This is a retrospective study of the epidemiology, clinical features, laboratory findings, treatment and outcome of haemorrhagic disease in 42 Kelantanese infants who were admitted to Hospital Universiti Sains Malaysia during a 2-year period (1987-1988). Classical haemorrhagic disease of the newborn was the commonest presentation (48%), followed by early onset (29%) and late onset (24%) disease. Home deliveries accounted for 81% of the affected infants. Most of these babies were not given vitamin K at birth in contrast to those delivered in hospitals. All except one infant were breastfed. The six commonest presenting clinical features were pallor, jaundice, umbilical cord bleeding, tense fontanelle, convulsions and hepatomegaly. All the infants had prolonged prothrombin and partial thromboplastin times which were corrected by administration of vitamin K. Subdural haemorrhage was the commonest form of intracranial haemorrhage, followed by subarachnoid haemorrhage. The overall case fatality rate was 14%. The results of this study once again emphasize the value of vitamin K prophylaxis in the newborn.
MeSH terms: Age Factors; Female; Vitamin K Deficiency Bleeding/blood; Vitamin K Deficiency Bleeding/classification; Vitamin K Deficiency Bleeding/epidemiology*; Vitamin K Deficiency Bleeding/therapy*; Home Childbirth; Hospitalization*; Humans; Infant; Infant, Newborn; Malaysia/epidemiology; Male; Population Surveillance*; Pregnancy; Prognosis; Retrospective Studies; Risk Factors; Rural Population; Vitamin K/therapeutic use; Treatment Outcome
Toxin production of a Malaysian isolate of the toxic red tide dinoflagellate Pyrodinium bahamense var. compressum was investigated at various stages of the batch culture growth cycle and under growth conditions affected by temperature, salinity, and light intensity variations. In all the experiments conducted, only 5 toxins were ever detected. Neosaxitoxin (NEO) and gonyautoxin V (GTX5) made up 80 mole percent or more of the cellular toxin content and saxitoxin (STX), GTX6 and decarbamoylsaxitoxin (dcSTX) made up the remainder. No gonyautoxins I-IV or C toxins were ever detected. In nutrient-replete batch cultures, toxin content rapidly peaked during early exponential phase and just as rapidly declined prior to the onset of plateau phase. Temperature had a marked effect on toxin content, which increased 3-fold as the temperature decreased from the optimum of 28 degrees C to 22 degrees C. Toxin content was constant at salinities of 24% or higher, but increased 3-fold at 20%. Toxin content decreased 2-fold and chlorophyll content increased 3-fold when light intensity was reduced from 90 to 15 microE m-2 s-1. This accompanied a 30% decrease in growth rate. Toxin composition (mole % individual toxin cell-1) remained constant throughout the course of the nutrient-replete culture and during growth at various salinities, but varied significantly with temperature and light intensity changes. At 22 degrees C, GTX5 was 25 mole % and NEO was 65 mole %, while at 34 degrees C, GTX5 increased to 55 mole % and NEO decreased proportionally to 40 mole %. When light intensity was reduced from 90 to 15 microE m-2 s-1, NEO decreased from 55 to 38 mole %, while GTX5 increased from 40 to 58 mole %. These data suggest that low light and high temperature both somehow enhance sulfo-transferase activity.(ABSTRACT TRUNCATED AT 250 WORDS)
Food-handling practices were studied in 119 and 158 households, respectively, in an urban and a rural community in Peninsular Malaysia. Hazard analyses, including microbiological analysis of foods, were carried out in two households in each community and in a house that prepared food for distribution in the urban area. Kitchen hygiene was generally acceptable, although rated "poor" in some instances in the rural area. Food prepared for lunch was usually sufficient for dinner also, the leftover items being stored at ambient temperature until required. In the house that prepared food for distribution, breakfast was prepared during the evening, stored at ambient temperature overnight, and reheated before sale the next morning. There was a local preference for cooking food at temperatures close to boiling point; this reduced the numbers of vegetative cells but not those of spores. In some stored foods the populations of Staphylococcus aureus, Bacillus cereus and mesophilic aerobic bacteria increased, the last-mentioned reaching spoilage levels. Reheating reduced the populations of proliferating bacteria in most foods to acceptable levels but would not have destroyed heat-resistant enterotoxins. Because of their importance in combating acute bacterial foodborne disease, the control of the temperature and time factors during the cooking and storage of food should receive special attention in education on health and food safety.
