Mercury-Added Products Management: Challenges In Developing Countries And Lessons Learned From Medical Facility

The risks of mercury use have prompted the establishment of Minamata Convention on Mercury which placed strong emphasis on management of mercury-added products. This convention aims to reduce and phase out the use, manufacturing and trade of mercury-added products including batteries, switches and non-electronic measuring devices. This commitment will cause significant impacts especially in the developing countries in designing the right approach to achieve it. This is also true for medical industry which is well known for the utilization of mercury-added devices and dental amalgam in its services but had embarked on efforts in eliminating mercury for many years. The experiences learned within a medical facility can be useful in efforts to meet this global ambition of mercury phase out. This paper aims to provide conceptual discussion on the challenges faced by developing countries and lessons learned from medical facility that can helps the formulation of appropriate approaches to manage mercury-added products. The paper adopted medical industry as a case study and used document analysis to discuss the issue. The main challenges identified for developing countries include lacks of capacity, funding, data and newer technologies. Based on analysis of previous studies, this study proposed a mercury management framework in medical facility and identified the recommended practices, namely technological application, policy instrument, capacity building and guidelines development. These identified approaches are found to have specific relationships between cost and potential impacts, hence giving flexibility for adoption based on the available resources in promoting better mercury management system

Sleep quality and psychosocial correlates among elderly attendees of an urban primary care centre in Malaysia

Sleep quality can vary in relation to one’s general well-being and in the elderly, it is often affected by the presence of medical or psychological conditions. This study aims to determine the frequency of different components of sleep quality in the elderly, and their relationships with psychosocial and medical attributes. A cross-sectional study was conducted on 123 attendees aged 60 years and above at Pusat Perubatan Primer Universiti Kebangsaan Malaysia. Sleep quality and psychological distress were assessed using the validated Malay versions of Pittsburgh sleep quality index (PSQI) and Hamilton anxiety depression scale (HADS) respectively. Information on medical comorbidities and medications were obtained from the participants, their doctors and medical notes. Almost half of the patients experienced poor sleep quality (47.2%) which was significantly associated with older mean age (69.5 ±4.55). There was no statistical significance between sleep quality and other sociodemographic characteristics (gender, ethnicity and living arrangement). Most patients described their sleep quality as subjectively generally “fairly good” (69.1%) despite PSQI scores indicating poor sleep quality. A majority of the patients (59.3%) were on follow-up for 3 or more medical illnesses, with heart disease as the only medical comorbidity significantly associated with poor sleep quality. Most of them also complained of only “mild difficulty” with their sleep. Among the 7 sleep components of PSQI, “sleep disturbance” was the most frequent experience. Most experienced mild sleep disturbance (87.8%) and usage of hypnotic agents was low (6.5%). Only 23.6% of patients had significant psychological distress (HADS scores ≥ 8), with positive correlation with sleep quality.

Sexual Desire and Sexual Arousal In Malaysian Women : Are They Of The Same Entity?

Objective: To investigate the correlation between sexual desire and sexual arousal among Malaysian women in a primary care setting. Methods: The Malay Version of Female Sexual Function Index (MVFSI) was used to assess low sexual desire and lack of sexual arousal among the respondents. A total of 230 married women aged 18 – 70 years old participated in this study. Their sociodemographic, marital profiles and correlation between low sexual desire and lack of sexual arousal were examined. Results: More than 60% respondents with low sexual desire have co-exist low sexual arousal and 94.4% respondents with high sexual desire do have high sexual arousal ( χ²= 79.6, p <0.001 ), with correlation of r = 0.852. Conclusions: The strong correlation between sexual desire and arousal has both diagnostic and therapeutic indications, and may also strongly support the circular model (Basson-inspired model) of sexual response among women.

Malaysian postgraduate training in psychiatry: Are our trainees having consistent problem in basic science?

Objective: To assess postgraduate candidates’ knowledge on basic sciences and to compare their achievement based on two years study in the Department of Psychiatry, National University of Malaysia (UKM), Kuala Lumpur, Malaysia. Methods: This is a study assessing areas of difficulties in basic sciences for the Malaysian postgraduate candidates sitting for mock MCQ examination papers in two consecutive years. Results: The candidates in both years failed on MCQ papers (scoring marks are only 43% and 40% for the year 2006 and 2005 respectively), which is consistent with their final examination outcomes. The candidates in the year 2006 were much superior in neuroanatomy (percentages of median scores: 47% vs. 31%, p0.05) and stress/immunology (38.2% vs. 37.3%, p>0.05). Conclusion: Medical statistics and stress/immunology remain difficult subjects compared to neurophysiology and psychopharmacology. Malaysian postgraduate candidates need more efforts to understand basic sciences, especially statistics.

