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Fulltext Impact of socio-economic status on access and outcome of kidney transplantation in Malaysia

Peter Gan Kim Soon, Sanjay Rampal, Lim Soo Kun, Tin Tin Su

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):33-33.
MyJurnal

Introduction: Low socio-economic status (SES) has been associated with poorer access and worse outcome in kid-ney transplantation (KT) for high-income countries. In contrast, relatively little is known about the KT access and outcome between the socio-economic gradient in Malaysia, which is a low- and middle-income country. The aim is to determine the association of SES with access and outcome of kidney transplantation in Malaysia. Methods: We examined the Malaysian National Renal Registry for kidney transplant candidates listed between 2002 to 2011. Cox’s regression was used to assess associations of SES with transplant access and outcome (survival). Results: 1234 patients were transplanted in 2002-2011 after excluding pediatric patients and multiple transplantations. The mean age of patients was 42.3 ± 12.3 years, 789 (63.9%) were male and 797 (65.0%) were of Chinese ethnicity. After multivariate adjustment, the highest income group were 20% less likely to access KT compared the lowest income group (adjusted HR=0.80, CI: [0.62, 1.04] producing trend for P-Value = 0.001. While patient with highest education were 50% more likely to survive compared to patient with lowest education (adjusted HR=0.50, CI: [0.34, 0.73] producing trend for P-Value < 0.001. Conclusion: Even in a healthcare system that is almost achieving universal health coverage, disparities exist in both extremes of the socio-economic gradient for the access and outcomes for KT in Malaysia. Reducing the SES disparities in KT will require policy initiatives addressing the components of SES (income, education, and employment) as well as the pathways by which this affect the health of KT patient.
Fulltext What are the barriers and solutions to renal transplantation in Malaysia? a qualitative key-informant study

Peter Gan Kim Soon, Sanjay Rampal, Lim Soo Kun, Tin Tin Su

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):8-8.
MyJurnal

Introduction: Kidney transplantation (KT) is the preferred end-stage renal disease (ESRD) treatment because it pro-vides a better survival rate, quality of life as well as a cheaper alternative. However, Malaysia’s KT rates is consis-tently low considering that ESRD rates have been increasing exponentially. With only four hospitals performing KT, there’s a gap to indicate a lack of evaluation in KT system of Malaysia. Qualitative study was undertaken to explore and describe the barriers and solutions improve the rates and service of KT in Malaysia. Methods: Semi-structured interviews adopted as qualitative methodological approach to explore current KT policy and service in Malaysia be-tween March – May 2018 in Kuala Lumpur. Eight key-informants selected using stakeholder analysis and informed consent were obtained. Interviews were digitally audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Barriers and solutions of Malaysia’s KT are the results of complex interplay of personal, cultural, and environmental factors that can be categorized and described using the five levels of influence conceptualized by the socio-ecological model (SEM). Guidance for developing culturally appropriate and sensitive interventional strategies was elicited from the key informants’ experiences to improve KT rate and services in Malaysia. Conclusion:Malaysia is experiencing very low rate of KT compared to other countries. The use of SEM provided a framework to foster a better understanding of current practice, barriers and solutions to KT in Malaysia. Implications of these find-ings could prompt policy change for better KT service delivery model. Further stakeholder engagement and evalua-tion is required to align best practices to improve KT rates and service in Malaysia that is comparable to high-income countries.
Adolescent tobacco use and health in Southeast Asia

Al-Sadat N, Misau AY, Zarihah Z, Maznah D, Tin Tin Su

Asia Pac J Public Health, 2010 Jul;22(3 Suppl):175S-180S.
PMID: 20566551 DOI: 10.1177/1010539510372835

The use of tobacco by adolescents is a major public health concern worldwide. There are 1.2 billion smokers globally, of which more than 50% are young people. The Southeast Asian countries have about 600 million tobacco smokers within the global burden of tobacco users. Most smokers begin at early stage of life and persist through adulthood. Malaysia alone has about 5 million smokers, 20% of whom are younger than 18 years old. Many factors are implicated in the continuous rising trend of tobacco use among adolescents in Southeast Asia. A triad of family, environmental, and individual factors synergistically acts to motivate adolescents toward smoking. This article discusses the current trends of tobacco use and implications of increasing rise in adolescent smoking in the Southeast Asia region.
A Double-Blind, Randomized Controlled Trial of Pre-incision Wound Infiltration Using Diclofenac Versus Bupivacaine for Post-operative Pain Relief in Open Thyroid and Parathyroid Surgery

Loh JW, Taib NA, Cheong YT, Tin TS

World J Surg, 2020 08;44(8):2656-2666.
PMID: 32193622 DOI: 10.1007/s00268-020-05458-6

