Measles Outbreak in Long Urun Not Due To New Strain

KUCHING, Jan 25 (Bernama) -- The measles outbreak which killed 13 Penan children and one adult in Long Urun in the Bakun area last month was not caused by a new strain of the disease, Deputy Chief Minister Tan Sri Dr George Chan said Tuesday.

Dr Chan, who is also state Modernisation of Agriculture Minister, said samples analysed by a team from the Sarawak Medical Department and Universiti Malaysia Sarawak (Unimas) confirmed the virus was not a mutated strain.

"With this strain, the ongoing vaccination of about 700 Penans in the affected settlements takes only 72 hours to be effective. They will be protected against the disease," he told reporters after opening Sarawak Agriculture Department's Senior Officers' Conference in Damai about 35km from here.

The Health Ministry in Kuala Lumpur had been expected to send an investigating team to Sarawak if the results revealed a new strain.

Dr Chan said the semi-nomadic Penans in the Bakun area had not been exposed to measles and so did not develop an immune system naturally.

Apart from the 35 Penan patients, whose conditions were improving at the Bintulu Hospital, no new cases had been reported since yesterday, he said.

Due to the difficult terrain and remoteness of their temporary settlements in Long Urun, he said the flying doctor's service using helicopters had been deployed with 12 medical teams, comprising five personnel each, to vaccinate them.

"It is one of the unfortunate things that it is quite difficult to vaccinate them in the jungle but we have to try our best to get as many (Penans) as possible," he said.

It takes about three hours by logging road to reach Long Urun from the Sungai Asap Resettlement Scheme at Bakun and another three hours from there to Bintulu.

The first death was reported on Dec 27 last year and the last on Jan 11.

-- BERNAMA

Mentakab Hospital::Aedes Breeding Ground

Mentakab Hospital Conducts Dengue Checks Every Three Days

KUANTAN, Jan 26 (Bernama) -- The Mentakab Hospital, which was among 142 premises issued compound notices for breeding the Aedes mosquito, has taken the initiative to conduct dengue checks every three days.

Its director, Dr Bahari Che Awang Ngah, told Bernama here Wednesday that apart from conducting regular checks, the surrounding areas and drains would also be cleaned.

He said that since the Aedes mosquito can breed in just three days, it is important to carry out checks every three days to ensure an Aedes-free environment.

"Previously, we conducted checks twice a week but since the number of dengue cases had increased we need to be more alert," he said.

Dr Bahari said the hospital had been issued a compound notice by the Pahang Health Department and the hospital had been taking various initiatives to avoid a similar occurrence.

Tuesday, Health Minister Datuk Dr Chua Soi Lek said 17,555 premises in Pahang were inspected and the Mentakab Hospital was among the 142 issued compound notices carrying a RM500 fine.

Dr Chua had said that the action to compound even a hospital shows that the ministry would not favour any government department or agency.

Meanwhile, Pahang Menteri Besar Datuk Seri Adnan Yaakob said dengue in the state was under control and advised the public to remain calm.

However, he urged the public to keep their premises clean to prevent the Aedes mosquito from breeding.

"We assess the areas through the number of cases reported. If one case is reported in a particular area it is normal but if two cases are reported it is serious. But so far the situation is under control," he told reporters after chairing the weekly state executive council meeting, here.

Two deaths have been reported in Pahang so far due to suspected dengue. A 46-year-old man in Temerloh died on Jan 6 and a 16-year-old student from Sekolah Menengah Tengku Ampuan Afzan, Kuantan, died two days ago.

"Since the Aedes mosquito breeds in clean water, it should be easier to tackle the problem if we can keep the premises clean," he said.

-- BERNAMA

Measles-Hit Bakun Regions Placed Under Quarantine

KUALA LUMPUR, Jan 23 (Bernama) -- The central and interior regions of Bakun in Sarawak have been declared as areas under quarantine beginning Sunday following a measles outbreak that killed 13 children and an adult recently, the Health Ministry's Communicable Disease Control Director Dr Ramlee Rahmat said Sunday.

He said the quarantine order was issued by the Sarawak Health Department.

"This is in order to prevent spread of the disease and to assess the situation," he told Bernama here.

He said the Sarawak Health Department and the state government would strictly enforce the quarantine order in the areas, and advised the public not to visit the areas until the outbreak had been contained.

"We need to assess the situation in order to determine the spread of the disease and to contain the outbreak by controlling the movement of people in and out of the area," he said.

Dr Ramlee assured the public that the situation was under control and that the Sarawak Health Department had been monitoring the situation closely since the start of the outbreak.

"They (Sarawak Health Department) and the state government have managed it well, taking all precautions and preventive measures," he said.

Asked if the state health department had asked for any assistance from the Health Ministry, Dr Ramlee said "they have not asked" but expressed his confidence that they could handle the situation well.

Sarawak Deputy Chief Minister Tan Sri Dr George Chan Hong Nam has been reported as saying that a total of 66 measles cases had been recorded, including the 14 deaths.

He said those who died were from a longhouse in Sungai Urun in Belaga, located near the Bakun project site or about 150 km inland from Bintulu.

Some of the residents from the Sungai Asap Resettlement Scheme had also been affected and have been placed under strict observation and treatment at Bintulu Hospital.

Dr Chan had said that based on the State Health and Medical Services Department, the Penan community in Sungai Urun had never been exposed to measles.

-- BERNAMA

Local councils to be fined, says Chua

From the NST

For the first time, local councils will be fined for failing to destroy mosquito breeding grounds. The Health Ministry will fine local councils RM500 for each breeding ground found in areas under their jurisdiction, said Health Minister Datuk Dr Chua Soi Lek.

The councils will also be fined for breeding grounds found on their own premises. These fines are imposed under the Destruction of Disease Bearing Insects Act 1975.

All State and district health department enforcement officers can now issue compound notices against errant local councils.

The Health Ministry will also take to task those in charge of its own hospitals and clinics for allowing the Aedes to breed, he said.

The public, however, was not doing enough, he said after opening the second scientific meeting of the Malaysian Society of Hypertension in Kuala Lumpur today.

"They want the authorities to do all the cleaning up.

"When a community based clean-up operation is organised, they just sit at home and watch others do the work.

"These are the same people who keep complaining that the authorities are not doing a good job," he added.

Dr Chua said the Cabinet gave the Health Ministry the green light to take action against errant local councils nationwide at its weekly meeting on Wednesday.

"This clearly shows how serious the Government is in containing the dengue epidemic."

The move was necessary because the dengue outbreak was reaching serious proportions, he added.

"We expect the number of cases to increase within the next one to two weeks, probably very much more than what is being reported now."

Dr Chua had asked the authorities to act following numerous complaints and reports that local councils were not clearing up breeding grounds.

"Local councils should be more responsible."

In Malacca, all State Assemblymen were ordered to take the lead in cleaning up their constituencies.

They have been told to lead gotong-royong sessions at least twice a month as part of the effort to fight the dengue menace, said Chief Minister Datuk Seri Mohd Ali Rustam.

The campaign would also involve local councillors, community leaders, the private sector and the public.

"The fight against dengue can only be won if everyone played their part in ensuring cleanliness," he said.

There was one death, in Alor Gajah, out of 29 cases reported in the State between Jan 1 and Jan 15.

Of these, 22 were in Melaka Tengah, six in Alor Gajah and one in Jasin.

Mohd Ali said gotong-royong sessions were previously carried out once a month.

Finally after being directed by the cabinet, the MOH will be taking action against errant local councils. But is a RM500 fine going to be effective against these errant local councils? The MOH will also take action against those in charge of its hospitals and clinics if Aedes are breeding in places under their charge. Looks like the MINIster is also aware that these 'health grounds' can also be Aedes breeding grounds. The public has also been reminded to play its part in keeping their own surroundings clean and free of Aedes.

Heart Attack::Where to Go?

Source: http://www.medicinenet.com

Heart Attack: Less Treatment May Be Better
By Ed Edelson
HealthDay Reporter

FRIDAY, Jan. 21 (HealthDayNews) -- Someone who has a heart attack or other life-threatening heart condition may be better off going to a general community hospital than to one with a sophisticated cardiology facility, a new, large study finds.

Because the study covers so many countries, some cardiologists are cautioning against drawing specific conclusions.

The study, which covered thousands of incidents from many countries, found the short-term death rate for patients admitted to general hospitals was no different than for those who went to hospitals equipped for catheterization, a procedure in which a very thin tube is inserted into an artery. This is done to get information that can lead to bypass surgery or other invasive treatments.

The research on more than 28,000 patients in 14 countries ranging from the United States to Europe to Australia found that the six-month death rate was 14 percent higher for those admitted to hospitals with catheterization facilities than for patients who went to a hospital without such a facility. The report is in the Jan. 21 online issue of the British Medical Journal (BMJ).

The great majority of patients in the study, 77 percent, were admitted to hospitals with cardiac catheterization facilities.

