Acinetobacter spp is a known nosocomial pathogen causing a wide range of clinical diseases such as pneumonia, wound infection and bloodstream infections (BSI). The clinical outcomes of acinetobacter BSI were determined by a 1:1 case control study involving 58 confirmed cases of acinetobacter BSI who were compared to other gram-negative infections. The crude mortality of acinetobacter BSI was 47.2%, which was significantly greater than other gram-negative BSI (OR 1.89, 95% CI 1.10-3.24) but there were no significant differences in attributed mortality between the two groups. We found that patients treated in intensive care units (ICU), who had longer ICU stays, who presented with shock or coagulopathy, had prior exposure to carbapenems, had mechanical ventilation, were on a ventilator for longer periods, had a nasogastric tube, had an arterial catheter or had parenteral nutrition at a significantly greater risk of mortality due to acinetobacter BSI. Patients presenting with septic shock (OR 17.95, 95% CI 3.36-95.84) or having a central venous catheter (OR 12.48, 95% CI 1.09-142.68) were independently at higher risk for mortality. Appropriateness of therapy reduced the mortality attributes of acinetobacter BSI (OR 0.197, 95% CI 0.040-0.967) but did not significantly reduce crude mortality in acinetobacter BSI patients. This study shows the importance of preventing acinetobacter BSI and the appropriate use of antimicrobial agents to reduce mortality.
Depression among elderly primary care patients is a serious problem with significant morbidity and mortality. This is a cross sectional study to determine the prevalence of depression and its associated factors among the elderly patients attending the outpatient clinic, Universiti Sains Malaysia Hospital. This study utilized Malay version Geriatric Depression Scale 14 (M-GDS 14) to screen for elderly depression among Malaysian population. It also looked into associated risk factors for elderly depression using sociodemographic, family dynamics, and medically related questionnaires. Out of 244 subjects, 34 or 13.9% were found to have depression. Three variables were found to be significantly associated with depression. Elderly patient with any illness that limits the patient's activity or mobility has more risk of developing depression (OR 2.68 CI 1.15 - 6.24). Elderly patients who were satisfied with their personal incomes (OR 0.29 CI 0.10 - 0.85), and who had children or son/daughter-in-law to take care of them when they are sick (OR 0.10 CI 0.01 - 0.83) have a lower chance of having depression. Screening the elderly for depression, would help in diagnosing the elderly depression better and offer them the treatment needed.
Study site: Outpatient clinics, Hospital Universiti Sains Malaysia (HUSM)
OBJECTIVE: The aim of the study was to determine the prevalence of mother-infant bed sharing in Klang district, Peninsular Malaysia and to identify factors associated with bed sharing.
METHOD: This was a cross-sectional study involving 682 mother-infant pairs with infants up to 6 months attending government clinics in Klang district, Peninsular Malaysia. Data were collected by face-to-face interview using a pretested structured questionnaire for a 4-month period in 2006. Data regarding maternal, paternal, obstetric, infant, occupancy, breast-feeding characteristics, and bed-sharing practice were collected. Data on bed sharing were based on practice in the past 1-month period. Bed sharing was defined as an infant sharing a bed with mother, and infant must be within arms reach from the mother, whereas a bed was defined as either a sleeping mattress placed on a bed frame or placed on the floor. The prevalence of bed sharing was estimated. Relationship and magnitude of association between independent factors and bed sharing were examined using odds ratio and 95% confidence interval. Logistic regression analysis was used to control for confounding factors.
RESULTS: The prevalence of bed sharing among mothers with infants aged between 1 and 6 months was 73.5% (95% confidence interval: 70.0-76.7). In multivariate analysis, urban/rural differences, mothers' ethnicity, occupation, family income, husbands' support on bed sharing, number of children younger than 12 years staying in the house, and breast-feeding were associated with bed sharing.
CONCLUSIONS: These factors need to be considered in analyzing the overall risks and benefits of bed sharing, paying attention to breastfeeding practices.
INTRODUCTION: Coitus and orgasm in late pregnancy are believed to facilitate the onset of labour. We aim to evaluate the relationship at term of reported coitus and orgasm with spontaneous labour.
METHODS: Women at term scheduled for non-urgent labour induction were asked to keep a coitus and orgasm diary. These women were recruited for a randomised trial on the effect of coitus to promote spontaneous labour. For this analysis, the women were categorised into coitally-active and abstinent groups according to their coital diary. Spontaneous labour prior to the date of scheduled labour induction was the primary outcome. Labour, delivery and neonatal outcome were also evaluated. Multivariable logistic regression analysis was used to control for significant variables.
