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Life events and stress: do older men and women in Malaysia cope differently as consumers?

Ong FS, Phillips DR, Chai ST

J Cross Cult Gerontol, 2013 Jun;28(2):195-210.
PMID: 23652824 DOI: 10.1007/s10823-013-9190-9

The study of major life events and their effects on well-being has considerable relevance for scientific disciplines and policy making in understanding the consumer behaviour of older people. There is evidence of differences in reactions to and coping with stress between males and females but relatively little knowledge about such gender differences amongst older people, especially in middle-income countries. This study of older Malaysians looked at both coping strategies and gender differences in reactions to stress when people are confronted with certain life events. Seventeen major life events were used in interviews with 645 respondents aged 50 years or older in five major urban areas in Peninsular Malaysia. The analysis showed older women tended to experience higher levels of chronic stress than older men. They also had more health problems, had lower levels of self-esteem and were less satisfied with life. Whilst the results showed little support for gender differences in coping behaviours, stress had a significant influence on the way older men and women change store preferences. A hypothesis that older women would use more emotion-focused coping strategies was not supported. Knowledge of how older Malaysians cope with life events and stress and especially in this instance with regard to consumption behaviour, is likely to be of considerable academic and policy related interest.
Resistant hypertension during antituberculosis treatment: how is rifampicin implicated?

Lee SL, Lim WJ, Chai ST

Med J Malaysia, 2020 09;75(5):591-593.
PMID: 32918434

A 67-year-old mental institute resident was treated for smear-positive pulmonary tuberculosis. His background history included chronic essential hypertension which was well-controlled with amlodipine 10mg daily. However, his blood pressure became suboptimal one week into antitubercular treatment, necessitating escalation of antihypertensive therapy up to six medications. Following completion of antitubercular treatment, his blood pressure improved markedly. The number of antihypertensives was able to be reduced to only two after a month. We postulate that rifampicin has attenuated the therapeutic effect of amlodipine via potent induction of hepatic CYP3A4 but the failure to control the blood pressure even with medications unrelated to cytochrome P450 pathways raises the spectre of an additional interaction.
When polymyositis meets Graves' disease: A rare case report

Chai ST, Lim YS, Achok HN

Med J Malaysia, 2021 Nov;76(6):937-940.
PMID: 34806691

Polymyositis is rarely associated with Graves' disease. A 22- year-old woman was admitted for progressively worsening proximal muscle weakness of both upper and lower extremities. One month prior to admission, she was diagnosed with thyrotoxicosis and prescribed carbimazole 10mg twice daily. Neurological examination confirmed proximal myopathy and blood investigations revealed marked elevation of muscle enzymes, particularly creatine kinase. Electromyography demonstrated myopathic changes while right quadriceps muscle biopsy showed only traces of inflammatory myopathy. She was treated with pulsed intravenous methylprednisolone followed by tapering doses of oral prednisolone, which was eventually down-titrated to 5mg daily during subsequent clinic visits. The initial clinical improvement that she exhibited did not persist despite being rendered euthyroid. She was readmitted approximately one year later with the same complaint. A second course of intravenous methylprednisolone brought about clinical improvement as well as reduction of creatine kinase levels. A diagnosis of polymyositis was then made, for which she was managed with oral prednisolone 20mg daily in combination with gradual up-titration of azathioprine. She continued to show clinical and biochemical improvements during follow-ups. Polymyositis should be considered in the diagnostic workup of proximal myopathy in a patient with Graves' disease, especially in the setting of markedly raised muscle enzymes.
Fulltext Smoking and cognitive impairment among older persons in Malaysia

Momtaz YA, Ibrahim R, Hamid TA, Chai ST

Am J Alzheimers Dis Other Demen, 2015 Jun;30(4):405-11.
PMID: 25260596 DOI: 10.1177/1533317514552318

INTRODUCTION: Previous studies have shown conflicting results on the association between smoking and cognitive function. This study aims to examine the relationship of smoking with cognitive function.
METHODOLOGY: Data for the study, consisting of 2553 older adults aged 60 years and older, were drawn from a nationwide household survey entitled "Determinants of Wellness among Older Malaysians: A Health Promotion Perspective" conducted in 2010.
RESULTS: Current smokers had lower rates of cognitive impairment compared to never smokers (17.4% vs 25.9%), while cognitive function in former or ex-smokers was almost similar to that of the never smokers. Findings from multiple logistic regression analysis showed that current smokers were 37% less likely to be cognitively impaired, compared to the never smokers (odds ratio [OR] = .63; 95% confidence interval [CI]: .46-.86) while controlling for potential confounders. No difference in cognitive function was observed between former smokers and never smokers (OR = .94; 95% CI: .71-1.25).
CONCLUSION: Although the findings indicated a negative association between cigarette smoking and cognitive impairment, we are unable to conclude whether this relationship is causal or affected by other unmeasured confounding factors, especially survival bias.
Fulltext Bilateral Genu Valgum in an Adolescent with Primary Hyperparathyroidism: A Case Report and Review of Literature

