MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/epidemiology; Breast Neoplasms/prevention & control; Breast Neoplasms/therapy*; Counseling; Female; Humans; Malaysia; Risk Factors; Incidence
"This paper aims to show that the establishment of a better data collection and reporting system in Malaysia since 1991 has led to an apparent increase in the maternal mortality ratio.... Because of improved surveillance, the maternal mortality ratio may continue to appear to rise for a few years but should decline after that reflecting the improvement in the health status and service delivery in Malaysia."
MeSH terms: Asia; Asia, Southeastern; Data Collection*; Delivery of Health Care*; Demography; Developing Countries; Health; Health Services Research; Malaysia; Maternal Mortality*; Mortality; Organization and Administration; Population; Population Dynamics; Quality of Health Care*; Research; Research Design*; Program Evaluation
A study was carried out on 117 schoolchildren comprising 51 boys and 66 girls between the ages of 10 and 13 years to evaluate the effect of Ramadan-fasting on body weight. The results revealed that more than 90% of the subjects experienced a decrease in body weight during Ramadan. The initial mean body weight of the boys and girls were 35.7 ± 6.7 kg and 35.2 ± 6.1 kg respectively. After four weeks' fast, the boys and girls significantly lost (p<0.001) an average of 4.2% and 3.7% of their initial body weight respectively. Dietary intake and activity pattern were also assessed in a subgroup of 20 boys and 30 girls during the same period. The mean daily energy intake during Ramadan-fasting {boys 1230 ± 363 kcal (5.15 ± 1.52 MJ), girls 1034 ± 290 kcal (4.33 ± 1.21 MJ)} was significantly lower (p<0.001) than intake assessed before Ramadan {boys 1520 ± 463 kcal (6.36 ± 1.94 MJ), girls 1344 ± 428 kcal (5.62 ± 1.79 MJ)}. Both values were found to be below the suggested daily dietary intake for Malaysians of similar sex and age group recommended by Teoh (1975). Both boys and girls significantly decreased their intakes of fat, carbohydrate and thiamine during Ramadan. However, intakes of protein, niacin, vitamins A and C were found to be comparable to non-fasting values. During Ramadan, the mean intake of all nutrients analysed except protein were lower than recommended values. The boys spent significantly more (p<0.05) time sitting and significantly less (p<0.05) time standing and in moderately active pursuits during Ramadan. During this period, the boys spent more time in prayers compared with the girls. Time spent on all other activities did not differ between the fasting and non-fasting months. The findings suggest that the decrease in body weight during Ramadan may be primarily due to the reduction in energy intake since activity pattern remain fairly constant. The nutrient intake pattern of the adolescents studied may be of great concern in the long-term, as it does not meet the requirements for the normal growth of adolescents.
Studies were conducted in selected areas in three states namely Johor (n=117, male=55, female=62), Negeri Sembilan (n=130, male=52, female=78) and Malacca (n=97, male=33, female=64) involving free living elderly (age range from 60 to 93 years old). Respondents were divided into three age cohort groups that is 60 to 69 years, 70 to 79 years and above 80 years old. Assessment of macro and micronutrients were obtained from 24-hour diet recall for three consecutive days. Household measurements were used to estimate the amount of food consumed. Mean energy intake for both sexes were lower than the Malaysian RDA. Mean energy intake were also found to decline with age increment. The percentage of carbohydrate from total calories is higher compared to fat and protein. No respondents were found to consume less than 1/3 RDA for protein. Although no significant difference in nutrient intake was noted among age cohort groups, there was a decline in the intake of protein, fat and carbohydrate. Significantly (p <0.05) lower carbohydrate intake was noted in cohort group above 80 years. As for vitamins and minerals consumption, more than 50% of the elderly population studied consumed less than 2/3 RDA for vitamin A, thiamine, riboflavin, niacin and calcium. Very low intake of nutrient may lead to many health problems. Overall mean energy intake indicate the respondents consume less than the Malaysian RDA for all three age cohort groups. Total mean energy intake were also found to decline with age increment for both sexes. Due to the low energy intake, higher percentage of elderly were found consuming less than 2/3 RDA for thiamine (65%), riboflavin (63%) and niacin (90%). Other nutrients which were also being consumed less than 2/3 RDA by the respondents are vitamin A (67%) and calcium (65%). The intake of calcium which was found to be extremely low (ranged from 277 to 303 mg) could lead to problems like osteoporosis.
