Achieving smoking cessation is an arduous process, where smokers try different methods or approaches to achieve cessation. Quit smoking attempts play an important role in smoking cessation.Thus, this study was conducted to determine the factors associated with attempt-to-quit smoking among the currentsmokers in Sarawak.This cross-sectional study was conducted among adult smokers in Sarikei, Sarawak by face-to-face interview using an adapted and validated questionnaire. Non-probability sampling method was used to select the study place. An adult smoker was selected systematically from each selected household. A total of 482 smoker households were identified with a response rate of 92.3%. Data was analysed using IBM SPSS Version 22.0. A p-value of <0.05 was considered statistically significant. The mean (SD) age of the smokers was 36.3(13.3) years. However, the mean (SD) age of smoking initiation was 18.5(4.8) years. Majority of the smokers were male (91.5%), with the male to female ratio being 1:0.1. Mean (SD) score on The Fagerström Test for Nicotine Dependence was 4.75(2.4), while motivation to quit smoking score was 3.04(1.0). Majority of the smokers (83.1%) hadever seen pictorial health warnings on cigarette packs. More than half of the smokers (54.8%) had ever tried to quit smoking. Binary logistic regression analysis revealed that marital status, religion, ethnicity, pictorial health warnings on cigarette packs and motivation to quit smoking appeared to be the significant predictors of attempt-to-quit smoking (p<0.05). Understanding the attempts to quit smoking will assist inclinical expectations. Thus, a smoking cessation programme should be designed in line with these factors, to aid quit smoking attempts.
Smoking ; Attempt-to-quit ; Addiction ; Motivation ; Pictorial Health Warning ; Sarawak

The Siriraj I Gγ(Aγδβ)0 -thalassaemia is a novel mutation involving a 118kb deletion of the β-globin gene cluster. It was first reported in 2012 in two unrelated families from the southern part of Thailand. The carriers in the heterozygous state are clinically asymptomatic. Nonetheless, its complex interaction with other β-thalassaemia could give rise to different clinical phenotypes, ranging from mild thalassaemia intermedia to thalassaemia major. We report here a case of a six-year-old Malay boy, presented with pallor, growth failure and hepatosplenomegaly. His haemoglobin at presentation was 9.2g/dL with a mean cell haemoglobin of 22.6pg and a mean cell volume of 69.9fl. His peripheral blood smear showed features of thalassaemia intermedia. Haemoglobin (Hb) analysis revealed markedly raised Hb F (83%), normal HbA2 levels and absent HbA. Deoxyribonucleic acid (DNA) analysis showed compound heterozygous IVS1-1 (G→T) β-globin gene mutation and Siriraj I Gγ(Aγδβ)0 -deletion (genotype βIVS1-1/ β Siriraj I deletion). Both his father and elder sister are carriers of Siriraj I Gγ(Aγδβ)0 -thalassaemia while his mother carries IVS1-1 (G→T) gene mutation. Clinically, the patient is transfusion dependent on six weekly regime. To the best of our knowledge, this is the first reported case in Malaysia involving unique Siriraj I Gγ(Aγδβ)0 -thalassaemia and IVS1-1 (G→T) in a compound heterozygous state. In summary, detection of Siriraj I Gγ(Aγδβ)0 -thalassaemia is essential as this deletion can lead to severe disease upon interaction with a β-thalassemia point mutation as demonstrated in our case. The establishment of effective carrier screening and genetic counselling is important to prevent its adverse consequences.

Visual conditions such as anisometropia, monovision and monocular undercorrection affect the combination of visual input from both eyes. This study investigated the effects of monocular blur, in binocularly normal participants, on stereoacuity and binocular contrast sensitivity. Fifteen young adults (age range between 19 and 23 years old) with normal visual acuity and binocular vision participated in this study. Stereopsis was measured using the TNO test with a series of positive spherical lenses placed before the dominant eye. The procedure was repeated using the Titmus Stereotest on five participants as a control experiment. Monocular and binocular contrast sensitivities were also measured using the Pelli-Robson Contrast Sensitivity Chart. Blur was induced monocularly with a series of positive spherical lenses placed before the dominant eye and binocular contrast sensitivity was re-measured. Stereopsis scores decreased significantly when monocular blur was imposed. Across blur levels, absolute stereopsis scores measured with TNO test were worse than those measured with Titmus stereotest (all p < 0.05). However, the ratio of scores obtained without blur and under monocular blur appeared to be similar for both tests. Stereopsis without blur was between 6.82× to 8× better than that obtained with the highest level of imposed monocular blur. Binocular contrast sensitivity score decreased significantly with increasing level of monocular blur (p < 0.01). Binocular contrast sensitivity score without blur was 1.62× better than that obtained under binocular viewing with highest level of imposed blur. Stereopsis tests are more sensitive than measurements of binocular contrast sensitivity as an indicator of interocular acuity discrepancies which could occur in anisometropic or monovision patients. However, the choice of stereopsis test is crucial, as the TNO test appears to be more sensitive to monocular blur than the Titmus stereostest.
Depth Perception

INTRODUCTIONThis prospective study aims to evaluate botulinum toxin type A (BTX-A, Botox ®) as a treatment for idiopathic detrusor overactivity (IDO) for patients with symptoms of overactive bladder (OAB).

