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Knowledge, attitude and practice towards dietary iron among patients with thalassemia and their caregivers in Peninsular Malaysia

Chin DM, Kader Maideen SF, Rashid A

Med J Malaysia, 2019 Oct;74(5):365-371.
PMID: 31649210

INTRODUCTION: Thalassemias are the most common human monogenic disorders in the world. Regular blood transfusion and increased intestinal absorption of iron among thalassemia patients will lead to iron overload, which will not only markedly decrease their life expectancy but also pose a heavy burden to the healthcare system. The objective of this study was to evaluate the level of knowledge, attitude and practice towards dietary iron among thalassemia patients and their caregivers.
METHODS: An analytical cross-sectional study using purposive sampling method was conducted at eight thalassemia societies in Peninsular Malaysia. 260 respondents comprised of patients and caregivers were assessed with two separate sets of questionnaires.
RESULTS: Knowledge on dietary iron among the respondents was unsatisfactory, despite them having good knowledge on thalassemia disorder. Female patients were found to have better dietary knowledge, attitude and practice compared to males. The percentage of caregivers with good attitude and good practice were significantly higher compared to adult patients. Caregivers with children on iron chelators were noted to have better dietary attitude and practice. Thalassemia knowledge and children on vitamins were found to be the predictors of dietary knowledge among the patients and caregivers respectively.
CONCLUSION: The level of knowledge on dietary iron among the patients and caregivers was unsatisfactory in spite of their attitude and practice towards dietary iron were good. Effective delivery of dietary information to the patients and caregivers is essential to enable them to choose a healthy diet for their condition.

Matched MeSH terms: Life Expectancy
Fulltext Development of clinical pathway for Mild Cognitive Impairment and Dementia to quantify cost of age-related cognitive disorders in Malaysia

Syed Mohamed Aljunid, Namaitijiang Maimaiti, Zafar Ahmed, Amrizal Muhammad Nur, Norashidah Mohamed Nor, Normazwana Ismail, et al.

Malaysian Journal of Public Health Medicine, 2014;14(3):0-0.
MyJurnal

As the Malaysian population ages, the burden of age-related cognitive disorders such as dementia and Alzheimer’s disease will increase concomitantly. This is one of the sub-study under a research project titled by quantify the cost of age-related cognitive impairment in Malaysia, which was undertaken to develop a clinical pathway for Mild Cognitive Impairment (MCI) and Dementia. The clinical pathway (CP) will be used to support the costing studies of MCI and Dementia. An expert group discussion (EGD) was conducted among selected experts from six (6) government hospitals from different states of Malaysia, Ministry of Health, and United Nations University, International Institute for Global Health, UKM and UPM. The expert group includes psychiatrist specialists and public health medicine specialists. A total of 15 participants took part in the EGD. The group was presented with the different approach in managing MCI and Dementia. Finally, the group came to the consensus agreement on the most appropriate and efficient ways of managing the two conditions. In the EGD, an operational definition for MCI and Dementia was agreed upon and a pathway was developed for the usual practice in the Malaysian health system. A typical case used, as a reference is a 60-year-old patient referred to a memory clinic with complaint of “forgetfulness”. After three outpatient visits in the clinic, the diagnosis of MCI and Dementia could be clinically established. The clinical pathways covered all active clinical and non-clinical management of the patient over a period of one year. The experts identified the additional resources required to manage these patients for the whole spectrum of lifetime based on the expected life expectancy. The Clinical pathway (CP) for MCI and Dementia was successfully developed in EGD with strong support from practitioners in the health system. The findings will help the researchers to identify all-important clinical activities and interventions that will be included in the costing study.

Matched MeSH terms: Life Expectancy
Aging and economic growth: empirical analysis using autoregressive distributed lag approach

Normaz Wana Ismail, Siti Wardah Abd Rahman, Tengku Aizan Tengku Abdul Hamid, Rusmawati Said

Sains Malaysiana, 2016;45:1345-1350.

