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Stress experienced by mothers of Malaysian children with mental retardation

Ong LC, Chandran V, Peng R

J Paediatr Child Health, 1999 Aug;35(4):358-362.
PMID: 28871653 DOI: 10.1046/j.1440-1754.1999.00383.x

OBJECTIVE: To compare parenting stress among Malaysian mothers of children with mental retardation and a control group, and to determine factors associated with stress.
METHODOLOGY: Seventy-five mothers of children with mental retardation aged 4-12 years and 75 controls (those without disabilities who attended the walk-in paediatric clinic) participated in the Parenting Stress Index (PSI). Intelligence quotient (IQ) and Child Behaviour Checklist (CBCL) scores, together with sociodemographic data, were entered into a multiple stepwise regression analysis, using the PSI as the criterion.
RESULTS: Mothers of children with mental retardation scored significantly higher than control subjects in both the child-related domain (difference between means 26.1, 95% confidence interval 19.6-32.5) and parent-related domain (difference between means 15.0, 95% confidence interval 7.9-22.1) of the PSI. The total child behaviour scores from the CBCL (P < 0.01), IQ scores (P < 0.01) and sibship size (P < 0.01) were associated with child-related domain scores. For the parent-related domain, CBCL (P < 0.01) and IQ scores (P = 0.01) remained important factors but Chinese ethnicity (P < 0.01) and maternal unemployment (P < 0.01) were also significant predictors of stress.
CONCLUSION: A large proportion of mothers of children with mental retardation experienced substantial parenting stress, especially Chinese and unemployed mothers, and this warrants appropriate intervention.
Study site: Outpatient clinic, Paediatric Institute, Hospital Kuala Lumpur, Malaysia
Fulltext Congenital talipes in Malaysian neonates: incidence, pattern and associated factors

Boo NY, Ong LC

Singapore Med J, 1990 Dec;31(6):539-42.
PMID: 2281348

A study was carried out on 8,369 neonates delivered in the Maternity Hospital, Kuala Lumpur over a period of four months. Forty-nine neonates (5.6 per 1000 livebirths) had congenital talipes. The incidence of congenital talipes equinovarus (CTEV) was 4.5 per 1000 livebirths while that of congenital talipes calcaneovalgus (CTCV) was 1.3 per 1000 livebirths. 6/11 (54.5%) of the CTCV was unilateral, the ratio of right to left feet involvement being 1:1. Only 12/38 (31.5%) of the CTEV were unilateral, the ratio of right to left feet involvement being 1:2. Congenital talipes was significantly more common in the low birthweight neonates (p less than 0.001). However, the condition was not significantly more common in neonates with breech presentation nor in those born to primigravida mothers. Our data suggested that multifactorial genetic background as the most likely underlying cause of congenital talipes in Malaysian neonates.
Fulltext Beta-blockers for heart failure: an evidence based review answering practical therapeutic questions

Ong HT, Ong LM, Kow FP

Med J Malaysia, 2012 Feb;67(1):7-11.
PMID: 22582541 MyJurnal

Beta-blockers are underutilised in heart failure because clinicians may be unsure whether all beta-blockers are useful, how therapy should be initiated and whether beta-blockers are contraindicated in some patients. Bisoprolol, carvedilol and metoprolol succinate have been clearly proven to reduce mortality and hospitalisation in patients with Class II to IV heart failure; limited evidence also support short-acting metoprolol tartrate and nebivolol. Initiating dose should be very low (1.25 mg bisoprolol, 3.125 mg carvedilol, 12.5 mg metoprolol succinate) and increased gradually over weeks. Treatment benefit appears proportional to magnitude of heart rate reduction and thus target dose should be the maximum tolerated for adequate bradycardia. Even in decompensated heart failure or those with coexisting bronchospasm, beta-blockers are not contraindicated although the dose may have to be reduced or withheld temporarily. The consistent trial data should reassure clinicians and encourage them to confidently initiate beta blockers in patients with systolic heart failure.
Predictors of parenting stress in mothers of children with spina bifida

