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Objective: This paper aims to discuss the answers to a Critical Review Paper used in the Malaysian Master of Medicine (Psychiatry) and Master of Psychological Medicine examination conducted in May 2013. Methods: One part of this broader postgraduate examination is to evaluate the students' skills of critical appraisal through answering questions based on a journal paper. Results: Model answers were provided at the end of the Critical Review Paper. The objective of the study presented in the review paper was to investigate the association of cigarette smoking with verbal working memory and psychopathology of patients with schizophrenia. Conclusion: This review paper had fairly evaluated the students' understanding and critical thinking on the given topic. This paper may serve as a guideline to teach students how to critically appraise research papers related to psychiatry. [ABSTRACT FROM AUTHOR]

Objectives: This paper examines the ethnic and gender differentials in high blood pressure (HBP), diabetes, coronary heart disease (CHD), arthritis and asthma among older people in Malaysia, and how these diseases along with other factors affect self-rated health. Differentials in the prevalence of non-communicable diseases among older people are examined in the context of socio-cultural perspectives in multi-ethnic Malaysia. Methods: Data for this paper are obtained from the 2004 Malaysian Population and Family Survey. The survey covered a nationally representative sample of 3,406 persons aged 50 and over, comprising three main ethnic groups (Malays, Chinese and Indians) and all other indigenous groups. Bivariate analyses and hierarchical logistic regression were used in the analyses. Results: Arthritis was the most common non-communicable disease (NCD), followed by HBP, diabetes, asthma and CHD. Older females were more likely than males to have arthritis and HBP, but males were more likely to have asthma. Diabetes and CHD were most prevalent among Indians, while arthritis and HBP were most prevalent among the Indigenous groups. Older people were more likely to report poor health if they suffered from NCD, especially CHD. Controlling for socio-economic, health and lifestyle factors, Chinese were least likely to report poor health, whereas Indians and Indigenous people were more likely to do so. Chinese that had HBP were more likely to report poor health compared to other ethnic groups with the same disease. Among those with arthritis, Indians were more likely to report poor health. Conclusion: Perceived health status and prevalence of arthritis, HBP, diabetes, asthma and CHD varied widely across ethnic groups. Promotion of healthy lifestyle, early detection and timely intervention of NCDs affecting different ethnic groups and gender with socio-cultural orientations would go a long way in alleviating the debilitating effects of the common NCDs among older people. [ABSTRACT FROM AUTHOR]

The objective of this paper is to assess the attitude of Malaysian stakeholders to genetically modified (GM) salmon and to identify the factors that influence their acceptance of GM salmon using a structural equation model. A survey was carried out on 434 representatives from various stakeholder groups in the Klang Valley region of Malaysia. Public attitude towards GM salmon was measured using self-developed questionnaires with seven-point Likert scales. The findings of this study have confirmed that public attitudes towards GM salmon is a complex issue and should be seen as a multi-faceted process. The most important direct predictors for the encouragement of GM salmon are the specific application-linked perceptions about religious acceptability of GM salmon followed by perceived risks and benefits, familiarity, and general promise of modern biotechnology. Encouragement of GM salmon also involves the interplay among other factors such as general concerns of biotechnology, threatening the natural order of things, the need for labeling, the need for patenting, confidence in regulation, and societal values. The research findings can serve as a database that will be useful for understanding the social construct of public attitude towards GM foods in a developing country. [ABSTRACT FROM AUTHOR]

The Water-associated Disease Index (WADI) was developed to identify and visualize vulnerability to different water-associated diseases by integrating a range of social and biophysical determinants in map format. In this study vulnerability is used to encompass conditions of exposure, susceptibility, and differential coping capacity to a water-associated health hazard. By assessing these conditions, the tool is designed to provide stakeholders with an integrated and long-term understanding of subnational vulnerabilities to water-associated disease and contribute to intervention strategies to reduce the burden of illness. The objective of this paper is to describe and validate the WADI tool by applying it to dengue. A systemic ecohealth framework that considers links between people, the environment and health was applied to identify secondary datasets, populating the index with components including climate conditions, land cover, education status and water use practices. Data were aggregated to create composite indicators of exposure and of susceptibility in a Geographic Information System (GIS). These indicators were weighted by their contribution to dengue vulnerability, and the output consisted of an overall index visualized in map format. The WADI was validated in this Malaysia case study, demonstrating a significant association with dengue rates at a sub-national level, and illustrating a range of factors that drive vulnerability to the disease within the country. The index output indicated high vulnerability to dengue in urban areas, especially in the capital Kuala Lumpur and surrounding region. However, in other regions, vulnerability to dengue varied throughout the year due to the influence of seasonal climate conditions, such as monsoon patterns. The WADI tool complements early warning models for water-associated disease by providing upstream information for planning prevention and control approaches, which increasingly require a comprehensive and geographically broad understanding of vulnerability for implementation. [ABSTRACT FROM AUTHOR]

