The Family Health Programme in Malaysia started off with a humble beginning in the 1920s by the introduction of midwifery legislation under the Straits Settlement Ordinance and the Federal Malay states Midwifery Enactment. Institutionalisation of nursing training took placed in the 1940s while the rural health services for pregnant women and children were established in the 1950’s. In 1967, the school health program was initiated, followed by the de-livery of the school health services in 1972. The Ministry of Health (MoH) set up a Maternal and Child Health unit within the MoH organisation in 1974 to oversee the maternal, child and school health activities. In 1996, the Family Health Development Division was established with the prenatal, adolescent, adult, people with disability and nu-trition health services were incorporated into the family health activities. Subsequently, the age-group wellness and population genetic screening were introduced in year 2000. The family health programme has embraced the public health approach as its building blocks. Throughout the years, individual patient care has advanced the most through the improvement of standards and quality of services within the health clinics. Plateauing of maternal mortality ratio and under-5 mortality rate, increasing trend of non-communicable diseases, remerging of communicable diseases, urbanisation and globalization, and increasing ageing population are new challenges in the delivery of family health services to the community. In order to cater for these challenges, it is crucial to recognise the population health as one of the main component in the family health programmes. Transformation in the scope of new family and popu-lation health is needed to improve the delivery of family programme beyond the boundary of MoH facilities.
The International Atomic Energy Agency (IAEA) in 1992 has reported a 60Co gamma factor ГIAEA-Co-60 as 0.351 mSv m-2 (GBq h)-1. Experiments that were carried-out in 2003 at the Malaysian Institute for Nuclear Technology (MINT) obtained a gamma factor, ГEKS-Co-60 as 0.368 + 0.017 mSv m-2 (GBq j)-1. Despite a difference of 4.84%, ГEKS-Co-60 is considered closer to ГIAEA-Co-60 as three previously reported value have recorded a larger difference. In fact, the range of ГEKS-Co-60 i.e. 0.351-0.385 covers ГIAEA-Co-60.
[Badan Tenaga Atom Antarabangsa (IAEA) pada tahun 1992 telah melaporkan faktor gama 60Co, ГIAEA-Co-60 sebagai 0.351 mSv m-2 (GBqj)-1. Eksperimen yang dilakukan di Institut Penyelidikan Teknologi Nuklear (MINT) pada tahun 2003 mendapati faktor gama 60Co, ГEKS-Co-60 sebagai 0.368 + 0.017 mSv m-2 (GBq j)-1. Walaupun perbezaan sebanyak 4.84%, ГEKS-Co-60 dianggap dekat dengan ГIAEA-Co-60, kerana tiga nilai yang dilaporkan sebelum ini mempunyai perbezaan yang lebih besar. Lagipun, julat ГEKS-Co-60 iaitu 0.351-0.385 merangkumi ГIAEA-Co-60].
The population of Malaysia is approximately 14 million and theoretically 1 in 2500 marriages are between heterozygotes for thalassaemia and 1 in 10,000 children can be expected to have thalassaemia major. Hypertransfusion is not possible because of insufficient blood supplies and each child requires an iron chelator, Desferal, at US$5800 a year for life: this high cost makes it sizeable proportion of the 'active reproductive' population. Abortion is not legal and antenatal diagnosis has not bee established. An approach to the prevention of this disease would be public education and identification of carriers. Numerous techniques have been utilised in population screening for traits of thalassaemia and haemoglobinopathy. These include osmotic fragility tests; blood smear examination for basophilia, microcytosis, and hypochromia; and genetic studies. Blood smear examinations are extremely subjective and interpretations depend upon the skills of a trained technologist. Osmotic fragility tests although cheap are cumbersome and require accurate preparations of saline solutions. Genetic studies are not available in the region. The medical examination for entrance to colleges and institutions includes investigative procedures such as chest x-ray and urine examinations. In addition a blood sample could be analysed for the red cell parameters. A similar study could be attempted for all secondary school leavers. The current estimated cost on the Coulter S as in this study was 80 cents (U.S.) in contrast to the prohibitive costs of managing a case of transfusion-dependent thalassaemia. These two groups would cover a sizeable proportion of the 'active reproductive' population. Analysis of the red cell parameters provides useful information for the identification of carriers of alpha-, beta-, delta-beta-thalassaemia and HbE. Additional studies which include haemoglobin analysis and serum ferritin would provide the necessary evidence for the confirmation of these findings.
