Citation: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare & Society: Essays By Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019
First edition: 2008
Contents of second edition:
Preface to the Second Edition iii
Acknowledgements iv
Contents vi
Foreword by Dr Harbaskh Singh vii
Foreword by Professor Chris van Weel (in the First Edition) viii
Foreword by Datuk Dr D M Thuraiappah (in the First Edition) ix
Section 1: Primary Health Care and Family Medicine 1
1 Put not New Wine into Old Bottles 3
2 The Importance of Primary Care 6
3 Primary Health for all the People 11
4 The Evolution of General Practice 16
5 Future of Family Medicine in Developing Countries 23
6 Family Practice: Uniting Across Frontiers 27
Section 2: Training for Family Medicine 31
7 Specialisation in Primary Healthcare training for the new General Practice in Malaysia [summary] 32
8 A Proposal for the Training of Physicians in Primary Care for the Rural Areas of Malaysia 34
9 The Family Physician in Asia: Looking to the 21st Century 40
10 Training Family Doctors in a Developing Country 46
Section 3: Family Medicine journals 51
11 Family Physician [inaugural issue of Family Physician] 52
12 Our journal [inaugural issue of Malaysian Family Physician] 56
Section 4: Healthcare Improvement 58
13 The Future of the Health Services in Malaysia. [summary] 59
14 Quality in Family Practice 68 15 Foreword, In: Chee HL, Barraclough S (ed). Health Care in Malaysia 75 Section 5: Ethics and Professionalism 81
16 Ethical Consequences of Technological Change 83
17 Dr Sun Yat Sen Oration. Between Faith and Reason 91
18 Ethics, Professionalism and the “Trade” 99
19 Rural Health and Global Equity: Am I My Brother’s Keeper? 103
20 Achieving Equity Through a Primary Care-Led Health System 108 Section 6: Civil Society 112
21 Looking Back, Looking Forward 113
Appendix 1: Dr M K Rajakumar: A brief curriculum vitae 120
Appendix 2: Books and articles about Dr M K Rajakumar 124
Appendix 3: Reflections and comments 125
Four new species of the genus Mallinella Strand, 1906, from the natural forests of Malaysia, are described as Mallinella bicanaliculata sp. n. (♂♀), M. calautica sp. n. (♂♀), M. laxa sp. n. (♂♀), and M. obliqua sp. n. (♂♀). The four new species belong to four species groups and were collected from the forest litter in Sabah state by sieving.
Background: Based on studies and some clinical practice pneumatic dilatation utilizing the widely available wire guided polyethylene pneumatic dilator system using a 30mm balloon inflated for 15 seconds upon loss of waist noted (during fluoroscopy) at 7 to 10psi obtains optimal disruption of the lower esophageal sphincter. We employed this technique till August 2001 without any complications (notably perforation) with good clinical outcome and durability.
Aims: To study the efficacy of pneumatic dilatation with the pneumatic balloon dilated only till loss of waist.
Materials and Methods: A total of 10 treatment naïve achalasia patients enrolled from August 2001 till July 2002 were dilated till loss of waist and the outcome and durability was compared with our historical controls.
Findings: A total of 10 patients with age 45±18 (range 22-67) years with 8 females: 2 males and 5 Malays: 5 Chinese with 3 patients with megaoesophagus underwent pneumatic dilatation using a 30 mm Rigiflex® pneumatic dilator till loss of waist was noted during fluoroscopy at 7psi and the balloon deflated immediately. All the patients reported symptomatic improvement in dysphagia, regurgitation and demonstrated a 3-12 month post procedural weight gain of 6±5 (range: 1-15) kg. One patient required a second dilatation only after 13 months. All the remaining patients remain well till today after the initial single dilatation. The durability of the dilatation was 27±7 months (range: 13-33) months. There were no complications noted. There were no complaints of excessive reflux. This data was compared with our historical control (patients before August 2001), i.e. the pneumatic dilator inflated for 15 seconds upon loss of waist, and there was no difference in clinical outcome, or the durability of dilatation or the duration of stay post procedure.
