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  1. Fulltext Antibiotic prescribing for childhood febrile illness by primary care doctors in Malaysia
    Teng CL, Hanafi NS, Ng CJ, Chia YC, Atiya AS
    J Paediatr Child Health, 2006 Oct;42(10):612-7.
    PMID: 16972968 DOI: 10.1111/j.1440-1754.2006.00937.x
    AIM: Fever in children, a mostly benign and self-limiting illness, is often viewed with consternation by the care givers. It results in early consultation and excessive use of antipyretics and antibiotics. In this study, we document the prescribing practice of doctors from three primary care settings in Malaysia and identify the predictors of antibiotic prescription.
    METHODS: Interview of care givers bringing febrile children (age = 12 years) to three primary care settings: public primary care clinics, private general practice clinics and a university-based primary care clinic.
    RESULTS: Data from 649 children were analysed. Mean age of children 4.1 years and 55% were boys. One-third of the children had prior consultation for the same episode of fever. About 80% of the febrile children were diagnosed to have upper respiratory tract infection, viral fever and gastroenteritis. Overall antibiotic prescribing rate was 36.6% (public primary care clinic 26.8%, private general practice clinic 70.0% and university-based primary care clinic 32.2%). Independent predictors of antibiotic prescription were: clinic setting, longer duration of fever (>7 days), higher temperature (>38 degrees C) and the diagnosis of upper respiratory tract infections. After controlling for demographic and clinical factors, antibiotic prescription in private general practice clinic was seven times higher than public primary care clinic (odds ratio 7.1, 95% confidence interval 4.0-12.7), and 1.6 times higher than university-based primary care clinic (odds ratio 1.6, 95% confidence interval 1.0-2.5).
    CONCLUSION: Differences in the patients' demographic and clinical characteristics could not adequately explain the high antibiotic prescribing rate in private general practice clinics. This inappropriately high antibiotic prescribing for febrile children in private general practice clinics is a suitable target for future intervention.
    Matched MeSH terms: India/ethnology
  2. Interethnic variability of warfarin maintenance requirement is explained by VKORC1 genotype in an Asian population
    Lee SC, Ng SS, Oldenburg J, Chong PY, Rost S, Guo JY, et al.
    Clin. Pharmacol. Ther., 2006 Mar;79(3):197-205.
    PMID: 16513444
    Chinese and Malay subjects have been reported to require less maintenance warfarin than Indians that could not be accounted for by cytochrome P450 (CYP) 2C9 variants. Vitamin K epoxide reductase complex 1 (VKORC1) is the target enzyme of warfarin, and VKORC1 intronic variants and haplotypes have recently been shown to influence VKORC1 activity and warfarin requirements.
    Matched MeSH terms: India/ethnology
  3. Strategies for evaluating B*18 allelic diversity by sequence-based typing applied to studies of a population from Singapore and African-Americans
    Hou L, Tu B, Ling G, Tang T, Cao K, Steiner NK, et al.
    Tissue Antigens, 2006 Jan;67(1):66-9.
    PMID: 16451205
    Strategies to resolve B*18 alleles which carry a deletion in intron 1 close to the 5' end of exon 2 relative to other HLA-B alleles or a null allele mutation in exon 1 and to resolve ambiguities among allele combinations including B*18 are described. B*18 allele frequencies from volunteer donors recruited for two hematopoietic stem cell registries show the presence of two alleles, B*180101 and B*1802, in a population from Singapore and only B*180101 in African-Americans.
    Matched MeSH terms: India/ethnology
  4. Prevalence and correlates of functional disability in multiethnic elderly Singaporeans
    Ng TP, Niti M, Chiam PC, Kua EH
    J Am Geriatr Soc, 2006 Jan;54(1):21-9.
    PMID: 16420194
    To make comparative estimates of prevalence of late-life functional disability, examine sociodemographic and health correlates, investigate sex and ethnic differences, and estimate population attributable risk of modifiable risk factors.