The advent of multislice computed tomography (CT) has revolutionised the performance of body CT and allowed the development of CT angiography (CTA). CTA is a robust and minimally invasive method of visualizing the arterial vascular system. The newer generation of multidetector scans has allowed for shorter scanning times with no respiratory misregistration at peak vascular opacification following peripheral contrast injection. The volume of data obtained from these scans can be further manipulated to generate two-dimensional (2D) and three-dimensional (3D) images with no increase in radiation to the patient. Hence, CTA has gained popularity and importance as the alternative diagnostic tool especially for ill patients in which conventional angiography is inadvisable.We present an infant with coarctation of the aorta and hypoplastic aortic arch, in which CT angiography was used to pinpoint the diagnosis. The CT findings were subsequently confirmed at surgery.
Haemoglobin Bart's hydrops fetalis syndrome is totally lethal. Globin chain electrophoresis on mylar backed cellulose acetate strips, by a method modified from Ueda and Schneider has been established to demonstrate total absence of alpha chains in this syndrome. This simple test can identify fetuses, stillbirths and newborns with homozygous αo-thalassaemia. In this region where DNA studies are limited, and prenatal diagnosis is unavailable, this test which describes the phenotypic expression of Hb Bart's syndrome will improve genetic counselling of women at risk of homozygous αo-thalassaemia.
The aim of this study was to determine the effect of different ratios of low protein flour to oyster mushroom (Pleurotus sajor-caju) powder on the physicochemical properties and sensory acceptability of edible tablespoon. Fresh grey oyster mushroom was dried in a convection oven at temperature of 55.0˚C ± 2.0˚C for 20 h prior to the grinding process. The low protein flour (LPF) was then incorporated with oyster mushroom powder (OMP) at different ratios of 100:0, 96:4, 92:8, 88:12 and 84:16, before being with vegetable oil, sugar, egg white and water in formulating the edible tablespoon. The proximate analyses were carried out in triplicate for calorie content, colour profile, hardness value and morphological structure of edible tablespoon. This study revealed that with decreasing LPF and increasing OMP in the formulation, the ash content (1.24% to 1.92%), crude fat content (8.98% to 10.40%) and fiber content (0.13% to 1.24%) were observed to have increased as well as the hardness value (2042.03g to 2844.57g) and pore’s size of the morphological structure of edible tablespoon. However, the carbohydrate content (78.64% to 75.56%) significantly decreased (p>0.05) together with L* value (from 68.47 to 61.71) when the decrease was in the the percentage of LPF and an increase the percentage of OMP. The calorie content, moisture content and protein content of edible tablespoon were not significantly (p>0.05) affected by different ratios of LPF to OMP. The edible tablespoon formulated with up to 8% of OMP was accepted by the sensory panelists but further increase in OMP addition significantly decreased the degree of likeness in terms of colour, odour, taste and overall acceptability of edible tablespoon. This study suggested that oyster mushroom edible tablespoon could be potential alternative disposable cutlery which will help to reduce the use of huge amount of non-biodegradable materials for environmental conservation.
Decomposable organic waste is recognized as one of the main components
of waste comprising between 42% to 80.2% of its composition. Organic
waste is any biodegradable material originating from either plants or
animals and the volume generated is expected to increase in the near future.
This study examines a better prediction model for determining the trends in
organic waste generation at the administration café of the UiTM Campus in
Tapah. The data for organic waste generation was collected and recorded
daily from two stalls at the café. The collection process was undertaken over
five working days (Monday - Friday) from 4th March to 20th April 2019. The
Least Square and Simple Moving Average Models were performed in this
study. It was found that the Simple Moving Average Model was superior to
the Least Square Model as it yielded consistently lower Root Mean Square
Error (RMSE), Mean Square Error (MSE) and Mean Absolute Deviation
(MAD) values. The Moving Average showed that the upward and downward
trends in organic waste over time and the trend cycle were smoother than the
original data.
