The prevalence of teenage smoking has decreased over the past decade following the implementation of the national tobacco control programme. However, the effect of the programme on smoking cessation in teenagers has not been determined.
Twenty-eight participants (12 teenagers, 8 teachers, and 8 doctors) were interviewed using 5 in-depth interviews and 3 group discussions. Social cognitive theory (SCT) was applied as the theoretical framework. Semi-structured interview protocols were used, and thematic analysis and analytic generalisation utilising SCT were performed.
The current national tobacco control programme was found to be ineffective in promoting smoking cessation among teenagers. The participants attributed the ineffective campaign to the followings: inadequacy of message content, lack of exposure to the programme, and poor presentation and execution. In addition, the participants perceived the developed tobacco control policies to be a failure based on poor law enforcement, failure of retailers to comply with the law, social availability of cigarettes to teenagers, and easy availability of cheap, smuggled cigarettes. This study highlighted that the programme-related problems (environmental factors) were not the only factors contributing to its perceived ineffectiveness. The cunning behaviour of the teenagers (personal factor) and poor self-efficacy to overcome nicotine addiction (behavioural factor) were also found to hinder cessation.
Tobacco control programmes should include strategies beyond educating teenagers about smoking and restricting their access to cigarettes. Strategies to manage the cunning behaviour of teenagers and strategies to improve their self-efficacy should also be implemented. These comprehensive programmes should have a foundation in SCT, as this theory demonstrates the complex interactions among the environmental, personal, and behavioural factors that influence teenage smoking.
adolescent; health campaigns; qualitative research; tobacco cessation; tobacco smoking
Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorrhage secondary to jejunal ascariasis and a literature search on lower gastrointestinal haemorrhage associated with jejunal infestation with Ascaris.
ascariasis; aetiology; complications; diagnosis; gastrointestinal haemorrhage; jejunal diseases; melaena; parasitology
The epidemiological study of vision problems is important for developing national strategies for the prevention of visual impairment. There was a lack of information regarding vision problems among school children in East Malaysia. The purpose of this study was to compare the refractive errors and degrees of visual impairment between Native Iban and Malay school children who participated in a formal government vision loss prevention programme conducted in a rural area of Betong Division, Malaysia.
In total, 293 Native Iban and Malay school children (Standard 1, Standard 6, and Form 3) received refractive assessments by an optometrist after failing tests in the formal government school vision screening programme in 2008. A criterion for referral was a visual acuity of 6/9 or worse in either eye. Assessments of the refractive errors of the children were performed using dry retinoscopy and subjective refraction techniques at community clinics.
The overall prevalences of refractive error and visual impairment among the sampled populations were 47.7% and 3.5%, respectively. Approximately 97.1% of reported cases were myopia. The Malay sample population was found to be more myopic than the Native Iban population (U = 8240.50, P < 0.05, r = 0.14), but no significant association was found between myopia and ethnicity (χ2 = 2.66, P > 0.05). Both Native Iban and Malay children in education levels higher than Standard 1 were more likely to have myopia (P < 0.05). Myopia was found to be more likely to affect females than males at a statistically significant level among Native Iban children (χ2 [1.N = 170] = 6.279, P < 0.05, odds ratio = 2.327, 95% CI = 1.184–4.575). There was no statistically significant association between visual impairment and ethnicity (χ2 = 1.60, P > 0.05). Approximately 94.1% of children with refractive errors suffered from having either the wrong prescription (7.8%) or having uncorrected refractive errors (92.2%).
The Native Iban population was found to be less myopic than the Malay population despite having a similar frequency of myopia. The proportion of children with myopia increased with the level of education in both ethnicities. A high percentage of untreated refractive error problems among Native Iban and Malay children in the Betong Division indicates that there is a need for government intervention for the purpose of economic and healthcare improvements.
child; myopia; optometry; refractive errors; visually impaired persons
The current Western psychiatric wisdom states that suicide is always or almost always associated with mental disorder. Careful Asian studies are casting doubt on this conclusion. Using information from the public record (newspapers, coroner’s reports, and various web-based sources), we sought evidence that, in the absence of mental disorder, suicide may be associated with major financial loss. Reports of 15 individuals who completed suicide following major financial loss were identified, thus an association between these events is supported.
