Introduction: Chinese medicine (CM) external therapy is commonly used to treat rheumatoid arthritis (RA) in combination with conventional drug. This study aims to provide a comprehensive synthesis on the efficacy of CM external therapy combined with conventional drug treatment in RA. Methods: Randomised controlled trials (RCTs) experimenting the efficacy of CM external therapy (acupuncture, moxibustion and CM fumigation) combined with conventional drug in comparison with conventional drug only in RA patients were collected from PubMed, Medline, Cochrane Central of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Quality was assessed using the Cochrane Risk of Bias Tool. The outcome measures which include Disease Activity Score-28 (DAS28), Visual Analogue Scale (VAS), Swollen Joint Count (SJC), Tumour Necrosis Factor (TNF-α), serum levels of C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were analysed using Review Manager 5.4.1 and GRADEpro GDT online software. Results: Fifty RCTs fulfilling the criteria were included. Although some level of efficacy was statistically noted on the use of CM external therapies, their certainty levels are mixed, ranging only in between moderate and low. Conclusions Mixed levels of certainty has hindered the drawing of conclusion. The addition of CM external therapies to conventional drug treatment may provide some benefits in RA. Further clinical trials with considerations in minimising the risk of bias are recommended to provide more high-quality evidence in the effect of CM external therapies as a complementary treatment in RA.
Medicine, Chinese Traditional ; Fumigation ; Meta-Analysis [Publication Type] ; Moxibustion ; Arthritis, Rheumatoid ; Systematic Review [Publication Type]

Introduction: There is an increasing number of publications on health literacy from Malaysia. We conducted a systematic review of Malaysian studies to determine the prevalence of limited general health literacy and the associated factors among Malaysian adults. Materials and Methods: We conducted a comprehensive search for Malaysian studies on health literacy using PubMed, Scopus and Google Scholar. Cross-sectional studies that measured general health literacy using specific rating scales among adults in Malaysia were retrieved for qualitative analysis. Quantitative synthesis of the prevalence of limited health literacy measured using two rating scales (Newest Vital Sign, NVS and various versions of European Health Literacy Survey, HLS) was performed using random effect model. Results: Twenty-five studies measuring general health literacy were retrieved for qualitative analysis; the majority were various versions of HLS and NVS. Pooled prevalence rates of limited health literacy were: HLS: 48.59%; NVS: 91.41%. Subgroup analysis of participant type revealed prevalence of limited health literacy measured using NVS was lower in clinical samples vs non-clinical samples (85.67% vs 94.70%). Moderator analysis revealed a small effect of ethnicity on prevalence of health literacy measured using HLS. Assessment of included studies showed very few of them had statistically significant associations between socio-demographic factors and limited health literacy. Conclusion Prevalence of limited health literacy in Malaysian adults was very high: almost one in two adults in HLS studies and nine out of ten adults in NVS studies. Socio-demographic factors associated with limited health literacy were inconsistent with other studies.
Adult ; Health Literacy ; Malaysia ; Prevalence ; Systematic Review [Publication Type]

nformation regarding water fluoridation (WF) in Malaysia has been substantially documented, but is scattered in various government publications and may be lost to the stakeholders. This paper is a review of water fluoridation in Malaysia and its effect on oral health: a history of WF in Malaysia, the current policy, the evidence of its effectiveness, the challenges and the future directions. A search for relevant physical and electronic documents of WF in Malaysia resulted in the identification of 70 documents for review. WF was gazetted as national policy with an optimal fluoride level of 0.7 parts-per-million (ppm) in 1972, with a reduction of the level to 0.5 ppm in 2005. Evidence showed that WF effectively reduced population dental caries while fluorosis was not a prevalent public health concern. Strong collaboration between stakeholders and the extensive network of piped water supplies resulted in 80% of the population receiving WF in 2013. However, the coverage was reduced to 74.1% in 2018, largely due to the cessation of WF in Pahang. The key challenges in WF included a lack of funding, weak legislation, use of reverse osmosis water filtration system, difficulty to maintaining an optimal level of fluoride in the water, and lack of local data on the impact of WF cessation on oral health, and its cost-effectiveness. This review will provide dental health professionals with scientific evidence on WF and oral health in Malaysia and assist them in answering relevant questions about WF raised by the public.
Dental Caries ; Fluorosis, Dental ; Malaysia ; Review [Publication Type] ; Fluoridation