RESULTS: On univariate analysis, the inverse association of coitus with spontaneous labour was borderline (odds ratio [OR] 0.6; 95 percent confidence interval [CI] 0.3-1.0; p-value is 0.052). Orgasm was not associated with spontaneous labour (p-value is 0.33). After adjustment, coitus (adjusted OR 0.4; 95 percent CI 0.2-0.8; p-value is 0.009) displayed a significant inverse association with spontaneous labour. Coitus and orgasm were not associated with any other adverse pregnancy outcome.
CONCLUSION: Women who reported coitus were less likely to go into spontaneous labour prior to their scheduled labour induction. Reported coitus and orgasm were not associated with adverse pregnancy outcome.
Stigma and discrimination towards people living with HIV have been widely documented, and have extended their impact into the workplace. Stigmatising attitudes towards people living with HIV (PLHIV) in the workplace significantly hinder HIV prevention efforts and indirectly affect national development. This cross-sectional study was designed to determine the level of knowledge about HIV and AIDS and assess attitudes towards PLHIV among the general staff of Universiti Putra Malaysia (UPM), as well as to identify factors that are associated with it. Self-administered questionnaires were posted to a total of 344 general staff from six randomly selected faculties, and they were a given a week to return the questionnaires. The response rate was 38%. Data were analysed using Pearson's correlation, independent t-test and multiple linear regression. The respondents showed a considerably high level of knowledge about HIV/AIDS (mean knowledge score of 15.57+/-1.93 out of 18 points) although there were some misconceptions (N=129). Likert scale responses to 20 attitude statements revealed that respondents generally had moderately positive attitudes toward PLHIV (average score of 69.65+/-10.08 out of 100 points). Attitudes were inconsistent when it involved direct contact and interaction with PLHIV. Factors significantly associated with level of knowledge and attitudes included age, education and income. There was no difference in mean score for knowledge and attitudes by gender. Further efforts are necessary to improve attitudes of the general staff towards PLHIV, particularly in areas of direct contact with PLHIV.
Major (sodium, potassium, calcium, magnesium) and minor elements (iron, copper, zinc, manganese) and one heavy metal (lead) of Cavendish banana flour and Dream banana flour were determined, and data were analyzed using multivariate statistical techniques of factor analysis and discriminant analysis. Factor analysis yielded four factors explaining more than 81% of the total variance: the first factor explained 28.73%, comprising magnesium, sodium, and iron; the second factor explained 21.47%, comprising only manganese and copper; the third factor explained 15.66%, comprising zinc and lead; while the fourth factor explained 15.50%, comprising potassium. Discriminant analysis showed that magnesium and sodium exhibited a strong contribution in discriminating the two types of banana flour, affording 100% correct assignation. This study presents the usefulness of multivariate statistical techniques for analysis and interpretation of complex mineral content data from banana flour of different varieties.
Serum human chorionic gonadotropin (hCG) and estradiol levels are higher in women with hyperemesis gravidarum (HG) than in unaffected pregnant controls. We postulated that higher levels of these hormones may be associated with clinically more severe HG. The aim of this study was to evaluate the effect of maternal hCG and estradiol levels on the severity of HG.
Background: The World Health Organization recommends the practice of exclusive breastfeeding of infants for the first 6 months after birth. The objective of present study was to estimate the prevalence and the factors influencing exclusive breastfeeding. The perceptions of mothers about breastfeeding in an urban slum area of Western India were also enquired.
Methods: This cross sectional study was conducted over six months amongst 200 mothers of children in the age group of 6 – 12 months attending the growth and development clinic in one of the urban health centres. Data was collected using a pre-tested, structured questionnaire on breastfeeding practices. Factors related to exclusive breastfeeding were analysed using bivariate and multivariate analysis.