life change events; medicalisation; stress; suicide; public health
Pheochromocytomas are rare tumours originating from the chromaffin tissue. The clinical manifestations are variable and are not specific; as a result, pheochromocytomas often imitate other diseases. The diagnosis is usually established by biochemical studies, i.e., the measurement of catecholamines or their metabolites in urine or plasma, followed by radiographic and scintigraphic studies for localisation. Surgical removal of the tumour is the preferred treatment. We report a 30-year-old woman presenting with an adrenal incidentaloma that was 7.6 × 5.3 × 4.8 cm in size on an abdominal computed tomography scan. Investigations for adrenal hormones, including a low-dose dexamethasone suppression test, plasma aldosterone level, 24-hour urinary metanephrine and vanillylmandelic acid levels, and plasma metanephrine level were all within the normal ranges. During the surgical resection, the patient had a hypertensive spell. Surgery was postponed, and the blood pressure was adequately controlled with α blockers, followed by β blockers. After 2 weeks, the surgery was followed by a pathological biopsy that confirmed the pheochromocytoma diagnosis.
adrenal incidentaloma; catecholamines; hypertension; pheochromocytoma; scintigraphy
As a small—although growing—journal based in Malaysia, the Malaysian Journal of Medical Sciences (MJMS) has faced several challenges in the past, such as promoting our journal as well as making sure our article bank does not go empty. However, we strive to improve ourselves by taking all means necessary to increase the quantity and, most importantly, quality of our publications, as well as to increase our journal’s visibility and citability. This editorial will focus on MJMS statistics throughout 2011—where MJMS turned 18—as well as future plans for our journal.
manuscripts; publishing; reports; special events; statistics
Chronic granulomatous mastitis is known as a benign and relatively rare disorder that is often difficult to differentiate from breast carcinoma. We highlight the case of a 34-year-old woman who had recurrent episodes of right breast swelling and abscess for 8 years. These were proven to be chronic granulomatous mastitis by tissue biopsies on 3 different occasions. Her condition improved on similar courses of antibiotics and high-dose prednisolone. However, she subsequently developed progressive loss of vision due to an orbital tumour. She then underwent a craniotomy and left orbital decompression with excision of the tumour, which proved to be a metastatic carcinoma. A trucut biopsy of the right breast was then done and showed features consistent with an infiltrating ductal carcinoma. This case illustrates the possibility that chronic granulomatous mastitis could be a precursor for malignancy and the difficulty in differentiating one from the other. The possible mechanisms of development and the implications for future management are also discussed.
breast; carcinoma; disease progression; granulomatous mastitis; surgery
Malaria is a disease that causes enormous human morbidity and mortality. One
feature of mature Plasmodium falciparum-infected erythrocytes
leading to the development of severe malaria is thought to be cytoadherence and
blockage of the microvasculature. Therefore, an understanding of mechanisms that
mediate parasite adhesion leading to malaria pathology is needed to yield new
treatments for malaria. However, to date, cytoadherence-associated pathology is
still under debate. Is cytoadherence needed to develop severe malaria?
This review will discuss the available information on associations of
cytoadherence with the development of severe malaria.
cerebral malaria; cytoadherence; endothelium; malaria
A comparison of the job satisfaction of health care professionals has not been well studied in Malaysia. This study aimed to compare the job satisfaction level among 8 groups of health care professionals in private settings, using the Job Satisfaction Survey (JSS).
A total of 81 health care professionals, including nurses, physiotherapists, occupational therapists, medical laboratory technologists, dieticians, medical imaging practitioners, environmental health officers, and optometrists in private (non-government) settings in the Klang Valley, were interviewed using the Job Satisfaction Survey scale invented by Dr Paul E Spector. Their job satisfaction scores were calculated and determined.
In the demographic data, the majority of the subjects were 20–30 years old (81.5%), were female (72.8%), had a basic degree (98.8%), were single (64.2%), and had 1–5 years of working experience (83.9%). A Kruskal–Wallis analysis showed significant differences (P < 0.05) in promotion, supervision, operating conditions, co-workers, nature of the work, and communication, but there were no significant differences (P > 0.05) in pay, fringe benefits, and contingent rewards in JSS score among the 8 health care professions. The Friedman Test showed a significant difference of overall JSS scores (χ2 = 526.418, P < 0.001) among the 8 health care professions.
The overall job satisfaction levels are different among health care professionals in private settings, especially regarding promotion, supervision, operating conditions, co-workers, the nature of the work, and communication.
job satisfaction; health care; non-governmental organizations; private sector
Tooth erosion is a growing dental problem; however, the role of diet in the aetiology of tooth erosion is unclear. A cross-sectional study was conducted to determine the association between tooth erosion occurrence and the consumption of acidic foods and drinks among undergraduate university students.