Female Sexual Dysfunction Among Malaysian Women in A Primary Care Setting: Does The Frequency of Sexual Activity Matter?

The aim of the study was to compare sexual functioning among Malaysian women in a primary care setting between those with a low and high frequency sexual intercourse.Across-sectional study on 230 married Malaysian women in a primary-care setting was conducted at the Bandar Tun Razak Clinic, Cheras. A validated Malay version of Female Sexual Function Index questionnaire (MVFSFI) was used to assess the sexual functioning profiles among women with low and high sexual activity. The percentage of women who had sexual intercourse 3-4 times a week, 1-2 times a week and < 1-2 times a month were 13.4%, 44.3 % and 42.4 % respectively. Women with a low frequency of sexual intercourse (Low SI) tended to suffer from more sexual dysfunction, (χ²=28.98, p < 0.001) compared to those with a high frequency of sexual intercourse (High SI) group. Women who were less sexually active (having low frequency intercourse, ie. ≤ 1 – 2 times per week) were found to be less sexually aroused (χ²= 25.9, p< 0.001), less orgasmic (χ²=19.8, p< 0.001), less lubricated during sexual activity (χ²=11.1, p< 0.001), complain of sexual pain (χ²=4.3, p = 0.033) and feels less satisfied sexually (χ²=12.6, p< 0.001).The problem of female sexual dysfunction (FSD) in the Malaysian primary care population with low sexual activity needs to be addressed.

The prevalence of genital arousal disorder during sexual activity and potential risk factors that may impair genital arousal among Malaysian women

Objective: To investigate the prevalence of genital arousal disorder and the potential risk factors that may impair genital arousal among women at a primary care setting in Malaysia. Methods: A validated questionnaire for sexual function was used to assess genital arousal function. A total of 230 married women aged 18–70 years old participated in this study. Their sociodemographic and marital profiles were compared between those who had genital arousal disorder and those who did not. The risk factors were examined. Results: The prevalence of genital arousal disorder in the primary care population was 50.4% (116/230). Women with genital arousal disorder were found to be significantly higher in groups of more than 45 years old (p55) (p =.001), those having 4 children or more (p=.028), those having less sexual intercourse (less than 1–2 times a week) (p=.001), and those at post-menopausal state (p=.002). There was no significant difference between these two groups in term of salary (p=.29), suffering from medical problems (p=.32), dysmenorrhea (p=.95), menarche (p=.5) and hormonal replacement therapy (p=.6). Conclusion: Women with infrequent sexual intercourse are less likely to be sexually aroused (OR=0.29, 95% CI: 0.11-0.74).

Personality profile among hypertensive patient undergoing pharmacological treatment in primary care setting

Objective: This study aimed to determine the association between the personality traits and social factors with compliance to anti-hypertensive pharmachotherapy. Methods: This cross sectional study was conducted from 1st of June until 31st of December 2004, which involved Hospital Universiti Kebangsaan Malaysia Primary Polyclinic in Bandar Tasik Selatan, Cheras and Salak Polyclinic in Sepang, Selangor. A total of 200 patients who fulfilled all the inclusion criteria, were selected as respondents. This study used the Mini International Neuropsychiatric Interview (M.I.N.I) for the psychiatric diagnoses and personality characteristics were assessed by using Personality Assessment Schedule (PAS) Results: The prevalence rate of non-compliance was 38.5%. Paranoid personality trait (27.3%) was the most common type of personality traits that associated with non-compliance to the medications prescribed. The results of this study revealed a statistically significant difference between drug compliance and age, race, gender and the site where the study was conducted. No association was found between patients’ education level, occupation, income, marital status, family history of hypertension and personality traits and drug compliance. Conclusion: This study suggested that drug compliance among hypertensive patients was influenced by the presence of psychosocial factors. Hence, it is important for medical practitioners to understand these factors and administer treatment more individual.