To assess the impact of visual impairment (VI) on health-related quality of life and to compare the health burden of VI and other health conditions in Singapore.
Decision-making on behalf of an incapacitated patient at the end of life is a complex process, particularly in family-centric societies. The situation is more complex when attempts are made to accommodate Eastern concepts of end-of-life care with more conventional Western approaches. In this case report of an incapacitated 74-year-old Singaporean man of Malay descent with relapsed Stage 4 diffuse large B cell lymphoma who was without an established lasting power of attorney, we highlight the difficult deliberations that ensue when the patient's family, acting as his proxy, elected to administer lingzhi through his nasogastric tube (NGT). Focusing on the questions pertaining to end-of-life decision-making in Asia, we consider the issues surrounding the use of NGT and lingzhi in palliative care (PC) and the implementation of NGT for administering lingzhi in a PC setting, particularly in light of a dearth of data on such treatment measures among PC patients.
Diabetes mellitus is a common chronic disease in Singapore. Its occurrence in pregnant women was 1.3% in a previous report. In a survey of 145 consecutive pregnant women registered at Alexandra Hospital the incidence of gestational diabetes was 13.1% when a total screen with 75 gm oral glucose challenge was used. The mean age of this sample was 27 years and the mean gestation at screening 33 weeks. There was an excess of Malay and Indian patients. Fifty percent had traditional risk factors tor gestational diabetes. Whether this higher incidence is a result of more stringent screening and/or increased occurrence remains to be confirmed.
Misuse of alcohol among adolescents, particularly schoolchildren has become one of the public health concerns in Malaysia due to its serious effects and an increased risk of alcohol related injuries, especially motor vehicle injuries. This is the most common type of youthful fatal injury in Malaysia. However the availability of data on the extent of alcohol abuse particularly among school children in this country is limited. Therefore, we conducted this study with the objectives of identifying the prevalence of alcohol drinking among school children in Kuala Lumpur, factors rekited to alcohol drinking among the adolescents and to assess health status of their parents through the presence of any related alcohol diseases and the habits of alcohol drinking among their parents.
In this baseline study a two stage stratified sampling design was used to recruit 8532 eligible students from the selected secondary schools in Kuala Lumpur. The prevalence of alcohol drinking was 9.0% (771 / 8532) . Significant factors identihed related to alcohol consumption were akoholic father (OR=1.29), akoholic mother (1 .55) ; elder siblings consume alcohol (2 .49) and the Chinese ethnic group (1 .55) . The study revealed that factors which signihcantly contributed to the habit of alcohol drinking were related to whether their parents consumed alcohol or not or either their eMer siblings were ako taking alcohol. Therefore, the, results from this study could be used as a baseline data to describe the level of alcohol consumption among adolescents particularly school children. Ehfective public health interventions that focus on the familial context of adolescents' drinking habits may be developed.
This study was carried out to determine the role of p53 and p21 in the pathogenesis of prostatic adenocarcinoma and their association with tumour grade.
Aim: To evaluate the psychometric performance of the Malay version of the Medical Outcome Study (MOS) Social Support Survey among a sample of postpartum Malay women in Kedah, North West of Peninsular Malaysia.
Materials and methods: 354 women between 4 to 12 weeks postpartum were recruited for the validation study. They were given questionnaires on socio-demography, the Malay versions of the MOS Social Support Survey, the Edinburgh Postnatal Depression Scale (EPDS) and the 21-items Beck Depression Inventory-II (BDI-II). 30 of the participants, who were bilingual, were also given the original English version of the instrument. A week later, these women were again asked to complete the Malay version of MOS Social Support Survey.
Results: The median number for item 1 (the single item measure of structural support) was 3 (inter-quartile range = 2 - 4). Extraction method of the remaining 19 items (item 2 to item 20) using principle component analyses with direct oblimin rotation converged into 3 dimensions of functional social support (informational support, affectionate support / positive social interaction and instrumental support) with reliability coefficients of 0.93, 0.74 and 0.72 respectively. Overall the scale displayed good internal consistency (Cronbach's alpha = 0.93), parallel form reliability (0.98) and test-retest reliability (0.97) (Spearman's rho; p<0.01). Its validity was confirmed by the negative correlations between the overall support index (total social support score) and all the three dimensions of functional support with the Malay versions of EPDS and BDI-II. The overall support index also displayed low but significant correlations with the single measure structural social support in the instrument (Spearman's rho = 0.14; p <0.01).
Conclusions: The MOS Social Support Survey demonstrated good psychometric properties in measuring social support among postpartum Malay women in Kedah, North West of Peninsular Malaysia and could potentially be used as a simple instrument in primary care settings.
