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This paper investigates the effect of socioeconomic status (age, education, stratum, marital status, ethnicity, employment status, income and number of children) on the health of older Malaysian women. Data from the female sample of the 1999 IRPA study on Perception of Needs and Problems of the Elderly: Implications on Policies and Programmes" were used. Five measures for health (self rated health, relative health, number of health problems, functional independence and use of health screening) were selected as dependent variables where bivariate and multivariate analyses were performed. Results showed that the nine independent variables combined accounted for 4.1% to 11% of the variance in the respective measures of health. Predictors for the selected health indicators from the regression analysis were ethnicity, income adequacy, age and income category. This study has demonstrated that the socioeconomic status of older women is closely linked with health outcomes. Asia Pac J Public Health 2006; 18(Suppl.): 42-53. [ABSTRACT FROM PUBLISHER]

With a rapidly growing older population in Malaysia, there is an urgent need in determining reference values that meet the minimum requirements for designing an ergonomically friendly home environment for the elderly. A comfortable, safe and satisfactory match between the artefact and the elderly can be achieved if such reference values are available. A study was conducted to develop an anthropometric database of older Malaysians to be used as a standard reference in designing the home for the elderly. This paper presents some of the anthropometric data obtained and highlights the design implications for an elderly friendly home environment and the potential use of the anthropometric data. Thirty-nine anthropometric body dimensions were measured and recorded for 230 respondents aged 60 years and over in five urban locations (Kuala Lumpur, Shah Alam, Petaling Jaya, Ampang and Johor Bahru). Respondents consisted of 129 males (56.1 %) and 101 females (43.9%), with a mean age of 67 years. With the availability of anthropometric dimensions of the elderly, better home environments can be designed for older Malaysians in the population. Asia Pac J Public Health 2006;18(SuppL): 35-41. [ABSTRACT FROM PUBLISHER]

This paper examined the pattern of living arrangements and health status of the older persons, to assess the effect of various living arrangement on older persons' economic well being and life satisfaction. Results indicate that more than half of older persons live alone with no other kin and one-fourth co-reside with either their children or other individuals. Majority of those living alone were widowed Malay females, aged 65 years and above, who had no formal or low education, had low health status and spent the least on health. However, the number of older persons living alone decreased as the number of living children increased. Gender preference for the co-residence children varies according to ethnicity. Given their sources and amount of income and their health status, older persons were better off co-residing either with children or others, as the older persons also require non-financial assistance especially when they are ill. However, co-residing older persons reported low life satisfaction compared to their counterparts living alone. Asia Pac J Public Health 2006; 18(Suppl.): 26-34. [ABSTRACT FROM PUBLISHER]

The lack of anthropometric dimensions for the elderly can severely limit the ability to design suitable products and living facilities for them. In this paper, the static anthropometry data of 230 elderly people in Malaysia (male and female) aged 60 and above was compared with the anthropometric dimensions of various populations obtained from the literature. These comparisons can give some indications of the relative sizes of various populations in the world and provide guidelines when designing in this globalised economy. Using mean stature, it was found that the female elderly Malaysian has an average height of 148.9 cm as compared to the Polish (152.4 cm), Chilean (151.2 cm), Dutch (154.3 cm), British (151.5 cm) and Australian (152.8 cm) elderly female. For the elderly Malaysian male, the average height is 162.4 cm as compared to the Chilean (165.8 cm), Dutch (165.6 cm), British (164 cm) and Australian (165 cm) elderly male. This variation in stature amongst populations clearly demonstrates the need to collect anthropometric data to match the living environment with the body dimensions of the expected users. Properly designed, the living environment can increase the comfort, safety and health of the elderly. Asia Pac J Public Health 2006; 18(Suppl.):20-25. [ABSTRACT FROM PUBLISHER]

The lack of income in old age often results in low quality housing options for the elderly. This paper aims to determine the level of housing satisfaction among elderly poor in Peninsular Malaysia. This study involved 485 older welfare recipients from Kelantan, Kedah, Malacca and Perak. The average monthly income of the respondents was RM147.48 (Median = 135, SD = 46.68). Results showed that a majority of the respondents lived in traditional houses with low quality construction material (plank, cement and zinc). About half of the respondents are owners of their present dwelling but more than half did not meet basic housing requirements. Nevertheless, almost three quarter of them were satisfied with the present housing condition. Relatives and neighbours play an important role in providing shelter and assistance to this vulnerable group. Multiple regression analysis showed that satisfaction towards housing was significantly related to financial satisfaction. In general, the elderly dissatisfaction with their housing was high to moderate (2.24 ± 0.480). It indicated a skewed and unrealistic level of housing satisfaction among the elderly poor. This is perhaps attributable to the fact that most of them were grateful for simply having a roof over their heads. Asia Pac J Public Health 2006; 18(Suppl. ): 14-19. [ABSTRACT FROM PUBLISHER]

