An alarm about suspected toxic gas leakage was raised in a primary school. All the students were evacuated by the staff and the community to a district hospital in Teluk Intan, Perak, about 8 km from the school. Sixty-four primary students from the school, four secondary school students and a student’s mother, who was near the school were all examined by a team of medical officers: Perceptions and records of the incidence from the students, staff and medical officers were recorded and examined by the author who visited the school and the hospital after the incidence. Psychosomatic symptoms related to anxiety attack were predominant There was no evidence of any gas leak. Symptomatic management was given by the medical officers. The psychogenic aetiology of the subsequent physical symptoms and behaviour, and the difference from epidemic hysteria are discussed.
Pseudoseizures, weakness of limbs, elective mutism, dystonia and behaviour problems were the presenting symptoms in three children from three different families with crises superimposed on chronic marital and familial stresses. Lack of open communication among parents and children contribute to the use of physical symptoms as an expression of emotional conflicts. Psychotherapeutic management includes individual and family counselling which begin with obtaining a history of psychosocial background and recent stresses. The families, in addition to seeking modern medical intervention, proceeded with their own religious, cultural and social management.
With about 1% of Malaysian medical practitioners being psychiatrist, the patients need the psychiatric skill and care of general practitioners for both early referral and follow-up care. The psychological reactions aroused by the mentally ill patients may be jointly managed by the doctors and their families. The primary care doctor can play an effective therapeutic and supporting role in the rehabilitation of the patient that may include, when available, other workers in social and psychiatric services.
Three iIIustrative cases of children with depression managed at the University Hospital, Kuala Lumpur; showed similar features of depressive illness and the association with family problems and depressed parents as described in Western countries. The Multi-Axia System of classification (MAS), as suggested in a WHO publication provided a useful means of classification as well as management. Two of the axes are biological and psycho-social factors in the aetiology of psychiatric syndromes (the third axis) and the intellectual level (the second axis of the child). Appropriate counselling of the parents is an important part in the management of depression in children.
Marital and sexual counselling is an important aspect of the work of a primary care physician or family practitioner. The preventive aspect of this counselling is fairly obvious in the practice of family planning. The medical practitioners have to be aware of the socio-cultural background of his patients or refer to qualified allied health professionals.
The assumption when constructing a control chart is that the process parameters, i.e. mean and standard deviation, are known. Nevertheless, this assumption is not realistic in practical situations. In most of the application of a control chart, the mean and standard deviation are unknown and are estimated from an in-control Phase-I samples. When the process parameters are estimated, the control chart performs differently compared with the corresponding chart with known process parameters because of the variability of estimators. The usual practice to evaluate the performance of a control chart is to use the average run length (ARL). The ARL is the average number of samples plotted on a control chart before an out-of-control signal is detected. In addition, the expected ARL (EARL) is used as a performance measure for the random process mean shift. In this article, the performance of the side sensitive group runs (SSGR) chart with known and estimated process parameters are studied and examined in terms of ARL and EARL.
This article highlighted the recent development in the prevention and management of child abuse in Malaysia. There is now a willingness to recognise the conlplex social, moral, medical, educational, legal and economic problems related to child abuse. Multidisciplinary research, comprehensive and longitudinal targeted services to prevent child abuse and neglect are needed.
The side sensitive group runs (SSGR) chart is better than both the Shewhart and synthetic charts in detecting small and moderate process mean shifts. In practical circumstances, the process parameters are seldom known, so it is necessary to estimate them from in-control Phase-I samples. Research has discovered that a large number of in-control Phase-I samples are needed for the SSGR chart with estimated process parameters to behave similarly to a chart with known process parameters. The common metric to evaluate the performance of the control chart is average run length (ARL). An assumption for the computation of the ARL is that the shift size is assumed to be known. In reality however, the practitioners may not know the following shift size in advance. In light of this, the expected average run length (EARL) will be considered to measure the performance of the SSGR chart. Moreover, the standard deviation of the ARL (SDARL) will be studied, which is used to quantify the between-practitioner variability in the SSGR chart with estimated process parameters. This paper proposes the optimal design of the estimated process parameters SSGR chart based on the EARL criterion. The application of the optimal SSGR chart with estimated process parameters is demonstrated with actual data taken from a manufacturing company.
Adolescence is a crucial stage between childhood and adulthood during which an individual learns new behaviours and practices including dietary patterns. This study aimed to examine the diet and oral health status among adolescents, and employed a structured questionnaire with three sections, namely, demographic, Adolescents' Food Habits Checklist (AFHC) and the Kayser-Jones Brief Oral Health Status Examination (BOHSE). The AFHC was formulated consisting of 23 items to collect information about dietary patterns with respect to food purchase, preparation and consumption habits. Meanwhile, the BOHSE contained nine items to evaluate the oral conditions of adolescents. The relationship between dietary pattern and oral health in adolescents was investigated. A total of 160 adolescents were randomly selected in this study. The data analysis was presented in the form of tables. This study adhered to the STROBE checklist's Guidelines for Systematic Reporting of Examination. According to the findings, food consumption dietary patterns among adolescents had the highest mean score (4.475). This demonstrates that adolescents practiced healthy food consumption. A significant positive correlation was found between food purchase, food preparation, food consumption and dietary patterns. Moreover, females had a slightly higher mean score than males, showing that females have a healthier diet status than males. This study can serve as points of reflection and recommendations on dietary patterns and oral health status.
A forty-four year old wife of an alcoholic husband with irregular employment sought repeated medical care for her headache, bodyache, chest pain and alleged falls at home. The family backgrounds of the battered wife and the violent husband, his alcoholism and their financial problems all contributed to the violence in marriage. Their six children had lived in fear and two of them had behaviour problems. Awareness of the multiple problems associated with a battered wife should prompt cooperation between medical, social and other workers involved in the management.
Study site: medical outpatients clinic of
T.H. Woon
M.B., B.S., M.D., M.R.A.N.Z.C.P.
Associate Professor and Head
Department of Psychological Medicine
Faculty of Medicine
University of Malaya
Kuala Lumpur, 22-11
and
Shirley George
M.B., B.S., M.P.M.
Psychiatrist
Psychiatric Unit
General Hospital, Seremban.
Running Title:
Battered wife - psychodynamics and social background of a
Malaysian family - alcoholic husband - medical symptoms -
multidisciplinary management.
University Hospital to the psychiatric Walk- inClinic