The purpose of this study was to examine the impact of aging on economic growth. The study used dynamic growth model and employed Autoregressive Distributed Lag (ARDL) approach for the period of 1980 to 2011. Three proxies for aging are used namely fertility rate, life expectancy and old dependency ratio. However, only fertility rate is detected to have a long run cointegration. The major finding of this study showed that a reduction of fertility rate lead to higher economic growth. This implied that even though Malaysia will face aging society by 2020, the economic growth is still stable and can increase by investing more on human capital.

Matched MeSH terms: Life Expectancy
Fulltext Cerebral amyloid angiopathy: an important differential diagnosis of stroke in the elderly

Azmin S, Osman SS, Mukari S, Sahathevan R

Malays J Med Sci, 2015 Jan-Feb;22(1):74-8.
PMID: 25892953

Cerebral amyloid angiopathy (CAA) accounts for approximately 10-20% of spontaneous intracerebral haemorrhage (ICH). This figure is thought to be higher in the elderly population. With the increasing life expectancy of our population, we anticipate that the prevalence of CAA- related ICH will increase in tandem. Although CAA-related ICH and hypertension-related ICH are distinct entities based on histopathology and imaging, the clinical presentation of the two conditions is similar. The use of brain computed tomography (CT) scans remain the ICH imaging modality of choice in Malaysia due to its availability, cost, and sensitivity in detecting acute bleeds. On the other hand, the use of brain magnetic resonance imaging (MRI) with susceptibility-weighted imaging (SWI) sequencing enables the clinician to determine the presence of chronic blood products in the brain, especially clinically silent microbleeds associated with CAA. However, the use of brain MRI scans in our country is limited and leads to a blurring of lines when differentiating between hypertension-related ICH and CAA-related ICH. How this misrepresentation affects the management of these conditions is unclear. In this study, we present two cases of ICH to illustrate this point and to serve as a springboard to question current practice and promote discussion.

Matched MeSH terms: Life Expectancy
Health trends in three Asian countries--Ceylon, Malaysia and Singapore

Arumanayagam P, San SJ

Int J Epidemiol, 1972;1(2):101-9.
PMID: 4204766
Matched MeSH terms: Life Expectancy
The increasing life span of Malaysians

Sandosham AA

Med J Malaya, 1969 Sep;24(1):1-2.
PMID: 4243837

According to the statistical information recently released, the expectation of life of the average Malaysian had increased by 1966 to about 67 years and there was every prospect of the trend being continued. No doubt the sound economy leading to higher living standards and better nutrition and the improved health services in the rural areas account for present day Malaysians being healthier and living longer. The health of children in particular has shown great improvement, the infant deaths having dropped from 75.5 per 1,000 children below the age of one in 1957 to 48 in 1966, and the crude toddler mortality rate from 10.7 to 5.1. Further improvement may be expected, especially in the rural areas with the current malaria eradication programme and the proposal to get the rural health clinic personnel to visit homes in the kampongs to disseminate knowledge on health, nutrition and home economics. It is to be hoped that at the same time, the family planning campaign in the rural areas will begin to produce results so that the economic and other benefits are not spread too thin over a large population. However, almost simultaneously with the release of the information that the life span had increased and that the average Malaysian of 55 may now expect to live for about another 20 years, came the shocking announcement by the government that the compulsory retiring age has been reduced from 60 to 55. Why is the Malaysian considered too old for government service when he reaches the magic age of 55 while there has been new thinking on retirement policies in Western countries? In view of the longer active life expectancy, there has been a fuller recognition in many countries of the contribution that older people can make to the life of the community. In the case of the professional man, this enforced premature retirement from government service may actually prove a blessing in disguise. The doctor, dentist, engineer, etc., may, in fact, welcome the opportunity of being released early so that he can set himself up in private practice or join in partnership with his fellows in the private sector. What happens to the vast majority of government servants who are not so luckily placed? What is he to do when he is thrown out without any training or preparation into a ruthless competitive world of commerce and industry at the age of 55 when he could be usefully employed in the public services for a few more years?
It has been estimated that there are in West Malaysia alone about 800,000 people in the age group of 55 and above. This latter figure will keep increasing with the rising span of life and a population growing steadily at the rate of over three percent per annum. With the better control of infectious and communicable diseases, problems of degenerative diseases are becoming more common. The picture of medical practice in the country has begun to change with more and more people presenting themselves with condition resulting from cardiovascular derangement, neoplasm and mental and senile changes. Traditionally, the old folks in Asia have been housed and cared for by the children but modernization in outlook and urbanization are steadily changing that state of affairs. The old folks are finding themselves more and more dependant on themselves and the poorer ones tend to finish up in overcrowded homes run by charitable organizations with little or no geriatric care. These people, however, should not be penalized because they are too old and cannot earn any more. Most modern countries accept their responsibility to support the aged in dignity and comfort by providing adequate old age pensions and properly run old folks’ homes and do not leave them to the charity of a few benevolent members of society. We would like to see more done for them in this country.

