The relationship between healthcare services and inequalities is more likely when a group that shares a salient identity faces severe inequalities of various kinds. Such inequalities may be catalyzed by economic, social, political or concern cultural status. The objectives of this review are to identify the issues and challenges involve in healthcare inequalities, to compare factors contributes to healthcare inequalities and to purpose suggestions and recommendations for improvement based on issues and challenges between United States and India. Comparing annual year healthcare report, documentation of healthcare institutional, Ministry of Health‘s report and circular, official institutional website, scientific healthcare journals, articles and reports published in 1994 until 2011 regarding healthcare inequalities between United States and India. Health inequalities in the healthcare system contributed by the different in socioeconomic status and accessibility to the healthcare facility due to high cost of treatment has been common risk ‘Catastrophic’ factors to the inequalities in both countries. Health financing system and resource allocation that benefit only the upper class social spectrum of the population. Disparities occur due to the imbalance in distribution of wealth, discrimination and change in the world economy. Adapting healthcare system that provides care to all classes of people need improvement as no healthcare system is perfect. This matter must be tackle urgently as it’s a matter of national concern.
Delivery of Health Care ; Socioeconomic Factors ; Developed Countries ; Developing Countries ; United States ; India ; Quality Improvement ; Health Status

Ocular abnormalities have apparent effects on brain activation. However, neuroimaging data about the ocular characteristics of healthy participants are still lacking to be compared with data for patients with ocular pathology. The objective of this multiple participants’ functional magnetic resonance imaging (fMRI) studies was to investigate the brain activation characteristics of healthy participants when they view stimuli of various shapes, pattern and size. During the fMRI scans, the participants view the growing ring, rotating wedge, fl ipping hour glass/bow tie, quadrant arc and full checker board stimuli. All stimuli have elements of black-and-white checkerboard pattern. Statistical parametric mapping (SPM) was used in generating brain activation via fi xed-effects (FFX) and conjunction analyses. The stimuli of various shapes, pattern and size produce different brain activation with more activation concentrated in the left hemisphere. These results are supported by the conjunction analysis which indicated that the left pre-central, post-central, superior temporal and occipital gyrus as well as the left cingulate cortices were involved when the participants viewed each given stimulus. Differential activation analysis showed activation with high specifi city in the occipital region due to the stimuli of various shapes, pattern and size. The activation in the right middle temporal gyrus was found to be signifi cantly higher in response to moving stimuli as compared to stationary stimuli. This confi rms the involvement of the right middle temporal gyrus in the observation of movements. The black-and-white checkerboard stimuli of various shapes, pattern and size, stationary and moving was found to 1) activate visual as well as other cortices in temporal and parietal lobes, 2) cause asymmetry in brain function and 3) exhibit functional integration characteristics in several brain areas.
Photic Stimulation

The physiotherapy services have played major roles as a part of rehabilitation components and emerging in most hospitals throughout Malaysia as well as internationally. As such, there is still a lack of scientific research and reporting about the finding of service quality studies in physiotherapy services at teaching hospitals settings in Malaysia. This study was to assess the level of patients' satisfaction and its contributing factors as well as to assess the quality of physiotherapy services at teaching hospitals in Klang Valley. The cross sectional study was conducted from March until July 2011 among outpatients (311 patients) who has been referred to the Physiotherapy Clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and Universiti Malaya Medical Centre (UMMC) in Klang Valley. Patients were recruited using simple random sampling technique and data were collected by using the validated self-administered Service Quality (SERVQUAL) Questionnaire. About 62.4% respondents in teaching hospitals have met their expectation. ‘Assurance’ showed the highest satisfaction score and ‘Caring Services’ showed the lowest satisfaction score among the entire dimension studied. The factors which significantly influence patient satisfaction include age, education status, working status and number of visit. There are relationships between patient satisfaction with SERVQUAL, Outcome and Corporate Culture components. However, the predictors contributed for overall patient satisfaction at Physiotherapy Clinics at teaching hospitals was not influenced by factors studied (p>0.05). The levels of satisfaction that met patients’ expectation is ‘Moderate’ for teaching hospitals and the ‘Caring Services’ should be focus in order to improve the level of patient satisfaction.

