The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes.
Spontaneous pneumothorax (SP) is a common medical condition but continues to be a frequent management problem among doctors. Despite the availability of guidelines on management of SP, studies have shown that the compliance with the guidelines is low. The various treatment options available in treating this condition further confuse doctors on the right approach in managing SP. The objective of this study is to investigate the awareness of the availability of these existing guidelines and to investigate how the doctors involved in the initial management of SP would manage this condition. A self completed questionnaire which included three case scenarios were distributed among doctors in two teaching university hospitals and two large Ministry of Health hospitals. This study showed that there is a lack of awareness of the existing guidelines even among the senior doctors and there is a variation in the initial management of SP. Therefore a locally produced guideline may be beneficial to standardise and improve the management of SP.
The Malaysian National Health Morbidity Survey III (NHMS III), conducted in 2006, was a cross-sectional household survey of the prevalence of chronic diseases, involving 34,539 respondents of age > or =18 years old, in all states of Malaysia. Data collection was by face-to-face interview. Those who self-professed not to be diabetics underwent finger-prick glucose test following at least 8 hours of fasting. The overall prevalence of diabetes mellitus (known and newly diagnosed) was 11.6%. The Indians had the highest prevalence of 19.9% followed by Malays 11.9% and Chinese 11.4%. The prevalence of people with known diabetes and newly diagnosed diabetes was 7.0% and 4.5% respectively. Impaired Fasting Glycaemia was found to be 4.2%. Majority (73.5%) of the patients used government healthcare facilities for their diabetic care. Usage of insulin alone or in combination was low at 7.2% of patients. Only 45.05% of known diabetics have ever had their eye examined. Amputees formed 4.3% of the patients with known diabetes while 3.4% had suffered a stroke event and 1.6% was on some form of renal replacement therapy.
Study name: National Health and Morbidity Survey (NHMS-2006)
To create a national registry of contact-lens related corneal ulcers (CLRCU) patients in Malaysia with the aim of detecting outbreaks, identifying pattern of causative organisms, determining patient demography, risk factors, wearing patterns and monitoring outcome of treatment. The CLRCU registry is an ongoing patient registry established in 2007 as a surveillance tool used by Malaysian Ministry of Health ophthalmology departments. Notification of patients clinically suspected of CLRCU was performed online through the National Eye Database (NED). Data collected included patient demography, contact lens type, causative organism and treatment outcome. During 2007-2008, a total of 202 patients were notified to the CLRCU registry with a mean age of 26.7 years (71.8% female). All registered patients wore soft contact lens and monthly disposable lenses were the most popular (83.5%). The majority of patients had bacterial CLRCU and the most common causative organism was Pseudomonas (79.7% of bacterial cases). No epidemics were identified during the period of data examination. Use of contact lenses, which is increasing during modern times, may lead to CLRCU as a severe complication. The CLRCU registry is an effective tool which uses a web-based notification system that allows quick and up to date reports of CLRCU cases. This provides the ability to monitor outbreaks of disease and identify important causative and associated factors of the disease which may be used to reduce future incidence.
The EQ-5D is a quality of life instrument that measures five dimensions of health. This study investigated the reliability and validity of its use in the Malaysian dialysis population. Test-retest reliability, convergent and discriminant validity were assessed. Responses of 86 subjects who completed both surveys were used in analysis. Test-retest reliability using Cohen's kappa was acceptable in four out of five dimensions, with the exception of self-care. Convergent validity was present. Discriminant validity was found in only two out of six hypotheses tested. In conclusion, the EQ-5D has potential in this population but further study is required.
OBJECTIVE: Asians are known to have different tear characteristics compared to Caucasians that may affect contact lens wear. There are scanty research studies that have evaluated tears during continuous wear contact lens in Asia. The present study aims to evaluate changes in tears in subjects wearing continuous wear rigid gas permeable contact lens (CWRGP) for 6 months.