Patients in the better-equipped hospitals were 10 times more likely to have an invasive procedure such as bypass surgery, the report said; 41 percent of them had such a procedure, compared to 3.9 percent of those in the less specialized hospitals. They were also nearly twice as likely to have a bleeding complication and 33 percent more likely to have a stroke.

"International cardiological societies have developed criteria which are perhaps too liberal with regards to indications for early invasive procedures," said study author Dr. Frans Van de Werf, chairman of the department of cardiology at the University Hospital Gasthuisberg in Leuven, Belgium. "Alternatively, cardiologists may do more invasive procedures than recommended by these guidelines."

Asked whether the most important finding of the study was that someone with an acute heart problem should be taken to the nearest hospital or that invasive procedures are being overdone, Van de Werf replied, "both are equally important."

The study has important implications, not only for decisions in the first minutes when a serious heart problem occurs, but also for follow-up therapy, the journal report said.

"These findings support the current strategy of directing patients with suspected acute coronary syndrome to the nearest hospital with acute-care facilities, irrespective of the availability of a catheterization laboratory, and argue against early routine transfer of these patients to tertiary care hospitals with interventional facilities," the report said.

Asked what a patient or family member could do to influence such a decision, Van de Werf said, "I am afraid not so much can be done by the patients or accompanying people."

The findings must be approached with caution because of the sprawling nature of the study, which included 106 hospitals and a wide variety of patients, said Dr. Sidney Smith, a professor of medicine at the University of North Carolina, and a spokesman for the American Heart Association.

Because the patient population was so diverse, the study is important as a "hypothesis-generating mechanism," Smith said, but it is far from definitive.

"What is needed are randomized clinical trials in which specific groups of patients can be studied," he said. "This study provides fruit for thought, but not the basis for national strategies of care."

SOURCES: Frans Van de Werf, M.D., Ph.D, chairman, cardiology department, University Hospital Gasthuisberg, Leuven, Belgium; Sidney Smith, M.D., professor, medicine, University of North Carolina, Chapel Hill; Jan. 21, 2005, BMJ online

In Malaysia, most big cities now have medical centres which are equipped with the means of carrying out interventional procedures for heart attack patients. Present thinking is that patients with heart attacks should be rushed to these centres for immediate and after care after preliminary screening. Now here we have a report in the BMJ which is saying that less treatment rather than more maybe better. But because of the nature of the study carried out, its findings should be approached with caution and at the most the study provides food for thought. Further and better controlled studies are certainly needed to form the basis of strategies for care of heart attack patients.

'Morning After' Treatment Advised to Prevent AIDS

Thu Jan 20,11:39 PM ET

WASHINGTON (Reuters) - A "morning after" treatment for the AIDS virus can help prevent infection after a rape, contact with a contaminated needle or even a night of passion without a condom, U.S. health officials said on Thursday.

Taking drug cocktails for four weeks seems to greatly reduce the risk of becoming infected with the virus, which is transmitted through sex -- heterosexual and homosexual -- drug use and shared needles, the Centers for Disease Control and Prevention said.

These drug cocktails, called highly active antiretroviral therapy or HAART, are routinely taken for life by HIV-infected patients who can afford it and have access. HAART can keep a patient healthy despite infection with the deadly and incurable virus.

The CDC said there was no ethical way to do a random trial comparing post-exposure prevention to a placebo or dummy pill.

But trials on animals and studies of rape victims and of people at high risk of HIV infection because of their behavior have shown that taking a two- or three-drug cocktail after the possible exposure does prevent infection.

"A 28-day course of HAART is recommended for persons who have had nonoccupational exposure to blood, genital secretions, or other potentially infected body fluids of a person known to be HIV infected when that exposure represents a substantial risk for HIV transmission," the CDC said.

The quicker, the better, it said.

In its report, the CDC pointed to a study of needlestick injuries to health-care workers. "In this study, the prompt initiation of zidovudine (AZT) was associated with an 81 percent decrease in the risk for acquiring HIV."

In another trial of 200 gay and bisexual Brazilians at high risk of HIV infection, doctors gave out "starter packs" of AZT and another AIDS drug called lamivudine.

In the group that used the drugs after having unprotected sex, one person became infected, while 11 people in the group that did not take the drugs became infected.

South African rape victims got a similar treatment and none of the women who started the drugs within 48 to 72 hours became infected.

"Although 400,000 new HIV infections occur in the United States each year, relatively few exposed persons seek care after nonoccupational exposure," the CDC said.

"Preferred regimens include efavirenz and lamivudine or emtricitabine with zidovudine or tenofovir and lopinavir/ritonavir (coformulated in one tablet as Kaletra) and zidovudine with either lamivudine or emtricitabine. Different alternative regimens are possible."

More on Dengue

1. Dengue Cases Rising Rapidly
PUTRAJAYA, Jan 20 (Bernama) -- The number of dengue cases is rising fast, hitting 1,415 cases in the second week of this year from 1,054 the previous week or up 34.9 per cent.
Health Ministry disease control division director Dr Ramlee Rahmat said Selangor recorded the most number of cases, increasing by 153 cases to 654 in the Jan 9 to 15 period.

It was followed by Kuala Lumpur which saw 39 new cases to 246 and Pahang from 40 to 69 cases, he told reporters, here Thursday.

He said the total number of cases in other states also rose except in Terengganu which declined from 21 cases in the first week to 17 in the second.

Dr Ramlee said the ministry's enforcement officers have stepped up checks for potential breeding places of aedes mosquitoes, the carrier of the dengue virus, by inspecting 65,073 premises in the second week compared to 54,508 before.

The premises included shophouses, construction sites, schools, factories, government offices, abandoned houses, places of worship, cemeteries, garbage dumps, vacant land, road dividers and recreational parks.

"We found 685 premises breeding aedes mosquitoes and construction sites remained the worst culprit at 13.1 per cent followed by factories (8.1 per cent) and vacant land (7.1 per cent)," he said.

He said the owners of 267 premises were fined while three premises were ordered closed.

Fogging was carried out in areas with dengue cases while anti-larvae chemical was dropped into water containers in 6,269 premises.

-- BERNAMA

2. School Bus Operators Urged To Fog Buses
PUTRAJAYA, Jan 19 (Bernama) -- School bus operators are urged to conduct fogging in their buses before picking up schoolchildren to protect them from being bitten by the dengue-carrying aedes mosquito.

Federal Territories Minister Tan Sri Mohd Isa Abdul Samad said schoolchildren who go to school in the morning were exposed to aedes mosquitoes who feed twice a day, with the first one between 6 and 7am.

He said the ministry had directed the Road Transport Department (RTD) to inform school bus operators to do so as soon as possible.

"School buses usually pick up the children between 6 and 6.30am and they are prone to aedes mosquito-bites then," he told reporters after chairing his ministry's post-cabinet meeting, here Wednesday.

Mohd Isa said house-to-house inspections implemented by the Kuala Lumpur City Hall Health Unit to prevent dengue would also be conducted at night.

He said pamphlets would be distributed during the inspections to raise public awareness on dengue prevention.

On another matter, Mohd Isa said the Federal Territories Day celebration on Feb 1 would be celebrated moderately and the official celebration would be held at Dataran Merdeka in Kuala Lumpur.

"Kuala Lumpur will be the host and representatives from the Federal Territories of Putrajaya and Labuan would also be present on that day," he said.

-- BERNAMA

3. Ministry Backs Action Against Errant Local Councils
PETALING JAYA, Jan 21 (Bernama) -- The Housing and Local Government Ministry will back any action against local authorities, which are found to have neglected public places or premises under their care, resulting in these places becoming breeding grounds for the aedes mosquito.

Minister Datuk Seri Ong Ka Ting said Friday that the places under the responsibility of the local councils included public parks and playgrounds.

"Nobody is above the law, be they individuals, NGOs (non-governmental organisation) or local authorities.

"Somebody must be responsible for the area. If they (local authorities) are not doing their job properly, I think they should be fined," he told reporters after launching MCA's Life-Long Learning Campaign here.

Ong said the local authorities were not exempted from the law as the rule applied to all, even if they were regulators.

Ong, who was also the MCA president, was asked to comment on the warning issued by the Health Ministry's Communicable Disease Control Director, Dr Ramlee Rahmat, that the ministry would not hesitate to take action against all those found providing breeding grounds for the aedes mosquito, the dengue carrier.

The warning was issued following the increase in the number of the dengue cases reported in Kedah, Melaka, Johor, Negeri Sembilan, Terengganu, Kelantan, Sabah and Sarawak.

The Health Ministry said the dengue outbreak, declared on Jan 9, was initially confined to Selangor, Federal Territory, Penang and Pahang but had spread to other states since.

-- BERNAMA

MOH now says that the dengue outbreak is spreading to other states and has not been contained in the earlier mentioned states :: Selangor, FT/KL, Penang and Pahang. The 'migration' during the present long weekend and the CNY season is very worrying as it would help to spread the disease.
The Housing and Local Government Ministry has given the MOH to take action against errant local authorities who are allowing public places to become aedes breeding grounds. Joe public can help by reporting such breeding grounds.
The fogging of public transport vehicles should not be confined to school buses, other vehicles like public buses, vans, trains etc should be similar fogged. But who is going to enforce it.