The advent of population ageing brings forth the issues such as income adequacy and health of older persons. The main objective of this paper is to investigate the relationship between the two variables. Results showed that there is a significant relationship between perception of income adequacy and self rated health (χ 2 = 104.52, df = 12, p<0.001). Older persons with poorer self assessment of health would probably require more medical attention which they might not be able to afford and this demand might result in the awareness of income inadequacy. The data also showed that older women who have more health problems, were mostly widows and have lower and fewer sources of income. Expenditure on health and medical care was low because a majority of the respondents were staying with their children, and can be relied on to pay for their expenses. Since Malaysia is fast becoming an aged nation, there is more need to raise awareness among the younger groups in preparedness for their old age. Asia Pac J Public Health 2006; 18(Suppl.): 2-8. [ABSTRACT FROM PUBLISHER]

BACKGROUND: In 2009, a pandemic (pdm) influenza A(H1N1) virus infection quickly circulated globally resulting in about 18,000 deaths around the world. In Japan, infected patients accounted for 16% of the total population. The possibility of human-to-human transmission of highly pathogenic novel influenza viruses is becoming a fear for human health and society. METHODOLOGY: To address the clinical need for rapid diagnosis, we have developed a new method, the "RT-SmartAmp assay", to rapidly detect the 2009 pandemic influenza A(H1N1) virus from patient swab samples. The RT-SmartAmp assay comprises both reverse transcriptase (RT) and isothermal DNA amplification reactions in one step, where RNA extraction and PCR reaction are not required. We used an exciton-controlled hybridization-sensitive fluorescent primer to specifically detect the HA segment of the 2009 pdm influenza A(H1N1) virus within 40 minutes without cross-reacting with the seasonal A(H1N1), A(H3N2), or B-type (Victoria) viruses. RESULTS AND CONCLUSIONS: We evaluated the RT-SmartAmp method in clinical research carried out in Japan during a pandemic period of October 2009 to January 2010. A total of 255 swab samples were collected from outpatients with influenza-like illness at three hospitals and eleven clinics located in the Tokyo and Chiba areas in Japan. The 2009 pdm influenza A(H1N1) virus was detected by the RT-SmartAmp assay, and the detection results were subsequently compared with data of current influenza diagnostic tests (lateral flow immuno-chromatographic tests) and viral genome sequence analysis. In conclusion, by the RT-SmartAmp assay we could detect the 2009 pdm influenza A(H1N1) virus in patients' swab samples even in early stages after the initial onset of influenza symptoms. Thus, the RT-SmartAmp assay is considered to provide a simple and practical tool to rapidly detect the 2009 pdm influenza A(H1N1) virus.

Introduction: In April 2008, Japan launched a radical reform in regional health planning that emphasized the development of disease-oriented clinical care pathways. These 'inter-provider critical paths' have sought to ensure effective integration of various providers ranging among primary care practitioners, acute care hospitals, rehabilitation hospitals, long-term care facilities and home care. Description of policy practice: All 47 prefectures in Japan developed their Regional Health Plans pursuant to the guideline requiring that these should include at least four diseases: diabetes, acute myocardial infarction, cerebrovascular accident and cancer. To illustrate the care pathways developed, this paper describes the guideline referring to strokes and provides examples of the new Regional Health Plans as well as examples of disease-oriented inter-provider clinical paths. In particular, the paper examines the development of information sharing through electronic health records (EHR) to enhance effective integration among providers is discussed. Discussion and conclusion: Japan's reform in 2008 is unique in that the concept of "disease-oriented regional inter-provider critical paths" was adopted as a national policy and all 47 prefectures developed their Regional Health Plans simultaneously. How much the new regional health planning policy has improved the quality and outcome of care remains to be seen and will be evaluated in 2013 after the five year planned period of implementation has concluded. Whilst electronic health records appear to be a useful tool in supporting care integration they do not guarantee success in the application of an inter-provider critical path.

BackgroundPandemic influenza A(H1N1) virus infection quickly circulated worldwide in 2009. In Japan, the first case was reported in May 2009, one month after its outbreak in Mexico. Thereafter, A(H1N1) infection spread widely throughout the country. It is of great importance to profile and understand the situation regarding viral mutations and their circulation in Japan to accumulate a knowledge base and to prepare clinical response platforms before a second pandemic (pdm) wave emerges.MethodologyA total of 253 swab samples were collected from patients with influenza-like illness in the Osaka, Tokyo, and Chiba areas both in May 2009 and between October 2009 and January 2010. We analyzed partial sequences of the hemagglutinin (HA) and neuraminidase (NA) genes of the 2009 pdm influenza virus in the collected clinical samples. By phylogenetic analysis, we identified major variants of the 2009 pdm influenza virus and critical mutations associated with severe cases, including drug-resistance mutations.Results and conclusionsOur sequence analysis has revealed that both HA-S220T and NA-N248D are major non-synonymous mutations that clearly discriminate the 2009 pdm influenza viruses identified in the very early phase (May 2009) from those found in the peak phase (October 2009 to January 2010) in Japan. By phylogenetic analysis, we found 14 micro-clades within the viruses collected during the peak phase. Among them, 12 were new micro-clades, while two were previously reported. Oseltamivir resistance-related mutations, i.e., NA-H275Y and NA-N295S, were also detected in sporadic cases in Osaka and Tokyo.