Results: Prevalence of exclusive breastfeeding reported by the participants was 61.5%. Having a male child, maternal age < 30 years, level of education of mother parity, receiving infant feeding advice, initiation of breastfeeding within one hour of birth and administration of colostrum to the baby were associated with exclusive breastfeeding (p
The present study deals with the assessment of Langat River water quality with some chemometrics approaches such as cluster and discriminant analysis coupled with an artificial neural network (ANN). The data used in this study were collected from seven monitoring stations under the river water quality monitoring program by the Department of Environment (DOE) from 1995 to 2002. Twenty three physico-chemical parameters were involved in this analysis. Cluster analysis successfully clustered the Langat River into three major clusters, namely high, moderate and less pollution regions. Discriminant analysis identified seven of the most significant parameters which contribute to the high variation of Langat River water quality, namely dissolved oxygen, biological oxygen demand, pH, ammoniacal nitrogen, chlorine, E. coli, and coliform. Discriminant analysis also plays an important role as an input selection parameter for an ANN of spatial prediction (pollution regions). The ANN showed better prediction performance in discriminating the regional area with an excellent percentage of correct classification compared to discriminant analysis. Multivariate analysis, coupled with ANN, is proposed, which could help in decision making and problem solving in the local environment.
The aim of this study was to investigate the relationship between dental anxiety and dental decay experience among antenatal mothers attending Maternal and Child Health clinics in Malaysia. A cross-sectional study was conducted on a consecutive sample of 407 antenatal mothers in Seremban, Malaysia. The questionnaire consisted of participants' demographic profile and the Dental Fear Survey. The D(3cv)MFS was employed as the outcome measure and was assessed by a single examiner (intraclass correlation = 0.98). A structural equation model was designed to inspect the relationship between dental anxiety and dental decay experience. The mean Dental Fear Survey score for all participants was 35.1 [95% confidence interval (34.0, 36.3)]. The mean D(3cv)MFS score was 10.8 [95% confidence interval (9.5, 12.1)]. Participants from low socio-economic status groups had significantly higher D(3cv)MFS counts than those from high socio-economic status groups. The path model with dental anxiety and socio-economic status as predictors of D(3cv)MFS showed satisfactory fit. The correlation between dental anxiety and dental decay experience was 0.30 (standardized estimate), indicating a positive association. Socio-economic status was also statistically significantly associated with the D(3cv)MFS count (beta = 0.19). This study presented robust evidence for the significant relationship between dental anxiety and dental decay experience in antenatal mothers.
To compare sleep habits and disturbances between Malaysian children with epilepsy and their siblings (age range 4-18 years) and to determine the factors associated with greater sleep disturbance.
The purpose of this study was to determine the association between different ethnic groups and the prevalence, awareness, and control of diabetes in Malaysia. A population-based cross-sectional study using multistage sampling was conducted in Malaysia. Diabetes is defined as having a fasting blood glucose > or =7 mmol/L or a self-reported diabetic on treatment. Among the 7683 respondents aged > or =30 years, the prevalence of diabetes mellitus was 15.2% (95% CI = 14.1, 16.4). Multivariate analysis showed that compared with Malays, Chinese had lower odds (adjusted odds ratio [aOR] 0.71; 95% CI = 0.56, 0.91) and Indians had higher odds of having diabetes (aOR 1.54; 95% CI = 1.20, 1.98). The odds of diabetes increased with age, family history of diabetes, body mass index, and lower education levels. Among those with diabetes mellitus, 45.0% were aware and 42.7% were under treatment. Among treated diabetics, 25.1% had their fasting blood sugar under control. There is a significant association between prevalence of diabetes and different ethnic groups.
The task of identifying firearms from forensic ballistics specimens is exacting in crime investigation since the last two decades. Every firearm, regardless of its size, make and model, has its own unique 'fingerprint'. These fingerprints transfer when a firearm is fired to the fired bullet and cartridge case. The components that are involved in producing these unique characteristics are the firing chamber, breech face, firing pin, ejector, extractor and the rifling of the barrel. These unique characteristics are the critical features in identifying firearms. It allows investigators to decide on which particular firearm that has fired the bullet. Traditionally the comparison of ballistic evidence has been a tedious and time-consuming process requiring highly skilled examiners. Therefore, the main objective of this study is the extraction and identification of suitable features from firing pin impression of cartridge case images for firearm recognition. Some previous studies have shown that firing pin impression of cartridge case is one of the most important characteristics used for identifying an individual firearm. In this study, data are gathered using 747 cartridge case images captured from five different pistols of type 9mm Parabellum Vektor SP1, made in South Africa. All the images of the cartridge cases are then segmented into three regions, forming three different set of images, i.e. firing pin impression image, centre of firing pin impression image and ring of firing pin impression image. Then geometric moments up to the sixth order were generated from each part of the images to form a set of numerical features. These 48 features were found to be significantly different using the MANOVA test. This high dimension of features is then reduced into only 11 significant features using correlation analysis. Classification results using cross-validation under discriminant analysis show that 96.7% of the images were classified correctly. These results demonstrate the value of geometric moments technique for producing a set of numerical features, based on which the identification of firearms are made.