A study was conducted from March to June 1991 to determine the prevalence of obesity among primary school children in the State of Selangor. One School Health Team in each of the 9 Districts of Selangor participated in the collection of data, the whole project being coordinated by the Selangor State Health Department. A total of 28 rural and 24 urban schools were selected for the study, involving a total of 2,688 pupils in Standard 1 and Standard 6. The prevalence of obesity, using >120% of the reference weight-for-height as the criteria, varied considerably in the different districts, with an overall prevalence of 7.8% in the State. The proportion of boys affected (66.7%) was twice that among girls (33.3%). The prevalence of obesity of 9.8% in the urban schools was significantly higher than the 6.1% found for rural schools (p<0.0001). 151 (11.1%) were from Standard 6 and 59 (4.4%) were from Standard 1 (p<0.0001). It was also found that there was a significantly higher prevalence of obesity amongst primary 6 children (p<0.0001). Whilst the problem may not be as serious as that found in developed countries, the findings of this study should serve as an early warning to health authorities of the seriousness of the problem.
Our earlier report showed that diet rich in calcium and sodium fed to guinea pigs can be urolithogenic. In this study, we investigated the effect of adding 3% or 15% cellulose as a source of fiber into similar diet to asses the formation of kidney calculus. From the result, animals fed diet with 3% cellulose showed a relatively high concentration of urinary oxalate, urate and large number of crystals in the kidneys. When the cellulose level was raised to 15%, the concentrations of urinary calcium, urate and the number of crystals formed in the kidneys were lowered. We therefore, conclude that high fiber diet may be beneficial in reducing the incidence of kidney stones of calcium origin.
In this paper we use data from the Second Malaysian Family Life Survey (MFLS-2) to examine the extent to which ethnic differences in the living arrangements of the older population in Peninsular Malaysia can be explained by ethnic differences in demographic and socioeconomic characteristics. We also investigate whether the three main ethnic groups of Malaysia differ in the extent to which their living arrangements are influenced by these factors. For the married, the higher incidence of remarriage and lower housing costs for Malays each contribute importantly to their lower coresidence rates. The relatively poorer health of Indians and better health of Malays also contribute to the ethnic differences in coresidence rates for the married, as does the higher incidence of daughter-only families among Malays. The explanatory variables considered here explain less of the ethnic differences in coresidence rates for the unmarried.
Study name: Malaysian Family Life Survey (MFLS-2)
MeSH terms: Ethnic Groups; Family Characteristics; Housing; Humans; Malaysia; Marriage; Nuclear Family; Surveys and Questionnaires; Residence Characteristics; Single Person; Incidence
Flow cytometric analysis of lymphocyte subsets were evaluated in 391 healthy Asian subjects ranging in age from birth to 40 years. Lymphocyte subsets were analysed using specific monoclonal antibodies: CD20 (B cells), CD3 and CD2 (T cells), CD16 and CD56+ (NK cells), CD4/CD3+ (helper-inducer T cells), CD8/ CD3+ (suppressor/cytotoxic T cells), HLA-DR expression on CD3 and CD25 (Tac) on CD3. The total white cell count, absolute lymphocyte counts, and B cell percentages peaked in infancy and declined steadily with age. Absolute counts of each subset, which were derived from absolute lymphocyte counts, also followed this trend. Increases with age were seen in the NK, T cell (CD2, CD3), and CD8 percentages. Males tended to have higher NK and CD8 percentages than females, and, conversely, females had higher CD3 and CD4 percentages than males. Comparison of our results with studies involving Caucasian subjects indicated higher NK percentages in our Asian population and lower CD4 absolute counts in the males of our population. These results indicate the presence of age, sex, and probable racial differences in lymphocyte subset expression. Our results may serve as reference standards for the Asian population.
Several sizes of plastic cap were designed and made to fit the vertex of the penile glans. The foreskin is prepared in the usual manner, the glans capped with the specially made plastic cap and the foreskin pulled forwards over the cap. A crushing or non-crushing forceps is applied across the foreskin. The plastic cap separates the glans from the clamp, and its unwanted portion is cut with a knife without fear of injuries in the glans. We find this method to be safe even if it is used by a surgeon with limited experience.
X-ray microradiography of surgically excised breast specimens offers the possibility of morphological characterization of calcifications. When combined with digital imaging techniques there exists added potential for obtaining valuable basic quantitative morphometric information regarding differences between microcalcifications in tissues exhibiting evidence of fibrocystic change, benign and malignant tumours. A total of 157 excised breast specimens from 84 patients were microradiographed using a Softex Super Soft X-ray unit and Kodak AA high resolution industrial film. A Quantimet 570C image analysis system was used to digitize and analyse the microradiographs. Of the 157 microradiographs, 51 (from 30 patients) revealed microcalcification clusters. The existence of significant differences between the three identified categories of tissue were indicated by clustering parameters. These included the number of particles per cluster, area of clusters, maximum distance to nearest neighbour, and geometric mean distance to nearest neighbour. The distribution pattern index (DPI), another of the clustering parameters used in this study, has been observed to be a particularly powerful discriminator. The value for fibrocystic change was found to be significantly smaller (0.514) than that for benign tumour (0.796) whilst that for benign tumour was observed to be significantly larger than that for malignant tumour (0.604) at a p-value of less than 0.05 (Kruskal-Wallis one-way analysis of variance).
MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Breast Diseases/etiology; Breast Diseases/radiography*; Breast Neoplasms/complications; Breast Neoplasms/radiography*; Calcinosis/etiology; Calcinosis/radiography*; Diagnosis, Differential; Female; Fibrocystic Breast Disease/complications; Fibrocystic Breast Disease/radiography*; Humans; Image Processing, Computer-Assisted; Mammography; Mathematics; Microradiography; Middle Aged; Models, Biological
This report describes the ethical and legal aspects of assisted reproduction technology (ART) that have been instituted in Asian countries. The data were collected by a questionnaire circulated to ART units in Asia. These are Taiwan, Singapore, Korea, Indonesia, Thailand, Japan, Iran, India, Jordan, Malaysia, China, Israel, Hong Kong, Pakistan, Lebanon, Saudi Arabia, and Persian Gulf countries. According to the survey, there are approximately 260 ART centers in Asia (half of which are in Japan). On a global basis each ART centre in Asia serves an average population of 13 million people. On the other hand, in those Asian countries where the standards of living are relatively high, the availability of ART services, including the more sophisticated and costly ART procedures like micromanipulation, is similar to that in the Western world. In most of the Asian countries practising ART, however, no state registry exists. Taiwan is the only country that has specific legislation, and in six other countries some kind of ministerial regulations are practised. We conclude that ART is now practised in 20 countries in Asia. The prevailing rules and cultural heritage in many of these Asian countries has a major influence on the implementation of ART in Asia. However, in view of the complicated and sensitive issues involved, and as no supervision on ART clinics exists in most of the Asian countries, we advocate that some kind of quality control should be urgently instituted in all centres practising ART. In this way, it is hoped that the highest standards be attained for all parties concerned.
Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.
A significant difference in the levels of thyroxine (T4), thyroid stimulating hormone (TSH) and thyroid volume among settlements at various selected Orang Asli locations is reported. The levels improved according to the level of socio-economic development. No significant difference was found in mental performance by location.
Cerebral lupus (CL) is a common cause of morbidity and mortality in patients with SLE. The brain CTs of 27 consecutive adult patients with SLE and various neurological presentations were reviewed. The median age and duration of neurological symptoms at the time of the brain CT were 30 years (range = 14-51 years) and six days (range = 1 day-22 years), respectively. Eleven patients (41%) had normal CTs. The abnormalities in the remaining patients could be divided into six categories: (a) cerebral atrophy alone (two patients); (b) calcification alone (three patients); (c) infarct(s) alone (five patients); (d) cerebral atrophy and calcification (three patients); (e) cerebral atrophy and infarct(s) (one patient) and (f) cerebral atrophy, calcification and infarct(s) (two patients). Altogether eight patients (30%) (age range = 17-47 years) had intracerebral calcification: the globus pallidus was involved in all, putamen in two, head of the caudate nucleus in one, thalamus in one, centrum semiovale in two and cerebellum in three patients. Two patients had extensive calcifications of most of the basal ganglia, centrum semiovale and cerebellum. There was no relationship between the presence/degree of calcification and age of patients/duration or type of neurological presentation. The pathogenesis of cerebral calcification in CL is unknown. Cerebral lupus must now be included in the differential diagnosis of intracerebral calcification.
A descriptive study was undertaken on 595 dairy cattle abortion submissions to the California Veterinary Diagnostic Laboratory System from July 1, 1987, to December 31, 1989, to determine the etiologic nature and distribution (seasonal and geographical) of dairy cattle abortion in California as reflected by laboratory submissions. Univariate analysis was performed to characterize abortion-related submissions by farm and laboratory variables, and logistic regression analysis was performed to determine factors that may influence success of abortion diagnosis in the laboratory. The proportions of dairies that submitted abortion-related specimens from northern, central, and southern milksheds during the 2.5-year period were 20.3%, 15.7%, and 13.1%, respectively, and 60% of submissions were from medium-sized (200-999 cows) dairies. Submissions consisted of fetus (58%), placenta (2%), fetus and placenta (12%), and fetus, placenta, and maternal blood (0.84%); fetal tissues and uterine fluid constituted the rest. An apparent pattern in abortion submissions was indicated by a peak in submissions during the winter and summer of 1988 and 1989. Infectious agents were associated with 37.1% of submissions; noninfectious causes, 5.5%, and undetermined etiology, 57.3%. Bacterial abortion accounted for 18% of etiologic diagnoses; protozoal, 14.6%; viral, 3.2%; and fungal, 1.3%. Submissions comprising fetus, placenta, maternal blood, or their combinations were associated with a higher likelihood of definitive diagnosis for abortion than tissues, as were fresher specimens and submissions associated with the second trimester of fetal gestation.