A total of 150 undergraduate students (33 males and 117 females) aged 19 to 24 years at Universiti Kebangsaan Malaysia participated in this study. The Basic Erosive Wear Examination was used to assess the occurrence of tooth erosion. Information regarding dental hygiene practices, usual dietary habits, and consumption of acidic foods and drinks was obtained through a structured questionnaire.
In all, 68% of subjects had tooth erosion. Subjects who reported having received information about healthy eating were less likely to have tooth erosion (χ2 [1, N = 150] = 7.328, P = 0.007). The frequencies of milk (OR = 0.29, 95% CI = 0.13–0.67) and tea/coffee (adjusted OR = 0.42, 95% CI = 0.19–0.95) consumption were negatively associated with tooth erosion. Dental hygiene practice, the frequency and amount of acidic food and drink intake, and body mass index classification were not significantly associated with the risk of tooth erosion (P > 0.05).
A high prevalence of tooth erosion was observed among this group of students. Preventive measures, such as dietary advice and increased consumption of milk at a younger age, may reduce the occurrence of tooth erosion among this age group.
beverages; cross-sectional study; food habits; public health; tooth erosion; young adult
Neurologic and airway compromise as a result of traumatic vascular injuries to the neck region often lead to more severe complications and thus require special consideration. Furthermore, these cases pose diagnostic and therapeutic challenges to healthcare providers. Here, we report a case of a 28-year-old motorcyclist presenting with progressively enlarged Zone 2 neck swelling on the left side following a high impact collision. There were no symptoms or signs suggesting neurologic or laryngeal injury. Computed tomography angiogram of the neck revealed signs of an active arterial bleed. The apparent vascular injury was managed by close observation for signs of airway compromise, urgent angiogram, and selective catheter embolisation of the left lingual artery. The patient subsequently recovered without further operative exploration of the neck. At 6 months post-trauma, the neck swelling fully subsided with no complications from angioembolisation. This case illustrates the individualised treatment and multidisciplinary approach in managing such cases. We review our rationale for this diagnostic and therapeutic approach.
diagnostic imaging; embolisation; neck; trauma; vascular system injury
Coronary heart disease (CHD) was the second leading cause of death in Malaysia in 2006. CHD has known risk factors including hypertension, diabetes mellitus, and obesity.
This cross-sectional study examined the prevalence of cardiovascular risk factors among 260 participants aged 20 to 65 years in a rural community in Sarawak.
The prevalences of overweight and obesity in this study were 39.6% and 11.9%, respectively. Approximately 13% of participants had hypertension, and 1.5% had a random blood sugar greater than 11.1 mmol/L. Chi-square tests showed significant associations between obesity and gender (P = 0.007), low high-density lipoprotein cholesterol and race (P = 0.05), high total cholesterol and age (P = 0.007), age and hypertension (P = 0.011), smoking and gender (P < 0.001), and smoking and income (P = 0.050). Age-adjusted logistic regression showed that women were 0.246 times more likely to be obese, that older participants (> 45 years) were 0.395 times more likely to have high cholesterol and that those with a higher monthly household income (> RM830) were 2.471 times more likely to smoke.
These findings indicate that we should be concerned about the high rates of overweight in this rural community to prevent obesity.
adult; cardiovascular diseases; epidemiology; obesity; prevalence; risk factors
Acute meningoencephalitis is an important cause of morbidity and mortality around the globe. The objective of this study was to examine the distribution of acute meningoencephalitis and its aetiological agents among children admitted to a tertiary hospital in southern Bangladesh.
This prospective study was carried out in Khulna Medical College Hospital from 2007 to 2009. All of the admitted children between 1 month and 12 years of age were enrolled over a 2-year period if they met the inclusion criteria of having an acute onset of fever (≤ 14 days) and any of the following 3 signs: neck stiffness, convulsion, or altered mental status. Cerebrospinal fluid (CSF) was collected within hours and sent to the laboratory for cytological and biochemical analyses. CSF was examined by Gram staining and a latex agglutination test to detect common bacteria. Serum and CSF were also tested for Japanese encephalitis virus antibodies.