This article focuses on the life of medical doctor Kōzō Andō (安藤公三) and his family as My word count now says it is 198 words Japanese citizens in the British Empire, medical practitioners within inter-imperial biomedical frameworks and as intermediaries of Japanese imperialism during the Japanese occupation of Southeast Asia in World War II. The Andō family came to settle on the Malay peninsula in the late nineteenth century which was under the control of the British but still part of Japan's nan'yō imaginary. Both Kōzō Andō and his younger brother Jun'ichiro (安藤純一郎) were trained as medical doctors at the King Edward VII Medical College in Singapore, one of the well-regarded training institutions for medicine in the British Empire and Southeast Asia at the time. When Japan invaded Malaya, Kōzō Andō was made Chief Medical Officer of Syonan (Singapore), a position which he held until his retirement and return to Japan in 1943. The life of Kōzō Andō points to his ambiguous situation in Malaya under British and Japanese empires due to his positionality as Japanese, as part of a larger Asian racial category in Malaya, and as a medical doctor in an inter-imperial setting. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) technology is growing at a fast pace and permeates many aspects of people’s daily lives. Medical students’ inclination towards AI in the medical field increases the probability of successful AI adoption and its value in the medical field. This study was conducted to evaluate medical AI readiness among undergraduate medical students. A cross-sectional study was conducted from March 2022 to April 2022 in a private medical institution in Malaysia. A non-probability purposive sampling method was used to enroll students and a questionnaire was distributed online via Google Forms. The questionnaire, captioned “Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS)”, was used for data collection. The analysis included frequency tables, percentages, standard deviation, unpaired t-test, and analysis of variance (ANOVA) test. Out of 105 participants, 67.62% scored 53 to 83, followed by 24.76%, who scored 84 to 114, and 7.62%, who scored 22 to 52 on the medical AI readiness scale. The mean of the total score of medical AI readiness obtained was 75.04. There were significant correlations between age and study year with the ability, vision, and ethics domains of medical AI readiness. A significant association was observed between previous training with all four domains of medical AI readiness. Policymakers and the educational sector should set up more AI training centers to provide and introduce basic courses on AI. More AI courses should be provided to younger populations to engage in AI digital information earlier, thus enabling them to acquire more confidence in interacting with AI technology in the future. [ABSTRACT FROM AUTHOR]

An increase in the number of residents in nursing homes has become a significant concern due to the rise in medication demand and subsequently medication-related issues, especially in frail elderly. Community pharmacists are the closest healthcare professionals available that can contribute to this population to allow optimal utilization of the prescribed drugs and to prevent drug-related problems. The present study aimed to investigate the awareness of community pharmacists on issues regarding frail elderly and to determine their willingness in collaborative care of frail elderly in nursing homes and the services they are willing to offer. This was a cross-sectional study utilising a set of questionnaire that was delivered to practicing community pharmacists in Peninsular Malaysia from June 2018 until December 2018. Majority of the participants agreed to the fact that aging is the primary cause of frailty (n=98, 88.3%), and that chronic disease is also a cause of frailty (n=96, 86.5%). Most of the community pharmacists were also keen to participate in the collaborative care of frail elderly, and were willing to provide their pharmacy service to the frail elderly. There was a positive correlation between the awareness of community pharmacists on issues regarding frail elderly and their willingness on collaborative care of frail elderly in nursing homes (r=0.374, n=111, p=0.01). Majority of the pharmacists were aware of the issues regarding the frail elderly, and were willing to participate in the collaborative care of frail elderly in nursing home. [ABSTRACT FROM AUTHOR]