Kanaheswari Y, Razak NN, Chandran V, Ong LC

Spinal Cord, 2011 Mar;49(3):376-80.
PMID: 20838404 DOI: 10.1038/sc.2010.125

Prospective cross-sectional multidimensional study using clinical assessment and standard measures.
Journey of the Human Papillomavirus (HPV) in a Developing Country over 5 Years (2010 - 2015)

Danial M, Sivasangari S, Arulappen A, Ong L

Asian Pac J Cancer Prev, 2016;17(3):1363-8.
PMID: 27039773

Human papillomavirus (HPV) is a prevalent sexually transmitted infection with serious medical, sexual, and relationship consequences. HPV vaccine protection is available globally but unfortunately vaccine uptake is inconsistent everywhere. From this study, it was observed that the awareness of cervical cancer, HPV virus and HPV vaccination in Malaysia is high, at 83.1%, 73.9% and 73.3% of respondents, respectively. However, a considerably low percentage had undergone HPV vaccination (8.6%) compared to those who had experienced a Pap smear (32.9%). Awareness between cervical cancer and HPV virus and vaccination was low. Health care providers and the governing bodies have to play a vital role in disseminating holistic information on the vaccine and the importance of getting vaccinated to the public more vigorously in Malaysia.
Fulltext Epidemiology of head injury in Malaysian children: a hospital-based study

Rohana J, Ong LC, Abu Hassan AA

Med J Malaysia, 1998 Sep;53(3):217-22.
PMID: 10968156

A prospective observational study was carried out at the Emergency Department, Hospital Kuala Lumpur to determine the proportion of accidental head injury among children and the circumstances of injury. The study was carried out from November 1993 to January 1994 on all children below 14 years who presented to the Emergency Department with accidental head injury. Accidental head injury made up (4.75%) of all cases seen at the Casualty Department. The ratio of boys to girls was 2:1. The mean age of head injured children was 5.2 (S.D. 3.63) years. The leading cause of head injury was fall (63%) followed by road traffic accidents (RTA) in (30.7%) while the rest were due to 'impact' (injury caused by flying object or missiles) injuries. More than half (54.4%) of those injured in RTA were pedestrians. Pedestrian injury was particularly important in the 5-< 14 years age group, where adult supervision was lacking in two thirds of the children. None of the patients who were involved in vehicle-related injuries had used a suitable protective or restraining device. All three patients who died were from this group. This study emphasises the need for stricter enforcement of laws related to the use of protective devices and measures to decrease child pedestrian injury. The issues of lack of adult supervision, both in and outside the home need to be addressed.
Comparison of parenting stress between Malaysian mothers of four-year-old very low birthweight and normal birthweight children

Ong LC, Chandran V, Boo NY

Acta Paediatr, 2001 Dec;90(12):1464-9.
PMID: 11853347 DOI: 10.1080/08035250152708905

A study was carried out to compare parenting stress between 116 mothers of very low birthweight (VLBW) children and 96 mothers of normal birthweight (NBW) children at 4 y of age, using the Parenting Stress Index (PSI). Multiple regression analysis was used to determine factors associated with child-domain stress (CDS) and parent-domain stress (PDS). There was a significantly higher proportion (39.7%) of mothers of VLBW children with high CDS scores >90th percentile than mothers of NBW children (20.8%). No significant differences were observed for PDS scores. Lower intelligence quotient (IQ) scores and adverse child behaviour, as evidenced by higher Child Behavior Checklist (CBCL) scores, were significantly associated with higher CDS scores (p < 0.001). Factors associated with higher PDS scores were higher CBCL scores (p < 0.001), mothers who were the primary caregivers (p < 0.001), male sex (p = 0.018) and lower level of maternal education (p = 0.048). These factors remained statistically significant even when physically and cognitively impaired children were excluded from the analysis.