A total of 140 children were included in the study, which accounted for 2.5% of admissions between 2007 and 2009. The number of acute meningoencephalitis cases was relatively higher (37.9%) during the monsoon season. The CSF report revealed a pyogenic form in 24 (18.5%) and a viral form in 13 (10.0%) cases. Altered mental status was significantly less frequent (P < 0.001) in cases of pyogenic meningoencephalitis (62.5%) than in cases of non-pyogenic meningoencephalitis (93.4%). Bacterial causes were identified in 11 (8.5%) children; the causative agents included Streptococcus pneumoniae (n = 8), Neisseria meningitides (n = 2), and Haemophilus influenzae (n = 1). Three (2.3%) patients were positive for Japanese encephalitis virus.
S. pneumoniae was the most common bacteria causing acute meningoencephalitis among the study subjects, and Japanese encephalitis virus was present in few patients.
aetiology; Bangladesh; children; infectious diseases; meningoencephalitis; symptoms
Brain disorders account for more than 34% of the global burden of disease, crippling nations by decreasing their “mental capital”—with greater effect in developing countries. Early detection is the key to their management, but establishing such programmes seems nearly impossible due to the high prevalence of the dysfunctions as compared with the high cost of neuroimaging devices. Thus, at first sight, the research of the Decade of the Brain and the international Human Brain Mapping Project might seem to be condemned to benefit only a small elite. Cuba has shown that is not so by using neurotechnology for the last 3 decades to implement stratified active screening programmes for brain disorders at the population level. This experience has shown that, by the transformation of health indicators, an appropriate use of technology can be integrated with attention to the population at the primary levels of both health care and education. An essential component of neurotechnology is neuroinformatics, which—like its counterpart bioinformatics—combines databases, analysis tools, and theoretical models to craft tools for early disease diagnosis and management. Much work remains to be done and will depend critically on south—south cooperation to solve problems for countries with similar situations.
brain disorders; international cooperation; medical informatics; neuroimaging; neurosciences; technology
Thailand is one of the developing countries encountering medical workforce shortage. From the national registry in 2006, there were 33 166 physicians: 41.5% worked in the government sector, 21.6% worked in the private sector, and the remaining worked in non-medical fields. There is no current data to confirm the effectiveness of the national policy to increase physician production. We demonstrate our findings from the strength, weakness, opportunity, and threat (SWOT) analysis in medical students and the potential impact on national workforce planning.
We introduced SWOT analysis to 568 medical students during the 2008–2010 academic years, with the objective of becoming “a good physician in the future”.
Pertinent issues were grouped into 4 categories: not wanting to be a doctor, having inadequate medical professional skills, not wanting to work in rural or community areas, and planning to pursue training in specialties with high salary/low workload/low risk for lawsuit. The percentages of medical students who described themselves as “do not want to be a doctor” and “do not want to work in rural or community areas” increased from 7.07% and 25.00% in 2008 to 12.56% and 29.65% in 2010, respectively.
Further intervention should be considered in order to change the medical students attitudes on the profession and their impact on Thai health system.
health planning; health systems plans; medical students; manpower
Cocaine- and amphetamine-regulated transcript (CART) is a hypothalamic anorectic neuropeptide that controls feeding behaviour and body weight. The study objective was to investigate the association of the CART prepropeptide gene (CARTPT) rs2239670 variant with obesity and its related anthropometric indicators among patients of a Malaysian health clinic in Kampar, Perak, Malaysia.
A total of 300 Malay/Peninsular Bumiputera, Chinese, and Indian subjects (115 males, 185 females; 163 non-obese, 137 obese) were recruited by convenience sampling, and anthropometric measurements, blood pressures, and pulse rate were taken. Genotyping was performed using AvaII polymerase chain reaction–restriction fragment length polymorphism.
Genotyping revealed 203 (67.7%), 90 (30.0%), and 7 (2.3%) subjects with the GG, GA, and AA genotypes, respectively, with a minor allele (A) frequency of 0.17. No significant difference in the CARTPT rs2239670 genotype and allele distribution was found between obese and non-obese subjects, and logistic regression showed no association between the mutated genotypes (GA, AA) and allele (A) with obesity, even after adjusting for age, gender, and ethnicity. Furthermore, the measurements did not differ significantly between the genotypes and alleles. No significant difference in the genotype and allele distribution was found among genders, but they were significantly different among ethnicities (P = 0.030 and P = 0.019, respectively).