BACKGROUND: Pre-incision wound infiltration using NSAID is an alternative method to manage post-operative pain in surgery. It is postulated that NSAID delivered peripherally exerts efficient analgesic and anti-inflammatory effect with minimal systemic complication. This study explored the efficacy of using diclofenac for wound infiltration in open thyroidectomy and parathyroidectomy as compared to conventional agent, bupivacaine.
METHODOLOGY: The study was designed as a double-blind, randomized controlled trial involving 94 patients who underwent open thyroidectomy or parathyroidectomy in Hospital Pulau Pinang, Malaysia, from November 2015 to November 2016. The study compared the efficacy of pre-incision wound infiltration of diclofenac (n = 47) versus bupivacaine (n = 47) in post-operative pain relief. Wound infiltration is given prior to skin incision. Mean pain score at designated time interval within the 24-h post-operative period, time to first analgesia, total analgesic usage and total analgesic cost were assessed.
RESULTS: Ninety-four patients were recruited with no dropouts. Mean age was 49.3 (SD = 14.2) with majority being female (74.5%). Ethnic distribution recorded 42.6% Chinese, 38.3% Malay, followed by 19.1% Indian. Mean duration of surgery was 123.8 min (SD = 56.5), and mean length of hospital stay was 4.7 days (SD = 1.8). The characteristics of patient in both groups were generally comparable except that there were more cases of total thyroidectomy in the diclofenac group (n = 31) as compared to the bupivacaine group (n = 16). Mean pain score peaked at immediate post-operative period (post-operative 0.5 h) with a score of 3.5 out of 10 and the level decreased steadily over the next 20 h starting from 4 h post-operatively. Pre-incision wound infiltration using diclofenac had better pain control as compared to bupivacaine at all time interval assessed. In the resting state, the mean post-operative pain score difference was statistically significant at 2 h [2.1 (SD = 1.5) vs. 2.8 (SD = 1.8), p = 0.04]. During neck movement, the dynamic pain score difference was statistically significant at post-operative 1 h [2.7 (SD = 1.9) vs. 3.7 (SD = 2.1), p = 0.02]; 2 h [2.7 (SD = 1.6) vs. 3.7 (SD = 2.0), p = 0.01]; 4 h [2.2 (SD = 1.5) vs. 2.9 (SD = 1.7), p = 0.04], 6 h [1.9 (SD = 1.4) vs. 2.5 (SD = 1.6), p = 0.04] and 12 h [1.5 (SD = 1.5) vs. 2.2 (SD = 1.4), p = 0.03]. Mean dose of tramadol used as rescue analgesia in 24 h duration was lower in the diclofenac group as compared to bupivacaine group [13.8 mg (SD = 24.9) vs. 36.2 mg (SD = 45.1), p = 0.01]. The total cost of analgesia used was significantly cheaper in diclofenac group as compared to bupivacaine group [RM 3.47 (SD = 1.51) vs. RM 13.43 (SD = 1.68), p
Fulltext Comparative validity of a Food Frequency Questionnaire (MyUM Adolescent FFQ) to estimate the habitual dietary intake of adolescents in Malaysia

Mohamed K, Tin TS, Jalaludin MY, Al-Sadat N, Majid HA

Asia Pac J Clin Nutr, 2018 7 27;27(4):898-907.
PMID: 30045437 DOI: 10.6133/apjcn.022018.03

BACKGROUND AND OBJECTIVES: The food frequency questionnaire (FFQ) is a dietary tool used to assess the habitual intake of the population. The goal of this study is to examine the reproducibility and validity of the FFQ that was developed for a multi-ethnic population in Malaysia.
METHODS AND STUDY DESIGN: Collective food data from MyHeARTs 2012 database were used to construct the MyUM Adolescent FFQ. Seventy-eight participants between 13 and 15 years old in 2014 were selected through convenient sampling for test-retest study. They completed the MyUM Adolescent FFQ twice, with an interval period of one week. One hundred and fifty-six MyHeARTs study participants who were 15 years old in 2014 were randomly selected for this comparative valid-ity study. They completed a 7-day diet history (7DDH) and subsequently completed the self-administered MyUM Adolescent FFQ.
RESULTS: Pearson's correlations between the FFQ and 7DDH for all macronutrients were statistically significant. Energy-adjusted correlations for protein, carbohydrate, and fat were 0.54, 0.63 and 0.49 respectively. Most of the micronutrients and minerals, were statistically correlated ranging from 0.31 to 0.49 after energy adjustment. Cross-classification analyses revealed that more than 70 percent of adolescents were classified into either the same or adjacent quartile of nutrient intake when comparing data of 7DDH and FFQ. No serious systematic bias was evident in the Bland-Altman plots.
CONCLUSION: The 200-item FFQ developed for Malaysian adolescents has moderate to good comparative validity for assessment of macronutrient and micronutrient intake.