Background: The period of hospital stay and the first month after discharge have been found to be the most problematic stages for family caregivers of stroke survivors. It is just at home that patients and caregivers actually understand the whole consequences of the stroke. The adult offspring often have more different needs and concerns than spousal caregivers. However, relatively little attention has been paid to the needs of this particular group of caregivers. Therefore, this qualitative content analysis study aimed to explore the supportive needs and coping behaviors of daughter and daughter in-law caregivers (DILs) of stroke survivors one month after the patient's discharge from the hospital in Shiraz, Southern of Iran., Methods: This is a qualitative content analysis study using semi-structured and in-depth interviews with a purposive sampling of seventeen daughter and daughter in-law caregivers., Results: The data revealed seven major themes including information and training, financial support, home health care assistance need, self-care support need, adjusting with the cultural obligation in providing care for a parent in-law, and need for improving quality of hospital care. Also, data from the interview showed that daughter and daughter in-law caregivers mostly used emotional-oriented coping strategies, specially religiosity, to cope with their needs and problems in their care-giving role., Conclusion: The results of this qualitative study revealed that family caregivers have several unmet needs in their care-giving role. By providing individualized information and support, we can prepare these family caregivers to better cope with the home care needs of stroke survivors and regain control over aspects of life.

Tuberculosis, an ancient disease continues to be a health care burden in Malaysia in the 21st century. Extrapulmonary tuberculosis is a less common presentation of tuberculosis and in particular peripancreatic tuberculous lymphadenitis is rarely seen. We report a case of a young immunocompetent boy presenting with a two month history of non productive chronic cough associated with loss of appetite and loss of weight. Investigations including CT Scan and Endoscopic ultrasound revealed multiple mediastinal lymphadenopathy and peripancreatic lymphadenopathy with central caseation necrosis. Histology of cervical lymph node was suggestive of tuberculosis and mycobacterium PCR was positive. The patient was subsequently treated with antituberculous therapy and had marked clinical improvement of his symptoms. This case outlines a rare presentation of a common disease and the application of newer investigative tools in making the diagnosis.

Aim: To evaluate the feasibility of diagnostic and therapeutic transgastric (TG) peritoneoscopic interventions with a forward-viewing endoscopic ultrasound (FV-EUS)., Methods: This prospective endoscopic experimental study used an animal model. Combined TG peritoneoscopic interventions and EUS examination of the intra-abdominal organs were performed using an FV-EUS on 10 animal models (1 porcine and 9 canine). The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs, EUS-guided fine needle aspiration (EUS-FNA), EUS-guided radiofrequency ablation (EUS-RFA), and argon plasma coagulation (APC) for hemostatic control. The animals were kept alive for 7 d, and then necropsy was performed to evaluate results and complications., Results: In all 10 animals, TG peritoneoscopy, followed by endoscopic biopsy for the liver, spleen, abdominal wall, and omentum, was performed successfully. APC helped control minor bleeding. Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease. Intraperitoneal EUS-FNA was successfully performed on the liver, spleen, and kidney. Similarly, a successful outcome was achieved with EUS-RFA of the hepatic parenchyma. No adverse events were recorded during the study., Conclusion: Peritoneoscopic natural orifice transluminal endoscopic surgery (NOTES) interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures. It promises potential as a platform for future EUS-based NOTES.

This article investigates the influence of perceived health status on the daily activity participation of older Malaysians. Data from the Survey on Perceptions of Needs and Problems of the Elderly, which was conducted in 1999, were used. The negative binomial regression results show that older persons with good perceived health status reported more varieties of daily activity participation, especially among the uneducated and those with below-average self-esteem. The multinomial logistic regression model suggests that older persons with good perceived health status tended to engage daily in paid work only or with leisure activities, whereas those perceived to have poor health were more likely to engage in leisure activities only or leisure and family role activities. Promotion of a healthy lifestyle at a younger age encourages every person to monitor and take responsibility for their own health, which is a necessary strategy to ensure active participation at an older age, and thus improve their well-being.

Knowledge of the characteristics of older adults with type 2 diabetes mellitus (T2DM) is indispensible for improvement of their care. A cross-sectional study in two rural public primary healthcare centres in Malaysia identified 170 actively engaged older patients with T2DM, with suboptimal glycaemic control and frequent hypoglycaemia. The prevalence of multiple co-morbidities, complications of T2DM, high cardiovascular risk, neurological, musculoskeletal and visual deficits suggested high risk of disabilities and dependency but not yet disabled. This short window for interventions presents as an opportunity for development of a more comprehensive approach extending beyond glycaemia control to risk management, preventing functional loss and continuity of social participation.