INTRODUCTION: To determine sociodemographic and psychological factors associated with bullying behavior among young adolescents in Malaysia.
METHODS: This is a cross-sectional study of four hundred ten 12-year-old adolescents from seven randomly sampled schools in the Federal Territory of Kuala Lumpur, Malaysia. Sociodemographic features of the adolescents and their parents, bullying behavior (Malaysian Bullying Questionnaire), ADHD symptoms (Conners Rating Scales), and internalizing and externalizing behavior (Child Behaviour Checklist) were obtained from adolescents, parents and teachers, respectively.
RESULTS: Only male gender (OR=7.071, p=0.01*, CI=1.642-30.446) was a significant sociodemographic factor among bullies. Predominantly hyperactive (OR=2.285, p=0.00*, CI=1.507-3.467) and inattentive ADHD symptoms reported by teachers (OR=1.829, p=0.03*, CI=1.060-3.154) and parents (OR=1.709, p=0.03*, CI=1.046-2.793) were significant risk factors for bullying behavior while combined symptoms reported by young adolescents (OR=0.729, p=0.01*, CI=0.580-0.915) and teachers (OR=0.643, p=0.02*, CI=0.440-0.938) were protective against bullying behavior despite the influence of conduct behavior (OR=3.160, p=0.00*, CI=1.600-6.241). Internalizing behavior, that is, withdrawn (OR=0.653, p=0.04*, CI=0.436-0.977) and somatic complaints (OR=0.619, p=0.01*, CI=0.430-0.889) significantly protect against bullying behavior.
DISCUSSIONS: Recognizing factors associated with bullying behavior, in particular factors distinctive to the local population, facilitates in strategizing effective interventions for school bullying among young adolescents in Malaysian schools.
The catechol-O-methyltransferase (COMT) gene is a candidate gene for schizophrenia as its encoded enzyme is involved in the metabolic inactivation of dopamine and noradrenaline. Several molecular genetic studies thus far have demonstrated that the COMT functional polymorphism of Val158Met is susceptible with schizophrenia. Hence, the present study aims to determine this genetic association of this SNP in the three major ethnic groups of the Malaysian population. A total of 317 patients (79 Malays, 154 Chinese and 84 Indians) meeting DSM-IV criteria for schizophrenia and 417 healthy subjects (160 Malays, 164 Chinese and 93 Indians) were recruited. A PCR-RFLP method was used to determine the genotypes and alleles present. We found a significant association of genotypes within the total pooled samples, as well as in the female subgroup, with a higher frequency of heterozygotes in schizophrenia subjects. However, there were no significant differences in allele and genotype frequency between the schizophrenic patients and normal controls in all three ethnic groups. Our current findings suggest that the Val158Met polymorphism has a weak association with schizophrenia in the Malaysian population and does not play a major role in conferring susceptibility to the schizophrenia in any of the three major local ethnicities.
Pseudomonas aeruginosa is a gram-negative bacillus that causes wide spectrum clinical infections. However, it is most frequently associated with hospital-acquired infection. In this case a 58-year-old male with underlying hypertension and dyslipidaemia was admitted for acute right leg cellulitis. Pseudomonas aeruginosa was identified from the case, though it was not a usual suspected organism. It might be due to community-acquired infection.
We performed a retrospective observational analytical study looking at the frequencies and characteristics of multiple sclerosis(MS) and neuromyelitis optica spectrum disorders(NMOSD) in consecutive patients with idiopathic inflammatory demyelinating disease (IIDDs) attending three centers (2009-2017). Of 523 patients with IIDDs, there were 173 patients with NMOSD and 230 patients with MS. The percentage of NMOSD: IIDDs was 33%. The percentage of NMOSD:Total MS and NMOSD cohort was 43%. Of 141 seropositive NMOSD patients, 134(95%) were from the three main ethnic groups. The percentage of seropositive NMOSD to IIDDs and to combined MS and NMOSD was 26.9% and 35% respectively. Ratios of MS to NMOSD were nearly equal at 1.3 to 1.0, reinforcing the high ratio of NMOSD to MS in Asia. Nearly half of the Chinese cohort were seropositive ie; 71/141 (50%) with the remainder being Malays; 56/141 (39.7%) and Indians; 7/141 (5%). Amongst the other indigenous groups seropositivity was seen in 2 each of Iban, Bajau, Kadazan descent as well as one of Bidayuh origin. Comparatively, seropositivity in NMOSD is commoner amongst the Chinese compared to the Malays (p ≤ 0.005) and Indians, p ≤ 0.05 with ratios as high as 10:1. In the MS group of 230 subjects, 123(53.5%) were Malays (ratio of MS:NMOSD of 2:1), 41(17.8%) were Chinese, (ratio of MS:NMOSD of 0.5:1.0) and 54 (23.5%)were Indians (ratios of MS:NMOSD of 5:1 amongst the Indians). The remainder from East Malaysia were made up of 2 each of Kadazans, Ibans and Bajaus including 3 each of Bidayuh and Eurasian descent. Comparatively, in the NMOSD and MS cohorts a female preponderance was noted more so amongst Chinese NMOSD patients, with rare familial occurrence in both but more in Malay MS/NMOSD patients. This study also highlighted some of the inter-ethnic differences in presentation of MS and NMOSD amongst the 3 main ethnic races in Malaysia and confirms indigenous races having MS/NMOSD which needs further research. It also reviewed current literature on similar inter-ethnic differences world wide. To conclude, MS and NMOSD are the commonest demyelinating diseases seen in Malaysia with interesting inter-ethnic differences and similarities.