CONCLUSION: Specific child characteristics and the social environment appear to have a greater impact on parenting stress than the biological risk of VLBW birth per se.
Predictors of neurodevelopmental outcome of Malaysian very low birthweight children at 4 years of age

Ong LC, Boo NY, Chandran V

J Paediatr Child Health, 2001 Aug;37(4):363-8.
PMID: 11532056 DOI: 10.1046/j.1440-1754.2001.00694.x

OBJECTIVE: To determine neonatal, early developmental and social risk factors that predict the neurocognitive and behavioural outcome of very low birthweight (VLBW) preschool children at four years of age.

METHODOLOGY: From a cohort of 151 eligible VLBW survivors born in Kuala Lumpur Maternity Hospital, 116 (76.8%) were prospectively followed up from birth till four years. A standardised neurological examination was performed at one and four years to determine the presence of impairment and cerebral palsy, respectively. Cognitive development was assessed using the Mental Scale of the Bayley Scales of Infant Development (MDI) at one year and the Weschler Preschool and Primary Scale of Intelligence-Revised (WIPPSI-R) at four years. Motor coordination was assessed using the Movement Assessment Battery for Children (Movement-ABC). Mothers completed the Child Behaviour Checklist (CBCL) and Parenting Stress Index (PSI) questionnaires. Logistic and multiple regression analyses were used to determine factors associated with cerebral palsy, IQ scores, Movement-ABC and CBCL scores.

RESULTS: Factors associated with cerebral palsy were lower MDI scores at one year (P = 0.001) and late neonatal cranial ultrasound abnormalities (P = 0.036). Minor (P = 0.016) or major impairment (P = 0.003) at one year of age and a low level of paternal education (P = 0.01) were associated with poor motor function on the Movement-ABC scale. Lower levels of maternal education (P < 0.001), impairment at one year (P = 0.002) and late neonatal cranial ultrasound abnormalities (P = 0.039) predicted Full Scale IQ scores. Higher PSI scores (P = 0.001), younger mothers (P = 0.003) and late neonatal cranial ultrasound abnormalities (P = 0.009) were associated with worsened child behaviour scores on the CBCL scale.

CONCLUSION: Social factors and the caregiving environment were important determinants of cognitive and behavioural outcome. Cranial ultrasound abnormalities in the late neonatal period and the developmental status at one year might be useful in identifying high risk infants in need of long-term surveillance.
Distribution of hair on the dorsum of the phalanges of the hand in a Chinese population from Malaysia

Dharap AS, Lim BC, Ong LB

Anthropol Anz, 1996 Dec;54(4):311-6.
PMID: 9008788

Hair distribution on the dorsum of phalanges of the hand was studied on 302 Chinese subjects (134 males and 168 females) randomly selected from the residents of Kota Bharu, Malaysia. Proximal phalangeal hair was seen on the dorsum of both hands in 99.3% of male subjects but in only 85.1% of female subjects. Chinese females showed a significantly lower (p < 0.05) incidence of proximal phalangeal hair on the hands than Chinese males. Comparison with other racial groups showed that Chinese females had significantly less (p < 0.05) hair on the proximal phalanges of the hands than Malay and African (Nigerian) females. The least common digital combination of proximal phalangeal hair in female subjects was the presence of proximal phalangeal hair only on the fourth digit (ring finger) and was noted in 0.6% of subjects. This has not been reported before. The frequency of middle phalangeal hair (MPH) distribution in Chinese falls between that in Malays and in Japanese which is probably explained by the fact that all these three racial groups originate from Asia. A study of digital combination of MPH in Chinese showed that the most common and the least common combinations in the Chinese differ considerably from those in other races. A total of 16 patterns of hair distribution was noted on the dorsum of the phalanges of the hands in Chinese subjects. Our study showed that though Chinese females had less digital hair on the hands than Chinese males, they showed a much larger variety of patterns of digital hair distribution than males.
Fulltext Dopa responsive dystonia with diurnal fluctuation (Segawa's syndrome)