The study was conducted to determine whether the clinical targets for the control of diabetes recommended by American Diabetes Association can be met in the context of routine diabetes practice. This cross-sectional study was undertaken on 211 type 2 diabetic patients at the Outpatients Diabetes Clinic, Hospital Universisti Sains Malaysia (HUSM) Kubang Kerian, Kelantan between the year 2001-2002. Patients' physical examination and their medical history as well as their family history were obtained by administering a structured questionnaire. Samples of patients' venous blood during fasting were taken and analysed for plasma glucose, glycated haemoglobin and lipid profile. Analysis showed that many patients had comorbidities or complications. A large number of them had poor glycaemic control (73%). Systolic and diastolic blood pressures of 75% and 85% subjects were > or = 130 and > or = 80 mmHg, respectively. Body Mass Index (BMI) values of 66% of the patients were outside the clinical target (BMI > or = 25 in male and > or = 24 kg/m2 in female). The lipid profile showed that 96% of the patients had at least one lipid value outside the clinical target level. In this study, 70% of the patients had total cholesterol > or = 5.2 mmol/L, 87% had LDL cholesterol > or = 2.6 mmol/L, 57% had HDL cholesterol less than the normal range, < or = 1.15 mmol/L in men and < or = 1.4 mmol/L in women, while 46% had triglycerides > or = 1.71 mmol/L. Complications of diabetes were observed in 48% of the total number of patients. As for the patients' systolic blood pressure, age and duration of diabetes were found to have significant effects. Older subjects with a longer duration of diabetes were more hypertensive. Variables that had significant effects on BMI were age, duration of diabetes, glycaemic control and gender. Younger females and newly diagnosed subjects with better glycaemic control (A1C < 7%) were found to have higher BMI values. The overall clinical targets were suboptimal. The prevalence of hyperlipidaemia and hypertension was high. It is imperative that better treatment strategies and methods be adopted to enhance diabetes control and reduce long-term complications of the disease.
Study site: Outpatients Diabetes Clinic, Hospital Universisti Sains Malaysia (HUSM)
We report the case of an infant who was found dead in the toilet of a nursery. Examination of the scene revealed an element of neglect in the care of the child. Postmortem showed evidence of drowning. Her blood sample showed a toxicologic evidence of alcohol exposure.
Background : Foot ulcers and its complications are an important cause of morbidity and mortality in diabetes. The aim of this retrospective study is to determine the ulcer-free survival in diabetic foot and its relevant predictors in a cohort of diabetic patients in the primary health care setting.
Methods : Data of newly diagnosed diabetics (n=1121) who received treatment in five health centers in the district of Kuala Langat, Selangor between 1st January 1999 until the 30th June 2008 were studied. Information was gathered by reviewing patient’s medical records. All patients were followed until 31st December 2008. The duration of ulcer-free survival was measured from the date of being diagnosed as diabetic until the development of the ulcer.
Results : The total incidence of diabetic foot ulcer was 9.9% (n=111), with an average annual incidence of 1%. The total incidence of amputation was 1.2%. Mean age of being diagnosed having diabetic was 52+10.7 year old and mean age of being diagnosed having diabetic foot ulcer was 54.68+10.16 year old. The mean for overall ulcer-free survival was 99 months (95%CI:96-102). Male gender (LR=6.56; p=0.01), smokers (LR=3.94; p=0.04), low body mass index (LR=4.45; p=0.03), impaired renal function (LR=5.17; p=0.02) and long duration between follow-up (LR=25.10; p
Two hundred and eleven (211) patients with type 2 diabetes mellitus who were on treatment and monitored for complications at the Outpatient Diabetes Clinic in Hospital Universiti Sains Malaysia, Kubang Kerian between 2001 - 2002 were selected for the study. A structured questionnaire was administered to obtain their medical and family history. Physical examination was performed and fasting venous blood sample was collected for plasma glucose and A1C analysis. Of the total 211 patients, only 4 % were on diet treatment alone, 37 % of them were on mono therapy while 59 % were on combination of therapies. Fasting plasma glucose (FPG) > 7.2 mmol/L and glycated hemoglobin (A1C) levels ≥ 7 % were observed in 60 % and 73 % of type 2 diabetic patients, respectively. Glycated hemoglobin level of 28 % of the subjects were < 7 %; 36 % were between 7 - 9 % and 36 % were more than 9 %. The worst glycaemic control was observed in Malay patients. A1C of Malay and non-Malay subjects were 8.7 ± 2.3 % and 7.7 ± 1.7 %, respectively. Younger patients (age group < 50 years) had significantly higher mean A1C than elderly patients. Duration of diabetes had a clear influence on glycaemic level. Patients with recently diagnosed diabetes (duration of disease < 5 years) had the best glycaemic control. In this study a large proportion of the patients had poor glycaemic control. The variables with significant effects on glycaemic control were ethnicity, age and duration of diabetes mellitus. Better treatment strategies and methods should be used to improve diabetes control and to reduce long-term complications of diabetes.
Study site: Outpatient diabetic clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
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.