MATERIALS AND METHODSNineteen patients with IDO were treated with intradetrusal injection of 200 units of BTX-A under cystoscopic guidance. There were 10 males and 9 females, with a mean age of 60 years (range, 38 to 87). Subjective responses were measured using the International Prostate Symptom Score and quality of life (QOL) score, as well as incontinent episodes, functional capacity and voiding intervals obtained from the voiding diary. They were recorded prior to, and at 6 weeks, 3, 6 and 9 months after BTX-A injections. Urodynamic studies were performed between 6 weeks to 3 months post-treatment.

RESULTSThere was statistically significant improvement in subjective parameters at 3 months post-treatment involving QOL (P = 0.002), incontinence episodes (P = 0.004), functional capacity (P = 0.01) and voiding interval (P <0.001). Reflex volume was significantly increased (P = 0.003), and maximal detrusal pressure (P = 0.001) as well as leak volume (P = 0.013) were significantly decreased during follow-up. Results of a gender-based subgroup analysis reveal that BTX-A may be more efficacious in females. Observed side effects included a patient who needed to perform CISC for about 3 months, a patient who had gross haematuria needed bladder washout and 3 patients who required treatments for urinary tract infection.

CONCLUSIONOverall BTX-A, which is well received by most patients, has become a very important part of the armamentarium for the treatment of IDO.

Adult ; Aged ; Aged, 80 and over ; Botulinum Toxins, Type A ; therapeutic use ; Female ; Health Status Indicators ; Humans ; Male ; Middle Aged ; Neuromuscular Agents ; therapeutic use ; Quality of Life ; psychology ; Urinary Bladder ; cytology ; Urinary Bladder, Overactive ; drug therapy ; psychology ; Urodynamics

OBJECTIVE: To investigate the development of early vocabulary capability in the prelingual deaf children after cochlear implantation (CI) , and to study the feasibility of current Chinese assessment procedures about language development for hearing-impaired children. METHOD: A total of 56 cases with severe-to-profound prelingual deaf children were participated in this study. The vocabulary development of CI children were evaluated by trained audiologists using the vocabulary assessment tools: Chinese communicative development inventory (CCDI) and mandarin expressive and receptive vocabulary test (MERVT). The questionnaire assessed by parents or guardians answered the questionnaire; vocabulary tests were evaluated by children accompanied with audiologists. Patients were assessed before operation and in 2 years after switch-on. RESULT: With the rehabilitation, early post-operative vocabulary development gradually improved. The vocabulary increased with an increase in the duration of CI use, and the receptive vocabulary developed earlier than the expressive ones. CONCLUSION After 2 years of CI use, the child partly developed the vocabulary capability. Children's vocabulary test, CCDI and MERVT test, is an important index to evaluate the development of children's language ability after cochlear implantation. Vocabulary test, together with auditory and speech perception assessment procedures, constitute a more complete auditory-speech-language evaluation system for Chinese children after cochlear implants.
Asian Continental Ancestry Group ; Child ; Cochlear Implantation ; Cochlear Implants ; Deafness ; therapy ; Follow-Up Studies ; Humans ; Language ; Language Development ; Language Tests ; Speech ; Vocabulary

We report a rare case of an 18 year old girl with Sturge- Weber syndrome, she had extensive facial port wine stains, right bupthalmos and advanced glaucoma involving both eyes. She underwent right eye glaucoma drainage device surgery under general anaesthesia, and had a difficult intubation due to extensive angiomatous like soft tissue swelling at her upper airway. This report highlights the importance of being aware of the need for continuous follow-up in Sturge-Weber syndrome patients as this syndrome can lead to blindness due to advance glaucoma and the awareness of possible difficult intubation for this group of patients.

Children deserve a childhood free from abuse, where their basic physical, intellectual, emotional and social needs are met. Child abuse is defined as any act of omission or commission by a parent or guardian that would endanger or impair the child's physical or emotional well-being, or that is judged by a mixture of community values and professionals to be inappropriate. A total of 247 cases of suspected child abuse in Singapore was investigated in 2012. Physical abuse, sexual abuse, and physical neglect or emotional abuse accounted for 60%, 30% and 10% of these cases, respectively. Primary care providers play an important role in the early detection and referral of child abuse cases, which enable timely intervention to ensure the well-being of the child and prevent further abuse. Hospitals and other medical centres form the largest source of referrals of suspected child abuse.
Child ; Child Abuse ; diagnosis ; legislation & jurisprudence ; prevention & control ; Child Welfare ; Humans ; Parent-Child Relations ; legislation & jurisprudence ; Parents ; psychology ; Risk Factors