    Matched MeSH terms: India/ethnology
  5. Towards understanding the low prevalence of Helicobacter pylori in Malays: genetic variants among Helicobacter pylori-negative ethnic Malays in the north-eastern region of Peninsular Malaysia and Han Chinese and South Indians
    Maran S, Lee YY, Xu SH, Raj MS, Abdul Majid N, Choo KE, et al.
    J Dig Dis, 2013 Apr;14(4):196-202.
    PMID: 23241512 DOI: 10.1111/1751-2980.12023
    To identify gene polymorphisms that differ between Malays, Han Chinese and South Indians, and to identify candidate genes for the investigation of their role in protecting Malays from Helicobacter pylori (H. pylori) infection.
    Matched MeSH terms: India/ethnology
  6. Association of ethnicity and acute kidney injury after cardiac surgery in a South East Asian population
    Chew ST, Mar WM, Ti LK
    Br J Anaesth, 2013 Mar;110(3):397-401.
    PMID: 23171723 DOI: 10.1093/bja/aes415
    BACKGROUND: Postoperative acute kidney injury (AKI) is a frequent and serious complication after cardiac surgery. Clinical factors alone have failed to accurately predict the incidence of AKI after cardiac surgery. Ethnicity has been shown to be a predictor of AKI in the Western population. We tested the hypothesis that ethnicity is an independent predictor of AKI in patients undergoing cardiac surgery in a South East Asian population.

    METHODS: A total of 1756 consecutive patients undergoing cardiac surgery were prospectively recruited. Among them, data of 1639 patients met the criteria for analysis. There were 1182 Chinese, 195 Indian, and 262 Malay patients. The main outcome was postoperative AKI, defined as a 25% or greater increase in preoperative to a maximum postoperative serum creatinine level within 3 days after surgery.

    RESULTS: Five hundred and seventy-nine patients (35.3%) developed AKI after cardiac surgery. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery with Indians and Malays having a higher risk of developing AKI when compared with Chinese patients (odds ratio: Indian vs Chinese 1.44, Malay vs Chinese 1.51).

    CONCLUSIONS: Indians and Malays have a higher risk of developing AKI after cardiac surgery than Chinese in a South East Asian population. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery.

    Matched MeSH terms: India/ethnology
  7. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: is the whole greater than the sum of its parts?
    Wee HL, Cheung YB, Li SC, Fong KY, Thumboo J
    Health Qual Life Outcomes, 2005;3:2.
    PMID: 15644146
    Diabetes mellitus (DM) is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1) evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL) (which could be additive, synergistic or subtractive); (2) to determine the extent to which the SF-6D (a single-index preference measure) captures the multidimensional information provided by the SF-36 (a profile measure).
    Matched MeSH terms: India/ethnology
  8. Bone mineral density and hip axis length in Singapore's multiracial population
    Goh JC, Low SL, Das De S, DasDe S
    J Clin Densitom, 2004;7(4):406-12.
    PMID: 15618601
    Ethnic differences in bone density and hip geometry are known to exist, even within the same population. A recent study in Singapore showed that there were significant racial differences in hip fracture rates, with Chinese having the highest incidence of hip fractures. The aim of this study was to compare the bone mineral density (BMD) and hip axis length in Chinese, Malay, and Indian women. A total of 1575 women aged 20-59 yr were recruited, of which 77.6% (1222) were Chinese, 7.7% (122) Malays, and 14.7% (231) Indians. There was no significant difference in peak BMD of both lumbar spine and femoral neck among the three ethnic groups. However, in the older age group (50-59 yr), both Chinese and Malay women had significantly lower femoral neck BMD compared to Indian women. There was no significant loss in BMD of the lumbar spine between the second and fifth decades in all the three races. Between the second and fifth decade, Chinese and Malay women had significant bone loss in the femoral neck of 6.6% and 8.2%, respectively, whereas Indian women did not show any significant bone loss. Chinese women had significantly longer hip axis length compared to either Malay or Indian women (9.87 +/- 0.52 cm vs 9.67 +/- 0.49 cm; p < 0.005; and 9.69 +/- 0.55 cm, p < 0.05, respectively). The initial findings suggest racial differences in bone density and hip geometry exist in the local community. Future research should include prospective, longitudinal studies to determine the age-related bone loss in these three racial groups. It is also important to investigate the differences of spine and hip fracture rates and their relationship with bone density and hip axis length.