A New Experimental Stent

Source: http://www.medicinenet.com


Experimental Stent Could Revolutionize Treatment of Artery Disease
By Ed Edelson
HealthDay Reporter

TUESDAY, Jan. 18 (HealthDayNews) -- Belgian researchers are reporting a successful first trial that could change the definition of a stent -- the metal tube that is implanted to keep an artery open.

Current stents are implanted permanently to prevent an artery from closing again. But the researchers said they have used a metal stent that is absorbed by the body in a matter of weeks. And this stent does a better job of keeping arteries open than the permanent kind, the scientists added.

"The stent we use is 90 percent magnesium, which you find in normal blood and normal tissue," said Dr. Marc Bosiers, head of the department of vascular surgery at A.Z Sint-Blasius Hospital in Dendermonde. The other 10 percent is made up of rare earth elements. Eight years of animal tests and a trial with 20 persons have shown that the body starts absorbing the stent within a week to 10 days, and the stent is completely absorbed in no more than 60 days, he said.

The human trial also showed that a larger percentage of arteries that received the absorbable stent remained open six months later than the reported success rate with conventional stents, Bosiers said.

The researchers presented the findings Jan. 18 at the 17th International Symposium on Endovascular Therapy in Miami Beach, Fla.

The people in the trial all had severely blocked arteries below the knees, a condition called peripheral arterial disease that can lead to amputation. Six months after the implant, long after the stents had been absorbed, 15 of 19 arteries remained open. (One patient died of pneumonia unrelated to the procedure.) Typically, only 40 percent of below-the-knee blocked arteries remain open six months after a conventional stent has been implanted, Bosiers said.

Why should a stent that is absorbed by the body do better than one that remains in place? A permanent stent can cause chronic inflammation and damage to the blood vessel wall that induces growth of new tissue that eventually re-blocks the artery, Bosiers said.

The absorbable stent "does not stay long enough to be an inducer of chronic inflammation," he said. "You only need [an absorbable] stent for 10 to 14 days, but a conventional one must stay in the body for the rest of your life."

The trial reported at the meeting "was a first study to look at safety and efficacy," Bosiers said. "If the material is absorbed in the vessel wall, where does it go?" Extensive blood and tissue tests found that "nothing toxic was to be seen," he said.

The Belgian researchers are now initiating two large-scale trials designed to get regulatory approval for use of the absorbable stent in European medical practice, Bosiers said. One trial of treatment of below-the-knee arteries is being done at 10 European high-volume centers. The other will use the stent in blocked coronary arteries, he said.

"If we have a positive outcome in the below-the-knee study, we could go commercial with the stent in Europe at the beginning of 2006," Bosiers said. "We will be starting parallel studies in the United States by the end of the year. In these things, Europe is always a little bit ahead because the regulations are not as strict, but we hope to go commercial in the United States by 2007."

Dr. Deepak L. Bhatt, director of the interventional cardiovascular fellowship program at the Cleveland Clinic Foundation, said the trial results are "only a proof of concept, but a very important proof of concept. This is very likely to be the future of stenting. If it pans out, it will be a major advance."

The below-the-knee results are exciting because "right now we don't have great therapies for that sort of patients," Bhatt said. But an absorbable stent would have uses all over the body, because there are many cases in which a patient needs stenting but one cannot be implanted because it might interfere with treatment of later problems, he said.

Current stents are coated with drugs to prevent clotting. "Our next step will be to combine an active coating on a bioabsorbable medium," Bosiers said.

That prospect could truly expand the definition of a stent, Bhatt said. "We would be at a whole new level where a stent becomes a drug-delivery system," he said.

SOURCES: Marc Bosiers, M.D., head, department of vascular surgery, A.Z. Sint-Blasius Hospital, Dendermonde, Belgium; Deepak L. Bhatt, director, interventional cardiovascular fellowship program, Cleveland Clinic Foundation; Jan. 18, 2005, presentation, 17th Annual Symposium on Endovascular Therapy, Miami Beach, Fla.

An exciting development indeed. While most doctors involved in stenting are presently arguing about the pros and cons of the medicated stents, this magnesium stent might just prove the answer to stenting if it pans out. New hope for those with blocked coronaries.

Dengue Fever :: The Rising Tide

It looks like we are in for more dengue cases to come, it is another rising tide. It may not have reached epidemic proportions but if uncontrolled it would be heading in that direction. To check out on the present situation and maybe a clearer picture, clicked on the links below ::

1. Dewan Rakyat Sets Aside One Hour To Debate Motion On Dengue Fever :: 18th Jan
The Special Dewan Rakyat session Tuesday set aside one hour to debate a motion on dengue fever as the aedes mosquito spread fever has reached a serious magnitude, with more than 1,000 people being diagnosed with the ailment in a week.
The motion moved by Dr Raman Ismail (BN-Gombak) was accepted for debate by Dewan Rakyat Deputy Speaker Datuk Lim Si Cheng as it fulfilled the three criteria -- a specific issue, urgent and of public interest -- under Article 18.1 of the House Standing Orders....
Dr Raman, in tabling the motion, said dengue fever reported to have attained a serious proportion in several states, especially in Selangor, Kuala Lumpur, Penang and Pahang, had created a critical situation, threatening the lives of Malaysians, particularly those residing in epidemic areas....

2. Action Against Errant Local Authorities :: 18th Jan
The Health Ministry has the power to take action against local authorities which fail to ensure that the areas under their jurisdiction are free from dengue.
However, issuing compound fines was not the solution, said Health Ministry's Disease Control Division Director Dr Ramlee Rahmat Tuesday....
"Under the law, the ministry can take action against anyone and not necessarily individuals," he said and noted that the ministry had issued compound fines on schools and hospitals before.

3. KL Hospital Prepares For Upsurge In Dengue Cases :: 18th Jan
Kuala Lumpur Hospital (HKL) is preparing its facilities and medical staff to deal with the expected rise in dengue cases here and in Selangor in the next two weeks, Health Minister Datuk Dr Chua Soi Lek said...
There are currently 150 dengue cases in HKL, accounting for nearly eight per cent of the 1,700 patients in the hospital.
"This is definitely an increase compared to the average of 30 cases several weeks ago," he said.

4. Dengue Cases In Johor Up 37 Per Cent In First Week :: 18th Jan
Dengue cases in Johor in the first week of the year showed a 37 per cent increase compared to the same period last year, state Health Department (Public Health) Deputy Director Dr Daud Abdul Rahim said Tuesday.
During the first seven days, 71 cases of dengue fever and three cases of haemorrhagic dengue fever which did not lead to death were reported against 22 cases of dengue fever and six haemorrhagic dengue fever cases that were not fatal in the corresponding period last year, he said....
Last year 3,056 dengue cases were reported in Johor compared to 3,211 cases in 2003, marking a 4.8 per cent decrease.

5. JB City Council Opens Control Centre To Check Dengue Spread :: 19th Jan
The Johor Baharu City Council (MBJB) will open a vector-borne disease control centre and enforce Section 18(1) of the Infectious Disease Prevention and Control Act 1988 to check the spread of dengue fever in areas under its jurisdiction.
Johor Baharu Mayor Datuk Wahid Dahlan said 45 dengue cases were reported in the first two weeks of this year or 23 cases a week compared to an average of 11 cases a week last year.
"This is very worrying," he told a press conference here Wednesday.

Obviously this time around, Dengue has got the MOH and gomen worried. Worried enough for it to be given an hour of debate time in Parliament. The motion was moved not by the opposition but by a gomen backbencher.
The lackadaisical attitudes of the MOH, local health authorities, local council and people have contributed to this dengue menace. People are not too keen to have their houses sprayed near dinner time, i know of some who would lock up their houses and go somewhere else when they know that the fogging teams are coming. Such behaviour will not help in dealing with dengue. The MOH needs to go around and educate the people more. What Dr Daud said is very true :: "This is caused by the attitude of residents who do not care about the condition of places that are potential aedes breeding grounds which include their homes and surrounding areas."
The MOH's attitude also does not help much. It tells us that it has the power to take action against local authorities which fail to ensure that the areas under their jurisdiction are free from dengue. And in the next breath, says "issuing compound fines was not the solution." Why so friend-friend with the local authorities? Just make one as an example and the rest will toe the line. All for the good of the nation. The time for cooperation and not taking action is over. No more play-play, it is time to bring on the 'sledgehammer'. The MOH should show that it means business when lives are in danger. The other local authorities should follow MBJB's example and really get serious to ensure that the Dengue situation does not worsen.
Daunting times lie ahead as the chinese new year will be upon us soon. During this festive season there will be plenty of 'short term migration', some of those infected will travel back to infect others while others will be travelling to the dengue areas to get infected and eventually take them home after the festivities. So will there be an "outbreak" after the festivities? Just thinking aloud.