MATERIALS AND METHODS: Thirty five neophyte subjects (21 females, 14 females) were recruited for this study. Subjects were fitted with CWRGP lenses with Dk of 163 on both eyes. Tear was evaluated using Phenol red thread test (PRT), tear break up time (TBUT) test and tear meniscus height (TMH) measurement. Non parametric and parametric analyses were used to compare the parameters.
RESULTS: Values at baseline (BL) and six months (6M) were as follow: PRT, BL=19.10 ± 3.86 mm, 6M= 21.02 ± 4.27 mm, TBUT, BL= 8.58 ± 4.90 sec, 6M=8.08 ± 5.32 sec, TMH, BL= 0.38 ± 0.12 mm, 6M= 0.34 ± 0.07 mm. Statistical analysis showed significant difference in tear volume for PRT only at 6 months (p=0.007).
CONCLUSION: Our analysis showed minimal change in the tear characteristics after six months of CWRGP lens wear, which indicated low impact of CWRGP contact lens on tears characteristics of Asian eyes. However, careful monitoring is required to prevent development of adverse events during contact lens wear.
For the coherent understanding of heat acclimatization in tropical natives, we compared ethnic differences between tropical and temperate natives during resting, passive and active heating conditions. Experimental protocols included: (1) a resting condition (an air temperature of 28°C with 50% RH), (2) a passive heating condition (28°C with 50% RH; leg immersion in a hot tub at a water temperature of 42°C), and (3) an active heating condition (32°C with 70% RH; a bicycle exercise). Morphologically and physically matched tropical natives (ten Malaysian males, MY) and temperate natives (ten Japanese males, JP) participated in all three trials. The results saw that: tropical natives had a higher resting rectal temperature and lower hand and foot temperatures at rest, smaller rise of rectal temperature and greater temperature rise in bodily extremities, and a lower sensation of thirst during passive and active heating than the matched temperate natives. It is suggested that tropical natives' homeostasis during heating is effectively controlled with the improved stability in internal body temperature and the increased capability of vascular circulation in extremities, with a lower thirst sensation. The enhanced stability of internal body temperature and the extended thermoregulatory capability of vascular circulation in the extremities of tropical natives can be interpreted as an interactive change to accomplish a thermal dynamic equilibrium in hot environments. These heat adaptive traits were explained by Wilder's law of initial value and Werner's process and controller adaptation model.
The present study was undertaken to evaluate the anaerobic capacity in repeated sprint cycling bouts during mid-luteal (ML) and mid-follicular (MF) phases of ovarian cycle.
Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.
BACKGROUND: Nearly four-fifths of estimated 1.1 million smokers live in low or middle-income countries. We aimed to provide national estimates for Nepal on tobacco use prevalence, its distribution across demographic, socio-economic and spatial variables and correlates of tobacco use.
METHODS: A secondary data analysis of 2006 Nepal Demographic and Health Survey (DHS) was done. A representative sample of 9,036 households was selected by two-stage stratified, probability proportional to size (PPS) technique. We constructed three outcome variables 'tobacco smoke', 'tobacco chewer' and 'any tobacco use' based on four questions about tobacco use that were asked in DHS questionnaires. Socio-economic, demographic and spatial predictor variables were used. We computed overall prevalence for 'tobacco smoking', 'tobacco chewing' and 'any tobacco use' i.e. point estimates of prevalence rates, 95% confidence intervals (CIs) after adjustment for strata and clustering at primary sampling unit (PSU) level. For correlates of tobacco use, we used multivariate analysis to calculate adjusted odds ratios (AORs) and their 95% CIs. A p-value < 0.05 was considered as significant.