Matched MeSH terms: Life Expectancy*
Long-Term Cost-Effectiveness of Insulin Glargine Versus Neutral Protamine Hagedorn Insulin for Type 2 Diabetes in Thailand

Permsuwan U, Chaiyakunapruk N, Dilokthornsakul P, Thavorn K, Saokaew S

Appl Health Econ Health Policy, 2016 Jun;14(3):281-92.
PMID: 26961276 DOI: 10.1007/s40258-016-0228-3

BACKGROUND: Even though Insulin glargine (IGlar) has been available and used in other countries for more than a decade, it has not been adopted into Thai national formulary. This study aimed to evaluate the long-term cost effectiveness of IGlar versus neutral protamine Hagedorn (NPH) insulin in type 2 diabetes from the perspective of Thai Health Care System.
METHODS: A validated computer simulation model (the IMS CORE Diabetes Model) was used to estimate the long-term projection of costs and clinical outcomes. The model was populated with published characteristics of Thai patients with type 2 diabetes. Baseline risk factors were obtained from Thai cohort studies, while relative risk reduction was derived from a meta-analysis study conducted by the Canadian Agency for Drugs and Technology in Health. Only direct costs were taken into account. Costs of diabetes management and complications were obtained from hospital databases in Thailand. Both costs and outcomes were discounted at 3 % per annum and presented in US dollars in terms of 2014 dollar value. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were also performed.
RESULTS: IGlar is associated with a slight gain in quality-adjusted life years (0.488 QALYs), an additional life expectancy (0.677 life years), and an incremental cost of THB119,543 (US$3522.19) compared with NPH insulin. The ICERs were THB244,915/QALY (US$7216.12/QALY) and THB176,525/life-year gained (LYG) (US$5201.09/LYG). The ICER was sensitive to discount rates and IGlar cost. At the acceptable willingness to pay of THB160,000/QALY (US$4714.20/QALY), the probability that IGlar was cost effective was less than 20 %.
CONCLUSIONS: Compared to treatment with NPH insulin, treatment with IGlar in type 2 diabetes patients who had uncontrolled blood glucose with oral anti-diabetic drugs did not represent good value for money at the acceptable threshold in Thailand.

Matched MeSH terms: Life Expectancy
Fulltext Health screening for older people—what are the current recommendations?

Sazlina SG

Malays Fam Physician, 2015;10(1):2-10.
PMID: 26425289 MyJurnal

The world population of older people is on the rise with improved health services. With longevity, older people are at increased risk of chronic non-communicable diseases (NCDs), which are also leading causes of death among older people. Screening through case finding in primary care would allow early identification of NCDs and its risk factors, which could lead to the reduction of related complications as well as mortality. However, direct evidence for screening older people is lacking and the decision to screen for diseases should be made based on comorbidity, functional status and life expectancy, and has to be individualised.