Deaths from Dengue

361 Dengue Deaths Recorded Over Last Six Years

PUTRAJAYA, Jan 14 (Bernama) -- A total of 361 people died of dengue fever from 130,673 cases reported since 1999, Health Ministry Disease Control Division Director Dr Ramlee Rahmat said Friday.

He said the total did not include the latest death reported in the second week of this year.

In the last six years, 2002 recorded the highest number of dengue deaths with 99 from 32,767 cases reported, he told reporters here Friday.

Based on Health Ministry statistics, a total of 37 deaths were recorded in 1999 from 10,146 cases reported, 45 died in 2000 (7,146), 50 people in 2001 (16,368), 72 in 2003 (31,043) and 58 last year (33,203).

He said in Putrajaya alone, 213 cases were reported for the whole of last year and for the first week of this year there were eight cases.

However, he said, the number deaths and cases reported in Malaysia remained at a low level compared with several neighbours, including Thailand and Singapore.

The tourism sector need not worry as the ministry was constantly monitoring the situation, he said.

He added that the disease could be contained if everyone played their part, including continuously destroying larvae breeding areas.

--BERNAMA

Dengue fever by itself rarely causes death. But its haemorhagic variety carries a mortality risk. So we can assume that most if not all of these 361 deaths were due to the haemorrhagic form. As dengue is caused by viruses, there is no definative treatment for it. Only supportive management is available while the body fights off the viral attack.
While waiting for a vaccine to be developed, the main prong of prevention is to destroy the vector, the Aedes mosquito.

Government Hospital Specialists To Charge Fees Soon

KANGAR, Jan 14 (Bernama) -- Medical specialists in government hospitals will soon be allowed to charge fees for treating patients who are able to afford their services.

Deputy Health Minister Datuk Dr Abdul Latiff Ahmad said the scheme would be implemented in the Putrajaya Hospital and Selayang Hospital in Selangor as a pilot project.

If the effects were positive, it would be extended to specialists in all government hospitals, he told reporters after opening the RM100,000 Psychosocial Rehabilitation Unit building at the Beseri Health Centre here Friday.

"The charges would probably be similar to the fees in private hospitals and payments would be made directly to the specialists who provided the treatment," he said.

There are about 3,000 medical specialists out of the 9,000 doctors serving in government hospitals.

Dr Abdul Latiff also said the Health Ministry has formed a counselling team to help tsunami survivors in the country suffering from trauma caused by the disaster.

He said the counsellors would identify these survivors and, if necessary, experts would be assigned to provide psychological support and help them recover quickly to lead a normal life.

On the Psychosocial Rehabilitation Unit, he said it would provide follow-up treatment to mental patients with the help of their families and the local community.

He said the government planned to set up more such units which now existed only in Perlis, Kelantan, Kedah and Perak.

-- BERNAMA

This is not actually something new, it has been done in the past. Wonder if it would prove to be win-win-win this time around for the patient, the specialist and the MOH. But being in Boleh Land, one can expect that it will get abused in time to come.
The system used in the past allowed the specialist to have private patients and thereby increase his income. Over time it was found that the surgeons and the obgyns benefitted most while the other specialists were not making much more out of the system. So a portion of the gomen specialists was unsatisfied with the system. The other problem which cropped up was that non-private paying patients were disadvantaged as more time was being spent looking after the private patients. These patients were also getting earlier appointemnts for surgeries. So the system was eventually stopped and replaced with the fixed specialist allowance scheme.
As to how this newly transformed scheme will work, only time will tell as the MOH is keeping all info about this scheme under wraps. Anyway it will be tried out only in 2 hospitals ie Putrajaya Hospital and Selayang Hospital, presently.

Dengue Watch

1.Construction Sites Worst Culprits In Breeding Aedes Mosquitoes

PUTRAJAYA, Jan 11 (Bernama) -- Construction sites are the most common breeding ground for aedes mosquitoes that carry the potentially deadly dengue virus.

Health Ministry Disease Control Division Director Dr Ramlee Rahmat said 15.4 per cent of construction sites inspected nationwide last year were found breeding aedes.

It was worse in Selangor, where 75.1 per cent of all premises found breeding aedes were construction sites, followed by offices (16.6 per cent), factories (15.5 per cent) and vacant land (8.3 per cent), he told a press conference, here Tuesday.

Construction sites were also found to be the main dengue culprits in Kuala Lumpur Federal Territory with 33.2 per cent, followed by factories (13.7 per cent) and schools (6.8 per cent).

However, the most common aedes breeding ground in Pahang was vacant land at 48.1 per cent and recreational parks (9.1 per cent) while in Penang 17.6 per cent of all premises found breeding aedes were vacant land, followed by recreational parks (9.5 per cent).

Dr Ramlee said in the week from Dec 26 last year, there were 1,077 dengue cases reported in the country compared to 969 cases in the previous week.

Selangor recorded the highest increase of cases to 469 from 365, Kuala Lumpur from 211 to 249 and Penang from 59 to 62, but Pahang registered a decline from 61 to 31, he said.

On the whole, the number of cases last year rose 2,690 to 33,203 from 30,513 a year before, he said.

Meanwhile in SHAH ALAM, Mayor Ramli Mahmud said Shah Alam City Council (MBSA) issued 13 compound fines to premises found breeding aedes in an operation last week.

In the operation, 1,127 premises including residential compounds, factories, schools, shrines and recreational parks were inspected, he said.

He said the MBSA was providing free fogging service to Shah Alam residents and those requiring the service should contact the MBSA's Health Department at 03-55105133 ext. 273 or 274.

-- BERNAMA

2.City Hall To Launch Anti-Dengue Campaign

KUALA LUMPUR, Jan 11 (Bernama) -- An anti-dengue campaign will be launched in Cheras on Saturday, Federal Territories Minister Tan Sri Mohd Isa Samad said Tuesday.

He said ongoing efforts to stamp out the menace had to be beefed up as City Hall (DBKL) studies showed breeding trends of the mosquitoes kept changing.

"Two years ago the peak was in July but now it is at the year-end," he told a press conference here.

He said of the 207 cases reported in the city from Jan 1 to 8, 58 were confirmed as dengue fever.

Of the total, 19 were reported in Setapak, 15 in Kepong, 12 in Cheras, eight in the city centre, three in Jalan Klang Lama and one in Damansara.

Last year, 1,542 confirmed dengue cases were reported in the city.

Mohd Isa said abandoned building projects would be among the priority areas for the anti-dengue campaign.

"DBKL must take action to clean up the areas concerned and get the developers to pay later, if they could be traced," he added.

-- BERNAMA

3.Ministry says dengue figures will be made public
Beh Lih Yi
Jan 11, 05 6:44pm

The Health Ministry has assured that all relevant information regarding the dengue situation in the country would be made public as and when they are available.

"We can make them public. I will check with my ministry officials. To me it is public knowledge, there is nothing to hide," its parliamentary secretary Lee Kah Choon told malaysiakini when contacted this afternoon.

He said his ministry will consider publishing the latest dengue-related information such as the reported cases on the ministry's official website.


The Health Ministry, he said, will also conduct an awareness campaign and coordinate with the housing and local government ministry to carry out fogging at dengue affected area.

Lee's assurance of the ministry's transparency in handling dengue cases came after the country has been put on alert of a possible dengue outbreak.

Last Friday, Health Minister Dr Chua Soi Lek warned of a possible dengue outbreak in the next month or two.

According to him, sharp increase of cases were recorded in Kuala Lumpur, Selangor, Penang and Pahang where about 1,000 cases were reported in a week.

Despite the alert, the public have not been able to gain access to either the ministry's website or media reports to obtain a full picture of the dengue situation in the country.

So far, the ministry has only released the number of suspected dengue cases in the four states as at Jan 1 during a press conference in Putrajaya today.

Outbreak or epidemic

The ministry's disease control division director Dr Ramlee Rahmat told malaysiakini that his division is in the midst of compiling the latest statistics from the health department of all the states.

He described the current dengue situation as "serious" but declined to confirm its status - whether it is an outbreak or an epidemic.

"An outbreak goes with the trend (of reported cases), not by number of cases while an outbreak or epidemic is when there is more than one case occurring in one locality within a period of a week," he explained.

"For disease control and prevention purpose however, we tell our hospital that when there is more than one case reported in the same area, there is a dengue outbreak.

"However, the use of the term "outbreak" could give other meanings to the public," Ramlee noted.

According to him, a total of 58 deaths due to dengue haemorrhagic fever and 33,203 of cases were reported last year, as opposed to 72 deaths and 30,513 cases reported in 2003.

A total of 969 suspected dengue cases were reported nationwide in a week between Dec 19-25 last year and another 1,077 new suspected cases were reported from Dec 26 to Jan 1 this year.

Selangor is the worst hit with 469 new cases recorded in the last week of 2004, a jump from 365 cases reported a week before. This was followed by Federal Territory with 249 cases which saw an increase of 104 cases in a week.

Ramlee explained that the figures were new cases after the patient developed dengue symptoms such as painful joints, fever and a rash. Dengue symptoms usually begin within a week of a bite from a carrier mosquito.