Ong LC, Tang SF, Lal TR

Med J Malaysia, 1994 Jun;49(2):176-8.
PMID: 8090100

A 10-year-old girl presented with progressive dystonia with diurnal fluctuation. Response to low dose L-Dopa was dramatic and sustained with no complications. Recurrence of symptoms was observed on attempted withdrawal. Because of the dramatic response to therapy, dopa-responsive dystonia must be considered in the differential diagnosis of disorders presenting as gait disorders in childhood.
Parenting stress among mothers of Malaysian children with cerebral palsy: predictors of child- and parent-related stress

Ong LC, Afifah I, Sofiah A, Lye MS

Ann Trop Paediatr, 1998 Dec;18(4):301-7.
PMID: 9924586 DOI: 10.1080/02724936.1998.11747964

A hospital study was carried out to compare parenting stress among 87 Malaysian mothers of children with cerebral palsy and a control group (comprising 87 mothers of children without disability who attended the walk-in paediatric clinic), using the Parenting Stress Index (PSI) questionnaire. Multiple regression analysis was used to determine socio-demographic and medical factors associated with child-domain stress (CDS) and parent-domain stress (PDS). Mothers of children with cerebral palsy scored significantly higher than control subjects on all sub-scales of CDS and PDS (p < 0.01), except for the sub-scale of 'role restriction'. The presence of cerebral palsy (p < 0.001) and activities of daily living (ADL) scores (p < 0.001) were significantly associated with CDS. Factors predictive of PDS were ADL scores (p < 0.001), number of hospitalizations over the past year (p = 0.024), level of maternal education (p = 0.018) and Chinese mothers (p < 0.001). Although this study demonstrated that Malaysian mothers of children with cerebral palsy experienced higher levels of stress than controls, the impact of cerebral palsy per se on parenting stress was modified by other factors such as increased care-giving demands, low maternal education and ethnic background. Habilitation should be directed at easing the burden of daily care, minimizing hospital re-admissions and targeting appropriate psychosocial support at specific subgroups to change parental perception and expectations.
Study site: neurology clinics or physiotherapy department or inpatients, Paediatric Institute, Kuala Lumpur, Malaysia
Blood cholinesterase levels in a group of Malaysian blood donors

Chan L, Balabaskaran S, Delilkan AE, Ong LH

Malays J Pathol, 1994 Dec;16(2):161-4.
PMID: 9053566

Data on blood cholinesterase levels in the Malaysian population is lacking. The spectrophotometric method of Ellman was used to determine the red cell, plasma and whole blood cholinesterase (ChE) levels in 407 Malaysian blood donors. The mean+1SD for plasma ChE in females (n = 48) was 2.37 + 0.70 umol/min/ml and 2.76 + 0.75 umol/min/ml in males (n = 359). The mean plasma ChE in males was higher than in females (p < 0.001). The mean+1SD for red cell ChE in females was 9.01 + 1.20 umol/min/ml whereas in males it was 7.69 +1.30 umol/min/ml (the mean red cell ChE in females was higher than in males, p < 0.0001). The mean+1SD for whole blood ChE for females was 4.31+ 0.58 umol/min/ml and for males it was 4.95 + 0.71 umol/min/ml. The mean whole blood ChE in males was higher than in females (p < 0.0001). Sex influenced the plasma, red cell and whole blood ChE. In males the plasma ChE was affected by the race factor. The mean+1SD plasma ChE for the Malay, Chinese and Indian were 2.92 + 0.80, 2.73 + 0.71 and 2.61+ 0.73 respectively (p < 0.002). The age factor in males affected the red cell ChE with 7.88 + 1.32 in the (30-69) age group and 7.47 + 1.23 in the (15-29) age group (p < 0.005). The whole blood ChE in females was affected by blood groups. The mean+1SD whole blood ChE for blood groups A,B and O were 4.19 + 0.42, 3.93 + 0.46 and 4.49 + 0.62 respectively (p < 0.03). The significant difference is between the ChE of group B and O, but the ChE of group A could not be determined to be different from group B or O. These results serve as guidelines for our local population in the evaluation of cholinesterase levels with regard to pesticide poisoning, liver biosynthetic capacity and unusual sensitivity to succinylcholine.
Outcome of closed head injury in Malaysian children: neurocognitive and behavioural sequelae