There are few studies on associations between respiratory health and allergens, fungal and bacterial compounds in schools in tropical countries. The aim was to study associations between respiratory symptoms in pupils and ethnicity, chemical microbial markers, allergens and fungal DNA in settled dust in schools in Malaysia. Totally 462 pupils (96%) from 8 randomly selected secondary schools in Johor Bahru, Malaysia, participated. Dust was vacuumed from 32 classrooms and analysed for levels of different types of endotoxin as 3-hydroxy fatty acids (3-OH), muramic acid, ergosterol, allergens and five fungal DNA sequences. Multiple logistic regression was applied. Totally 13.1% pupils reported doctor’s diagnosed asthma, 10.3% wheeze and 21.1% pollen or pet allergy. Indian and Chinese children had less atopy and asthma than Malay. Carbon dioxide levels were low (380–690 ppm). No cat (Fel d1), dog (Can f 1) or horse allergens (Ecu cx) were detected. The levels of Bloomia tropicalis (Blo t), house dust mite allergens (Der p 1, Der f 1, Der m 1) and cockroach allergens (Per a 1 and Bla g 1) were low. There were positive associations between levels of Aspergillus versicolor DNA and daytime breathlessness, between C14 3-OH and respiratory infections and between ergosterol and doctors diagnosed asthma. There were negative (protective) associations between levels of C10 3-OH and wheeze, between C16 3-OH and day time and night time breathlessness, between cockroach allergens and doctors diagnosed asthma. Moreover there were negative associations between amount of fine dust, total endotoxin (LPS) and respiratory infections. In conclusion, endotoxin at school seems to be mainly protective for respiratory illness but different types of endotoxin could have different effects. Fungal contamination measured as ergosterol and Aspergillus versicolor DNA can be risk factors for respiratory illness. The ethnical differences for atopy and asthma deserve further attention. [ABSTRACT FROM AUTHOR]

Thalassaemia screening programme has been conducted in Malaysia since 2004. The aim of the programme was to reduce the burden of the disease by identifying thalassaemia carriers. However, the response towards the screening activities was unsatisfactory as there was lack of public awareness against the importance of thalassaemia screening. An alternative approach is to screen blood donors. The purpose of this study was to observe the prevalence of thalassaemia carriers among healthy blood donors. Seven hundred and thirty eight healthy blood donors were screened in Hospital Tengku Ampuan Rahimah, Klang from July to September 2010 using cation-exchange high performance liquid chromatography (HPLC). Cases with haemoglobin variants were further analyzed by gel electrophoresis at alkaline pH. Result shows that the blood donors consisted of 413 Malays (56%), 162 Indians (22%), 148 Chinese (20%) and 15 others (2%). There were 19 (2.6%) individuals with haemoglobin E trait, six (0.8%) with co-inheritance of haemoglobin E and αα- thalassaemia and five (0.7%) with β-thalassaemia trait. Haemoglobin Constant Spring and haemoglobin A2 prime were observed in two (0.3%); and Haemoglobin Lepore and alpha chain variant in one (0.2%). αα-thalassaemia and normal haemoglobin A2 β-thalassaemia could not be excluded in 190 cases (26%), as they required deoxyribonucleic acid (DNA) studies for identification. Thalassaemia screening in blood donors is more feasible and effective. Therefore, a wider scale population screening including blood donors could benefit the existing thalassaemia screening programme in Malaysia. [ABSTRACT FROM AUTHOR]

Familial hypercholesterolemia (FH) is an autosomal dominant disorder characterized by elevations in total cholesterol (TC) and low density lipoprotein cholesterol (LDLc). Development of FH can result in the increase of risk for premature cardiovascular diseases (CVD). FH is primarily caused by genetic variations in Low Density Lipoprotein Receptor (LDLR), Apolipoprotein B (APOB) or Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) genes. Although FH has been extensively studied in the Caucasian population, there are limited reports of FH mutations in the Asian population. We investigated the association of previously reported genetic variants that are involved in lipid regulation in our study cohort. A total of 1536 polymorphisms previously implicated in FH were evaluated in 141 consecutive patients with clinical FH (defined by the Dutch Lipid Clinic Network criteria) and 111 unrelated control subjects without FH using high throughput microarray genotyping platform. Fourteen Single Nucleotide Polymorphisms (SNPs) were found to be significantly associated with FH, eleven with increased FH risk and three with decreased FH risk. Of the eleven SNPs associated with an increased risk of FH, only one SNP was found in the LDLR gene, seven in the APOB gene and three in the PCSK9 gene. SNP rs12720762 in APOB gene is associated with the highest risk of FH (odds ratio 14.78, p<0.001). Amongst the FH cases, 108 out of 141 (76.60%) have had at least one significant risk-associated SNP. Our study adds new information and knowledge on the genetic polymorphisms amongst Asians with FH, which may serve as potential markers in risk prediction and disease management. [ABSTRACT FROM AUTHOR]