Academic dissertations on Kampo medicine have a certain peculiarity about them, when they are drawn up by the rules of western medical writing. Compared to western medicine, oriental medicine tends to employ more subjective terms, because of its many humanistic elements.Study objectives, methods, results and discussions however, need to be stated objectively in a way that makes a paper easy to understand for both referees and readers. Although it would be ideal to use designated terms when making objective statements, there are in fact many terms that have multiple meanings, which need to be clarified in a paper. And when presenting new evidence, one must declare how far any problems have been resolved, as clearly as possible.We have explained the recent changes to our regulations for contributors, regarding Kampo formulae naming conventions, abstract word counts, and contributions by mail. Here we discuss how our editing work proceeds, and our thoughts on how papers are re-reviewed or rejected.
Medicine, Kampo ; Medicine ; Academic Dissertations [Publication Type] ; counts ; Review [Publication Type]

Proliferating trichilemmal cyst is a rapidly growing large cutaneous adnexal neoplasm occurring on the head and neck region of elderly women. Malignant transformation has rarely been reported in these lesions. We describe here a 85-year-old lady who presented with a large ulcerated growth over the scalp for one year duration. Incisional biopsy revealed proliferating trichilemmal cyst with malignant transformation. She underwent wide local excision of this growth. She is alive and without evidence of disease after 14 months of follow up. Because of limited number of cases reported in literature, management of malignant proliferating trichilemmal cyst is controversial. Treatment mainly entails wide local surgical excision. Many other adjuvant modalities have been tried. This paper presents the diagnosis and management of one case of malignant proliferating trichilemmal cyst followed by review of the literature.
Cysts ; Literature ; Review [Publication Type] ; Malignant - descriptor ; Malignant Neoplasms

This is a report on schools of Traditional Chinese Medicine (TCM) and the state of the traditional education system in Singapore. School texts made in the People's Republic of China were used in Singaporean schools. In 1994, however, the Minister of Health appointed a committee to review TCM practices, and recommended measures to safeguard patients' interests and safety. The committee's report published in 1995 recommended that TCM practices in Singapore should be regulated, and recommended steps to upgrade training standards. In compliance with said committee, TCM schools have added basic western medical science to their curricula. And TCM school requirements in Singapore were revised to 3 years full-time curricula or 6 years part-time curricula. In 2000, the TCM Practitioners Act was passed. Singapore is small country with a population of 4.16 million. However, it promotes traditional medical education projects and studies enterprisingly, receiving WHO support and NCCAM grants.
Singapore ; Schools ; Medicine, Chinese Traditional ; seconds ; Review [Publication Type]

Besides young children, pregnant women are at high risk of malaria in highly endemic countries. This paper reviews evidence from studies conducted in Papua New Guinea (PNG) in the last 20 years on the burden and prevention of malaria in pregnancy and highlights gaps in our knowledge of malaria in pregnancy in PNG. Overall, primigravidae were found to be at higher risk than multigravidae, with up to 40% of primigravidae but only 10-25% of multigravidae infected with Plasmodium falciparum at delivery. Such infections were found to be associated with a 128-145 g decrease in birthweight. Mean birthweights reported between 1980 and 2003 range from 2.58 to 2.72 kg in primigravidae and 2.84 to 3.09 kg in multigravidae, with 21% to 48% and 9% to 19% of babies born to primigravidae and multigravidae, respectively, of low birthweight (<2500 g). The negative impact of malaria in pregnancy is compounded by relatively low rates of antenatal coverage. The current PNG national treatment policy which prescribes a treatment course of first-line antimalarial treatment (currently chloroquine and sulphadoxine-pyrimethamine) at first antenatal clinic contact, followed by weekly chloroquine prophylaxis and iron and folate supplementation, may no longer be effective given the high levels of resistance to chloroquine in PNG and poor compliance. In order to reduce the burden of malaria in pregnancy in PNG, alternative methods of control such as insecticide-treated nets and intermittent preventive treatment in pregnancy (IPTp), as well as improved modes of delivery of maternal health interventions, are urgently needed.
Malaria ; Pregnancy ; therapeutic aspects ; Review [Publication Type] ; Human Females