RESULTS: Total number of households, eligible women and men interviewed was 8707, 10793 and 4397 respectively. The overall prevalence for 'any tobacco use', 'tobacco smoking' and 'tobacco chewing' were 30.3% (95% CI 28.9, 31.7), 20.7% (95% CI 19.5, 22.0) and 14.6% (95% CI 13.5, 15.7) respectively. Prevalence among men was significantly higher than women for 'any tobacco use' (56.5% versus 19.6%), 'tobacco smoking' (32.8% versus 15.8%) and 'tobacco chewing' (38.0% versus 5.0%). By multivariate analysis, older adults, men, lesser educated and those with lower wealth quintiles were more likely to be using all forms of tobacco. Divorced, separated, and widowed were more likely to smoke (OR 1.49, 95% CI 1.14, 1.94) and chew tobacco (OR 1.36, 95% CI 0.97, 1.93) as compared to those who were currently married. Prevalence of 'tobacco chewing' was higher in eastern region (19.7%) and terai/plains (16.2%). 'Tobacco smoking' and 'any tobacco use' were higher in rural areas, mid-western and far western and mountainous areas.
CONCLUSIONS: Prevalence of tobacco use is considerably high among Nepalese people. Demographic and socioeconomic determinants and spatial distribution should be considered while planning tobacco control interventions.
The Ministry of Higher Education in Malaysia has called for the implementation of a soft skills module in all public universities in Malaysia. In response to this and as part of curriculum development efforts for a new integrated program for 2011, a study was undertaken to improve the University of Malaya (UM) Faculty of Dentistry's communication skills course. One of the study objectives was to investigate dental students' attitudes towards communication skills learning and the association between their attitudes and demographic and education-related characteristics. A cross-sectional survey--using a self-administered twenty-four-item adapted Communication Skills Attitude Scale (CSAS) that contained both positive (PAS) and negative (NAS) attitude subscales--was carried out targeting all final-year dental students at the UM and the Universiti Kebangsaan Malaysia (UKM). A total of 148 students completed the survey, yielding a response rate of 88.1 percent. Overall, UKM students had significantly more positive attitudes towards communication skills learning (PAS score: mean=48.69, SD=4.48, p<0.001) than UM students (mean=46.03, SD=4.22). There was no statistically significant difference in negative attitudes between the two groups. UKM students with more positive attitudes tended to be female (p<0.05). UM students with more negative attitudes perceived themselves as poor communicators (p<0.05), and UKM students with more negative attitudes tended to have poor English proficiency (p<0.05). This study found that both UM and UKM final-year dental students have positive and negative attitudes towards learning communication skills. These attitudes were significantly associated with certain background and education-related attributes. Outcomes of this study served as a valuable guide in strengthening the communication skills course for the UM's new, integrated dental curriculum.
Educators in medical schools around the world are presently experimenting with innovative ways of using web-based learning to supplement the existing teaching and learning process. We have recently used a popular open-source course management system (CMS) called the modular object-oriented dynamic learning environment (Moodle) to construct an online site (DPhysiol) to facilitate our face-to-face teaching of physiology to a group of first-year students in the Bachelor of Medicine and Bachelor of Surgery program. The integration of the Moodle site into our teaching was assessed using online log activity, student examination marks, and feedback from students. The freely available Moodle platform was simple to use, helped to effectively deliver course materials, and has features that allowed cooperative learning. Students who used the CMS throughout their academic year and commented favorably regarding its use as a complement to the face-to-face classroom sessions. The group of students used the CMS obtained significantly higher scores in the final examination compared with the previous class that did not use the CMS. In addition, there was a significant correlation between student participation and performance in online quizzes and their final examination marks. However, students' overall online usage of the CMS did not correlate with their examination marks. We recommend Moodle as a useful tool for physiology educators who are interested in integrating web-based learning into their existing teaching curriculum.
The aim of this study was to determine the prevalence of symptoms and problems in hospitalized hematological cancer patients. A cross-sectional design was carried out with 105 respondents in Ampang hospital in Kuala Lumpur. The European Organization for Research and Treatment of Cancer Quality Of Life questionnaire (EORTC QLQ-C30) was used. Patients with a minimum response of "a little" were defined as having a symptom/problem while patients with a response of "quite a bit" were classified as having a "severe symptom/problem". The four most prevalent symptoms/problems identified were fatigue, financial difficulties, reduced role function and reduced social function. Multiple myeloma patients (MM) were identified as having the most symptoms/problems.