Objective: To compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on upper limb function recovery among patients who recently had stroke. Methods: Subjects with recent stroke (within 1 month) were randomized to rTMS (n=25) and tDCS (n=26) applied over the non-lesioned hemisphere for three sessions per week, followed by tailored upper limb rehabilitation training for a total of 2 weeks. The primary outcomes were changes in the Motor Assessment Scale (MAS), Fugl-Meyer arm score test, Nine-Hole Peg Test (9HPT), hand grip strength, and modified Barthel Index at weeks 2 and 4. Both therapists responsible for training and assessment were blinded to the intervention allocated. Results: There was an improvement in all the motor performance scales among both groups (p<0.001). These improvements persisted at discharge. However, there was no significant difference in any of the assessment scales between the two groups. The rTMS group showed a statistically non-significant greater improvement in MAS, 9HPT, and handgrip strength than the tDCS group. Conclusion Both interventions produce a statistically significant improvement in upper limb function. There was no statistically significant difference between the two intervention methods with respect to motor performance. It is suggested that a larger study may help to clarify the superiority of either methods.

OBJECTIVE: To identify the prevalence of malnutrition in elderly hip fracture and to investigate the relationship between hip fracture patients and malnutrition on functional recovery and mortality. METHODS: All hip fracture patients age >65 years admitted to a rehabilitation unit were recruited from July 2015 to June 2016. Nutritional status was assessed by Mini-Nutritional Assessment Short-Form (MNA-SF) within 72 hours of admission. Patients were reassessed at 6 months for functional status and place of residence. Length of hospital stay, in-patient mortality rate, and 6-month mortality rate were also recorded. RESULTS: There were 218 patients recruited. The mean age was 83.5±7.5 years. According the MNA-SF, 46 (21.1%) were well nourished, 115 (52.6%) were at risk of malnutrition, and 57 (26.1%) were malnourished. Malnourished individuals were significantly older, had lower Mini-Mental State Examination score and albumin level, were functionally more dependent and were more likely to reside in elderly care facility. A higher proportion of elderly care residents were at-risk or were malnourished on admission, discharge and at 6 months. Functional recovery was slower in the malnourished group. In-patient mortality was higher in malnourished individuals compared to those at risk of malnourishment and well-nourished individuals. CONCLUSION: The prevalence of malnutrition is high and is associated with poor functional recovery and elderly care placement. Residents of elderly care facilities are especially at risk due a higher prevalence of malnourishment. Health authorities are encouraged to evaluate the dietetic component in elderly care facilities and initiate nutrition supplementation in their planning of healthcare resources.
Aged* ; Delivery of Health Care ; Hip Fractures* ; Hip* ; Humans ; Length of Stay ; Malnutrition ; Mortality ; Nutritional Status* ; Prevalence ; Rehabilitation

INTRODUCTIONTo explore the relationship between ethnic origin and mode of feeding with early neonatal jaundice, we examined maternal and neonatal risk factors for hyperbilirubinaemia in a multi-ethnic Asian cohort of healthy term newborns.

MATERIALS AND METHODSThis is an observational cohort study in a maternity ward serving a multi-ethnic cosmopolitan community. The relationship between hyperbilirubinaemia (bilirubin >or=150 mmol/L before 48 hours to 72 hours after birth), ethnic origin, weight loss after birth, need for phototherapy, and other factors were examined. Bivariate comparisons and binary logistic regression were used to investigate the relationship between hyperbilirubinaemia/phototherapy with maternal and neonatal risk factors.

RESULTSA consecutive group of 1034 neonates (56% Chinese, 24% Indian subcontinent, 9% Malay) with birth weights >or=2500 g was investigated. Overall factors that contributed significantly to hyperbilirubinaemia/phototherapy were gestational age, Chinese ethnic origin, weight loss of >or=7%, vaginal delivery, glucose-6-phosphate-dehydrogenase (G6PD) deficiency, breastfeeding and ABO incompatibility. Chinese neonates who were totally breastfed had a higher risk for jaundice [adjusted odds ratio (OR) = 1.64; 95% confidence intervals (CI), 1.11- 2.44; P <0.014], and phototherapy (adjusted OR = 2.75; 95% CI 1.77-4.27; P <0.001) compared to those supplemented with, or totally formula fed. In contrast, the risk of jaundice for non- Chinese infants did not differ according to the mode of feed. Although weight loss as a whole increased the risk for jaundice (adjusted OR = 1.43; 95%CI, 1.03-1.99; P = 0.031), jaundice in Chinese neonates was not due to ineffective breastfeeding because both Chinese and non-Chinese breastfed infants lost similar weights.

CONCLUSIONSChinese ethnic origin was an independent risk factor for hyperbilirubinaemia and phototherapy. Breastfeeding was not a risk factor for hyperbilirubinaemia/phototherapy in non-Chinese Asian infants.

Asian Continental Ancestry Group ; Breast Feeding ; Ethnic Groups ; Female ; Gestational Age ; Humans ; Hyperbilirubinemia, Neonatal ; etiology ; therapy ; Infant Formula ; Infant, Newborn ; Jaundice, Neonatal ; etiology ; Male ; Phototherapy ; Risk Factors