Lee SP, Chai ST, Loh LT, Ali NM

J ASEAN Fed Endocr Soc, 2020;35(2):220-223.
PMID: 33442194 DOI: 10.15605/jafes.035.02.07

Primary hyperparathyroidism in children and adolescents is rare and often symptomatic at presentation. A 15-year-old bo presented with bilateral genu valgum for two years. Biochemical results were consistent with primary hyperparathyroidism Calcium levels normalized two months after removal of a left inferior parathyroid adenoma.
Loneliness as a risk factor for hypertension in later life

Momtaz YA, Hamid TA, Yusoff S, Ibrahim R, Chai ST, Yahaya N, et al.

J Aging Health, 2012 Jun;24(4):696-710.
PMID: 22422758 DOI: 10.1177/0898264311431305

The present study aims to determine the impact of loneliness on hypertension in later life.
Fulltext Assessment of factors influencing morale in the elderly

Loke SC, Abdullah SS, Chai ST, Hamid TA, Yahaya N

PLoS One, 2011;6(1):e16490.
PMID: 21283551 DOI: 10.1371/journal.pone.0016490

We examined the relationship between morale measured by the Philadelphia Geriatric Morale Scale (PGC) and disability, social support, religiosity, and personality traits. Instruments predicting morale were then tested against PGC domains.
Appendectomy and asthma: a search for an association in older subjects

Koay KL, Mohd Zim MA, Botross NP, Thong YK, Nordin N, Ramachandran A, et al.

Med J Malaysia, 2024 Jan;79(1):47-51.
PMID: 38287757

INTRODUCTION: Several risk factors found to be associated with postoperative complications and cancer surgery, which carry a significant morbidity risk to cancer patients. Therefore, prehabilitation is necessary to improve the functional capability and nutritional status of a patient prior to surgery, so that the patient can withstand any postoperative activity and associated deterioration. Thus, this study aims to assess the effectiveness of prehabilitation interventions on the functional status of patients with gastric and oesophageal cancer who underwent esophagectomy and gastrectomy.
MATERIAL AND METHODS: An interventional study was carried out among oesophageal and gastric cancer patients who had undergone surgery at the National Cancer Institute of Malaysia. The prehabilitation process took a maximum of two weeks, depending on the patient's optimisation before surgery. The prehabilitation is based on functional capacity (ECOG performance status), muscle function (handgrip strength), cardio-respiratory function (peak flow meter) and nutritional status (calorie and protein). Postoperative outcomes are measured based on the length of hospital stay, complications, and Clavien-Dindo Classification.
RESULTS: Thirty-one patients were recruited to undergo a prehabilitation intervention prior to gastrectomy (n=21) and esophagectomy (n=10). Demographically, most of the cancer patients were males (67.7%) with an ideal mean of BMI (23.5±6.0). Physically, the majority of them had physical class (ASA grade) Grade 2 (67.7%), ECOG performance status of 1 (61.3%) and SGA grade B (51.6%). The functional capacity and nutritional status showed a significant improvement after one week of prehabilitation interventions: peak expiratory flow meter (p<0.001), handgrip (p<0.001), ECOG performance (p<0.001), walking distance (p<0.001), incentive spirometry (p<0.001), total body calorie (p<0.001) and total body protein (p=0.004). However, those patients who required two weeks of prehabilitation for optimization showed only significant improvement in peak expiratory flow meter (p<0.001), handgrip (p<0.001), and incentive spirometry (p<0.001). Prehabilitation is significantly associated postoperatively with the length of hospital stay (p=0.028), complications (p=0.011) and Clavien-Dindo Classification (p=0.029).
CONCLUSION: Prehabilitation interventions significantly increase the functional capacity and nutritional status of cancer patients preoperatively; concurrently reducing hospital stays and complications postoperatively. However, certain cancer patients might require over two weeks of prehabilitation to improve the patient's functional capacity and reduce complications postoperatively.