    Matched MeSH terms: India/ethnology
  9. CT scan in minor head injury: a guide for rural doctors
    Abdul Latip LS, Ahmad Alias NA, Ariff AR, Shuaib IL, Abdullah J, Naing NN
    J Clin Neurosci, 2004 Nov;11(8):835-9.
    PMID: 15519858 DOI: 10.1016/j.jocn.2003.12.017
    Minor head injury in a developing country like Malaysia is managed by primary care physicians and/or medical assistants in district hospitals. These patients are seen initially in their local hospitals, which have at least an X-ray machine for the purpose of screening. This study aimed to guide these physicians to manage these patients at a primary care level. A cross-sectional study was conducted and the study revealed significant predictors of significant computed tomographic (CT) findings. The presence of a Glasgow coma scale (GCS) score of 14 or 13 was associated with the risk of developing significant CT findings compared to patients with a GCS of 15 (p<0.001). Thirty-seven out of 50 patients with GCS of 14 or 13 developed clinically significant brain injury on CT scan. Similarly, the presence of skull fracture was associated with the risk of developing CT abnormalities (p<0.001). Forty-two out of 51 patients with skull fracture developed clinically significant CT findings. Vomiting was associated with developing CT abnormalities (p=0.017). Twenty-seven out of 40 patients with vomiting showed significant CT findings. Soft tissue injury was also found to be associated with developing CT abnormalities (p=0.007). Therefore, we propose reclassifying minor head injury based on the GCS score. Patients with a GCS score of 15 were classified as having mild head injury, while patients with a GCS score of 13 or 14 were at higher risk of developing brain injury and therefore categorized as high risk mild head injury. This group requires emergency CT scan examination, especially when associated with non-motor vehicle accidents, abnormal central nervous system (CNS) examination, craniofacial injuries or skull fractures. They should be referred to a general surgical unit which can treat head injuries or a neurosurgical tertiary centre.
    Matched MeSH terms: India/ethnology
  10. Cytogenetic abnormalities in de novo acute myeloid leukemia in adults: relation to morphology, age, sex and ethnicity - a single center study from Singapore
    Enjeti AK, Tien SL, Sivaswaren CR
    Hematol. J., 2004;5(5):419-25.
    PMID: 15448668
    Cytogenetic analysis performed at diagnosis is considered to be the most valuable prognostic factor in acute myeloid leukemia (AML). Large systematic studies of cytogenetic abnormalities in AML patients from Southeast Asia are not available. The karyotypic patterns in AML patients from a single center in Singapore were studied and compared with reports from other regions of the world to identify possible geographic heterogeneity.
    Matched MeSH terms: India/ethnology
  11. Time to achieve first blood pressure control after diagnosis among hypertensive patients at primary health care clinics: a preliminary study
    Cheong AT, Mohd Said S, Muksan N
    Asia Pac J Public Health, 2015 Mar;27(2):NP485-94.
    PMID: 23343640 DOI: 10.1177/1010539512472361
    This study aimed to examine the duration to achieve first blood pressure (BP) control after the diagnosis of hypertension. This was a retrospective cohort study on 195 hypertensive patients' (age ≥18 years) records from a primary health care clinic. The median time to achieve first BP control was 7.2 months (95% confidence interval [CI] = 4.99-9.35). Cox proportional hazards regression results showed female patients were 1.5 times more likely to achieve BP control when compared with male patients (hazard ratio [HR] = 1.50, 95% CI 1.09-2.09, P = .013). Those with monotherapy were 2 times more likely (HR = 2.09, 95% CI = 1.39-3.13, P < 0.001) and those on 2 drugs were 3.5 times more likely (HR = 3.49, 95% CI = 1.65-7.40, P = .001) to achieve BP control than those with nonpharmacological treatment. The median time to achieve BP control was longer than the recommended time. Doctors may need to consider starting the pharmacological treatment early and be more aggressive in hypertensive management for male patients.
