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Assessing doctors' competence: application of CUSUM technique in monitoring doctors' performance

Lim TO, Soraya A, Ding LM, Morad Z

Int J Qual Health Care, 2002 Jun;14(3):251-8.
PMID: 12108535

Quality assurance of medical practice requires assessment of doctors' performance, whether informally via a system such as peer review or more formally via one such as credentialing. Current methods of assessment are, however, subjective or implicit. More objective methods of assessment based on statistical process control technique such as cumulative sum (CUSUM) procedure may be helpful.
Fulltext Distribution of body weight, height and body mass index in a national sample of Malaysian adults

Lim TO, Ding LM, Zaki M, Suleiman AB, Fatimah S, Siti S, et al.

Med J Malaysia, 2000 Mar;55(1):108-28.
PMID: 11072496 MyJurnal

We describe the distribution of body weight, height and body mass index (BMI) by age, sex and ethnicity in Malaysian adults. A national sample of 28,737 individuals aged 20 or older had usable data. They were selected by stratified 2-stage cluster sampling. Percentile tables and curves by age, sex and ethnicity are presented. The body weight and BMI distributions were right skewed, while that of height was symmetrical. BMI distribution showed the expected increase with age, while that of height decrease with age. Differences in BMI between the 2 sexes and among the 4 ethnic groups were observed. Indian had the highest BMI, followed by Malay, Chinese and other indigenous ethnic group.
Study name: National Health and Morbidity Survey (NHMS-1996)
Fulltext Distribution of blood glucose in a national sample of Malaysian adults

Lim TO, Ding LM, Zaki M, Suleiman AB, Kew ST, Maimunah AH, et al.

Med J Malaysia, 2000 Mar;55(1):65-77.
PMID: 11072493 MyJurnal

We describe the distribution of capillary blood glucose (BG) by age, sex and ethnicity in Malaysian adults. A national sample of 20,041 individuals aged 30 or older had usable data. They were selected by stratified 2-stage cluster sampling. BG was measured using reflectance photometer. Percentile tables and curves by age, sex and ethnicity are presented. The BG distribution was right skewed and showed the expected increase with age. Except in Indian, women had higher BG than men. There were also marked ethnic differences. Indian had the highest BG concentration, followed by Chinese, Malay and other indigenous ethnic group.
Study name: National Health and Morbidity Survey (NHMS-1996)
Fulltext Distribution of blood pressure in a national sample of Malaysian adults

Lim TO, Ding LM, Goh BL, Zaki M, Suleiman AB, Maimunah AH, et al.

Med J Malaysia, 2000 Mar;55(1):90-107.
PMID: 11072495 MyJurnal

We describe the distribution of blood pressure (BP) by age, sex and ethnicity in Malaysian adults. A national sample of 21,391 individuals aged 30 or older had usable data. They were selected by stratified 2-stage cluster sampling. BP was measured using an automated oscillometric device, Visomat. Percentile tables and curves by age, sex and ethnicity are presented. The systolic and diastolic BP distribution was right skewed and showed the expected increase with age. This was markedly so in Malay and other indigenous women; as a result they had most severe hypertension.
Study name: National Health and Morbidity Survey (NHMS-1996)
Fulltext Distribution of blood total cholesterol in a national sample of Malaysian adults

Lim TO, Ding LM, Zaki M, Suleiman AB, Kew ST, Ismail M, et al.

Med J Malaysia, 2000 Mar;55(1):78-89.
PMID: 11072494 MyJurnal

We describe the distribution of capillary blood total cholesterol (BC) by age, sex and ethnicity in Malaysian adults. A national sample of 20,041 individuals aged 30 or older had usable data. They were selected by stratified 2-stage cluster sampling. BC was measured using reflectance photometer. Percentile tables and curves by age, sex and ethnicity are presented. The BC distribution was right skewed and showed the expected increase with age. There were ethnic differences. Malay had the highest BC concentration, followed by Indian, Chinese and other indigenous ethnic group. However, for all ethnic groups, BC concentrations were low in comparison those prevailing in Western populations.
Study name: National Health and Morbidity Survey (NHMS-1996)
Fulltext Clustering of hypertension, abnormal glucose tolerance, hypercholesterolaemia and obesity in Malaysian adult population

Lim TO, Ding LM, Zaki M, Merican I, Kew ST, Maimunah AH, et al.

Med J Malaysia, 2000 Jun;55(2):196-208.
PMID: 19839148

We determine the prevalence and determinants of clustering of hypertension, abnormal glucose tolerance, hypercholesterolaemia and overweight in Malaysia. A national probability sample of 17,392 individuals aged 30 years or older had usable data. 61% of adults had at least one risk factor, 27% had 2 or more risk factors. The observed frequency of 4 factors cluster was 6 times greater than that expected by chance. Indian and Malay women were at particular high risk of risk factors clustering. Individuals with a risk factor had 1.5 to 3 times higher prevalence of other risk factors. Ordinal regression analyses show that higher income, urban residence and physical inactivity were independently associated with risk factors clustering, lending support to the hypotheses that risk factors clustering is related to lifestyle changes brought about by modernisation and urbanisation. In conclusion, risk factor clustering is highly prevalent among Malaysian adults. Treatment and prevention programme must emphasise the multiple risk factor approach.
Study name: National Health and Morbidity Survey (NHMS-1996)
Fulltext Perceived unmet needs of an age-friendly environment: A qualitative exploration of older adults' perspectives in a Malaysian city

Lim XJ, Chew CC, Chang CT, Supramaniam P, Ding LM, Devesahayam PR, et al.