The director urged the public to step up measures to curb the breeding of the killer aedes mosquito and obtain advice from nearby clinics should they develop symptoms..

"If there are no drastic measures to reduce the number of mosquito breeding, we foresee the dengue cases will keep increasing in a short term because the carrier mosquito is there and we are all exposed to it," he warned.

Pro-active actions

Meanwhile, Puchong MP Lau Yen Peng urged the ministry and the local authority to identify potential dengue-affected areas immediately and take preventive measures.


"Pro-active actions such as fogging and clearing clogged drains must be carried out immediately. The latest dengue figures must be updated," Lau said when contacted.

He also demanded the Health Ministry to follow the World Health Organisation benchmark in classifying the seriousness of the dengue situation and called for transparency to be upheld.

Lau, a former Subang Jaya municipal councillor, claimed that he had been denied information pertaining to the dengue outbreak when he was a councillor, saying he was told that revealing the figures will affect the tourism industry.

----Malaysiakini.com

4.What dengue alert, when Health Ministry is not on alert?

Media Statement
by Lim Kit Siang

(Parliament, Monday): The Health Minister, Datuk Chua Soi Lek should take the Health Ministry into the information age by breaking away from the past secrecy syndrome and post the latest weekly updates of dengue cases and deaths on the Health Ministry website for public information to demonstrate real government seriousness in the war against dengue.

Following Chua's Friday warning of an impending dengue fever outbreak, the Deputy Prime Minister, Datuk Seri Najib Tun Razak, who is also Chairman of the Cabinet Committee on national health and safety, yesterday called on the authorities and the public to take a holistic approach to stop the spread of dengue fever "which is getting more serious" as the number of cases had jumped to 1,000 a week.

The government itself must set the example of a "holistic approach", which it has signally itself failed to do or the dengue threat would not have reached the serious level of 1,000 cases a week.

During the previous dengue epidemic, the then Health Minister, Datuk Chua Jui Meng sought to rebut DAP allegations of the seriousness of the outbreak and told Parliament on 11th March 2003 that "Di Malaysia, sejak tahun 1997 sehingga 2002 purata kes dengi (demam denggi dan deman denggi berdarah) setahun adalah 8,364 kes dan kematian sebanyak 54 kes".

This works to an average of 160 dengue cases per week in the six years from 1997 - 2002.

It does not reflect positively on the efficiency, capability and vigilance of the Health Ministry that it has not sounded the dengue alarm and alert earlier, although in the past three months, the number of dengue cases have shot up to the present 1,000 cases a week, which is six times the weekly average for the six years from 1997-2002.

In this connection, I fully agree with non-government organizations that the Health Ministry had been caught napping by the dengue outbreak, and should have issued the dengue alert earlier and Chua's outburst against the NGOs for this reprimand is most unwarranted.

The Health Ministry is not solely at fault, for the Local Government and Housing Ministry, with overall responsibility for the local government authorities, and the various State Governments must also bear equal responsibility for the worsening of the dengue outbreak, failing not only to keep the environment aedes mosquites-free, but in conveying the dengue alert to the public at the first available opportunity.

In actual fact, the Health Ministry itself has yet to demonstrate its full seriousness about the Health Minister's dengue warning. I have been visiting the Health Ministry website for the past three days since Chua's dengue warning, but there has been nothing on it about the dengue alert raising the question as to how the country could be on dengue alert when the Health Ministry itself is not yet on dengue alert!

The first step to demonstrate the Health Ministry's seriousness about the dengue alert is for the Health Ministry to stop being a "cobwebsite" and feature a special item on its website on the dengue menace, giving not only all the relevant information about the preventive measures that should be taken by the public, but even more important, providing the latest update information on a weekly basis of the number of dengue cases and death, state-by-state and even hotspot-by-hotspot.

For a start, Chua should make public the statistics of the dengue cases and deaths for last year and the previous two years, on a state-by-state and month-by-month basis, which will be the first signal that the Health Ministry has begun to enter the information age and is serious in wanting to get public support and involvement in the fight against preventable diseases.

(10/1/2005)

• Now is there really a danger of an outbreak of dengue in KL, Selangor and the other states or is all those involved using Dengue as a news-opportunity?


• Why are those involved Adopting A Lackadaisical Attitude, this is certainly not part of Malaysian gomen MINIsters' and authorities' culture?


• What is meant by an "outbreak". Is this true :: "For disease control and prevention purpose however, we tell our hospital that when there is more than one case reported in the same area, there is a dengue outbreak"? OR is this ['aut-"brAk] true?


• Are they just making mincemeat of the working together, non-lackadaisical and courteous attitude of Malaysian Culture?


• The PM certainly won't be having another honeymoon in the near future or ever again.

Hospital Kulat Reopening Delayed

No word yet about hospital
By By R. Sittamparam

Jan 1, the deadline for the opening of the Sultan Ismail Specialist Hospital in Pandan after fungal decontamination, has come and gone but the facility remains closed. The State Health Department is still awaiting word from the Health Ministry on the date for the re-opening of the hospital.

A spokesman said his department had learnt that the Public Works Department was still working on the clean-up at the hospital.

The RM557.8 million hospital was closed on Sept 25 last year after faulty air-conditioning led to a serious fungal infection.

The fungi identified as Aspergillus and Penicillium started growing at the ground floor of the hospital and spread to the upper floors, contaminating hospital equipment and furniture.

The hospital was 91 per cent completed with nearly 75 per cent of equipment installed when the problem was detected.

It is believed that the Government had allocated additional funds for the clean-up operation at the hospital.

The PWD had also instructed the contractor to do some upgrading work at the hospital including repairs and re-painting.

Works Minister Datuk Seri S. Samy Vellu stated last November that his ministry would not face problems in handing over the hospital to the Health Ministry by Jan 1. He said work was under way to treat the infection and keep it from recurring.

When contacted, State Excos for Housing and Public Works Datuk Baderi Dasuki and Local Government and Health, Datuk Halimah Sadique said they would look into the matter, and issue separate statements on it on Monday.

It has been more than 3 months since this Hospital Kulat was closed for cleaning up operations after having been in use for a short while. It appears that there must be plenty to clean up and not what our Works MINIster earlier described as the 'usual fungal infection' that new buildings can have. It also looks like the Works MINIster is not able to live up to his promise of having the hospital operational by his own deadline. Can the taxpayers receive an update soon from those in-charge regarding the state of the clean-up and when will this hospital be available for use minus the kulat infection?

Potential Dengue Outbreak Alert

MOH Warns Of Potential Dengue Outbreak In KL And Three States

KUALA TERENGGANU, Jan 7 (Bernama) -- Selangor, Penang, Pahang and Kuala Lumpur Federal Territory may face a dengue epidemic in one or two months unless the people in these areas take drastic preventive measures, Health Minister Datuk Dr Chua Soi Lek warned Friday.

He said in the past month Selangor reported an increase from the normal average 120 cases a week to 350 cases, Federal Territory from 100 to 250, Penang from 20 to 50 and Pahang from 30 to 80.

"This is a signal that we will be faced with an outbreak of the disease in certain states," he told reporters after visiting the Kuala Terengganu Hospital today.

He said as a preventive measure the ministry had inspected 2.83 million premises throughout the country, of which the owners of 14,186 premises were fined for breeding mosquitoes, 59 were charged in court and 13 closed down.

The ministry also disinfected more than 155,000 premises and carried out fogging from time to time.

"However, I urge the people especially those living in urban areas to give their full cooperation in preventing stagnant water from forming in their premises as no amount of enforcement or fogging will bring the desired results if they don't.

"The people must make sure their homes are not breeding ground for mosquitoes which multiply very quickly during the rainy season," he said.

Chua also said the ministry would give more attention to the Kuala Terengganu Hospital as it is the only major hospital in the state in the absence of private ones.

-- BERNAMA

Everyone has to play his/her part in containing this problematic illness. Dengue fever is endemic in our country, it is not dangerous but its haemorrhagic form can have dire consequences.
There is no specific treatment for dengue fever or its haemorrhagic form. The key is prevention and control of its vector, the Aedes mosquitoes. So remember to do your part by eliminating mosquito breeding sites around homes, ensuring that rain or run-off water do not collect, eg old tires, food containers etc. Regular change of water of pet and animal water containers will also help. In general, keep one's surroundings clean.

More HRT Woes

Timesonline

January 07, 2005

HRT causes alarming rise in fatal stroke risk
By Nigel Hawkes, Health Editor

HORMONE replacement therapy increases the risk of stroke by almost a third, and the risk of fatal or disabling stroke by more than half, a review of clinical trials has shown.

In the past, HRT was believed to protect against heart disease and stroke, but with more trials the balance of evidence has shifted. Most experts do not recommend the use of HRT except for brief periods, and the new analysis, which pools the results of 28 trials involving nearly 40,000 women, is likely to discourage many more.

The results, published on the online version of the British Medical Journal, show that strokes are increased by 29 per cent in women on HRT. The effect is seen in ischaemic strokes, caused by blockages of blood flow to the brain, not in the less common form of haemorrhagic stroke, caused by bleeding within the brain.