We experienced a case of severe alcoholic hepatitis. Combination treatment of continuous hemodiafiltration and steroid hormone was started immediately after admission. This treatment was very effective for severe alcoholic hepatitis, resulting in the shortening of the length of hospital stay. The reasons why this treatment was effective were; 1. The patient was younger, so the regeneration ability of liver cells was stronger. 2. The infection and bleeding of digestive organs except for acute renal failure were not found, resulting in the enhancement of the effectiveness for steroid hormone treatment. 3. The intensive blood purification treatment was started immediately. From this experience, we realized again that a fine collaboration of doctors, nurses and clinical engineers was very important in the intensive care of the severe diseases.
therapeutic aspects ; Steroid hormone, NOS ; Hepatitis, Alcoholic ; Combined ; Review [Publication Type]

Pregnancy-related deaths in four published perioperative mortality review reports were analysed. The aim is to look at the quality of surgical and anaesthetic services along with the perioperative care provided. The audit identified shortfalls in the logistic and support services and recommended remedial strategies. The review was conducted by a committee consisting of practising anaesthetists, surgeons and obstetricians who analysed the questionnaires collectively. A consensus was reached to categorise the death. There were 280 pregnancy-related deaths. Post-partum haemorrhage accounted for 31.8%, followed by hypertensive disorders of pregnancy (20.0% obstetric embolism (16.1%), sepsis (10.7%) and associated medical conditions (21.4%). In brief, there were comings in preoperative, intra-operative and post-operative care in some of the cases. Increased consultant input, clinical audit, improvements in monitoring and expansion of critical care facilities were the integral issues recommended.
Pregnancy ; Review [Publication Type] ; Aspects of mortality statistics ; seconds ; Sepsis

OBJECTIVE: An in-depth evaluation of rural immunization services in Papua New Guinea was conducted to determine the reasons for poor immunization coverage, as well as to document the impact of recent efforts to strengthen the national immunization program. METHOD: A qualitative process was used to complement quantitative monitoring data. An interview process, based on open-ended questions, active listening and observation, was designed whereby a team of program supervisors collected information from rural health staff. The teams interviewed health staff in 30 health centres that were selected to provide examples of contrasting field situations. RESULTS: This qualitative review provided valuable detail about why immunization services were failing, encompassing locally specific weaknesses, such as logistic reasons for not conducting outreach, and generic systemic problems such as lack of access to funding. In addition, the information gathered provided details on local solutions developed by better-performing facilities. Both these aspects added significant value to quantitative measures of program performance (derived from national health information system data and analysis of supervision checklists). The review also captured a number of behavioural reasons that will need to be overcome before an improvement in the services can be expected. CONCLUSIONS AND IMPLICATIONS: This in-depth evaluation provided valuable information about problems in peripheral immunization clinics and identified local solutions. The high level of detail collected will be important for planning future strengthening of the health system. The study modelled a supportive form of supervision with the potential to improve outcomes from future supervisory visits. Some of the major barriers to improved immunization were locally specific organizational issues, as well as complex human problems. While some issues can be remedied through further strengthening of immunization systems, others lack easy, rapid solutions.
Immunization ; Evaluation ; Health ; Papua New Guinea ; Review [Publication Type]