PLoS One, 2023;18(6):e0286638.
PMID: 37279237 DOI: 10.1371/journal.pone.0286638

This exploratory qualitative study investigates older adults' unmet needs in the age-friendly city of Ipoh, Malaysia. Seventeen participants were interviewed, including ten older adults residing in Ipoh City for at least six months, four carers, and three professional key informants. Interviews were conducted using semi-structured questions based on the WHO Age-Friendly Cities Framework. A 5P framework for active ageing based on the ecological ageing model was adapted for data analysis. The 5P framework consists of domains of person (micro), process (meso), place (macro), policymaking (macro), and prime, which allows for the dissection of older adults' unmet needs in planning for multilevel approaches, which were employed for analysis. Person: the personal needs requiring improvement included digital divide disparity, inadequate family support, and restricted sports activities attributed to physical limitations. Process: There were fewer social activities and a lack of low-cost and easily accessible venues for seniors. Economic challenges include expensive private healthcare services, variation in the quality of care in older residential care facilities, and limited savings for retirement. Place issues include unequal distribution of exercise equipment, public open spaces, the need for more conducive parking for seniors, and a place for social activities. Difficulties assessing public transportation, digitalized services, and unaffordable e-hailing services are common among seniors. Housing issues for seniors include a lack of barrier-free housing design and unaffordable housing. Policymaking: Insufficient private sector commitment to improving services to older adults, lack of policy governance on the quality of nursing homes, and insufficient multidisciplinary governance collaboration. Prime: Health promotion for preventing age-related illness is required to preserve health in old age, and full-time family caregivers' psychological well-being is often overlooked.
Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1996

Zainal M, Ismail SM, Ropilah AR, Elias H, Arumugam G, Alias D, et al.

Br J Ophthalmol, 2002 Sep;86(9):951-6.
PMID: 12185113

BACKGROUND: A national eye survey was conducted in 1996 to determine the prevalence of blindness and low vision and their major causes among the Malaysian population of all ages.
METHODS: A stratified two stage cluster sampling design was used to randomly select primary and secondary sampling units. Interviews, visual acuity tests, and eye examinations on all individuals in the sampled households were performed. Estimates were weighted by factors adjusting for selection probability, non-response, and sampling coverage.
RESULTS: The overall response rate was 69% (that is, living quarters response rate was 72.8% and household response rate was 95.1%). The age adjusted prevalence of bilateral blindness and low vision was 0.29% (95% CI 0.19 to 0.39%), and 2.44% (95% CI 2.18 to 2.69%) respectively. Females had a higher age adjusted prevalence of low vision compared to males. There was no significant difference in the prevalence of bilateral low vision and blindness among the four ethnic groups, and urban and rural residents. Cataract was the leading cause of blindness (39%) followed by retinal diseases (24%). Uncorrected refractive errors (48%) and cataract (36%) were the major causes of low vision.
CONCLUSION: Malaysia has blindness and visual impairment rates that are comparable with other countries in the South East Asia region. However, cataract and uncorrected refractive errors, though readily treatable, are still the leading causes of blindness, suggesting the need for an evaluation on accessibility and availability of eye care services and barriers to eye care utilisation in the country.
Case-control study of risk factors for human infection with a new zoonotic paramyxovirus, Nipah virus, during a 1998-1999 outbreak of severe encephalitis in Malaysia

Parashar UD, Sunn LM, Ong F, Mounts AW, Arif MT, Ksiazek TG, et al.

J Infect Dis, 2000 May;181(5):1755-9.
PMID: 10823779

An outbreak of encephalitis affecting 265 patients (105 fatally) occurred during 1998-1999 in Malaysia and was linked to a new paramyxovirus, Nipah, that infected pigs, humans, dogs, and cats. Most patients were pig farmers. Clinically undetected Nipah infection was noted in 10 (6%) of 166 community-farm controls (persons from farms without reported encephalitis patients) and 20 (11%) of 178 case-farm controls (persons from farms with encephalitis patients). Case patients (persons with Nipah infection) were more likely than community-farm controls to report increased numbers of sick/dying pigs on the farm (59% vs. 24%, P=.001) and were more likely than case-farm controls to perform activities requiring direct contact with pigs (86% vs. 50%, P=.005). Only 8% of case patients reported no contact with pigs. The outbreak stopped after pigs in the affected areas were slaughtered and buried. Direct, close contact with pigs was the primary source of human Nipah infection, but other sources, such as infected dogs and cats, cannot be excluded.