Introduction. The aim of this study is to determine pregnant women's knowledge regarding AIDS and to identify factors affecting their knowledge This information would provide some baseline data in designing health education measures for this target group.
Methods. A face-to-face interview was carried out on one-hundred pregnant women attending an urban antenatal clinic in Malaysia between October and November 1999.
Results. The mean age of the women was 27.8 years old (SD = 5.0, range 20 - 40 years). In general, these women had good knowledge of HIV and AIDS. More than 80% of them were aware of the main modes of HIV transmission. However, only half knew that HIV could be transmitted through breastfeeding. Sixty percent of women had the misconception that the virus could be acquired through blood donation. There was a lack of knowledge regarding the symptoms and the progression of AIDS. More than 90% of the women knew that AIDS is incurable. Three quarters of them were aware that early treatment can slow down the progression of the disease, but only 16% knew that maternal HIV transmission can be reduced by treatment. Good knowledge was positively correlated with higher level of education (p<0.05).
Discussion. Although health education programs in Malaysia have succeeded in educating pregnant women regarding AIDS in general, certain important information is still not being disseminated. Future health education should formulate targeted strategies to overcome this problem.
Severe, persistent back pain following back surgery is often referred to as Failed Back Surgery Syndrome (FBSS). Conservative measures such as physiotherapy, back strengthening exercises, transcutaneous electrical nerve stimulation and epidural steroids may be inadequate to alleviate pain. Spinal Cord Stimulators were implanted into two patients suffering from FBSS. Both patients responded successfully to spinal cord stimulation with reduction of pain and disability.
Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well, but some may develop rare life threatening side effects such as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole. This resolved after substitution with propylthiouracil. The clinical course was complicated by neutropaenic septicaemia and atrial fibrillation.
Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Data on 1800 term babies, 600 from each of the Chinese, Malay and Indian racial groups, were used to identify the factors affecting birthweight in Singapore. After adjustment for gestation, maternal height and other variables, the mean Indian birthweight was 100 g less than for the Chinese (P less than 0.001), 0.001), while the Malays averaged 33 g less than the Chinese. The shortfall in Indian birthweight is thought to be due, at least partly, to environmental factors.
The aims of this study were to examine the prevalence and severity of aggression in patients with first-episode psychosis and to identify the association between aggression and sociodemographic and clinical factors.
BACKGROUND: Depression, as one of the most disabling diseases around the world, had caught the global concern with its rising prevalence rate. There is a growing need of detecting depression, particularly in the old age population which is often left being overlooked.
METHODS: We conducted a cross-sectional community-based study which included 150 Chinese elderly aged 60 and above within Klang Valley area. We obtained the sociodemographic profiles and assessed the status of well-being, depression, and cognitive function of the participants with the help of instruments: WHO Five-Item Well-Being Index, Major (ICD-10) Depression Inventory, and 6-Item Cognitive Impairment Test.
RESULTS: We found that the prevalence of depression among the Chinese elderly within Klang Valley region was 10.7%. With multiple logistic regression, decision to consult doctor on depressed mood or memory problem and presence of cognitive impairment were shown to be significantly associated with unipolar major depression, whereas wellbeing status was also found to be statistically correlated with depression in univariate analysis.
CONCLUSION: The prevalence of unipolar depression among Chinese elderly within Klang Valley, Malaysia presented that there was an increased trend compared to the previous studies..
Stroke prevalence data among mixed Asian populations are lacking. Prevalence rates of stroke were studied among Singaporeans aged > or =50 years of Chinese, Malay, and Indian origin.