Ong LC, Chandran V, Zasmani S, Lye MS

J Paediatr Child Health, 1998 Aug;34(4):363-8.
PMID: 9727180

OBJECTIVES: To compare the neurobehavioural outcome of children aged 6-12 years with severe closed head injury [sCHI] (coma > 24 h), mild-to-moderate head injury [mCHI] (coma < 6 h) and orthopaedic controls.
METHODS: Twenty-nine children in each group, matched for age, sex and ethnicity, were assessed using the Glasgow outcome Scale (GOS), Weschler Intelligence Scale for Children (WISC-III), Movement Assessment Battery for Children (Movement ABC), Wide Range Assessment of Learning and Memory (WRAML) and a standardised neurological examination 6 months post-injury. Parental reporting of pre- and post-injury behaviour was documented using the Child Behaviour Checklist (CBCL).
RESULTS: Seven (24.1%) children with sCHI and three (10.3%) orthopaedic controls had residual motor deficits. Three (10.3%) children with sCHI and none in the other groups faced problems with independent ambulation. Twenty-seven (93.1%) of those with sCHI and all children in the other groups had GOS scores of good recovery or moderate disability. Twenty-two (81.5%) sCHI, five (18.5%) mCHI and one (3.7%) orthopaedic control reported a deterioration in school performance. MANOVAS identified a significant injury group effect for performance skills (P = 0.007), verbal skills (P = 0.002), memory and learning (P = 0.001) and motor skills (P = 0.001). Repeated measures ANOVA for pre- and post-injury CBCL scores showed significant differences related to somatic complaints (P = 0.004), problems of socialising (P = 0.003), delinquency (P = 0.004), aggressiveness (P = 0.010), thought (P < 0.001) and attention (P < 0.001). Post-hoc univariate analysis showed the significant differences were between that of the sCHI children and the other two groups.
CONCLUSION: Although most sCHI children seemed to have made good physical recovery, there were cognitive, motor, memory and learning difficulties and behavioural problems concomitant with a deterioration in school performance compared with those with lesser or no head injury. This highlights the need for better integrated rehabilitation services to enable a gradual return into mainstream school.
The first isolate of Mycoplasma pneumoniae in Malaysia

Cheong YM, Jegathesan M, Singh M, Wong S, Ong L

Malays J Pathol, 1985 Aug;7:51-2.
PMID: 3939616
Fulltext The external ear--the electrical aspects in relation to acupuncture--a preliminary report

Ong LS, Hamiadji T, Chong KL

Med J Malaysia, 1980 Sep;35(1):53-7.
PMID: 7253999

This study is based on measuring the d.c. (direct current) skin conductance of the acupuncture points representing the heart on the external ear. The subjects were 30 healthy volunteers and 20 cardiac patients. The results obtained showed that the skin resistance of the heart acupuncture loci on the auricle of the cardiac patients were markedly reduced when compared with that of the healthy controls. The value of this method of auricular electroacupuncture diagnosis is discussed.
Changes in blood pressure after Messenger RNA COVID-19 vaccination