Objective: The study aims to evaluate the predictors of non-prescription medicine purchasing patterns among pharmacy patrons in Malaysia. Methods: A cross-sectional nationwide study was undertaken in 2011 in sixty randomly selected community pharmacies across 14 Malaysian states. A pharmacy exit survey was conducted over a 6-month period across Malaysia. A one-stage random cluster sampling technique was employed as there was no national sampling framework available for conducting this survey. Face-to-face interviews using a validated and pre-tested questionnaire were conducted by trained data collectors. The non-prescription medicine purchasing pattern was explored and analysed descriptively. Chi-square/Fisher exact test was used to determine the association between study variables. Multinomial logistic regression analysis was used to determine the predictors of type of non-prescription medicine purchased. Results: A total of 2729 pharmacy patrons agreed to participate in 60 selected pharmacy outlets. A total of 3462 non-prescription medicine were purchased during the study period with an average of 1.3 medicines per participant. Most of the non-prescription medicine purchased was meant for alimentary tract and metabolism (31.8%), followed by respiratory system (19.4%) and musculoskeletal system (15.8%) usage. Factors found to be associated with the choice of non-prescription medicine purchased were age group [χ2 = 170.75, (df = 57), p<0.01], locality [χ2 = 48.16, (df = 19), p<0.01], gender [χ2 = 32.93, (df = 13), p = 0.002], ethnic group [χ2 = 118.89, (df = 39), p<0.01] and type of occupation [χ2 = 222.434, (df = 117), p<0.01]. Non-prescription medicine purchased defined about 20% of the variance in the combination of predictors such as locality, gender, age, ethnicity, type of occupation and household income. Conclusion: The predictors for selection of non-prescription medicine were locality (urban or rural), gender, age, ethnicity, type of occupation and household income per month. Future studies need to explore the safety and effectiveness of using these non-prescription medicines. [ABSTRACT FROM AUTHOR]

Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents. However, the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined. Thus, the aim of the present study was to assess any associations between breakfast consumption practices and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years. A self-administered questionnaire on dietary behaviour and lifestyle practices and a dietary food frequency questionnaire were used. Body composition and adiposity indices were determined using standard anthropometric measurement protocols and dual energy χ-ray absorptiometry (DXA). Mean age of the participants was 15.3±1.9 years. The majority of participants (71.2%) fell in the normal body mass index (BMI) ranges. Breakfast consumption patterns showed that only half of the participants (50%) were consuming breakfast daily. Gender-specific multivariate analyses (ANCOVA) showed that in both boys and girls, those eating breakfast at least 5 times a week had significantly lower body weight, body mass index (BMI), BMI z-scores, waist circumference, body fat mass and percent body fat (%BF) compared to infrequent breakfast eaters, after adjustment for age, household income, pubertal status, eating-out and snacking practices, daily energy intakes, and daily physical activity levels. The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity. Therefore, daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth. [ABSTRACT FROM AUTHOR]