Marked improvement in the management of thalassaemia has not been matched by progress in psychosocial rehabilitation as thalassaemia continues to pose challenges to patients and their family members. Few studies have been carried out in Malaysia to look at such issues. This study is therefore to explore the concerns, beliefs and feelings about thalassaemia. It was conducted in the year 2009 over 7 months on "focus groups", in patients aged 8-22 years and parents attending Paediatric Clinic of Tengku Ampuan Afzan Hospital, Kuantan, Pahang. Results showed that concerns and adverse impact were related to lower grades in education, poor self-image, less chance of employment, marriage, financial burden and social integration. Compliance to subcutaneous iron chelator was poor. There were various concerns related to blood transfusion therapy. It is evident that thalassaemia greatly affects the psychosocial dimensions and a more structured long term psychosocial support is needed to improve quality of life of patients.
Study site: Paediatric Clinic of Tengku Ampuan Afzan Hospital, Kuantan, Pahang.
East Asian and white Western observers employ different eye movement strategies for a variety of visual processing tasks, including face processing. Recent eye tracking studies on face recognition found that East Asians tend to integrate information holistically by focusing on the nose while white Westerners perceive faces featurally by moving between the eyes and mouth. The current study examines the eye movement strategy that Malaysian Chinese participants employ when recognizing East Asian, white Western, and African faces. Rather than adopting the Eastern or Western fixation pattern, Malaysian Chinese participants use a mixed strategy by focusing on the eyes and nose more than the mouth. The combination of Eastern and Western strategies proved advantageous in participants' ability to recognize East Asian and white Western faces, suggesting that individuals learn to use fixation patterns that are optimized for recognizing the faces with which they are more familiar.
A study was conducted to investigate the effects of repetitive light tasks of low and high precision on upper limb muscles and brain activities. Surface electromyography (EMG) and electroencephalography (EEG) were used to measure the muscle and brain activity of 10 subjects. The results show that the root-mean-square (RMS) and mean power frquency (MPF) of the muscle activity and the mean power of the EEG alpha bands were higher on the high-precision task than on the low-precision one. There was also a high and significant correlation between upper limb muscle and brain activity during the tasks. The longer the time and the more precise the task, the more the subjects become fatigued both physically and mentally. Thus, these results could be potentially useful in managing fatigue, especially fatique related to muscle and mental workload.
Adult intussusception is rare. It represents only 5% of all intussusceptions and 1% of bowel obstruction. Clinical presentations are usually variable with a variety of acute, intermittent and chronic symptoms. It is associated with an underlying pathologic process in 90% of cases. A lack of Malaysia data prompted review of the Sarawak experience with this uncommon entity, focusing on the clinical features, diagnostic procedure and treatment. During the last 5 years, there were 14 cases of surgically proven adult intussusception. Mean age was 45.9 years. There were 9 enteric and 5 colonic intussusceptions. Ninety-three percent of the intussusceptions were associated with a pathologic lesion. Thirty-three percent of the enteric lesions were malignant and 67% were benign. Eighty percent of the colonic lesions were malignant and 20% were benign. Computed tomography scan has a good diagnostic accuracy of 83% and should be considered for all patients with nonspecific abdominal symptoms or suspected bowel obstruction. Treatment of choice for colonic intussusception in adults is en bloc resection without reduction whenever possible, whereas a more selective approach for enteric lesions.
The international nasopharynx cancer (NPC) burdens are masked due to the lack of integrated studies that examine epidemiological data based on up-to-date international disease databases such as the Cancer Information (CIN) databases provided by the International Agency for Research on Cancer (IARC).