Matched MeSH terms: Life Expectancy
Mortality in rheumatoid arthritis: time to take it seriously

Arshad A, Shahid MS

APLAR Journal of Rheumatology, 2005;8(3):154-158.
DOI: 10.1111/j.1479-8077.2005.00158.x

Rheumatoid arthritis (RA) is often regarded as benign and not a serious disease. Yet patients with RA have a substantially reduced life expectancy. Patients with RA are particularly at risk of death from cardiovascular disease, infection and renal disease. A few variables are now recognized as important predictive markers, such as disease duration, severity, sex, educational level and treatment., Copyright (C) 2005 Blackwell Publishing Ltd

Matched MeSH terms: Life Expectancy
Relative importance of demographic, socioeconomic and health factors on life expectancy in low- and lower-middle-income countries

Mondal MN, Shitan M

J Epidemiol, 2014;24(2):117-24.
PMID: 24390415

BACKGROUND: We attempted to identify the pathways by which demographic changes, socioeconomic inequalities, and availability of health factors influence life expectancy in low- and lower-middle-income countries.
METHODS: Data for 91 countries were obtained from United Nations agencies. The response variable was life expectancy, and the determinant factors were demographic events (total fertility rate and adolescent fertility rate), socioeconomic status (mean years of schooling and gross national income per capita), and health factors (physician density and human immunodeficiency virus [HIV] prevalence rate). Path analysis was used to determine the direct, indirect, and total effects of these factors on life expectancy.
RESULTS: All determinant factors were significantly correlated with life expectancy. Mean years of schooling, total fertility rate, and HIV prevalence rate had significant direct and indirect effects on life expectancy. The total effect of higher physician density was to increase life expectancy.
CONCLUSIONS: We identified several direct and indirect pathways that predict life expectancy. The findings suggest that policies should concentrate on improving reproductive decisions, increasing education, and reducing HIV transmission. In addition, special attention should be paid to the emerging need to increase life expectancy by increasing physician density.

Matched MeSH terms: Life Expectancy*
Fulltext Author's Response: Regarding the Relative Importance of Demographic, Socioeconomic and Health Factors on Life Expectancy in Low- and Lower-Middle-Income Countries

Mondal MN, Shitan M

J Epidemiol, 2015;25(6):460.
PMID: 25986157 DOI: 10.2188/jea.JE20150046
Matched MeSH terms: Life Expectancy*
Impact of Socio-Health Factors on Life Expectancy in the Low and Lower Middle Income Countries

Mondal MN, Shitan M

Iran J Public Health, 2013 Dec;42(12):1354-62.
PMID: 26060637

This study is concerned with understanding the impact of demographic changes, socioeconomic inequalities, and the availability of health factors on life expectancy (LE) in the low and lower middle income countries.

Matched MeSH terms: Life Expectancy
Fulltext Frontonasal dysplasia in Yangon, Myanmar

Nang, Kham Oo Leik, Rhanye Mac Guad, Yuan, Seng Wu, Shwe, Yi Wai

Borneo Journal of Medical Sciences, 2020;14(3):51-55.
MyJurnal

Frontonasal dysplasia (FND) is an uncommon congenital anomaly affecting the eyes, nose and forehead. In this case report, a baby of a 22-year-old mother was diagnosed with a midline facial cleft, bifid nose and hypertelorism during an ultrasound scan at 29th week of gestation. Besides a history of miscarriage on first pregnancy, no other abnormalities findings were found in laboratory or radiological examination of the newborn. Counselling about abnormality and psychological support were given by both obstetrician and neonatologist during the antenatal period. The patient delivered vaginally at 36th week with spontaneous labour and no complication was observed. Further interventions including corrective treatment have been planned as they often interfere with important functions such as breathing and feeding. Thus, the paediatric surgical team decided to do the operation when the baby reaches one year old as then tissues have been developed to 90% of their eventual form to give optimal treatment results. Further life expectancy depends on the severity of the malformation and whether or not surgical intervention can improve the associated health problems. This case report raises the importance of awareness on the nutritional value of pregnant mothers especially carotene and folic acid intake which may be associated with the organ maldevelopment. Overall, this report outlined the management of this rare condition experienced by the patient, particularly in a resource-limited setting like Yangon in Myanmar and also reviewed the literature about the presentation and classification of this condition.