The purpose of this study was to characterize, differentiate and correlate visual field and brain activation in visual cortex for normal, glaucoma suspect (GS) and primary open angle glaucoma (POAG) participants using Standard Automated Perimetry (SAP) and functional Magnetic Resonance Imaging (fMRI) respectively. The fMRI scans and SAP test were both carried out in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). Two types of black-and-white checkerboard pattern were displayed to the participants during the fMRI scans. The fMRI data were analyzed using WFU pickatlas toolbox targeting visual cortex area. The results showed that there was no significant difference in number of activated voxel between the three groups in visual cortex (BA 17, 18 and 19) while viewing all the given stimuli (p > 0.05). The pattern standard deviation (PSD) of SAP for visual field also revealed no significant differences (p > 0.05) in all groups of participants. However, negative correlation between PSD and fMRI activation was observed. The PSD values increased with a decrease in fMRI activation. With reference to visual field analysis, the results suggest that glaucomatous neuropathy of POAG patients has led to a gradual decrease in visual cortex activation and a gradual increase in PSD.
Visual Cortex ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy

Trichoderma species are able to persist on living sapwood and leaves of cacao (Theobroma cacao) in an endophytic relationship. In this research, we evaluated the ability of Trichodema asperellum introduced at the incision site in the bark for side grafting with the concentration of 4 g/10 mL, 4 g/100 mL, and 4 g/1,000 mL (suspended in water) in suppressing vascular streak dieback (VSD) incidence and promoting growth of side grafts in the field. The incidence of VSD in two local clones of cacao, MCC1 and M04, without application of T. asperellum was 71.2% and 70.1% at 21 wk after grafting, respectively. However, when the two clones were treated with a concentration of 4 g/10 mL T. asperellum, the incidence was 20.6% and 21.7%, respectively, compared to 29.1% and 20.9% at 4 g/100 mL and 18.2% and 15.6% at 4 g/1,000 mL. By comparing to the control, the treatment with the same concentrations of T. asperellum listed above, the total number of stomata in MCC1 decreased by 41.9%, 30.2%, and 14.0% and in M04 by 30.5%, 21.9%, and -2.5% (exception), respectively. Otherwise, the total area of stomata opening increased by 91.4%, 99.7%, and 28.6% in MCC1 and by 203.8%, 253.5%, and 35.9% in M04, respectively. Furthermore, the number of buds and branches treated with a mixture concentration on the the two clones increased by 90.7% and 21.7%, respectively. These data showed that the application of T. asperellum to cacao scions while grafting can decrease VSD incidence in side grafts and increase growth of grafts in addition to decreasing total number of stomata, increasing total area of opened stomata, and increasing number of buds and branches.
Cacao* ; Clone Cells ; Incidence* ; Transplants* ; Trichoderma*

The ongoing pandemic of COVID-19 has presented multiple challenges to global healthcare services, dictating changes in almost every aspect of daily medical practice. Performing aerosol generating procedures (AGPs) in the field of interventional pulmonology can lead to profound formation of aerosols, leading to a high risk of infection among healthcare workers (HCWs). We share our experiences on performing AGPs in the midst of a COVID-19 pandemic by focusing on changes in AGP practices. In a pandemic, HCWs ought to adapt to the ever-changing situation and use available resources to provide the best possible healthcare to patients, ensure safety of staff, and continue medical education of future pulmonologists.
Aerosols ; Bronchoscopy/trends* ; COVID-19/transmission* ; COVID-19 Testing ; Humans ; Infection Control/trends* ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; Malaysia ; Practice Patterns, Physicians'/trends* ; Tertiary Care Centers ; Thoracoscopy/trends*