    Matched MeSH terms: India/ethnology
  12. Bone health in urban midlife Malaysian women: risk factors and prevention
    Lim PS, Ong FB, Adeeb N, Seri SS, Noor-Aini MY, Shamsuddin K, et al.
    Osteoporos Int, 2005 Dec;16(12):2069-79.
    PMID: 16234999 DOI: 10.1007/s00198-005-2003-4
    The aim of this study was to identify risk factors associated with osteoporosis in urban midlife Malaysian women and to assess the effectiveness of lifestyle intervention in bone loss prevention with hormone replacement therapy (HRT) as a positive control. A total of 514 disease-free, uterus-intact, non-HRT-using women aged 45 years and older were recruited into the study. After initial bone mineral density (BMD) assessments, they were randomized into three groups: GI (control), G2 (lifestyle intervention), and G3 (lifestyle intervention with HRT). The study group was composed of 67.5% Chinese, 27.8% Malay, and 4.2% Indians with a mean age of 51.07+/-5.28 years. Two-fifths were postmenopausal, and the prevalence of osteoporosis was 24.1%, seen predominantly at the hip. Postmenopausal women had significantly lower mean BMD and a higher incidence of osteoporosis compared with the premenopausal women, 42.1% vs. 11.1% (p<0.0005). A lower incidence of osteoporosis was found in women who took calcium supplementation regularly as opposed to those who do not, 18.7% vs. 29.3% (p=0.036). Age and a greater postmenopausal duration showed a significant negative association with BMD, whereas higher family income, weight, body mass index, and waist and hip circumference were positively correlated. After 18-20 months, the effect of intervention was assessed based on BMD values of 279 women at baseline and after intervention. Lifestyle intervention alone was effective in premenopausal women, preventing over 90% of spinal bone loss compared with the controls, who lost 11.6% (0.046 g/cm2) bone mass with similar losses of hip bone, 2.0% (0.026 g/cm2) vs. 1.5% (0.020 g/cm2). Premenopausal women on HRT also showed a substantial decrease in spine and hip BMD, 18.6% (0.081 g/cm2) and 9.0% (0.122 g/cm2), respectively. The lifestyle intervention program retarded postmenopausal bone loss by 21% and 37% compared with controls, who lost 9.6% (0.141 g/cm2) and 6.0% (0.138 g/cm2) bone mass at the spine and hip. In comparison, lifestyle intervention with HRT increased postmenopausal BMD by 12.7% (0.216 g/cm2) at the spine and 1.9% (0.042 g/cm2) at the hip. The changes in hip BMD were influenced by current age, ethnicity, and income, while intervention had the strongest effect on spine BMD changes. In conclusion, lifestyle intervention prevented spinal bone loss in premenopausal women and retarded postmenopausal spine and hip bone loss compared with controls. The benefits of physical activity on spine and hip BMD highlight its potential as a safe and cost-effective alternative to HRT, which is not advocated because of its potential adverse effects.
    Matched MeSH terms: India/ethnology
  13. Racial differences in Helicobacter pylori, serum pepsinogen and gastric cancer incidence in an urban Asian population
    Ang TL, Fock KM, Dhamodaran S, Teo EK, Tan J
    J Gastroenterol Hepatol, 2005 Oct;20(10):1603-9.
    PMID: 16174081
    In Singapore, the highest incidence of gastric cancer occurs in the Chinese (C), with lower rates among Malay (M) and Indian (I) subjects. The purpose of the present paper was to examine whether racial differences in the prevalence of Helicobacter pylori and serum pepsinogen (PG) could account for this difference.
    Matched MeSH terms: India/ethnology
  14. Fulltext The prevalence of functional impairment among elderly aged 60 years and above attending Klinik Kesihatan Batu 9 Ulu Langat, Selangor
    Loh KY, Khairani O, Norlaili T
    Med J Malaysia, 2005 Jun;60(2):188-93.