Matched MeSH terms: Life Expectancy
Fulltext Socio-economic development and mortality patterns and trends in Malaysia

Tan Poo Chang, Kwok Kwan Kit, Tan Boon Ann, Shyamala Nagaraj, Tey Nai Peng, Siti Norazah Zulkifli

Asia Pac Popul J, 1987 Mar;2(1):3-20.
PMID: 12341034

PIP: Morality in Peninsular Malaysia has reached a level that is quite similar to that prevailing in the low mortality countries. This article systematically documents changes in mortality levels and differentials in Malaysia over time and relates these to changes in development indicators and health-related policies. Remedial measures undertaken by the authorities including the expansion of hospital and health services into the estates, together with a comprehensive malaria-eradication program, improvements in sanitation laws, and increased provision of public utilities and education, resulted in beriberi being eliminated and the incidence of malaria, typhus, and smallpox being greatly reduced by the time of World War II. The gain in life expectancy over the period of 1957-1979 was greatest for the Malay, the most significant period being 1957-1967, which saw the introduction of rural health programs. The infant mortality rate and the neonatal and post-neonatal rates declined substantially for all ethnic groups in Peninsular Malaysia for the same time period. Although the lower infant mortality of the Chinese can be explained by their advantageous socioeconomic position the same reason cannot explain the lower decline in infant mortality levels of the Indians. Much still needs to be done to narrow, if not to eliminate, the existing mortality differentials of different groups in the country. Overall, the quality of life of the general population can be further enhanced by reducing the high mortality level of disadvantaged groups.

Matched MeSH terms: Life Expectancy*
Effect of postharvest ultraviolet-C treatment on the proteome changes in fresh cut mango (Mangifera indica L. cv. Chokanan)

George DS, Razali Z, Santhirasegaram V, Somasundram C

J Sci Food Agric, 2016 Jun;96(8):2851-60.
PMID: 26350493 DOI: 10.1002/jsfa.7454

Postharvest treatments of fruits using techniques such as ultraviolet-C have been linked with maintenance of the fruit quality as well as shelf-life extension. However, the effects of this treatment on the quality of fruits on a proteomic level remain unclear. This study was conducted in order to understand the response of mango fruit to postharvest UV-C irradiation.

Matched MeSH terms: Life Expectancy
Fulltext The status of men's health in Asia

Ng CJ, Teo CH, Ho CC, Tan WP, Tan HM

Prev Med, 2014 Oct;67:295-302.
PMID: 25117523 DOI: 10.1016/j.ypmed.2014.08.007

This study aims to compare health status and its risk factors between men and women who are from countries of different income status in Asia.

Matched MeSH terms: Life Expectancy*
Fulltext Managing the aging man in Asia: a review

Tong SF, Ho C, Tan HM

Int J Urol, 2011 Jan;18(1):32-42.
PMID: 20969645 DOI: 10.1111/j.1442-2042.2010.02652.x

The aging man is becoming a major burden to Asian countries because of the current poor health status of Asian men and the aging Asian population. Life expectancy at birth for men is shorter than women by an average of 4 years in Asian countries and major causes of death are cardiovascular disease, cancers, injuries and infections. However, there are considerable variations between Asian countries because of great disparity in socioeconomic status. Male-specific disorders, such as male sexual health and urological conditions, are other major health burdens because they have a great impact on men's quality of life. More importantly, many risk factors to the causes of mortality and morbidities, such as high-risk behavior and smoking, can be improved with health promotion and early intervention. The current evidence suggests that the poor health status of men is the result of their poor health care utilization, negative health-seeking behavior, the adverse social environment for men and gender-insensitive health care delivery. However, much evidence is still needed as Asian countries have great diversity in culture, societal values and men's needs. Asian time-tested wisdom on a balanced healthy lifestyle to longevity should be explored as potential men's health promotional programs. Taking into account Asian men's health-care needs, a gender-streamlined approach and man-friendly health care delivery should be on the national agenda in managing the aging man.