This paper describes a modified method of quantitative determination of histamine in human skin wounds using fluorescence spectrophotometer. In this study, histamine was used as an indicator to differentiate antemortem from postmortem wounds. Skin samples were obtained from 20 corpses which were brought to Hospital Kuala Lumpur and Universiti Kebangsaan Malaysia for medicolegal autopsy. Sections of human skin were processed biochemically for histamine determination using fluorescence spectrophotometer. Results revealed no significant difference in the histamine content of the antemortem wounds in comparison to postmortem wounds. Based on these results, detection of histamine is not suitable to differentiate antemortem from postmortem wounds.
To describe a quick and simple diagnostic approach to monocular diplopia. Diplopia is a common visual complain in casualty departments, general practice clinics, neurologic clinics as well as ophthalmic clinics. Monocular diplopia, however, is uncommon. Many well established clinical examination methods are available to address diplopia. Some require special equipments which are not easily available or unfamiliar outside of ophthalmic clinic. We describe a simple two-minute diagnostic approach to monocular diplopia. Basic knowledge and understanding of simple clinical examination techniques enhances diagnostic skill and allow proper localization of underlying disorders.
Anaemia is present in 31.3% of male and 73.6% of female subjects heterogenous for beta thalassaemia. In males, none had serum ferritin (SF) levels less than 10 ng/ml. In contrast, female subjects with haemoglobins less than 12 gm/dl, had SF levels less than 20 ng/ml. Statistical differences in the Hb, RBC, MCV, MCH, MCHC abd HBA were found with the normal groups (p<0.001). Comparison of the SF levels in both the males and females show no difference from those in the normal groups (p<0.10). Iron loading was not a significant feature in both the males and females. Correlation of the SF with age shows a weak negative correlation. Married females with children showed that the SF levels fell significantly with increasing age, suggesting the possibility that repeated pregnancies may deplete iron stores as reflected by the SF levels. In countries where iron deficiency and thalassaemia are highly prevalent, assays of serum ferittin will indicate if there is a need for supplemental iron in subjects hetergenous for beta thalassaemia.
Introduction: In several studies it was described that ineffective communication during patient handover between the hospital departments or during shift-to-shift transfer result in discontinuity of care, inappropriate treatment, and potential risks of injury for patients. The patient handover is a professional responsibility and accountability related to nursing care. SBAR (Situation - Background - Assessment – Recommendation) method as part of the international pa- tient safety goals(IPSGs) was developed to improve communication breakdown. Knowledge and attitude are essential factors associated with the implementation of patient handover, yet limited research was done on this. The purpose of this study was to examine the relationship between nurse knowledge and attitude toward a patient handover. Meth- ods: A cross-sectional approach was applied in this study. A total of 61 nurses consisting of the head nurse, and team leaders participated in sampling technique done by simple random sampling method from the hospital database. Data collection used a structured questionnaire with a good result of validity and reliability. Univariate and bivariate test were used for data analyzing with Statistical Package for the Social Science (SPSS) Version 18. Results: There is a relationship between nurses' knowledge and attitude toward patient handover with OR 5.280 (1.063-26.227); OR 5.333 (1.351-21.062), respectively and statistically significant (p
Introduction: Rapid ongoing industrialisation particularly in developing countries has triggered an
increased risk of occupational noise-related disease occurrence. Machinery and work tasks in metal fabrication
processes may produce high noise levels that can be harmful to hearing. This study aimed to investigate the
workers’ exposure to noise at a fabrication plant and their perceptions toward hearing loss symptoms and its association.
Methods: This study was conducted at a Heating, Ventilating and Air Conditioning fabrication plant in Johor.
With a 31% response rate, 50 respondents who were selected using purposive sampling answered a
questionnaire regarding demographic background, noise exposure and perceived hearing loss symptoms. Noise
measurements were also conducted among 30 of them based on the concept of sampling the maximum
risky workers. The noise was measured using a sound level meter IEC 60651 Class 2. Minimum (Lmin)
and maximum (Lmax) sound pressure levels were measured for 5-minute and repeated for three exposure
periods (morning, afternoon, evening). Results: 68% and 32% of the workers were 20-30 years old and had
been employed for 3-5 years, respectively. Average noise exposure level observed was 63.3-101.5 dBA. 25%
of the workers reported that they were sometimes experienced the symptoms of hearing loss. These include
difficulty in understanding conversation and ringing in the ear. However, noise exposure and hearing loss
symptoms were not significantly associated. Conclusion: The study findings suggest that the workers have a risk
of developing hearing loss. Intervention programme and enforcement on hearing protection of the workforce
are highly recommended.