MeSH terms: Cooking; Food Handling/standards*; Food Microbiology; Food Preservation/methods; Humans; Hygiene*; Malaysia; Rural Population; Temperature; Time Factors; Urban Population
Heart mitochondria freshly isolated from ginseng treated rats respired higher at ADP-induced, state 3 respiratory rates and with greater respiratory indices. These mitochondria were less susceptible to experimentally-induced functional impairment. Control heart mitochondria incubated with ginseng extract also showed that ginseng prevented mitochondria from incubation induced deterioration with NAD-linked substrates. Comparison of force of contraction of isolated, perfused and electrically paced hearts showed that deterioration of the force of heart contraction was consistently smaller throughout the experiment in hearts from ginseng treated rats. These results indicated that Panax ginseng was able to delay experimentally induced heart mitochondrial impairment and muscle contraction deterioration.
Intracranial haemorrhage is a major cause of severe morbidity and mortality in child abuse cases in developed countries. However, similar data are not available in most developing countries. This study therefore aimed to determine the incidence of intracranial haemorrhage amongst all cases of child physical abuse, the nature of the injuries incurred, and the morbidity and mortality resulting therefrom. Among 369 cases of physical abuse seen over a 4-year period, 41 (11.4%) had intracranial haemorrhage, of whom 37 (90%) were 2 years old or less. A history of trauma was present in only eight (20%), of which only two were compatible with the injuries incurred. Subdural haemorrhages accounted for 80% of the cases, with skull fractures present in only nine cases. Fifty-four per cent of the 37 children aged 2 years of age or less had no external signs of trauma, but 11 of them had retinal haemorrhages. This is in contrast to the children older than 2 years of age who all had external signs of trauma. The overall prognosis was dismal with an early mortality of almost 30% (13 cases) and at least seven cases with severe neurological sequelae. These findings are comparable with studies from developed countries which have established that non-accidental injury must be considered as a cause of intracranial haemorrhage in any young child, despite the absence of external signs of trauma.
Eighty-five children who presented with stridor were reviewed in order to determine the aetiology of stridor in these cases. Congenital causes accounted for 57.6% of cases. Laryngomalacia was the commonest congenital abnormality (77.5%). Other common causes of stridor were a foreign body in the airway (acquired) and laryngotracheobronchitis (33.3%) (infective). Tracheostomized children are a problem in developing countries, requiring prolonged hospitalization. We overcome this problem by teaching parents how to maintain the tracheostomy tube at home.
Local strains acting across an area of skin loaded uniaxially in vivo are converted to stresses using the standard elastic formulae. The stress values are compared to those obtained using the classical Bossinesq and Michell stress functions. The results indicate that these functions are capable of describing the response of the skin, both in the low load and the high load regions.
The response of human skin to biaxial stretch tests in vivo was investigated and compared to the response to uniaxial tension. The results obtained illustrate the nonlinear, anisotropic, and viscoelastic (time-dependent) properties of skin under biaxial stretch. Preconditioning in the load-extension response was found not to be prominent. The results also suggest that the response of skin to a biaxial stretch in vivo is qualitatively similar to that in vitro. Values of the terminal stiffness and limit strain of skin under a biaxial stretch are found.
We report the fact that D. albomicans invaded into Shanghai suddenly in the autumn of 1991. Using 9 restriction enzymes, we analyse the RFLPs of mitochondrial DNA of 29 isofemale lines belonging to 4 populations of Shanghai, Jiading, Qinpu and Nanhui. We find that all 29 haplotypes are different from each other. Comparing with the populations of Canton, Kunming, Sanhutan (Taiwan), Sumoto (Japan), and Kuala Lumper (Malaysia), we come to the conclusion that D. albomicans caught in Shanghai and areas nearby is from a few of places in the south of China-mainland. This conclusion agrees with the viewpoint that this species is on the speciation stage of migration towards north. We also discuss the mtDNA polymorphism within the species.