Nipah virus (NiV) is a member of the genus Henipavirus, which emerged in Malaysia in 1998. In pigs, infection resulted in a predominantly non-lethal respiratory disease; however, infection in humans resulted in over 100 deaths. Nipah virus has continued to re-emerge in Bangladesh and India, and person-to-person transmission appeared in the outbreak. Although a number of NiV vaccine studies have been reported, there are currently no vaccines or treatments licensed for human use. In this study, we have developed a recombinant measles virus (rMV) vaccine expressing NiV envelope glycoproteins (rMV-HL-G and rMV-Ed-G). Vaccinated hamsters were completely protected against NiV challenge, while the mortality of unvaccinated control hamsters was 90%. We trialed our vaccine in a non-human primate model, African green monkeys. Upon intraperitoneal infection with NiV, monkeys showed several clinical signs of disease including severe depression, reduced ability to move and decreased food ingestion and died at 7 days post infection (dpi). Intranasal and oral inoculation induced similar clinical illness in monkeys, evident around 9 dpi, and resulted in a moribund stage around 14 dpi. Two monkeys immunized subcutaneously with rMV-Ed-G showed no clinical illness prior to euthanasia after challenge with NiV. Viral RNA was not detected in any organ samples collected from vaccinated monkeys, and no pathological changes were found upon histopathological examination. From our findings, we propose that rMV-NiV-G is an appropriate NiV vaccine candidate for use in humans. [ABSTRACT FROM AUTHOR]

The objectives of this study were to identify the most commonly used medicines for mainly prevalent ailments and to compare retail sector prices (RSPs), public sector prices (PSPs) and international reference prices (IRPs). A convenient sampling method was employed to survey 33 households in a metropolitan city. Each family was followed once a week for eight weeks to observe their diseases and medication usage. The RSPs and PSPs for per unit doses and defined daily doses (DDDs) were compared with the IRPs. The most common ailments identified were cardiovascular and endocrine disorders followed by central nervous system and musculoskeletal disorders. Accordingly, the most common drugs used were for the treatment of the above ailments. Among 81 commonly used medicines, 63 were branded and 18 were generic. Of the 81 drugs, 26 were essential drugs. Angiotensin-converting enzyme (ACE) inhibitors, beta-blockers and calcium channel blockers were among the most commonly used medicines. The differential between the prices of branded medicines and IRPs were found to be remarkable. This study further revealed that the majority of patients also used traditional medicines and nutritional supplements alongside their modern medicines. Wide variations were observed in RSPs and IRPs, warranting critical evaluation, regulation and emphasis on the economic aspects of drug policy. Widespread use of branded medicines in the absence of a national health insurance programme can lead to high out-of-pocket expenditures. Concomitant use of traditional medicines and nutritional supplements may have drug interaction potential, invoking detailed investigation for relevance. [ABSTRACT FROM AUTHOR]

The objective of this cross-sectional study was to determine the factors associated with the attitudes toward premarital sexual activities among school-going adolescents in Kelantan, Malaysia. It was conducted among 1032 secondary school students using a self-administered validated questionnaire. Multiple logistic regression revealed that the risk factors for having permissive attitudes toward practice of premarital sexual activities were male students (odds ratio [OR] = 1.83; 95% confidence interval [CI] = 1.34-2.48), being less religious (OR = 2.02; 95% CI = 1.49-2.73), and younger age group of students (13 to 14 years old; OR = 1.42; 95% CI = 1.05-1.92). Having good knowledge on sexual and reproductive health was a protective factor against permissive sexual attitude (OR = 0.27; 95% CI = 0.20-0.36). In conclusion, male and young adolescents were at risk of having permissive attitudes toward sexual behaviors, but good knowledge on sexual and reproductive health and being more religious may protect them from it. [ABSTRACT FROM PUBLISHER]

An enclave of animists in a predominantly Muslim nation, Temiars of peninsular Malaysia forge ingenious techniques to convert the commodities, concepts, and technologies that assault them towards their own religious and ideological uses. These aboriginal forest-dwellers, a Senoi or Orang Asli people known in the anthropological and psychological literature for their techniques of dreaming, use songs received in dreams for healing purposes. Temiars are Austroasiatic-speakers in a now Malay-dominant nation. Battling colonial and neo-colonial pressures in the Malay postcolony and the global economy, the members of this small-scale society take refuge in montane forests, yet they have long interacted with Malays, British colonists, Chinese and Tamils brought to work in British mines and plantations, and communist guerillas in the aftermath of the Second World War. The key element in their survival is a technique economically combining music, medicine, and culture. This medico-acoustic armature crafts the winds of breath, life, and voice into song. I explore how Temiars call on spirits through song, dance, and ceremony to address both individual and social wounds, as they craft their dances of healing and survival across the proverbial winds of history. Comparative materials on music, medicine, healing, and the environment from Africa, Europe, and elsewhere are examined. [ABSTRACT FROM AUTHOR]