Children with Autism Spectrum Disorder (ASD) have significant challenges in their daily life including social communication and interaction, emotional awareness and management, as well as behavioural issues. Many interventions are conducted based on theoretical backgrounds and past literature. There is lack of research study that interview and explore the real psychological needs of children with ASD in Malaysia. It is a significant component as their needs may vary depending on the cultural background, lifestyle, and social norms. Besides, there is a need to develop standardised intervention module to enhance intervention fidelity and replication of future study. The current study aims to scrutinise the psychological needs of children with ASD in Malaysia, develop a standardised group intervention module based on the identified needs, and then examine the feasibility of the developed module. Nine children with moderate to high functioning of ASD (7 to 12 years old) and their parents from Kuala Lumpur and Sarawak participated in the study. Result from the focus group interview suggests that children with ASD have three major psychological needs which are sociocommunication, awareness of danger, and emotions. The group intervention module was designed to fulfil these needs. The feasibility result shows that the designed module is practical, useful, and understandable for the participants. In view of this, future study may explore the effectiveness of the module. Once the module is proven effective, it can be patented and utilised to improve the psychological functioning of children with ASD in Malaysia.
Autism Spectrum Disorder ; children ; group intervention ; feasibility ; psychological needs.

Many techniques for prevention and correction of complication after blepharoplasty have been developed, however, satisfactory method has not yet been documented. The purpose of this article is to review common unfavorable complications after Asian cosmetic eyelid surgery, and to propose several methods of treatment for effective correction. From 1988 to 2008, authors reviewed 364 cases(480 eyes) of complications after cosmetic eyelid surgery. Follow-up period ranged from 6 months to 16 years. The results of treatments were classified into excellent, good, fair and unsatisfactory by operating surgeons, other surgeons, and by patients. About 40% of complications requiring revisional surgeries were treated early within 2 weeks after first operation. Other 60% of complications were treated by late reoperations, at least 6 months after first surgery. Majority of patients were satisfied with the results. However, a few patients reported unsatisfactory outcomes which required additional revisional procedures. The correction of complications following cosmetic eyelid surgery remains a difficult task. The strategies for successful Asian upper blepharoplasty include not only careful preoperative evaluation and delicate operative technique, but also, proper postoperative interventions such as early secondary blepharoplasty.
Asian Continental Ancestry Group ; Blepharoplasty ; Cosmetics ; Early Intervention (Education) ; Eyelids ; Follow-Up Studies ; Humans ; Surgery, Plastic

PURPOSE: The optimum loading dose of clopidogrel has not been established in Asian patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Our aim was to evaluate the impact of different clopidogrel loading doses on short- and long-term clinical outcomes in Asian STEMI patients undergoing primary PCI. MATERIALS AND METHODS: We studied 691 STEMI patients undergoing primary PCI, loaded with 600 mg (n=381) or 300 mg (n=310) of clopidogrel. The primary outcome was major adverse cardiac events (MACEs), defined as a composite of all-cause death, reinfarction, or target vessel revascularization (TVR). RESULTS: Baseline clinical and peri-procedural characteristics were mostly comparable between the 600 mg and 300 mg groups. There were no differences in 1 month MACEs as well as all-cause death, reinfarction, TVR, and stent thrombosis between the two groups. After a median follow-up of 921 days, MACEs [adjusted hazard ratio (HR) for the 600 mg group 1.79, 95% confidence interval (CI): 0.80-3.97, p=0.153], all-cause death (adjusted HR for the 600 mg group 0.97, 95% CI: 0.50-1.88, p=0.928), reinfarction (adjusted HR for the 600 mg group 1.03, 95% CI: 0.55-1.91, p=0.937), and TVR (adjusted HR for the 600 mg group 1.36, 95% CI: 0.68-2.69, p=0.388) did not differ between the two groups. These results were reliable even after analysis of propensity score-matched population, and were also constant among various subgroups. CONCLUSION: A 600 mg loading dose of clopidogrel did not result in better short- and long-term clinical outcomes in Asian STEMI patients undergoing primary PCI.
Angioplasty, Balloon, Coronary ; Asian Continental Ancestry Group* ; Follow-Up Studies* ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Stents ; Thrombosis

