Prevalence of obesity and its associated risk factors among Chinese adults in a Malaysian suburban village

<p><b>INTRODUCTION</b>Obesity is a major modifiable risk factor associated with most chronic diseases. The aim of this study was to determine the prevalence of obesity, and its associated risk factors, among apparently healthy Chinese adults in a Malaysian suburban village.</p><p><b>METHODS</b>This was a cross-sectional study conducted among the Chinese residents in Seri Kembangan New Village, Klang Valley, Selangor, Malaysia. Convenience sampling was used for the selection of participants. Body weight, height, waist and hip circumferences, and blood pressure were measured. Fasting venous plasma was drawn for the measurement of fasting glucose level and lipid profile. Data on sociodemographic factors, dietary habits, physical activity, perceived stress level and sleep duration were collected using interviewer-administered, pretested and validated questionnaires.</p><p><b>RESULTS</b>Among the 258 Chinese residents (mean age 41.4 ± 10.0 years) recruited, the prevalence of obesity was 40%. The obese participants had significantly higher mean blood pressure, and triglyceride and fasting plasma glucose levels than the non-obese participants (p < 0.05). The obese participants also had a significantly lower high-density lipoprotein cholesterol level than the non-obese participants. Logistic regression analysis showed that drinking soy milk (adjusted odds ratio [OR] 0.447; 95% confidence interval [CI] 0.253-0.787; p < 0.05) and the perception that a balanced diet consists mainly of vegetables (adjusted OR 0.440; 95% CI 0.215-0.900; p < 0.05) were associated with a reduced risk of obesity. The risk of obesity was higher in younger participants (adjusted OR 2.714; 95% CI 1.225-6.011; p < 0.05).</p><p><b>CONCLUSION</b>The prevalence of obesity was high among the apparently healthy suburban Chinese. Our findings suggest that soy milk consumption and the perception that a balanced diet consists mainly of vegetables are associated with a lower risk of developing obesity in this population.</p>

Family Gp in Australia the role it plays within the health care system

Australia has been internationally recognized as having one of the fairest and the finest health care systems in the world and one of the importantcomponents in the system is a 'Family GP'. To become known as a 'Family doctor' or 'My doctor'in a family, he has to identify the nature of a helath problem from a broad range of possibilities often when very little information is availableand has to act within the social and financial limitations. Matters on the role of a family GP as a guide to health care, on how to become a competent family doctor, on how to improve patient-doctor relationship, on giving health education,and on keeping confidentiality of personal or family health diaries were discussed. Other components involved are teamwork with other GPs, specialized medical professionals, pharmacists, local hospitals and nursing homes. Finally, the importance of continual medical education and Vocational Registration, to keep up to date with the latest medical advances and recognition of medical provide the best possible care, were looked into. It has been estimated that over 80

of the population, in both developed and developing countries visit a General Practitioner (GP) at least once a year. In accordance with theme "Development of Family Medicine in Myanmar" it is important to know how GP and family medicine comes together to improve health care in other countrie. Australia has been internationallyrecognized as having one of the fairest and the finest health care systems in the world and one of the important components in the system is a 'Family GP'. It is fair because Australians contribute to the system through taxes and Medicare levy according to their means. Medicare allows all Australians to get high quality health care according to need. It is one of the finest systems because it provides a very high standard of care, which is internationally acknowledge. The Australian Government also works continuously with the medical profession to further improve GP services to make the good system even better.

Clinical pharmacology in general practice: Bioavailability and therapeutic outcome

When physicians administer drugs to their patients.They do so in the expectation that the anticipated therapeutic effect will result.They are dismayed, therefore, when the patient either derives inadequate or no therapeutic benefit from the medication or worse still develops toxicity.Pharmacological principles state that effective drug therapy requires, not only that the appropriate drugs be given in adequate doses for adequate periods, but also that adequate concentraction of the drug must reach the site of action (blood) to be able to produce a reaponse.Bioavailability is the fraction of the admistered does which reaches the systemic circulation to be available to the receptors to produce a response and this is now reconized as one of the most important factors which determine the therapeutic outcome of many drugs.From the research done, the paper described two different done, the paper described two different aspects of bioavaility, which have to be taken into consideration.The first, fractional bioavailability, is due to the difference in the formulation of the same drug like Lariam and Mephaquin, as with mefloquine.The second phrmacokinetic availability, is due to difference in pharmacokinetics between sex, ethnic groups or diseases states like diarrhea and malaria. In addition, blood levels of different drugs like dapsone, chloroquine and propranolol can still differ (increased, descreases or delayed), .even in the same disease condition making off-hand prediction of response differcult.The use of clinical pharmacology to overcome this difficulty is discussed.