The constituents in a food emulsion interact with each other, either physically or chemically, determining the overall physico-chemical and organoleptic properties of the final product. Thus, the main objective of present study was to investigate the effect of emulsion components on beverage emulsion properties.
Multivariate analysis including correlation, multiple stepwise linear regression, and cluster analyses were applied to investigate the heavy metal concentrations (Cd, Cu, Fe, Ni, Pb, and Zn) in the different parts of bivalves and gastropods. It was also aimed to distinguish statistically the differences between the marine bivalves and the gastropods with regards to the accumulation of heavy metals in the different tissues. The different parts of four species of bivalves and four species of gastropods were obtained and analyzed for heavy metals. The multivariate analyses were then applied on the data. From the multivariate analyses conducted, there were correlations found between the soft tissues of bivalves and gastropods, but none was found between the shells and the soft tissues of most of the molluscs (except for Cerithidea obtusa and Puglina cochlidium). The significant correlations (P < 0.05) found between the soft tissues were further complemented by the multiple stepwise linear regressions where heavy metals in the total soft tissues were influenced by the accumulation in the different types of soft tissues. The present study found that the distributions of heavy metals in the different parts of molluscs were related to their feeding habits and living habitats. The statistical approaches proposed in this study are recommended for use in biomonitoring studies, since multivariate analyses can reduce the cost and time involved in identifying an effective tissue to monitor the heavy metal(s) bioavailability and contamination in tropical coastal waters.
Age at menarche has been shown to be an important indicator for diseases such as breast cancer and ischaemic heart disease. The aim of the present study was to document secular trends in age at menarche and their association with anthropometric measures and socio-demographic factors in university students in Bangladesh. Data were collected from 995 students from Rajshahi University using a stratified sampling technique between July 2004 and May 2005. Trends in age at menarche were examined by linear regression analysis. Multiple regression analysis was used to assess the association of age at menarche with adult anthropometric measures and various socio-demographic factors. The mean and median age of menarche were 13.12+/-1.16 and 13.17 years, respectively, with an increasing tendency among birth-year cohorts from 1979 to 1986. Menarcheal age was negatively associated with BMI (p<0.01), but positively associated with height (p<0.05). Early menarche was especially pronounced among students from urban environments, Muslims and those with better educated mothers. Increasing age at menarche may be explained by improved nutritional status among Bangladeshi populations. Early menarche was associated with residence location at adolescence, religion and mother's education.
OBJECTIVES: The clinical impact of seasonal influenza is understudied in tropical countries. The aim of this study was to describe the clinical features and seasonal pattern of influenza in children hospitalized in Malaysia, and to identify predictors of severe disease.
METHODS: Children hospitalized with community-acquired, laboratory-confirmed influenza at a teaching hospital in Kuala Lumpur, Malaysia during 2002-2007 were identified retrospectively. Clinical data were collected, and predictors of severe disease were identified by multivariate logistic regression. All influenza cases from 1982 to 2007 were also analyzed for seasonal patterns.
RESULTS: A total of 132 children were included in the study, 48 (36.4%) of whom had underlying medical conditions. The mean age was 2.5 years and 116 (87.9%) were <5 years old. The most common presenting features were fever or history of fever, cough, rhinitis, vomiting, and pharyngitis. Severe influenza was seen in 16 patients (12.1%; nine previously healthy), including 12 (9.1%; eight previously healthy) requiring intensive care. There were three (2.3%) deaths. Severe disease was associated with age <12 months, female sex, and absence of rhinitis on admission. Influenza was seen year-round, with peaks in November-January and May-July.
CONCLUSIONS: Seasonal influenza has a considerable impact on children hospitalized in Malaysia, in both the healthy and those with underlying medical conditions.
Study site: University Malaya Medical Centre (UMMC)
Limited longitudinal studies on smoking cessation have been reported in Asia, and it remains unclear whether determinants of quitting are similar to those found in Western countries. This study examined prospective predictors of smoking cessation among adult smokers in Thailand and Malaysia.