be done to change things, were in denial, and suppressed their feelings. Conclusion: Twenty five percent of the sample suffered from depression. The screening of depression in the vulnerable group such as sexually abused children is important, particularly for early
detection and treatment. By recognizing the coping strategies used in sexually abused children, the clinician could understand them better and plan for their psychological management.
Familial Paroxysmal Rhabdomyolysis of the non-exertional variety is a rare but treatable disorder previously not described in Malaysia. We report 3 Malay siblings of a consanguinous marriage who developed myoglobulinuria during a febrile illness. The first 2 died without being investigated, but the last had creatinine kinase levels of 24,800 UIL suggesting acute rhabdomyolysis. Fasting appears to be a major precipitating factor, and glucose infusions combined with alkaline diuresis may be life-saving.
Recently, Malaysia has taken a positive step toward providing a better water quality by introducing more water quality parameters into its Water Quality Standard. With regard to the natural radionuclides that may present in the water, 3 parameters were introduced that is gross alpha, gross beta and radium which need to be measured and cannot exceed 0.1, 1.0 and 1.0 Bq/L respectively. This study was conducted to develop a more practical method in measuring these parameters in aqueous environmental samples. Besides having a lot of former tin mining areas, some part of Malaysia is located on the granitic rock which also contributes to a certain extent the amount of natural radionuclides such as uranium and thorium. For all we know these two radionuclides are the origin of other radionuclides being produced from their decay series. The State of Kelantan was chosen as the study area, where the water samples were collected from various part of the Kelantan River. 25 liters of samples were collected, acidify to pH 2 and filtered before the analysis. Measurement of these parameters was done using liquid scintillation counter (LSC). The LSC was set up to
the optimum discriminator level and counting was done using alpha-beta mode. The results show that gross alpha and beta can be measured using scintillation cocktail and radium and radon using extraction method. The results for gross alpha, gross beta, 222Ra and 226Ra are 0.39-6.42, 0.66-16.18, 0.40-4.65 and 0.05-0.56 Bq/L. MDA for gross alpha, gross beta and radium is 0.03, 0.08 and 0.00035 Bq/L respectively.