The Role of Media and Retailer Message Recall on Malaysian Male Perceptions of E-Cigarette Use: The 2016 National Study of E-Cigarettes Prevalence

This study examined the perceptions of current smokers on electronic cigarette (EC) use, after exposure to information on EC use and its potential harms from various media and retail outlets. This cross-sectional study is a sub-analysis of the National Study of Electronic Cigarettes Prevalence (N = 4289) using the multi-stage stratified sampling method. Respondents were interviewed face-to-face by a trained data collector using a structured questionnaire printed in both Bahasa Malaysia and English. The analysis included 376 males who smoked conventional cigarettes and/or used ECs and reported ever seeing messages on ECs/vape in various platforms were analyzed using weighted simple and multiple logistic regression. Our findings showed different media types resulted in differing perceptions among smokers towards EC use especially between social media and conventional media. Those exposed to messages promoting EC in social media had higher odds of believing that ECs help people quit smoking (OR: 2.28), the urge to smoke is reduced by ECs (OR: 1.86), ECs are more effective than medication for quitting smoking (OR: 1.96), breathing is improved after using ECs (OR: 2.85), the smell of EC is better than a tobacco cigarette (OR: 2.73), and ECs should be regulated rather than banned completely (OR: 3.08). Vape shops, social, and conventional media provided very different perceptions among smokers towards EC use. Beyond using traditional communication channels, EC promoters have successfully utilized social media to promote ECs among smokers.

Methadone maintenance therapy (MMT): low versus high regulated model

Introduction

In Malaysia, MMT started with low regulated model since year 2002 to address increasing prevalence of HIV/AIDS among intravenous drug users. However, fear of widespread diversion and overdose death forced the government to implement high regulated MMT model. Universiti Malaya conducted both model among self-sponsored(low supervision) and government-sponsored(high supervison) program.

Objectives

To investigate the biodemographic profiles, psychosocial correlates, pattern of substance use, methadone dosing and client satisfaction level among the two groups.

Methods

We conducted a cross sectional study involving 50 clients from each model. The inclusion criteria inludes opiates dependents age > 18 years and above with written consent using convenience sampling from October to December 2008. Semistructured questionare for demographic and pattern of substance use interview, MINI Neuropsychiatric interview for psychiatric morbidity and CSQ-8 for client satisfaction measurement. Analysis was done using SPSS version 16.

Results

All the participants are males with the mean age of 40 years. 61% are married and 90% are employed during the interview. 80% received MMT more than one year and 65% achieved maintenance dose more than 50mg daily. 68% used substance more than 10 years prior to the MMT and 73% starts using heroin below age of 20 years old. 57% have comorbid psychiatric illness(anti-social personality, major depression and psychotic disorders) and 33% have medical illness(HIV+, Hepatitis B/C and tuberculosis). There were no significance difference in demographic profiles, pattern of substance use, psychiatric/medical comorbidities and clients satisfasfaction level between the two groups.

Conclusion

Both group are similar from the clients satisfaction perpectives.

Inapparent dengue in a community living among dengue-positive Aedes mosquitoes and in a hospital in Klang Valley, Malaysia

The public health burden of dengue is most likely under reported. Current dengue control measures only considered symptomatic dengue transmission. Hence, there is a paucity of information on the epidemiology of inapparent dengue. This study reports that many people have been unknowingly exposed to dengue infection. Almost 10% and 70% of individuals without any history of dengue infection and living in a dengue hotspot, in Selangor, Malaysia, were dengue IgM and IgG positive respectively. When dengue-positive mosquitoes were detected in the hotspot, 11 (6.3%) of the 174 individuals tested were found to have dengue viremia, of which 10 were asymptomatic. Besides, upon detection of a dengue-infected mosquito, transmission was already widespread. In a clinical setting, it appears that people living with dengue patients have been exposed to dengue, whether asymptomatic or symptomatic. They can either have circulating viral RNA and/or presence of NS1 antigen. It is also possible that they are dengue seropositive. Collectively, the results indicate that actions taken to control dengue transmission after the first report of dengue cases may be already too late. The current study also revealed challenges in diagnosing clinically inapparent dengue in hyperendemic settings. There is no one best method for diagnosing inapparent dengue. This study demonstrates empirical evidence of inapparent dengue in different settings. Early dengue surveillance in the mosquito population and active serological/virological surveillance in humans can go hand in hand. More studies are required to investigate the epidemiology, seroprevalence, diagnostics, and control of inapparent dengue. It is also crucial to educate the public, health staff and medical professionals on asymptomatic dengue and to propagate awareness, which is important for controlling transmission.