Fatal or disabling strokes are increased by 56 per cent in women on HRT, while minor and transient stokes that do less long-term damage are not affected. The team, from the University of Nottingham, said that patients with a high risk of stroke should stop taking HRT unless there is a strong medical reason not to.

The trials reviewed included a US study from the Women’s Health Initiative that in 2002 linked HRT with higher risks of breast cancer, heart attack and stroke. Last year the study, which involved almost 17,000 women over 50, said that those taking HRT for five years doubled the risk of life-threatening blood clots.

The Royal College of Obstetricians and Gynaecologists has advised that HRT should be used only in the short term to relieve menopausal symptoms.

The team, led by Professor Philip Bath, said: “A poor outcome after stroke, judged as combined death and dependency, was increased by half with hormone replacement therapy. We also found a significant increase in non-fatal stroke.”

They said it was not clear why HRT should increase the risk of stroke and its severity.

The review will raise further concerns among women seeking treatment for symptoms of the menopause, which include debilitating hot flushes, insomnia, headaches and irritability.

The number of prescriptions for HRT has fallen as more trials have emerged highlighting dangers. But experts say that in the short term the benefits can outweigh the risks because of improvements to quality of life with the relief of severe menopausal symptoms.

The researchers said: “We found that the use of hormone replacement therapy is associated with an increased risk of stroke, typically ischaemic in type and severe in nature.

“HRT cannot be recommended for the primary or secondary prevention of stroke.

“Extrapolation of the data suggests that patients at high risk of stroke — such as those with previous stroke, coronary heart disease or multiple vascular risk factors — should stop taking it unless there is a strong contrary medical reason.”

It wasn't so long ago that perimenopausal and menopausal ladies and even those who have been menopausal for 20 years, had HRT pills being dished out to them like sweets and lollipops in the belief that it would keep their skin, heart and bones young. The goodness of HRT was claimed to include protection against dementia, colon cancer and insomnia. Demand appeared to exceed supply and newer and newer HRT appeared on the scene. That was the period when the fountain-of-youth looked within reach. It is now all quiet on the HRT front, as more and more studies are turning out the bad side of HRT.
It looks like as far as new drugs or new drug therapies come on the scene, one [inclusive of the manufacturer, the prescriber and those taking the prescriptions] should act responsibly and approach and use them with great caution. Not many will recall the thalidomide baby disaster of the 60's. That was a lesson to be learnt and remembered but unfortunately many may have forgotten.

Immunisation Must For Relief Aid Workers Going To Tsunami-Affected

KUALA LUMPUR, Jan 4 (Bernama) -- All relief aid workers from Malaysia heading for countries affected by the tsunami must take immunisation jabs and antibiotics as a precaution against epidemic diseases.

Kuala Lumpur Hospital Emergency Department Head Datuk Abu Hassan Assari said the preventive measure was important to protect them from being exposed to such diseases in these countries when there is an outbreak.

He said the possibility of an epidemic outbreak of diseases in affected areas like Acheh, Sri Lanka and India was highly likely due to the prevailing conditions there.

"Apparently there is a lack of clean drinking water, the environment is polluted and there is a lack of medical supply to contain such an outbreak.

"Under normal circumstances, areas affected by such tragedies are prone to malaria, cholera, yellow fever, dengue, gastro-enteritis, dysentery and post- traumatic stress disorder," he told reporters at his office here Tuesday.

He said relief aid workers should take such immunisation that can be received at any government hospital at least a week before leaving to their destinations.

They should also be equipped with basic necessities like disaster overall suits, sleeping bags, raincoats, safety helmets, gloves, water-proof boots, masks, mosquito repellents and first aid boxes.

He also advised those on duty to drink only boiled water and avoid working in highly contaminated areas for a long time and treat cuts and bruises immediately.

"For those who do not get immunised before leaving, we will conduct a thorough check when they come back.

"We are not too worried about those sent by the government as they will receive a complete checkup; I'm only worried about individual volunteers and relief workers from non-governmental organisations. They must come forward to seek a thorough checkup on their return," he said.

He said two operations rooms had been set up to provide medical assistance -- the Bilik Gerakan Bencana HKL (tel: 03 - 2615 5370/73) and the Public Health Department at the Health Ministry in Putrajaya (tel: 03-8883 4700)

----BERNAMA

There is real danger of humanitarian volunteers working in the tsunami devastated regions getting communicable diseases especially the waterborne and those carried by mosquitoes. Though yellow fever is mosquito-borne, it is only present in sub-Saharan Africa and South America. There is no danger of yellow fever in Southeast Asia or the Indian Subcontinent. So those humanitarian workers going to Indonesia and Sri Lanka or India do not require yellow fever vaccination.
A very important issue to note is that active vaccination does not provide the one vaccinated with immediate protection. In most cases, some weeks are required before the vaccinee's body forms sufficient antibodies to confer immunity. The other point to note is that even after some weeks of being vaccinated, vaccination does not protect all vaccinees.
Going into the tsunami devastated areas, those volunteers who don't come from malarial endemic areas should arm themselves with malarial prophylaxis. Presently there is no malarial vaccine.
The following CDC [Center for Disease Control] sites give better accounts for those who intend to travel to help in the tsunami affected places ::

1. Interim Vaccination and Malaria Prophylaxis Recommendations for Persons Traveling to Areas Affected by the Tsunami
   
2. Health Information for Humanitarian Workers
   
3. Notice for Travelers to Tsunami affected areas
   
4. Health Recommendations for Workers who Handle Human Remain
   
5. Sanitation and Hygiene

To all those who intend to travel to the areas to help, the best of luck and do take care.

MOH Moves to Putrajaya (partially)

Health Ministry Moves To Putrajaya

KUALA LUMPUR, Jan 5 (BERNAMA) -- Nineteen of the 26 divisions of the Health Ministry have moved to the Federal Government Administration Centre in Putrajaya since Dec 3 last year.

Its Public Relations Officer S. Thanabalan said the ministry was occupying Block E1, E6, E7 and E10 at Parcel E in Precinct 1.

Among the divisions which have moved are Medical Development, Food Quality, Dental Health and Security, he said in a statement Wednesday.

Human Resources, Legal Advice, Finance, Corporate and Training Management are among the remaining seven divisions which would shift to Putrajaya in March, he said.

The ministry can be contacted at 03-8883 3888 or fax 03-8889 4971. Its address is Parcel E, Precinct 1, Federal Government Administration Centre, 62590 Putrajaya.

-- BERNAMA

It looks like the shift is only partial and will only be completed in March this year. Many a doctor who has been to the MOH which was located in Jln Cenderasari would probably miss the old place. Putrajaya is many many kilometres away. The old MOH had pretty shady carparks and the buildings were the usual gomen grey blocks. Precinct 1 would probably turn out hot and stuffy, correct me if i am wrong. Putrajaya looked that way when i last visited. Of course the MOH website makes no mention of this partial move and still maintains the old address.

Depression To Become Second Major Cause Of Death In M'sia

KUALA LUMPUR, Jan 4 (Bernama) -- Depression will be the second major cause of death in the country over the next 10 years, Health Minister Datuk Dr Chua Soi Lek said Tuesday.

This, he said, was based on the finding by the ministry and the World Health Organisation (WHO) as the number of people committing suicide in the country had been increasing yearly.

"The high risk group are people with problems like those from broken families, people facing financial problem and women who are single parents," he told reporters at Wisma MCA, here.

Currently, the majority of the deaths in Malaysia are caused by diseases, accident and cancer, followed by depression.

Dr Chua said the number of suicides was likely to increase because not many people were willing to come forward and seek the right treatment.

"Many people have a very simplistic view on the matter," he added.

He said the ministry would be focusing on this matter under the Ninth Malaysia Plan and a plan was currently being drafted to deal with the problem.

Earlier, Dr Chua, who is one of the MCA vice-presidents, presented a working paper to the party's presidential council on the healthy living skill programme which includes subjects like mental health, financial management, career development and lifestyle.

The programme is part of the MCA's Life Long Learning campaign launched last October.

Dr Chua also said that there was no outbreak of cholera or typhoid in Perlis Penang, Kedah and Perak which were hit by the Dec 26 tsunami.

He said the ministry was on constant alert and preventive measures would be taken immediately to prevent any outbreak.

-- BERNAMA

If what Dr Chua has to say regarding depression becoming the second major cause of death in this country is true, it is time the MOH starts organising 'laughter clinics' nationwide. He should also ensure that all companies, schools, factories, hospitals, clinics, MINIstries; gather everyone each morning and have a laughing session before doing anything else. When was the last time we saw the nurses and doctors attending to our medical complaints greeting with smiles in the OPD/JPL?
There are beneficial effects in humour and laughters. The MINIster could also ensure that this CD, Laughter CD for Depression is available in all gomen hospitals and clinics for those who are depressed and even those not so. For candidiasis sufferers, laughter can also get their happy hormones(endorphins) up and correct hormonal imbalances associated. Apart from depression and candidiasis, Laughter is the "Best Medicine" for Your Heart, says this article.
The MINIster of Health is also reported to be arranging for his MCA comrades to attend Media Relations Courses. For starters he might also want to arrange for himself to attend a laughter clinic, so that the next time we see him, he might look less glum and maybe smile or even laugh a little.