Background: Regarding the long-term safety issues with the use of inhaled corticosteroids (ICS) and the clinical predominance of dual bronchodilators in enhancing treatment outcomes in chronic obstructive pulmonary disease (COPD), ICS is no longer a “preferred therapy” according to the Global Initiative for Chronic Obstructive Lung Disease except on top of a dual bronchodilator. This has necessitated a change in the current therapy for many COPD patients. Objective: To determine a standardised algorithm to reassess and personalise the treatment COPD patients based on the available evidence. Methods: A consensus statement was agreed upon by a panel of pulmonologists in from 11 institutes in Malaysia whose members formed this consensus group. Results: According to the consensus, which was unanimously adopted, all COPD patients who are currently receiving an ICS-based treatment should be reassessed based on the presence of co-existence of asthma or high eosinophil counts and frequency of moderate or severe exacerbations in the previous 12 months. When that the patients meet any of the aforementioned criteria, then the patient can continue taking ICS-based therapy. However, if the patients do not meet the criteria, then the treatment of patients need to be personalised based on whether the patient is currently receiving long-acting beta-agonists (LABA)/ICS or triple therapy. Conclusion: A flowchart of the consensus providing a guidance to Malaysian clinicians was elucidated based on evidences and international guidelines that identifies the right patients who should receive inhaled corticosteroids and enable to switch non ICS based therapies in patients less likely to benefit from such treatments.

Sarcomas usually frequented in the head and neck region of young adults. Trachea is a rare site, and due to scarce clinical data, its clinical outcome is unclear. We reported a case of 60-year old patient presented with progressive worsening shortness of breath, cough, and progressive worsening dysphagia. Computer tomography scan revealed extensive 2 lobulated soft tissue lesions within and surrounding the trachea at the T4 level. Rigid bronchoscopy with mass cryo-debulking was performed and ultimately synovial sarcoma was diagnosed. Shortness of breath was completely relieved post-procedure.

Objective: Verbal autopsy (VA) through face-to-face interviews with caregivers is a way to determine cause of death without medical certification. In Malaysia, the use of VA has improved mortality statistics. However, during the coronavirus disease 2019 (COVID-19) pandemic, face-to-face interviews were delayed, reducing VA data collection and affecting data for mortality surveillance. This study aims to investigate the feasibility and acceptability of conducting VA interviews via telephone calls, and the quality of the data gathered. Methods: The study was conducted in Malaysia from September to October 2020 using a cross-sectional design. Participants were health-care workers from established VA teams across the country. They conducted VA interviews via telephone and provided feedback through a customized online form. Data collected from the form were used to assess the feasibility, acceptability and quality of the telephone interviews using IBM SPSS version 23. Results: Responses were received from 113 participants. There were 74 (65.5%) successful interviews, representing 91% of the 81 cases who were able to be contacted. More than two thirds of health-care workers provided positive feedback on the telephone interview method for themselves and the interviewees. Only 10.8% of causes of death were unusable. Discussion This study provides preliminary evidence that VA via telephone interview is feasible, acceptable and can be used as an alternative to face-to-face interviews without affecting data quality. During times when face-to-face interviews are not advisable, VA telephone interviews can be used for data collection for mortality surveillance.

Introduction: Fall is a health problem for older persons. This study investigates the potential factors of concern: the nutritional status of older persons and non-communicable disease association with incidence of falls. Methods: This study used data from NHMS 2018, and conducted a cross-sectional design by applying two-stage stratified cluster sampling. Descriptive statistics such as the percentage of each variable were done. Factors associated with falls were determined at both univariate and multivariable levels using simple logistic regression and multiple logistic regression. The data were presented as standard values for each analysis and adjusted odds ratios with 95% CI with p values (<0.05). Results: A total of 3,867 from 3,977 elderly (mean age 68.2+ 6.85) were recruited with the response rate of 97.2%. Factors associated with fall were 70 years old and above (AOR= 1.34, 95% CI: 1.09, 1.64), obesity (AOR=1.55, 95% CI: 1.21, 1.98), undernutrition (AOR=1.59, 95% CI: 1.30, 1.94), persons with 2 NCDs (AOR=1.49, 95% CI: 1.15, 1.92) and persons with 3 NCDs (AOR=1.63, 95% CI: 1.23, 2.16). Conclusions Advanced age, malnutrition, obesity, and having two or more NCDs are associated with falls in the NHMS 2018 study. In conclusion, falls are prevalent among older persons. There is an urgent need for public health strategies and programmes to decrease the incidence of modifiable risk factors and early identification of those at risk. Implementation of fall preventive programs which includes multifactorial interventions at hospitals and homes can also significantly reduce incidence of falls among older persons