CARTPT rs2239670 is not a predictor for obesity among the Malaysian subjects in this study.
cocaine- and amphetamine-regulated transcript protein; anthropometry; genetic association study; obesity; single nucleotide polymorphism; Malaysia
TSA (thiol-specific antioxidant antigen) is the immune-dominant antigen of Leishmania major and is considered to be the most promising candidate molecule for a recombinant or DNA vaccine against leishmaniasis. The aim of the present work was to express a plasmid containing the TSA gene in eukaryotic cells.
Genomic DNA was extracted, and the TSA gene was amplified by polymerase chain reaction (PCR). The PCR product was cloned into the pTZ57R/T vector, followed by subcloning into the eukaryotic expression vector pcDNA3 (EcoRI and HindIII sites). The recombinant plasmid was characterised by restriction digest and PCR. Eukaryotic Chinese hamster ovary cells were transfected with the plasmid containing the TSA gene. Expression of the L. major TSA gene was confirmed by sodium dodecyl sulphate–polyacrylamide gel electrophoresis and Western blotting.
The plasmid containing the TSA gene was successfully expressed, as demonstrated by a band of 22.1 kDa on Western blots.
The plasmid containing the TSA gene can be expressed in a eukaryotic cell line. Thus, the recombinant plasmid may potentially be used as a DNA vaccine in animal models.
CHO cells; gene expression; genetics; Leishmania major; plasmid; recombinant DNA
Calabash chalk is a naturally occurring mineral consumed by members of some
Nigerian communities for pleasure and by pregnant women as a remedy for
morning sickness. The consumption of this geophagic material motivated our
interest on the effect of the chalk on the histomorphology of the
Twenty-eight young Wistar rats, 4 weeks old, were divided into 4 groups of
equal size. Group 1 animals served as controls and received 1 mL of
distilled water. Groups 2, 3, and 4 received orally 1 mL of a Calabash chalk
suspension containing 40 mg/mL for 14, 21, and 28 days, respectively. Upon
completion of the treatments, the animals in groups 2, 3, and 4 were
sacrificed on days 15, 22, and 29, respectively, and the control group
animals were sacrificed on day 29. All animals were euthanised using
chloroform anaesthesia. The oesophagus and the stomach of each animal were
dissected out and routinely processed for histological studies.
There was oedema with haemorrhages in the mucosa of the stomach, and
acanthosis, hyperkeratosis, and koilocytic changes were observed in the
mucosa of the oesophagus of the groups treated with 40 mg/mL of Calabash
Calabash chalk caused histological changes to the stomach and the oesophagus
that may lead to other pathophysiological conditions.
Calabash chalk; gut; stomach; oesophagus; histology; Wistar rats
Spontaneous perforation of the extrahepatic bile duct leading to biliary peritonitis is a rare occurrence once other causes of biliary peritonitis, such as trauma, choledochal cyst, stone diseases, and distal atresia of the bile duct, are ruled out. A 7-month-old male infant was brought to the hospital in critical condition with distension of the abdomen. He had a history of vomiting and diarrhoea, low-grade fever, and refusal to feed for 2 days. Signs of peritonitis were found upon examination. Due to the poor general condition of the patient, the case was taken up for laparotomy, and a diagnosis of spontaneous extrahepatic bile duct perforation was made intra-operatively. In the present case, the cause was idiopathic. An external drain was placed near the site of the leak for 2 weeks. The patient recovered well and was discharged on post-operative day 16. Disease awareness for correct pre-operative diagnosis and interventional planning is required to reduce mortality, morbidity, and complications in spontaneous perforation of the common bile duct.
bile duct diseases; extrahepatic bile duct; gut; perforation; peritonitis; spontaneous rupture
Pheochromocytoma during pregnancy is potentially disastrous to the mother and fetus. Its ambiguous presentation is often mistaken for pre-eclampsia, although it may imitate other problems during pregnancy. Early diagnosis and timely, appropriate management reduces possible maternal and fetal complications. We identified a case of pheochromocytoma during pregnancy; the condition was initially diagnosed as pre-eclampsia complicated with gestational diabetes. Surgical intervention via left adrenalectomy was successfully performed in the second trimester. After surgery, all of the patient’s medical problems nearly subsided and she did not require further treatment. However, her fetus displayed restricted intrauterine growth, and the patient eventually had premature delivery via a caesarean section. A multidisciplinary team to identify and treat pheochromocytoma is mandatory to ensure optimal conditions for tumour removal and to anticipate any possible catastrophic events.
gestational diabetes; gynaecologic oncology; hypertension; pheochromocytoma; pregnancy; proteinuria