Conclusion: Forceful disruption of the lower esophageal sphincter utilizing the pneumatic dilator is effective but is associated with a 1-5% risk of perforation. We obtained identical results without loss of clinical improvement or durability utilizing our technique compared to the traditional method. Since August 2001 all our dilatations were performed in our unit utilizes this simplified method. We have yet to report a perforation after pneumatic dilatation.
Introduction: Megaesophagus is defined as an esophagus measuring 8cm or larger on the barium swallow examination in a patient with Achalasia cardia. Its existence defines a late stage of achalasia and therapy will include an esophagectomy in its management. The latter carries a high morbidity and mortality.
Materials and Methods: We reviewed retrospectively all treatment naïve patients with Achalasia from 1st January 2000 and identified 10 patients with megaesophagus and these patients were analysed.
Findings: The average presenting age is 52±15 (range 20-73) years with 4 males: 6 females with 5 Malays:3 Chinese:2 Indians. The duration of illness before diagnosis was 7±5 (range 1-16) years. All patients had dysphagia, regurgitation and weight loss. All 10 patients demonstrated aperistalsis but interestingly 8 patients failed Lower Esophageal Sphincter (LES) intubation during Standard Esophageal Manometry due to coiling of the catheter. Failure to elicit Failure of LES relaxation translates as a high technical failure of manometry (80%) in the diagnosis of Achalasia. A confident diagnosis of Achalasia was made on barium swallow in 9 cases (90%). All 10 patients underwent pneumatic dilatation. Eight patients required only single dilatation. However two patients required two dilatations. The durability of the twelve pneumatic dilatation 27±13 (Range: 9-44) months with good symptomatic relieve and an objective post procedural weight gain of 10±6 (range:1-19) kg over a period of 3-12 months. There was no complications noted post procedure.
Conclusion: In advanced cases of achalasia, barium swallow is superior to manometry for obtaining the diagnosis. Pneumatic dilatation is an effective and safe procedure for patients with megaesophagus.
Citation: Tan YL, Foong K. Implementing Pictorial Health Warnings in Malaysia: Challenges and Lessons Learned. Bangkok, Thailand: Southeast Asia Tobacco Control Alliance; 2010
Citation: ITC Project (March 2012). ITC Malaysia National Report. Findings from Wave 1 to 4 Surveys (2005–2009). University of Waterloo, Waterloo, Ontario, Canada; Universiti Sains Malaysia, Pulau Pinang, Malaysia; and Ministry of Health, Putrajaya, Malaysia
This report presents results of Waves 1 to 4 (2005 – 2009) of the ITC Malaysia Survey – a face-to-face and telephone survey of a cohort of approximately 2,000 adult smokers and, 1,000 youth smokers and non-smokers. Waves 1 to 3 also included a cohort of 1,500 adult non-smokers. The key findings contained in this report provide evidence regarding the attitudes and behaviours of adult and youth smokers and non-smokers to assist policy makers in implementing effective tobacco control policies in Malaysia.