Counsellors To Help Traumatised Tsunami Victims

Ministry To Pool Counsellors To Help Traumatised Tsunami Victims

KUALA LUMPUR, Jan 3 (BERNAMA) -- Women, Family and Community Development Minister Datuk Seri Shahrizat Abdul Jalil has appealed to counsellors and psychologists in the country to come forward and help the ministry assist traumatised tsunami victims to deal with their grief.

She said the victims, especially those who had lost family members, were in great need of counselling to help them continue with their lives after the Dec 26 tragedy.

"What are we going to do is we'll assemble counsellors who are willing to volunteer their services and I'll talk with (Health Minister) Datuk Dr Chua (Soi Lek), so that we have a pool of counsellors we can mobilise to help them," she told reporters after being briefed by the Malaysian Red Crescent Society (MRCS) on their activities in the tsunami-stricken areas in the country and Acheh, Indonesia.

Shahrizat, who is also MRCS vice-president, said there were now only 153 counsellors registered with the ministry as provided under the Counsellors Act 1998.

She said that although the government and other parties had provided necessities like clothes, food and medicine, the victims were now dealing with the trauma and only trained professionals could help them in this.


Counselling For Students Affected By The Tidal Waves

SUNGAI PETANI, Jan 3 (BERNAMA) -- The Education Ministry will provide counselling to students traumatised by the tidal waves or tsunami which struck several west coast states of Peninsular Malaysia last Sunday, said its minister Datuk Seri Hishammuddin Tun Hussein.

He said existing counselling teachers in the affected schools would provide such counselling while external counsellors would be brought in if there was such a need.

The ministry was aware that many students were traumatised following the loss of family members and property brought about by the tsunami, he said at a press conference after being briefed on the catastrophe in the Kuala Muda district at the Sekolah Menengah Kebangsaan Kota Kuala Muda, here Monday.

Out of the 2,086 students affected by the tsunami, 498 were secondary school students an 1,044 primary school students in Kedah, while 123 were secondary school and 421 primary school students in Penang.

Hishammuddin said he would monitor the problem daily through reports by teachers in the affected schools with regard to the students' psychological condition.

It looks like the gomen is really serious about providing counselling for those traumatised mentally by the tsunamis. First it was the MINIstry of Health setting up a psychiatric team to provide counselling for the tsunami survivors. Now it is reported that the Women, Family and Community Development MINIstry will coordinate with the MOH to pool resources. There are said to be only 153 counsellors registered with the ministry. The Education MINIstry, not wanting to be left out, will also will provide counselling to students traumatised by the 26/12 tsunamis. Education MINIster, DS Hishammuddin Tun Hussein, expected counselling teachers in school to do the counselling with outside help if needed. Really are these school counsellors trained for this. Would it be more helpful to approach the Malaysian Mental Health Association and the Malaysian Psychiatric Association. Members of these two associations are probably better equipped to provide psychological and psychiatric help for the tsunami survivors. Instead of having too many MINIstries and MINIsters involved, a state of having too many cooks spoiling the broth, the MINIster and the MOH should be the one involved to mobilise and organised all the available human resources with the help and involvement of the 2 associations and their members.
Or could it be a case of one too many MINIster trying to be in the spotlight of the local media. Tsunami trauma is obviously going to be problem for the survivors especially the children and there should be a coordinated effort to reduce their sufferings, we certainly don't need the MINIsters to be involved in a game of 'wun'upmun`ship.
Here is some advice on how to deal with children suffering mental trauma as a result of the tsunamis from a child psychologist, Robin Goodman. Check this article to see what mental trauma may plague tsunami victims. The victims may experience the following :: insomnia, anxiety, nightmares, depression, grief, helplessness and hopelessness, post-traumatic stress and distressing mental images.

Women and Body Image

As women, we all want to look and feel our best. This is not always easy, considering the busy life today's woman leads and the many responsibilities she may have. It can be tough to find time for exercising and eating right, not to mention controlling stress! Sometimes women can feel pressured to look and feel a certain way. We live in a culture that puts much emphasis on physical appearance. Developing and nurturing a positive body image and a healthy mental attitude is crucial to our happiness and wellness, as we move through the different stages of our lives.

Body image and our health and well being
Our health, which we sometimes can and cannot control, affects not just how we feel but how we look. Our body image - how we feel about how we look - can change when we have a health condition or illness. Pregnancy and menopause, natural life events women experience, can also affect body image. Learning about how our health affects our body image is an important first step in developing a positive body image.


The following resources focus on some of the top health concerns that can affect a woman's body image. Information and resources are provided for each health concern.

Aging
Alopecia (hair loss)
Cancer
Diabetes
HIV/AIDS
Lupus
Menopause
Oral Health
Polycystic Ovary Disease (PCOD)
Pregnancy
Skin Disorders

---From Medicinenet.com

This editorial review from Medicinenet.com provides a comprehensive review of medical problems faced by women during the varying stages of their lives. Effects of body image on health conditions and illnesses and vice versa. Click on the various links to know about the various conditions and life events.
At one time the MOH was considering having Well Women Clinics like those in the UK where ladies can go to confirm that they are well and if it should turn out that they do have problems, these problems can be solved. Click here to see the scope of such clinics.
Considering the fact that men are better known for not seeking help for their medical problems, the MOH should also consider setting up Well Men Clinics for men to go to and have their medical problems dealt with earlier.
The MOH could consider locating these clinics at the various district health clinics and have the growing number of Family Health Physicians within the MOH run them. Presently these specialists are being underutilised and are virtually functioning as regular health doctors and not doing all that they are capable of.

See also this item regarding the MOH aim to " Decentralise Expertise At Overcrowded Hospitals". Another of the new MINIster Datuk Dr Chua's new idea.

Report: Prozac Maker Knew of Problems in 1988

THURSDAY, Dec. 30 (HealthDayNews) -- Confidential company documents obtained by a leading medical journal suggest that drug giant Eli Lilly & Co. was aware that its antidepressant Prozac was linked to troubling side effects as far back as 1988, the same year the drug was introduced to the U.S. market.

The discovery is reported in the Jan. 1 issue of the British Medical Journal, and adds to the growing body of bad news for pharmaceutical companies. The papers have been turned over to the U.S. Food and Drug Administration.

Amid the pile of internal reviews and memos, according to the journal, is a document dated November 1988 that reports Prozac (fluoxetine) had caused behavioral problems, including agitation and panic attacks, in clinical trials.

The issue of disclosure is a loaded one. The FDA announced in October that antidepressants such as Prozac would now have to carry a "black box" warning that health-care providers should be on the lookout for, among other things, increased agitation, panic attacks, and aggression among users of the drugs.

This latest report also fuels the ongoing debate over which clinical studies should come to the attention of federal regulators and which should never the see the light of day.

"The discovery of research, reportedly 'missing' for the past 10 years, that connects Prozac to increased suicidal tendencies and violence is one more tragic example of a greater problem: Unless we mandate that all research be disclosed to the FDA during the drug approval process, regulators have no choice but to make their decisions based on the best-case scenarios that drug companies report to them," U.S. Rep. Maurice Hinchey (D-N.Y.), whose office is reviewing the documents, said in a statement. "These decisions affect the health and lives of millions of Americans. If Eli Lilly's research indicated dangerous side effects of their product and they withheld that information, they knowingly jeopardized the public's health. Their failure to disclose what they knew may have cost lives."

Morry Smulevitz, manager of global product communications at Eli Lilly, said he could not comment on the documents because he hasn't seen them.

"Certainly Lilly is committed to public disclosure of all clinical trial data so health-care providers and patients can make informed treatment decisions," he said. "Prozac has been prescribed for over 50 million people worldwide. It is one of the most studied drugs in the history of medicine, and its safety and efficacy is well-studied and well-documented and well-established. Beyond that, unfortunately, it's really difficult without having the ability to review the supposed missing documents that we're not aware of to know what we're trying to make comments upon."

Smulevitz said he had requested the documents from Jeanne Lenzer, a New York-based medical investigative journalist who received them and then sent them on to the BMJ and the FDA. But, he said, the request was not met.

Dr. Richard Kapit, the FDA reviewer who originally approved fluoxetine in 1987, told the BMJ that he had never been given the Lilly data. "If we have good evidence that we were misled and that data was withheld, then I would change my mind [about the safety of fluoxetine]," he said in a statement. "I do agree now that these stimulatory side effects, especially in regard to suicidal ideation and homicidal ideation, are worse than I thought at the time that I reviewed the drug."

The documents in question reportedly disappeared during a product liability suit brought in 1994 by families of the victims of Joseph Wesbecker, who, in 1989, killed eight people and wounded another 12 with an AK-47 before turning the gun on himself at his workplace in Louisville, Ky. Wesbecker, who had suffered a long history of depression, had started using fluoxetine just one month before the shootings.