Replantation and revascularization of amputated upper limb appendages outcome and predicting the factors influencing the success rates of these procedures in a tertiary hospital: An 8-year retrospective, cross-sectional study

PURPOSE

Worldwide advances in microsurgery have made salvaging of amputated hand via replantation and revascularization common procedures. The present study examines the outcome of these procedures in a tertiary hospital in Malaysia.

METHODS

Patients with hand amputation who underwent replantation or revascularization from 2005 to 2012 were identified and reviewed for patient characteristics, amputation characteristics and survival rates. Successfully treated patients were interviewed to assess the functional outcome using Quick Disability of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Statistical analysis was performed to evaluate outcome and elicit predictive factors.

RESULTS

Fifty-five patients were enrolled: 37 (67.3%) underwent replantation and 18 (32.7%) underwent revascularization. The overall success rate of 78% ( n = 43) was within the range of previously reported data (61.6% to 96.0%). Ischaemic time <6 h provided significantly better survival rates ( p < 0.05). Functional outcomes were successfully assessed in 34 patients (79%), at a mean follow-up of 40 months (range 11-93 months). The overall Quick-DASH and MHQ scores were 42.82 ± 23.69 and 60.94 ± 12.82, respectively. No previous reports of functional outcome were available for comparison. Both Quick-DASH ( p = 0.001) and MHQ scores ( p < 0.001) were significantly higher for finger injuries, followed by thumb, wrist and palm injuries.

CONCLUSION

Ischaemic time and level of injury are important predictors of success rate of replantation and revascularization of amputated upper limb appendages.

Prevalence and characteristics of e-cigarette users among Malaysian current and ex-smokers

INTRODUCTION

Electronic cigarettes (ECs) are new devices that have been accepted widely by both smokers and non-smokers. However, the evidence on EC used in Malaysia is scarce. The objective of this study was to determine the prevalence of EC use and the socio-demographic and smoking characteristics associated with current EC use among Malaysian current and ex-smokers.

METHODS

This was a sub-analysis of data from a cross-sectional, national-population- based EC study conducted from May to June in 2016 in Malaysia. A detailed description of the sampling methods can be found in the National E-cigarette Survey (NECS) 2016 report. Briefly, data were obtained from 1396 individuals who had ever been smokers, i.e., 957 (68.6%) current smokers and 439 (31.4%) ex-smokers.

RESULTS

Current EC use was found predominantly among current smokers (8.0%) as compared with ex-smokers (4.3%). Among current smokers, the main reasons given for smoking ECs were wanting to try it (44.7%), followed by intention to quit tobacco smoking (15.8%) and to reduce tobacco smoking (10.5%). Using multiple logistic regression analysis, we found that among current smokers, current EC users were more likely to be younger, i.e., 18-44 years (aOR= 4.83, 95% CI= 1.97-11.86, p=0.001), urban residents (aOR= 1.89, 95% CI= 1.15-3.11, p=0.012), single/ divorced/ widowed (aOR= 2.11, 95% CI= 1.24-3.61, p=0.006) and students (aOR= 2.25, 95% CI= 1.01-5.01, p=0.048). Among exsmokers, only younger respondents (18-44 years old) was reported as being more likely to be current EC users (aOR= 3.81, 95% CI= 1.14-12.76, p=0.030).

CONCLUSION

This study showed that currently using and ever having used ECs were more prevalent among current smokers. The reasons given for initiating EC use among current smokers were mainly wanting to try it, followed by intention to quit and to reduce tobacco smoking. Current EC use appears to be common among current smokers who are younger, urban residents, single/divorced/widowed and students. Therefore, EC cessation intervention strategies and policies should target these high-prevalence groups.

A comparison of smoking behaviour characteristics between Caucasian smokers in the United Kingdom and Malay smokers in Malaysia

OBJECTIVES

There is evidence that smoking behaviour differs by ethnicity. This study aims to compare smoking behaviour characteristics between Caucasian and Malay smokers.

METHODS

A cross sectional survey, involving 175 smokers attending smoking cessation clinics at the Institute of Psychiatry, London, United Kingdom and University Malaya, Kuala Lumpur, Malaysia between May 2005 and February 2007. Data on demographics, smoking history, nicotine dependence and smoking behaviour were collected.

RESULTS

All participants were males, mean age 30.7 ± 10.3 years. Caucasians initiated smoking significantly earlier (mean age 14.8 ± 2.8 years) (p = 0.001) and smoked regularly significantly earlier (mean age 17.3 ± 3.5) (p = 0.003) than Malays (mean starting age 16.9 ± 4.4 years and mean age regular use 19.5 ± 4.5 years), respectively. Caucasians smoked less for social integration than Malays (p = 0.03) but smoked more for regulation of negative affect than Malays (p = 0.008) and smoked more for hedonism than Malays (p < 0.001).