Citation: Hussin S, Lai CC, Md Firdaous H, Abu Talib P. Smoking among teenagers in Malaysia - a socio-psychological study. Shah Alam, Selangor: Karisma Publication; 2004
Citation: Chee HL. Health and nutrition of the Orang Asli: The need for primary health care amidst economic transformation. In: Abd Rashid MR (editor). Indigenous Minorities of Peninsular Malaysia: Selected Issues and Ethnographies. Kuala Lumpur : Intersocietal and Scientific; 1995, p48-73
Citation: Teng CL. Family Practice: Is It For Me? In: Ong HT (editor). The Life of a Doctor. Petaling Jaya: Unipress Medical & Healthcare; 2008, p115-119
Citation: Mohd Saleh N, Nasir NH, Ibrahim NI. Designing Health Benefits Policies In Malaysia (ENPHC): A Country Assessment Report. Putrajaya: Joint Learning Network for Universal Health Coverage; 2018
The behaviour and aggregation of fish in an artificial reef area in Tioman Island, Malaysia, was observed using underwater videography under a combination of shooting conditions. The camera distance and direction relative to the neighboring artificial reef module was varied, and comparisons of images with a color filter were made. A distance of 260 cm at a diagonal shooting angle provided a suitable observation of the reef fish around the reef module, and a red color filter provided a truer color replication in morning observations while better images were obtained without the color filter in afternoon light environments. Four criteria were considered to assess the artificial reef effectiveness: total abundance, appearance rate, residence time and feeding frequency. A total of 824 individuals were observed during the study. Mean residence times were shorter for schooling fishes such as Caesio caerulaurea and Liza subviridis, and longer for solitary swimmers like Cephalopholis boenak and Scolopsis bilineatus. Feeding frequency was lower for schooling fishes. A significant correlation was obtained between the feeding frequency and residence time for the high feeding frequency fishes (r = 0.89; p<0.05). The effectiveness of the artificial reef was suggested to be significant in solitary swimmers but less so for schooling fishes.
Long-memory is often observed in time series data. The existence of long-memory in a data set implies that the successive data points are strongly correlated i.e. they remain persistent for quite some time. A commonly used approach in modellingthe time series data such as the Box and Jenkins models are no longer appropriate since the assumption of stationary is not satisfied. Thus, the scaling analysis is particularly suitable to be used for identifying the existence of long-memory as well as the extent of persistent data. In this study, an analysis was carried out on the observed daily mean per hour of ozone concentration that were available at six monitoring stations located in the urban areas of Peninsular Malaysia from 1998 to 2006. In order to investigate the existence of long-memory, a preliminary analysis was done based on plots of autocorrelation function (ACF) of the observed data. Scaling analysis involving five methods which included rescaled range, rescaled variance, dispersional, linear and bridge detrending techniques of scaled windowed variance were applied to estimate the hurst coefficient (H) at each station. The results revealed that the ACF plots indicated a slow decay as the number lag increased. Based on the scaling analysis, the estimated H values lay within 0.7 and 0.9, indicating the existence of long-memory in the ozone time series data. In addition, it was also found that the data were persistent for the period of up to 150 days.
Bencana banjir boleh menjejaskan kehidupan dan harta benda. Risiko kejadian banjir boleh diminimumkan jika amaran
awal dapat dikeluarkan. Di atas inisiatif ini, peramalan aliran sungai harian dijalankan di sebuah stesen aliran sungai
di Sungai Muda, Malaysia yang terletak di dataran banjir. Peramalan dengan mengaplikasikan pendekatan kalut
melibatkan dua langkah iaitu pembinaan semula ruang fasa dan peramalan. Pembinaan ruang fasa melibatkan satu
pemboleh ubah iaitu data aliran sungai yang dibina semula kepada m-dimensi dengan menggunakan nilai optimum
dimensi pembenaman daripada kaedah Cao dan variasi nilai dimensi pembenaman untuk pendekatan songsang. Hasil
daripada pembinaan ruang fasa ini digunakan untuk meramal aliran sungai dengan menggunakan kaedah peramalan
setempat. Hasil kajian menunjukkan data aliran Sungai Muda adalah bertelatah kalut berdasarkan analisis daripada
kaedah Cao. Keseluruhan hasil peramalan bagi kedua-dua kaedah dapat memberikan peramalan yang baik berdasarkan
pekali korelasi yang tinggi. Namun, kombinasi parameter asas bagi pendekatan songsang memberikan hasil peramalan
yang lebih baik. Oleh itu, pendekatan songsang boleh dicadangkan bagi meramal data aliran sungai harian dengan
tujuan memberikan maklumat penting mengenai sistem aliran sungai di dataran banjir terutamanya di Sungai Muda.