The relatives' civil suit alleged that the company had known about possible side effects of the drugs, including a tendency towards violence.

The jury ruled 9-3 in favor of Lilly, but, in a shocking turnaround, the company later admitted it had made a secret deal with the plaintiffs. In 1997, the judge on the case, John Potter, amended the verdict to "dismissed as settled with prejudice," meaning it could be reopened. Potter was presiding over another case Thursday, and could not be reached for comment on the latest developments.

"It's been a big puzzle for many years," Lenzer said. "The documents went missing during a critical period in the [wrongful death] trial." Lenzer would not reveal who had sent her the documents.

The internal company document that stood out to Lenzer, she said, was one that discussed the finding that 38 percent of people have a stimulation effect, such as panic attacks and agitation, and that 19 percent of those could be attributed to the drug.

According to Lenzer, the document stated "one in five [patients] could be expected to experience this activation. And, later in the document, they talk about how to do damage control, how to get the doctors not to worry about this. Maybe the information actually got out and got buried. It's like a little flicker of a flame. Obviously they didn't get this out to a wide circulation. They didn't get it out to the people who needed to know. They didn't get it to the FDA safety officer who reviewed it."

Dr. Peter Breggin, the medical expert in the Wesbecker case, has said the activation effects could be higher than 38 percent.

Lenzer, however, said she is concerned that what she called a pattern of secrecy among drug companies continues.

She referred to the Treatment for Adolescents with Depression Study (TADS), the results of which appeared in the Aug. 18 issue of the Journal of the American Medical Association. Although the findings were hailed as a victory for antidepressants, Lenzer stated in a September letter to the BMJ that the research had a flawed methodology and failed to report certain negative results.

"This is still going on. It's not just 16 years ago. It's going on today, right now," she said.

An FDA spokeswoman said the agency had no comment at this point.

SOURCES: Jeanne Lenzer, freelance journalist, Kingston, N.Y.; Morry Smulevitz, manager of global product communications, Eli Lilly & Co., Indianapolis, Ind.; statement from U.S. Rep. Maurice Hinchey (D-N.Y.); U.S. Food and Drug Administration; Jan. 1, 2005, British Medical Journal

Article by :: By Amanda Gardner, HealthDay Reporter

2004 saw at least two widely used drugs, which were earlier said to be better than those they were replacing and having fewer serious side effects, were shown not to be so. Time has shown that they, themselves, have problems and side effects of their own. Of course i am talking about Vioxx and Celebrex.
Now on the 1st day of 2005, another widely used drug, Prozac, is in the limelight. Prozac users are suspected of having increased agitation, panic attacks, aggression and violent behaviour. If it is true that these were known some 16 years ago in 1988 then the pattern of secrecy among drug companies concerning their drugs and their side effects are indeed troubling. Here is another link regarding Prozac. For the article :: Internal Lilly Documents at Forsyth Trial Reveal Knowledge of Violent and Suicidal Tendencies, click here.

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Health Ministry Sets Up Psychiatric Team For Tsunami Survivors

SUNGAI PETANI, Dec 31 (Bernama) -- The Health Ministry has set up a psychiatric team to provide counselling for survivors of last Sunday's killer tsunami disaster in the country, the parliamentary secretary to the ministry, Lee Kah Choon, said Friday.

He said priority for the counselling service would be given to survivors who had lost family members to the tidal waves.

"The team will also offer its services to those who need them, particularly people suffering from trauma following the disaster," he told a press conference after visiting tsunami victims warded at the Sungai Petani Hospital, here.

Lee said the ministry did not want survivors to be emotionally disturbed by the disaster because it could develop into a serious problem in the long term.

He also said that the ministry had also set up medical and public health teams in the affected states.

Eight medical teams have been stationed in Kedah, eight in Penang, four in Perak and two in Perlis. Nine public health teams have been set up in Kedah, six in Penang, two in Perak and one in Perlis.

Lee said the ministry was also educating the survivors on cleanliness in terms of nutrition and hygiene to prevent outbreak of diseases such as cholera.

-- BERNAMA

It is certainly great for the MOH to consider setting up a psychiatric team to provide counselling for the tsunami survivors. Children especially those who have lost a parent, both parents or siblings would benefit certainly. But really at the present moment there is a greater need for the MOH to attend to the medical problems of the survivors especially those with physical injuries and other immediate needs. Sanitation, hygiene, proper clean water and food in sufficient amounts are of greater importance presently. The mental injuries and effects may have to take a backseat presently. The question, one would like to pose to the MOH parliamentary secreatry is whether we have sufficient numbers of psychiatric doctors and auxillary staff to have meaningful psychiatric teams.

Govt Plans To Put Health Clinics Under Hospital's Purview

BATU PAHAT, Dec 30 (Bernama) -- The Health Ministry is considering placing the administration of the government's health clinics under the purview of outpatient departments in hospitals to optimise human resources.

Minister Datuk Dr Chua Soi Lek said the move would enable smoother deployment and distribution of work, especially among doctors, and would facilitate better financial management.

"In a situation where we lack human resources such as doctors and nurses and other support staff, it is logical if a review is made for outpatient departments and health clinics to be merged under the administration of hospitals' outpatient departments," he said.

Speaking to reporters after visiting the Batu Pahat Health Clinic Thursday, he said doctors and nurses at health clinics were now not allowed to work at outpatient departments in hospitals and vice versa.

"If both (health clinics and hospitals' outpatient departments) were put under the administration of hospitals, it will allow flexibility to optimise existing human resources," he said.

The move would also make it easy for health clinic patients to seek services provided only by hospitals, Dr Chua said.

Doctors at health clinics could also obtain wider clinical experience, which is a pre-requisite if they want to undergo post-graduate studies, as they would be dealing with more patients at hospital wards, he said.

Presently, clinical exposure at health clinics was not recognised if the doctors wanted to further their studies, he said.

He said the study on the merger would be completed within one or two months' time before a decision was made.

Dr Chua also said that the Batu Pahat Health Clinic would be upgraded in 2006 under the Ninth Malaysia Plan where it would be equipped with various facilities including x-ray machines.

-- BERNAMA

It looks like our new MINIster in the MOH is at it again. This time he wants to reverse what has just been done not so long ago in the late 90's, probably 1996/97. Outpatient Departments/OPDs in gomen hospitals aka Jabatan Pesakit Luar/JPL have always been under the supervision of the Hospital Medical Superintendants now called Hospital Medical Directors. Then the last MINIster decided that it was time for a change and placed OPD/JPL under the local District Health Office/Pejabat Kesihatan Daerah. The pool of doctors in the OPD/JPL in past came from the hospital pool of doctors. With the change the OPD/JPL doctors were no longer from the hospital pool but came from doctors under the control of the District Health Officers. A portion of the doctors who were posted to the OPD/JPL were, in a manner of speaking, rejects from the various clinical departments of the hospital, some were waiting to resign and join the private sector, while others were marking time, waiting to be selected for further studies or transfers. Very few of the doctors are in the OPD/JPL by choice. Then came 1996/97 and the supervision and control of these doctors were transferred to the District Health Officer. As far as physical facilities were concerned most of the OPD/JPL remained where they were that is within the compounds of the hospitals. One fundamental change was that when there were insufficient doctors in the OPD/JPL, replacements/gantis were no longer sourced from the clinical departments of the hospital and often the District Health Officer had a difficult time looking for gantis. This often resulted in insufficient doctors to serve the OPD/JPL patients and of course complaints by patients mount. As the District Health Officer stays in his pejabat which is physically some distance from the OPD/JPL, the brunt of patients' complaints are directed to the office of the Hospital Medical Director. Unknowing to most patients the Hospital Medical Director is not the right proper officer to complain to. So patients are given the run-around with their complaints and temper rises.
Prior to 1996/97, the District Health Officer was administering only the Health Clinics in the district but with the change in 1996/97, the various OPD/JPL in his district also came under his supervision and administration. Now with the new plan, Health Kliniks would come under the administration of the Hospital Medical Director. The District Health Officer would be left with little to do or administer.
Some new physical facilities for OPD/JPL have been built since 1996/97 but these facilities are not within the vicinity of the hospitals which under the rancangan baru, the Medical Directors of which would be once again re-administering them. More confusion and problems are in store if the new plan is implemented.
Now what the new MINIster wants to do is to go back to pre-1996/97 circumstances. i cannot see why he has to gostan balik? As far as we know the majority of OPD/JPL doctors are not contemplating further studies and are not in the OPD/JPL to specialise. So what is the MINIster talking about when he mentions getting recognition for further studies while serving in the OPD/JPL or Health Kliniks? As for OPD/JPL and Health Klinik doctors managing hospital inpatients/ward patients, this is a no no. These doctors attend to outpatients and do one of two things, see and medicate and send the patients home or see and admit patients. Inpatient care is not in their job description. Is the MINIster going to suggest that they follow those patients they have admitted into the wards?
It looks like the new MINIster is keen to reverse more of what his predecessor had done. But is this re-organisation really necessary?