An outline is given of a simple cost-effective strategy aimed at the immunization of all children and pregnant women residing in the plantation sector of Malaysia. It is based on a partnership between government, nongovernmental organizations and the private sector, and is supported by UNICEF.
PIP: A cost-effective strategy aimed at the immunization of all children and pregnant women residing in the plantation sector of Malaysia is outlined. It is based on a partnership between government, nongovernmental organizations and the private sector, and is supported by UNICEF. Over a million people reside on the Malaysian plantation estates: only 17% of the estates have their own hospitals; immunization services exist on only 1.5%; 40% of the estates are at least 5 kilometers from the nearest government health facility; and 64% lack transport for workers and their dependents to seek care away from the plantations. Two nongovernmental organizations, the Malaysian Paediatric Association and the Malaysian Society of Health, initiated discussions with the United Planting Association of Malaysia. A pilot study was undertaken by the groups on 6 estates in Selangor State, which included all the children at their first birthday. Tuberculosis, diphtheria/pertussis/tetanus, poliomyelitis, and measles immunization coverages were 88%, 44%, 59%, and 66%, respectively. The association of plantations accepted the organizations' proposals for all estates to: register all births; provide free transportation to government health clinics for the immunization of all eligible children and pregnant women; and enforce immunization schedules and record-keeping. The Ministry of Health agreed to provide free immunization of children and pregnant women; send mobile teams to estates that could assemble 20 or more eligible people for immunization; provide the estates with educational materials dealing with immunization; arrange that the maintenance of the cold chain be supervised by local medical officers of health; consider the training of estate hospital assistants with the help of the nongovernmental organizations. The total immunization plan was launched in September 1990. A manual was distributed to the estate managers, hospital assistants on the estates, and the medical officers who would implement and monitor the program. It is expected that total child immunization will be achieved in the foreseeable future in the estate sector.
MeSH terms: Child, Preschool; Cost-Benefit Analysis; Female; Health Planning Guidelines*; Humans; Interinstitutional Relations*; Malaysia; Pilot Projects; Pregnancy; Public Health Administration*; Rural Population; Societies, Medical/organization & administration*
In January 1984, the Asia-Pacific Academic Consortium for Public Health (APACPH) was established, bringing together 5 schools of public health with the objectives: to raise the quality of professional education in public health; to enhance the knowledge and skills of health workers through joint projects; to solve health problems through closer links with each other and with ministries of health; to increase opportunities for graduate students through curriculum development; and to make child survival a major priority. The Consortium now comprises 31 academic institutions or units in 16 countries, and is supported by UNICEF, The World Health Organization, the China Medical Board of New York, and the governments of Japan and Malaysia. During 1985-1992, it also received major support from the United States through the US Agency for International Development and the University of Hawaii. During the past 10 years, APACPH has carried out such activities as setting up a data bank on the programs of its members, assessing public health problems, designing new curriculum and systems for service delivery, facilitating information and faculty exchanges, and running workshops for academic administrators. It has also organized conferences on the impact of urbanization on health, aging, child survival, AIDS, and occupational health. Since 1987 it has published the Asia-Pacific Journal of Public Health, the only English language journal on public health issues in the Asia and Pacific region, which will feature work being done by non-English-speaking researchers. Emphasis in the coming years will be placed on setting common standards for teaching and research, so that members can make more use of each other's programs. It is hoped that membership of the Consortium will continue to expand. A particular concern will be to focus more resources on preventive care rather than curative.
MeSH terms: Asia; Humans; Interinstitutional Relations*; International Cooperation*; Organizational Objectives; Pacific Islands; Schools, Public Health/organization & administration*
The Australian penchant for monitoring overseas developments in general and health matters is noted. The face validity of the findings of the International Project on Culture and Management (IPCM) is assessed positively and certain structural commonalities of the health systems of the USA and Australia are identified, without attributing causality in the development of managers' attributes. Linkages between Australia, Malaysia and Hong Kong are also explored briefly. In addition, key attributes of the sample of Australian managers are discussed together with the limitations related to emerging forms of provision and organization in health services and to their distribution in the study sample. The IPCM findings may be used in course design but are unlikely to cause any major change, although one may debate on the values of applicants towards health service management education courses. The findings may help to stimulate the establishment of performance measures for management education in Australia.