    PMID: 16114159
    The aim of this study was to determine the prevalence of functional impairment and its associated factors among patients aged 60 years and above attending Klinik Kesihatan Batu 9 Ulu Langat, Selangor. This is a cross sectional community health clinic based study. A total of 260 elderly patients attending the community health clinic were interviewed. They were clinically assessed for functional impairment by using the 9 item Instrumental Activities of Daily Living (IADL) scale. There were 118 (45.4%) elderly male and 142 (54.6%) elderly female with age ranging from 60 years to 92 years with the mean age of 67.5 and 65.5 years for male and female respectively. Chinese form the largest population (42.3%) followed by Malay (36.5%), Indian (19.2%) and others (2.0%). The overall prevalence of functional impairment among elderly aged 60 years and above in this study was 33.5%. Among the functionally impaired, two patients (0.8%) were totally dependent. There were significant associations between functional impairment and older age (p = 0.025), lower income group (p = 0.010), lower education level (p = 0.030) and history of chronic medical illness (p = 0.020). Functional impairment had no significant association with ethnic group, gender, occupation and living arrangement. For daily activities that were assessed, the commonest impairment was inability to perform shopping (40%) followed by impairment in climbing up staircase (36.6%) and impairment in taking medication (35%). Advanced age, lower income, lower education and history of medical illness are associated with functional impairment. Functional impairment is an important consideration in caring for the elderly patients in the community. These findings have implications in caring of the elderly in which attention need to be paid to activities such as shopping, climbing stairs and taking medication. The use of the IADL scale is feasible for screening of functional impairment among the elderly population in the community.
    Matched MeSH terms: India/ethnology
  15. Fulltext Do adolescents attending Bandar Mas primary care clinic consult health professionals for their common health problems?
    Khairani O, Zaiton S, Faridah MN
    Med J Malaysia, 2005 Jun;60(2):134-9.
    PMID: 16114152
    The aims of the study were to determine the prevalence of the common health problems namely acne, overweight, smoking and depressive symptoms among adolescents attending a primary healthcare clinic, whether they seek treatment for these problems and the reasons for not consulting health professionals. It was a clinic-based, crosssectional study. All adolescents aged 13 to 20 years who attended the clinic during the study period were included in the study. The respondents were given self-administered questionnaires and their weights were measured to assess if they had the above disorders. A total of 215 adolescents were included in the study. The proportion of adolescents who had acne were 70.7%, overweight 8.9%, smoking 41.9% and depressive symptoms 9.8%. Only 25% of those who had acne, 47% of those who were overweight, 9.5% who had depressive symptoms and none of those who smoked had ever sought treatment for these problems. The common reasons given for not consulting the health professionals were 'did not consider it as a problem', 'shy' and 'thought there was no treatment available'. The majority of the adolescents who attended the clinic did not consult health professionals the above common health problems. It is important to educate them on these disorders and encourage health-seeking behaviour in adolescents.
    Matched MeSH terms: India/ethnology
  16. Distribution of Helicobacter pylori cagA, cagE and vacA in different ethnic groups in Kuala Lumpur, Malaysia
    Tan HJ, Rizal AM, Rosmadi MY, Goh KL
    J Gastroenterol Hepatol, 2005 Apr;20(4):589-94.
    PMID: 15836708
    There is a geographic variation in Helicobacter pylori (HP) genotypes and virulence factors. Cytotoxin associated genes A (cagA) and E (cagE), and certain vacuolating cytotoxin (vacA) genotypes are associated with peptic ulcer disease (PUD). There is also a different prevalence of PUD among different ethnic groups in Malaysia. The present study compared the distribution of vacA alleles and cagA and cagE status in three ethnic groups residing in Kuala Lumpur, Malaysia, and their association with clinical outcome.
    Matched MeSH terms: India/ethnology
  17. The relationship of hostility, negative affect and ethnicity to cardiovascular responses: an ambulatory study in Singapore
    Enkelmann HC, Bishop GD, Tong EM, Diong SM, Why YP, Khader M, et al.