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is essential after percutaneous coronary intervention (PCI), while many studies have focused on determining the optimal degree of platelet inhibition and optimal DAPT duration to minimize complications after PCI. Current guidelines developed by the American College of Cardiology/American Heart Association and the European Society of Cardiology summarize previous studies and provide recommendations. However, these guidelines are mainly based on Western patients, and their characteristics might differ from those of East Asian patients. Previous data suggested that East Asian patients have unique features with regard to the response to antiplatelet agents. On comparing Western and East Asian patients, it was found that East Asian patients have a lower rate of ischemic events and higher rate of bleeding events after PCI, despite a higher on-treatment platelet reactivity, which is referred to as the “East Asian paradox.” As the main purpose of DAPT is to minimize ischemic and bleeding complications after PCI, these differences should be clarified before adopting the guidelines for East Asian patients. Therefore, in this article, we will review various issues regarding DAPT in East Asian patients, with a focus on the unique characteristics of East Asian patients, previous studies regarding antiplatelet agents in East Asian patients, and a guideline from an East Asian perspective.
Asian Continental Ancestry Group ; Aspirin ; Blood Platelets ; Cardiology ; Heart ; Hemorrhage ; Humans ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors

BACKGROUND AND OBJECTIVES: Although the size of the coronary artery is known to be closely related to the outcome of coronary artery bypass grafting and percutaneous coronary intervention, its normal value and determinants have not been examined in Koreans. SUBJECTS AND METHODS: One hundred and twenty seven normal coronary arteriograms were carefully selected from 3,412 studied consecutively. Of these, 53 women and 23 men, with no abnormalities in their cardiac function and not using nitrates, were studied. The lumen diameter was measured at 10 segments in the epicardial coronary arteries. RESULTS: For men, the mean lumen diameter of the proximal left anterior descending and left circumflex coronary arteries were 3.88+/-0.39 and 3.45+/-0.47 mm, respectively, and were not affected by the anatomic dominance. However, the left main and proximal right coronary arteries varied between 4.44+/-0.49 and 5.18+/-0.32 mm (p<0.05) and 3.29+/-0.60 and 4.05+/-0.42 mm (p<0.05), respectively, by the anatomic dominance. Women had a smaller mean coronary artery size than men [for diameter, -7% (p<0.01);for cross-sectional area, -13% (p<0.01)], and the left ventricular (LV) mass was significantly associated with coronary artery diameter (p<0.05). From a multiple linear regression analysis, gender was an only independent predictor of the coronary artery size (p<0.05). CONCLUSION: We revealed normal coronary artery dimensions in Koreans. Although, body size, hypertension, use of calcium channel blockers, anatomic dominance and age had no effect on the size of the coronary artery, but the LV mass and gender were shown to have an effect. The multivariate regression analysis showed gender was an only independent predictor of the coronary artery size.
Asian Continental Ancestry Group ; Body Size ; Calcium Channel Blockers ; Coronary Artery Bypass ; Coronary Vessels* ; Female ; Humans ; Hypertension ; Linear Models ; Male ; Nitrates ; Percutaneous Coronary Intervention ; Reference Values*

OBJECTIVE: The aim of this study was to examine the experience of volunteer psychiatrists who provided mental health interventions to adolescents and teachers of Danwon High School from April 16, 2014, to November 30, 2014. METHODS: Data for this study were collected from 72 volunteer psychiatrists about their intervention experiences for 212 adolescents and 32 teachers during the eight months following the disaster. Developmental survey themes were identified, and coding was used to analyze the data. In addition, qualitative data analysis was performed using ATLAS.ti (version 8.2, 2018, ATLAS.ti GmbH). RESULTS: A volunteer prepared with appropriate mental health interventions may facilitate the emergency response to a disaster. Intervention services included psychological first aid, psychoeducation, screening, anxiety reduction techniques, and group therapy. CONCLUSION: In the acute aftermath of the Sewol Ferry disaster of April 16, 2014, volunteer psychiatrists were able to provide mental health interventions in a disaster response setting. The outcomes from this study have important policy and mental health system implications for volunteer psychiatrists. The results of this study constitute the basis of a better understanding of the essential mechanisms of crisis interventions after a disaster.
Adolescent ; Anxiety ; Clinical Coding ; Crisis Intervention ; Disasters ; Emergencies ; First Aid ; Humans ; Mass Screening ; Mental Health ; Psychiatry ; Psychotherapy, Group ; Statistics as Topic ; Volunteers

BACKGROUNDEarly auditory and speech development in home-based early intervention of infants and toddlers with hearing loss younger than 2 years are still spare in China. This study aimed to observe the development of auditory and speech in deaf infants and toddlers who were fitted with hearing aids and/or received cochlear implantation between the chronological ages of 7-24 months, and analyze the effect of chronological age and recovery time on auditory and speech development in the course of home-based early intervention.

METHODSThis longitudinal study included 55 hearing impaired children with severe and profound binaural deafness, who were divided into Group A (7-12 months), Group B (13-18 months) and Group C (19-24 months) based on the chronological age. Categories auditory performance (CAP) and speech intelligibility rating scale (SIR) were used to evaluate auditory and speech development at baseline and 3, 6, 9, 12, 18, and 24 months of habilitation. Descriptive statistics were used to describe demographic features and were analyzed by repeated measures analysis of variance.