MeSH terms: Administrative Personnel/education; Australia; Delivery of Health Care/organization & administration; Health Facility Administrators/education*; Humans; Public Health Administration/education*
A questionnaire survey on smoking was conducted among 395 medical students (40% males, 60% females) at the School of Medical Sciences, University Sains Malaysia at Kubang Kerian, Kelantan. Thirty-five students (9%), all of them males, were current smokers. Twenty-eight percent of the smokers smoked more than ten cigarettes per day and 88% began smoking before entering the medical school. Social influence and cigarette advertisements were the main reasons given for starting smoking. Both smokers and nonsmokers were adequately informed of the common adverse effects of smoking. Ninety percent of smokers had tried to give up smoking but failed. Among the ex-smokers and nonsmokers, the main reasons given for not smoking was that smoking was useless. Among the female students, one-third felt that cigarette smoking was socially unacceptable among females. This was one of the three main reasons for not smoking. Very few of the students (4.6%) considered that doctors' advice would play an important role in smoking prevention.
Observational and survey methodologies were used to probe human behavioral factors influencing the use of insecticide-impregnated bednets to control malaria in rural Sabah, Malaysia. One aim was to investigate why a field trial of such nets in an interior area yielded disappointing results. A second aim was to gather baseline data prior to a field trial proposed for a coastal area. Interior villagers reported a significantly higher net usage rate than that observed directly, suggesting that subject self-reports need to be validated in some way. The poor results of the interior field trial appeared related to reluctance to regularly use nets, which were not in wide use previously. Prospects for reducing malaria transmission through bednets appeared better for the coastal area since nearly half of observed villagers were sleeping in them. However, significantly more coastal than interior villagers were observed watching television at night, an activity that may increase malaria risk by keeping villagers awake and out of bednets.
MeSH terms: Cross-Sectional Studies; Humans; Health Knowledge, Attitudes, Practice; Malaria/prevention & control*; Malaysia; Pyrethrins; Surveys and Questionnaires; Risk Factors; Rural Population; Health Behavior*; Permethrin
The correlation of clinical and demographic variables of thought disorder was studied in 45 Research Diagnostic Criteria (RDC) schizophrenics. Thought disorder was assessed by the scale for the assessment of Thought, Language and Communication (TLC). Negative thought disorder was significantly correlated with the rural background. Individual TLC items like Distractible speech, Illogicality, Clanging, Neologisms, etc. were correlated with the literate group and perseveration with the illiterate group. No significant correlation was noted between thought disorder and clinical variables.
MeSH terms: Educational Status; Female; Humans; Male; Mental Status Schedule; Prognosis; Psychiatric Status Rating Scales; Schizophrenia/diagnosis*; Schizophrenia/genetics; Schizophrenic Language*; Schizophrenic Psychology*; Social Environment; Socioeconomic Factors; Thinking*
Data from the First and Second Malaysian Family Life Surveys in 1976 and 1988, respectively, are analyzed to examine long-term trends in breastfeeding in Peninsular Malaysia, educational and ethnic differences therein, and the quality of retrospective data on infant feeding. The steady decrease between the mid-1950's and mid-1970's in breastfeeding was reversed to become a nearly monotonic increase since 1975. Part of the change is attributable to the changing composition of the Malaysian population. Over time, the percentages of births to subgroups with higher rates of breastfeeding--particularly Malays and more highly educated women--have increased. However, there is also evidence of changes in rates of breastfeeding within these subgroups. Many Malaysian infants have a total duration of breastfeeding (including with supplementation) considerably shorter than WHO's recommended four months of exclusive (unsupplemented) breastfeeding. Moreover, nearly all breastfed infants are first given supplementary food or beverage shortly after birth. Breastfeeding promotion efforts in Malaysia need to emphasize the appropriate timing of and types of supplementary feeding.
MeSH terms: Adolescent; Adult; Breast Feeding/ethnology; Breast Feeding/statistics & numerical data*; Data Collection; Educational Status; Female; Humans; Infant; Infant, Newborn; Malaysia