CONCLUSION

Malays smoke as a means of socially integrating. This has important public health implications. Social reasons and the social environment play a role in smoking uptake, smoking maintenance and smoking cessation and this should be borne in mind for strategies planning to promote smoking cessation.

Reasons for underutilisation of drug therapy for smoking cessation among Malaysian aboriginal smokers

Introduction

The smoking rate among Malaysian aboriginal people is double the rate of other Malaysians. Smoking is a major cause of morbidity and mortality in aboriginal people but smoking cessation among this population is very low. At present, pharmacotherapy for smoking cessation is not subsidised in the health services.

Objective and aim

The study aimed to explore potential reasons for the underutilisation of drug therapy for smoking cessation among aboriginal and non-aboriginal smokers.

Methods

A cross-sectional study was conducted among aboriginal and non-aboriginal smokers in the state of Selangor between March 2010-August 2010. Participants were asked to complete a questionnaire on demographics, smoking behaviour, physician counselling on smoking cessation and perceptions about drug therapy for smoking cessation.

Results

The overall response rate was 85% (250 Aboriginal smokers and 105 non-aboriginal smokers). Majority of smokers reported smoking cessation or reduction in the previous 6 months (Aboriginal 62% vs non-aboriginal 68%). Aboriginal participants were less likely to seek physician services (p = 0.001) and less willing to use nicotine replacement therapy (p = 0.01) or varenicline (p = 0.001). Among all smokers, having to buy the medication and price of the medication was the most important factor associated with less willingness to use the drugs but advice from physician was associated with willingness to use the drugs.

Conclusions

Regardless of ethnic origin, smokers were interested to quit smoking, but cost of medication may explain their lower uptake of drug therapy. Malaysian policy makers should consider making the drugs for smoking cessation freely available in the Malaysian health services.

Collective wisdom and decision making in surgical oncology

AIM

To describe systems for capturing and optimising collective knowledge and insight in areas of complexity and uncertainty in surgical oncology, with particular reference to the Delphi process and related systems.

METHODS

Internet search engines (Google, Google Scholar) and four databases (SCOPUS, PubMed, Medline and Embase) were searched to find English language articles on the use of The Delphi Process and related systems in surgical oncology, using a variety of search terms.

FINDINGS

There are a number of established systems for co-opting group knowledge and facilitating collective decision-making. These find applications in commerce, industry, government and defence. They have also been applied to problems in surgical oncology, for example using the Delphi process to optimise the management of colorectal cancers and metastases.

CONCLUSIONS

Collective decision making tools find practical applications in the allocation of resources and in clinical decision making in fields of surgical oncology practice where there is a wide range of evidence and expert opinion. Such methodologies set new standards for the collating of professional expertise and for the writing of "best clinical practice" guidelines in the cancer subspecialities.

Heme stability in the human embryonic hemoglobins

The three human embryonic hemoglobins undergo both monomolecular and nucleophile stimulated bimolecular oxidations. Azide acts as an efficient nucleophile for the oxidative process in which the three embryonic hemoglobins exhibit lower oxidation rates than the adult protein. The absolute rates of azide-induced oxidation together with the rates of spontaneous autooxidation correlate with the previously determined oxygen affinities of the embryonic hemoglobins. The pH dependence of the rates of oxidation and their chloride ion concentration dependence are discussed. Heme exchange to human serum albumin has been used to determine the relative binding constants for heme for each of the embryonic proteins. Rate data have also been employed to evaluate the tetramer-dimer equilibrium constant for each hemoglobin. Overall, the data indicate that the high oxygen affinity human embryonic hemoglobins are significantly less susceptible to anion-induced oxidation, and the heme groups in each of the embryonic globin proteins are more tightly bound than in the corresponding adult protein.

In vitro and in vivo assessment of urethral warming catheters for the transperineal cryoablation of prostatic carcinoma

OBJECTIVE

To evaluate the two most common urethral warming catheters currently available for their effectiveness in preventing urethral injury in an animal model and thus during transperineal cryosurgery for the treatment of prostate cancer.

PATIENTS, MATERIALS AND METHODS

The warming efficiency of the variable-diameter thin latex-balloon catheter (Cook, Australia) and the fixed-diameter PVC catheter (Candela, USA) were evaluated in a water-bath. A sheep model was then used for subsequent experiments to further evaluate the better catheter. The technique used for the insertion of the Cook catheter in a series of 33 patients treated with prostate cryosurgery is also described.

RESULTS

In vitro, the Cook catheter was more effective (P < 0.01) than the Candela catheter in preventing localized cooling. In vivo, results in five animals showed that the urethral epithelium was viable in all sections that had been protected by the catheter and focally denuded or necrotic in those sections not protected, with each animal used as its own control (P < 0.01 Fisher's exact test). The 33 patients treated while using the Cook catheter had no subsequent complications.