RESULTSWith 24 months of hearing intervention, 78% of the patients were able to understand common phrases and conversation without lip-reading, 96% of the patients were intelligible to a listener. In three groups, children showed the rapid growth of trend features in each period of habilitation. CAP and SIR scores have developed rapidly within 24 months after fitted auxiliary device in Group A, which performed much better auditory and speech abilities than Group B (P < 0.05) and Group C (P < 0.05). Group B achieved better results than Group C, whereas no significant differences were observed between Group B and Group C (P > 0.05).

CONCLUSIONSThe data suggested the early hearing intervention and home-based habilitation benefit auditory and speech development. Chronological age and recovery time may be major factors for aural verbal outcomes in hearing impaired children. The development of auditory and speech in hearing impaired children may be relatively crucial in thefirst year's habilitation after fitted with the auxiliary device.

Age Factors ; Asian Continental Ancestry Group ; Child, Preschool ; Cochlear Implantation ; Deafness ; rehabilitation ; Early Intervention (Education) ; methods ; Hearing Aids ; Home Care Services ; Humans ; Infant ; Language Development ; Longitudinal Studies

Compared with ST elevation myocardial infarction (STEMI), long-term outcomes are known to be worse in patients with unstable angina/non-STEMI (UA/NSTEMI), which might be related to the worse health status of patients with UA/STEMI. In patients with UA/NSTEMI and STEMI underwent percutaneous coronary intervention (PCI), angina-specific and general health-related quality-of-life (HRQOL) was investigated at baseline and at 30 days after PCI. Patients with UA/NSTEMI were older and had higher frequencies in female, diabetes and hypertension. After PCI, both angina-specific and general HRQOL scores were improved, but improvement was much more frequent in angina-related HRQOL of patients with UA/NSTEMI than those with STEMI (44.2% vs 36.8%, P < 0.001). Improvement was less common in general HRQOL. At 30-days after PCI, angina-specific HRQOL of the patients with UA/NSTEMI was comparable to those with STEMI (56.1 +/- 18.6 vs 56.6 +/- 18.7, P = 0.521), but general HRQOL was significantly lower (0.86 +/- 0.21 vs 0.89 +/- 0.17, P = 0.001) after adjusting baseline characteristics (P < 0.001). In conclusion, the general health status of those with UA/NSTEMI was not good even after optimal PCI. In addition to angina-specific therapy, comprehensive supportive care would be needed to improve the general health status of acute coronary syndrome survivors.
Aged ; Angina, Unstable/physiopathology/*therapy ; Asian Continental Ancestry Group ; Female ; Health Status ; Humans ; Male ; Middle Aged ; Myocardial Infarction/physiopathology/*therapy ; Odds Ratio ; *Percutaneous Coronary Intervention ; *Quality of Life ; Registries ; Republic of Korea

The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry that reflects current therapeutic approaches and acute myocardial infarction (AMI) management in Korea. The results of the KAMIR demonstrated different risk factors and responses to medical and interventional treatments. The results indicated that the incidence of ST-elevation myocardial infarction (STEMI) was relatively high, and that the prevalence of dyslipidemia was relatively low with higher triglyceride and lower high-density lipoprotein cholesterol levels. Percutaneous coronary intervention (PCI) rates were high for both STEMI and non-ST-elevation myocardial infarction (NSTEMI) with higher use of drug-eluting stents (DESs). DES were effective and safe without increased risk of stent thrombosis in Korean AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel, and cilostazol, was effective in preventing adverse clinical outcomes after PCI. Statin therapy was effective in Korean AMI patients, including those with very low levels of low-density lipoprotein cholesterol and those with cardiogenic shock. The KAMIR score had a greater predictive value than Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores for long-term mortality in AMI patients. Based on these results, the KAMIR will be instrumental for establishing new therapeutic strategies and effective methods for secondary prevention of AMI and guidelines for Asian patients.
Asian Continental Ancestry Group ; Aspirin ; Cholesterol ; Drug-Eluting Stents ; Dyslipidemias ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Korea* ; Lipoproteins ; Mortality ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Prevalence ; Registries* ; Risk Factors ; Secondary Prevention ; Shock, Cardiogenic ; Stents ; Thrombosis ; Triglycerides

There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B*1502 with carbamazepine SCAR, and HLA-B*5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.
Adult ; Allopurinol ; Anaphylaxis ; Anti-Bacterial Agents ; Asia ; Asian Continental Ancestry Group ; Aspirin ; Asthma ; Carbamazepine ; Child ; Cicatrix ; Contrast Media ; Coronary Artery Disease ; Diagnostic Tests, Routine ; Drug Hypersensitivity ; Ethnic Groups ; Humans ; Hypersensitivity ; Penicillins ; Percutaneous Coronary Intervention ; Phenotype ; Recurrence ; Skin Tests