Family GP in Australia the role it plays within the health care system

Australia has been internationally recognized as having one of the fairest and the finest health care systems in the world and one of the importantcomponents in the system is a 'Family GP'. To become known as a 'Family doctor'or 'My doctor' in a family, he has to identify the nature of a health problem from a broad range of possibilities often when very little information is availableand has to act within the social and financial limitations. Matters on the role of a family GP as a guide to health care, on how to become a competent family doctor, on how to become a competent family doctor, on how to improve patient-doctor relationship, on giving health education, and on keeping confidentiality of personal or family health diaries were discussed. Other components involved are teamwork with other GPs. specialized medical professionals, pharmacists. Local hospitals and nursing homes. Finally, the importance of continual medical education and Vocational Registration, to keep up to date with the latest medical advances and recognition of medical advances and recognition of medical practices which are committed to provide the best possible care,were looked into.

Importance of plasma protein binding of antituberculosis drugs on the response to shortcourse chemotherapy

Recently, there has been an increasing concern over the consequences of altered plasma protein binding of drugs in disease states, malnutrition and concomittant drug use on the therapeutic efficacy and toxicity of many antituberculous drugs. The increasing awareness of the problems associated with altered plasma protein binding necessitates studying the plasma protein binding profile of drugs used in short- course therapy for tuberculosis since such a study has not been done regardless of the fact that malnutrition and multiple drug use is often unavoidable and where drug resistance and hepatotoxicity has been a major issue. A total of 5 clinically healthy volunteers and 18 smear-positive tuberculosis patients, who were undertaking a short-course chemotherapy at the Union Tuberculosis Institute, were recruited and the plasma protein level and their binding property to rifampicin, isonazid and pyrazinamide at steary-state were studied. The findings showed that although the total plasma protein level was not significantly reduced, there is decrease in the mean albumin level in relation to the globulin level in tuberculous patients. The protein binding profile showed rifampicin to be highly bound (74-87 per cent) and pyrazinamide to be moderately bound (22-40 per cent ) to plasma proteins but no significant binding was seen with isoniazid (0.7-2.4 per cent ). All 3 drugs achieved adequate serum concentration well above the MIC throughout the study accompanied by rapid clinical improment and sputum conversion to negativity in 88.9 per cent of patients within one month of treatment. No sign of hepatic toxicity was seen in the study. Two patients (11.1 per cent ) had relapse after completion of therapy. The study highlights the importance of plasma protein binding of drugs and its influence on the metabolism and interaction between drugs used concomitantly in short-course chemotherapy. The study also showed that addition of pyrazinamide in short-course chemotherapy is very effective and well tolerated but increase in dosage of pyrazinamide during the twice-weekly phase may be necessary to prevent relapse.

Comparative multiple-dose pharmacokinetics of chloroquine in P. vivax malaria patients and healthy volunteers

Recent evidence of the emergence of resistance of P. vivax to chloroquine in Myanmar has increased the importance and urgency of understanding the cause of resistance as well as the need for devising the strategies to limit its spread. A comparative multiple-dose pharmacokinetic study was conducted on 5 clinically healthy volunteers and 10 malaria patients with P. vivax, admitted to the No. 2 Miliysty Hospital, Yangon, with the object to study whether there is any pharmacokinetic-dynamic relationship underlying the response of patients to standard chloroquine (1500 mg given over 3 days) therapy. Serum chloroquine concentrations reached well above the MIC level in all subjects with the patients' serum concentration (both peak and trough) and the AUC being significantly (2-3 times) higher than jnormal volunteers (p < 0.02). Both the clearance and the volume of distribution were also significantly lower in the malaria patients as compared to the healthy volunteers (p < 0.05). The elimination half-life (T1/2el) was shorter in malaria patients but the difference was not statistically significant. No significant difference was seen with other pharmacokinetic parameters, between normal volunteers and patients and between patients who do and do not recrudescenced. The study supports the emergence of chloroquine-resistant P. vivax in Myanmar and also excludes the possibility of apparent resistance due to pharmacokinetic causes, especially reduced bioavailability.

Potential use of Kyethingha-thee (Momordica charantia L. fruit) in the treatment of maturity onset diabetes mellitus

The hypoglycemic efficacy of Kyethingha-thee dired powder capsule was conducted on five uncomplicated type II non insulin dependent diabetes mellitus patients, who were admitted to the No. 2 Military Hospital, Yangon. Preliminary study revealed that it has hypoglycaemic effect with minimum effective dose of 3 grams for each patient and the time of maximum effect was 4 to 6 hours respectively. Kyethingha-thee was found to be 79.94 percent as effective as tolbutamide and 154.53 percent as effective as TMF 32. So far no adverse side effects were observed in any of these patients.