Matched MeSH terms: Life Expectancy
Fulltext Asian men’s health: gender disparity and life expectancy

Ho, Christopher C.K., Teo, C.H., Ng, C.J., Zulkifli, M.Z., Tan, M.H.

Journal of Surgical Academia, 2014;4(2):5-8.
MyJurnal

The aim of this review was to analyze the gender disparities found as well as the life expectancies in Asia. An analysis of the data on gender disparities as well as life expectancies of the different Asian countries was done based on the World Health Organization (WHO) Global Health Observatory Data Repository as well as the regional government databases. Middle Eastern countries have the highest male to female population ratio. The results show that in terms of population pyramid, Asia is moving towards a more geriatric population. Qatar has the highest life expectancy for men and is the only country in Asia where men live longer than women (difference of 2 years). In general, women in Asia live longer than men. High income countries like Hong Kong, Japan and Singapore have higher life expectancies as compared to those on the lower income nations. The life expectancy of Asian men still lags women. Men’s health care needs to be addressed urgently. The disparity in income-status reflecting the lifespan of men is an impetus for us to narrow the gap of health in Asian countries.

Matched MeSH terms: Life Expectancy
Fulltext Pathogenic role of immune cells in rheumatoid arthritis: implications in clinical treatment and biomarker development

Yap HY, Tee SZ, Wong MM, Chow SK, Peh SC, Teow SY

Cells, 2018 Oct 09;7(10).
PMID: 30304822 DOI: 10.3390/cells7100161

Rheumatoid arthritis (RA) is a chronic, autoimmune, systemic, inflammatory disorder that affects synovial joints, both small and large joints, in a symmetric pattern. This disorder usually does not directly cause death but significantly reduces the quality of life and life expectancy of patients if left untreated. There is no cure for RA but, patients are usually on long-term disease modifying anti-rheumatic drugs (DMARDs) to suppress the joint inflammation, to minimize joint damage, to preserve joint function, and to keep the disease in remission. RA is strongly associated with various immune cells and each of the cell type contributes differently to the disease pathogenesis. Several types of immunomodulatory molecules mainly cytokines secreted from immune cells mediate pathogenesis of RA, hence complicating the disease treatment and management. There are various treatments for RA depending on the severity of the disease and more importantly, the patient's response towards the given drugs. Early diagnosis of RA and treatment with (DMARDs) are known to significantly improve the treatment outcome of patients. Sensitive biomarkers are crucial in early detection of disease as well as to monitor the disease activity and progress. This review aims to discuss the pathogenic role of various immune cells and immunological molecules in RA. This review also highlights the importance of understanding the immune cells in treating RA and in exploring novel biomarkers.

Matched MeSH terms: Life Expectancy
Fulltext Western impressions of the Hong Kong health care system

Bennett CL, Pei GK, Ultmann JE

West. J. Med., 1996 Jul-Aug;165(1-2):37-42.
PMID: 8855683

Hong Kong, Taiwan, Singapore, and Malaysia are initiating health care reform to meet the changing demands of populations with improved socioeconomic status and access to modern technologies and who are living longer than in previous generations. Hong Kong, in particular, is facing a unique set of circumstances as its people prepare for the transition in 1997 from a British colony to a Special Administrative Region of China. While spending only 4% of its gross domestic product on health care, it has a large and regulated public hospital system for most inpatient medical care and a separate, loosely regulated private health care system for most outpatient medical care. In 1993 the Secretary for Health and Welfare of Hong Kong initiated a year-long process to debate the pros and cons of 5 fundamental programs for health care reform. After a year of open consultation, options were chosen. We describe the Hong Kong health care system, the fundamental changes that have been adopted, and lessons for reformers in the United States.

Matched MeSH terms: Life Expectancy

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