Ch'ng CC, Ong LM, Wong KM

Med J Malaysia, 2022 Nov;77(6):768-770.
PMID: 36448398

The SARS-Cov-2 (COVID-19) vaccination began in Malaysia in March 2021 among frontliners and healthcare workers. Everyone at our hospital received the tozinameran (BNT162b2) Messenger RNA COVID-19 vaccine. Although hypertension has not been mentioned explicitly as an adverse event, concerns were raised after some healthcare staff observed an increase in their blood pressures. In response to that, the hospital began collecting vital signs during second-dose appointments. Vital signs were measured before, immediately after and 15-30 minutes postvaccination. We report our findings from the institution-wide effort to monitor changes in blood pressure among its staff and respond to any possible unwanted events.
Fulltext Malaysian children with spina bifida: relationship between functional outcome and level of lesion

Ong LC, Lim YN, Sofiah A

Singapore Med J, 2002 Jan;43(1):12-7.
PMID: 12008770

To determine the relationship between spinal lesion level and functional outcome in children with spina bifida.
Fulltext Intrauterine growth of liveborn Malaysian infants between gestation of 28 to 42 weeks

Boo NY, Lye MS, Ong LC

Singapore Med J, 1994 Apr;35(2):163-6.
PMID: 7939812

A cross-sectional study was carried out on 8,478 consecutive normal singleton Malaysian neonates born in the Maternity Hospital, Kuala Lumpur. The objectives were to compare the mean birth-weights, crown-heel lengths and head circumferences of Malay, Chinese and Indian infants at gestation age from 28 to 42 weeks, and to construct the Malaysian growth charts. Above the gestation age of 34 weeks, the birthweights were significantly influenced by maternal gravida status (p < 0.03), ethnic origin (p < 0.001) and/or sex of the neonates (p < 0.026). Above this gestation age, neonates of multigravida mothers were significantly heavier than those of primigravida mothers; Indians were significantly lighter than Malays and Chinese; and males were significantly heavier than females. The head circumferences and body lengths of neonates were significantly influenced by ethnic origin, sex and/or maternal gravida status at gestation above 35 and 36 weeks respectively (p < 0.05). It was most likely due to the small sample size which explained our inability to detect statistically significant difference in all measurements (birthweight, length and head circumference) by sex, ethnicity and maternal gravida status at gestation below 35 weeks. Based on the measurements obtained in this study, percentile charts for the Malaysian population were constructed and made available for the first time. These charts will be useful for the assessment of Malaysian neonates during the perinatal period.
Fulltext Castanopsiscorallocarpus (Fagaceae), a new species from Royal Belum (Perak) in Peninsular Malaysia

Tan WH, Ong L, Strijk JS

PhytoKeys, 2023;219:1-10.
PMID: 37252448 DOI: 10.3897/phytokeys.219.95991

A new species from the Fagaceae family, Castanopsiscorallocarpus Tan & Strijk, is described from Royal Belum State Park in Peninsular Malaysia. Here, we provide technical illustrations, colour images and a description of its conservation status and the collecting locality, in addition to a comparative analysis with other species in the region. The solitary nut of C.corallocarpus has a morphologically unique cupule, lined with rows of thick coral-like spines not seen in other Castanopsis species.
Fulltext Cardiovascular effects of common analgesics

Ong HT, Ong LM, Tan TE, Chean KY

Med J Malaysia, 2013 Apr;68(2):189-94.
PMID: 23629578 MyJurnal

The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the heart from metabolic change as well as fluid retention. Aspirin is an anti-thrombotic agent because of its ability to inhibit the COX-1 enzyme that produces the pro-aggregatory thromboxane. However, it increases gastrointestinal bleeding, can promote fluid retention and is nephrotoxic, all of which may lead to adverse cardiovascular outcomes. Patients at especially high risk of cardiovascular events from analgesic use include the elderly, and those with heart failure, hypertension, rheumatoid arthritis, chronic renal disease, chronic obstructive airway disease and previous myocardial infarction, cerebrovascular disease or peripheral vascular disease. Adverse cardiovascular events can occur within a week of initiation of analgesic treatment.

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