Clinical trial to compare the analgesic efficacy of selected Traditional Medicine Formulations (TMF-06,-24,-25) on experimentally induced pain in human subjects

Forty clinically healthy volunteers participated in the study aimed to evaluate the therapeutic efficacy of three Traditional Medicine Formulations (TMF-06, TMF-24 and TMF-25) on experimentally-induced cold compressor stimulation pain. The rationale underlying the study is that these formulations have beenproduced locally and used extensively as standard analgesics for pain relief at the Traditional Medicine Hospitals and dispensaries as well as through self-medication over-the-counter-durgs by the local community for many years but has yet received little investigative attention regarding efficacy and sefety. The study was a placebo controlled double-blind, complete cross-over single dose design using aspirin (acetyl salicylate) as positive standard and was evaluated on three basic pain response parameters namely, pain threshold, pain tolerance and pain sensitivity range. All three formulations showed a significant analgesic efficacy (p < 0.01) when compared to placebo (TMF-25 > TMF-24 > TMF-60). No, adverse effects were noted even when given at maximum recomended dose. It was concluded dose. It was concluded that the three TMFs can be used as an alternative to aspirin for the symptomatic relief of mild to moderate pain.

Pharmacokinetics of mefloquine in uncomplicated plasmodium falciparum malaria patients in Myanmar

With the aim to study the pharmacokinetic basis underlying the therapeutic outcome of mefloquine in malaria patients, a single oral dose of 1000 mg mefloquine hydrochloride (Mepha) was administered to 24 patients with acute uncomplicated falciparum malaria and 10 healthy volunteers and was followed-up till day 42. The drug serum levels at various time intervals were analysed by a Waters HPLC and the pharmacokinetic profile studied. The study shows that although Myanmar malaria patients had a slower rate of absorption (T1/2ab = 6.38 + 0.60 hour; Tmax =1.31 + 0.12 days), the peak serum level reached was much higher (Cmax = 2.24 + 0.05 ug/ml) than those of the westerners.

Clinical trial to determine the antidiarrhoeal potential of traditional medicine formulations TMFs-16, TMF-35a and TMF-43

Clinical trial to determine the therapeutic efficacy of three Traditional Medicine Formulations, claimed to have antidiarrhoeal action, were studied on 150 acute diarrhoeal patients admitted to the Infectious Diseases Hospital, Yangon. TMF-16 was found to possess a good antidiarrhoeal action with the antidiarrhoeal index (ADI) of 28.71 percent, which is approximately equal to that of the standard drug, loparamide which had the ADI of 27.94 percent. TMF-35a also possess a mild to moderate antidiarrhoeal action (ADI = 21.5 percent), but TMF-43 showed little or no antidiarrhoeal action (ADI = 9.64 percent). The cllinical significance of the study is that both TMF-16 and loparamide were found to reduce the stool output as well as the amount of fluid replacement required. TMF-16 is well tolerated, available locally and cheaply, and thus, may prove beneficial in the symptomatic relief of non-specific acute diarrhoea.

Clinical trial of antidiabetic traditional medicine formulation (TMF) No. 32

Clinical trial to determine the therapeutic efficacy of a traditional antidiabetic drug, TMF-32, was carried out on six Type II NIDDM patients who were admitted to the Traditional Medicine Hospital, Yangon. All patients, 3 males and 3 females, had a fasting blood glucose level of more than 150 mg percent (205.2 + 35.6) and a 2 hour post-prandial blood glucose level of more than 200 mg percent (323.0 + 62.09) and were clinically free from complications of diabetes. The study was a complete cross-over design, using tolbutamide as a control and was conducted under strict diabetic diet wupplying approximately 2500 kcals per day. Hypoglycaemic efficacy calculated from oral glucose tolerance test (OGTT) curves indicated that TMF-32, at doses of 2G and 3G, significantly reduces the blood glucose levels in these patients (p < 0.01 in both doses). The maximum hypoglycaemic effect was seen at approximately 2 hours after dosing and the duration of action lasted only up to 6 hours. Construction of log. dose-response curves showed TMF-32 of having a hypoglycaemic potency of 73 percent of tolbutamide but frequent side effects and cost of drug give rise to contradicting questions on whether it may be useful as a standard traditional antidiabetic drug.

Effect of acute diarrhoea on the bioavailability of chloroquine in Myanmar subjects

Considering the possibility of altered bioavailability of during acute diarrhoea, there is a need to determine the therapeutic status of chloroquine as an antimalarial prophylactic during an attack of acute diarrhoea and to develop a reasonable basis for dose adjustment if necessary, in such clinical situations. Chloroquine 300 mg base was administered orally to 16 adult diarrhoeal patients from the Infectious Disease Hospital, Yangon and 12 healthy non-diarrhoeal volunteers. The drug serum levels at various time intervals up to 96 hours were analysed fluorometrically and the pharmacokinetic profile studied. Acute diarrhoea was found to decrease the rate, but did not alter the extent of absorption of chloroquine. Since the overall bioavailability of chloroquine remains unchanged, it was concluded that if there is no vomiting, dosage adjustment is not necessary in acute diarrhoea.