    Int J Psychophysiol, 2005 May;56(2):185-97.
    PMID: 15804452
    This study tested the hypotheses that ambulatory heart rate and blood pressure would be higher for individuals high but not low in hostility when they experienced negative affect or social stress and that this interaction would be stronger for Indians compared with other Singapore ethnic groups. Ambulatory blood pressure monitoring was done on 108 male Singapore patrol officers as they went about their daily duties. After each BP measurement participants completed a computerized questionnaire including items on emotional experience. Individuals high in hostility showed higher systolic blood pressure when reporting negative affect whereas this was not true for those low in hostility. Ethnic differences were obtained such that Indians showed an increase in mean arterial pressure when angered whereas MAP was negatively related to anger for Malays and unrelated for Chinese. Also a three-way interaction between ethnicity, hostility, and social stress indicated that hostility and social stress interacted in their effects on DBP for Indian participants but not for Chinese or Malays. Finally, a three-way interaction was obtained between ethnicity, hostility and negative affect for heart rate in which heart rate increased with increasing levels of negative affect for Chinese high in hostility and Malays low in hostility but decreased with increasing negative affect for all other participants. These data are consistent with higher CHD rates among individuals high in hostility and also provide additional evidence on ethnic differences in cardiovascular reactivity in Singapore.
    Matched MeSH terms: India/ethnology
  18. Prevalence and determinants of excessive daytime sleepiness in an Asian multi-ethnic population
    Ng TP, Tan WC
    Sleep Med, 2005 Nov;6(6):523-9.
    PMID: 16271696
    BACKGROUND AND PURPOSE: To investigate the prevalence and determinants of daytime sleepiness in an Asian multi-ethnic population. Cross-sectional survey based on a questionnaire in multi-ethnic Asian adult population of Singapore (2.4 million).
    PATIENTS AND METHODS: Measured frequency of excessive daytime sleepiness (EDS), socio-demographic status, sleep duration, perceived sleep insufficiency, frequent awakenings, difficulty falling asleep, snoring, breathing pauses, GHQ-12, shift work, solvent exposure at work, substance use, medications, and chronic diseases in random sample of 2,298 adults, aged 20-74 years, representing Chinese, Malays and Indians.
    RESULTS: Among the respondents, 10.8% reported usually feeling sleepy in the daytime, and 9.0% were classified as having EDS. Marked ethnic difference was observed, with higher rates of EDS in Malays and Chinese, compared to Indians. Increased risk of EDS was associated with perceived sleep insufficiency; snoring and breathing pauses; shift work and solvent exposure at work; psychiatric morbidity and chronic diseases, particularly chronic rhinitis; and medications with sedating effects.
    CONCLUSIONS: Daytime sleepiness is associated with a multiplicity of highly prevalent risk factors in the community, including sleep behavior, breathing-, work- and medically related factors. Significant ethnic differences, which were not explained by these factors, were observed between Chinese, Malays and Indians.
    Matched MeSH terms: India/ethnology
  19. The age of menopause and the menopause transition in a multiracial population: a nation-wide Singapore study
    Loh FH, Khin LW, Saw SM, Lee JJ, Gu K
    Maturitas, 2005 Nov-Dec;52(3-4):169-80.
    PMID: 16257608
    To describe the prevalence of menopausal symptoms, define the mean age of menopause, and determine contributory factors, which influence the experience of symptoms among Singaporean women of different racial groups.
    Matched MeSH terms: India/ethnology
  20. Fulltext Prevalence, associated factors and predictors of anxiety: a community survey in Selangor, Malaysia
    Kader Maideen SF, Mohd Sidik S, Rampal L, Mukhtar F
    BMC Psychiatry, 2015;15:262.
    PMID: 26497745 DOI: 10.1186/s12888-015-0648-x
    Anxiety is the most common mental health disorders in the general population. This study aimed to determine the prevalence of anxiety, its associated factors and the predictors of anxiety among adults in the community of Selangor, Malaysia.
    Matched MeSH terms: India/ethnology
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