CONCLUSION

The urethral warming catheter currently in use for prostatic cryosurgery in Australia is more effective in vitro than its competitor and is effective in preventing urethral injury in vivo.

Conformational relaxation and ligand binding to singly reduced human embryonic haemoglobins

The reaction of the three human embryonic haemoglobins with aquated electrons follows a complex set of steps in which a single haem centre undergoes both reduction and spin state changes coupled to slower protein relaxation events. In the presence of ferrous haem ligands the spin state changes are coupled directly to the ligand binding process. The rate constants for the reaction of the single reduced haem with O2 are similar to those determined by flash photolysis at high pH, whilst CO binding to the beta type haems is more rapid and the alpha haems less rapid than the analogous processes observed using photolysis techniques.

Patterns of supradiaphragmatic metastases in testicular germ cell tumours

The imaging and clinical findings of 31 patients with supradiaphragmatic nodal metastases from primary testicular germ cell cancers were reviewed. In 11 patients the primary testicular tumor was a seminoma, and in 20 a non-seminomatous germ cell tumour (NSGCT). The patterns of spread of these tumour types were compared. All patients had chest radiographs (CXR): 27 had chest computed tomography (CT). One patient with seminoma and eight with NSGCT (40%) had lung metastases. Mediastinal lymphadenopathy was seen on CT in seven patients with seminoma (64%) and in nine patients with NSGCT (45%). Neck lymphadenopathy was present in 10 of 11 (91%) patients with seminoma, and 13 of 20 (65%) patients with NSGCT. Neck disease co-existed with mediastinal disease in six of 11 (55%) patients with seminoma, but in only two of 20 (10%) patients with NSGCT (P=0.012). This study gives further supporting evidence for the relative importance of haematogenous spread in teratoma, and lymphatic spread in seminoma. The contiguous nature of disease spread from abdomen to chest and neck in seminoma is confirmed. In NSGCT, supradiaphragmatic spread is more random but tends to occur in the paraoesophageal and subcarinal groups.

The chloride effect in the human embryonic haemoglobins

The interactions of the three human embryonic haemoglobins with chloride ions have been investigated. Each of the three embryonic haemoglobins exhibits a unique pattern of oxygen-affinity-dependence on chloride ion concentration. Human embryonic haemoglobin Portland (zeta 2 gamma 2) is found to be completely insensitive to chloride ion concentration. Haemoglobin Gower I (zeta 2 gamma 2) shows a small concentration dependence, whilst haemoglobin Gower II (alpha 2 epsilon 2) exhibits a dependence approaching that of the adult protein. The degree of co-operativity for each protein is essentially chloride concentration independent. The chloride-dependent and -independent components of the alkaline Bohr effects have been measured for each of the embryonic haemoglobins and compared with that of the adult protein. Both the chloride-binding data and the Bohr effect have been analysed in terms of the recently developed allosteric model proposed by Perutz [Perutz, Fermi, Poyart, Pagnier and Kister (1993) J. Mol. Biol. 233, 536-545].

Effect of diluting propofol on the incidence of pain on injection and venous sequelae

The effect of diluting propofol in 5% dextrose on the incidence of i.v. injection pain was studied in 100 adult patients. Severe injection pain occurred in 32% (16 patients) who received undiluted propofol, compared with 10% (five patients) who received dilute propofol. We concluded that the dilution of propofol significantly reduced the incidence of severe pain during injection without increasing postoperative venous sequelae.

Plasma cholinesterase changes during the puerperium

Changes in plasma cholinesterase activity during the puerperium were studied in 16 women who received epidural analgesia for labour followed by vaginal delivery, and in five women who underwent elective Caesarean section under epidural analgesia. A consistent fall in cholinesterase activity was demonstrated during the first 2 to 3 days post partum, followed by a rise to approximately normal nonpregnant values by the end of the puerperium. An additional patient who manifested prolonged paralysis following an emergency Caesarean section under general anaesthesia, including a suxamethonium infusion, was also studied. Possible mechanisms by which the transient decrease in cholinesterase activity is produced, and its clinical significance, are discussed.

Casualty X-ray reporting: a student survey

The radiographs of 337 patients attending the casualty department of a large teaching hospital were reviewed by two medical students of different seniority, a radiology registrar and a consultant radiologist. All the films had been examined initially by the casualty officer when the patient attended. The senior medical student reported the films more reliably than the junior student and was only slightly less reliable than the casualty officer. The radiology registrar was more accurate than the casualty officer where both reports could be compared with the consultant's opinion. Only rarely did the consultant radiologist disagree with the radiology registrar but in one patient this led to a change in management. The need for a radiological opinion has been confirmed.