Current approach of skin lesions suspected of malignancy in general practice in the Netherlands: a quantitative overview.

BACKGROUND: The role of general practitioners (GPs) in skin cancer care is increasing. Previous, hospital-based studies suggest that GPs might not have the capabilities to gain responsibility concerning skin cancer care. OBJECTIVES: To evaluate the current approach of GPs towards skin lesions suspected of malignancy in the Netherlands. METHODS: In three general practices, all consultations in 2015 concerning skin lesions suspected of malignancy were identified and reviewed. Patients demographics, circumstances of consultation, evaluation of skin lesion(s), presumed diagnosis, diagnostic accuracy and policy were evaluated. RESULTS: Five hundred and eighty consultations were identified. Patient took initiative for encounter in 90%. Case-finding occurred in 2%. Diagnostic tools were used in 22%; dermoscopy was used in 8% and a diagnostic excision in 10%. The GP diagnosed a benign lesion in 69%. Therapeutic interventions were applied in 31% and a wait-and-see policy in 40%. The diagnosis after referral was a benign tumour in 39% of the cases, a malignancy in 29% and a premalignant lesion in 17%. The positive predictive value (PPV) of the presumed benign, malignant and premalignant diagnoses was 86%, 54% and 18%, respectively. CONCLUSIONS: Most lesions that are presented to the GP with a suspicion of a malignancy appear to be benign lesions. In the examined practices, the diagnosis of the GP is mainly based on clinical examination and little use is made of available diagnostic tools. The use of a diagnostic tool like a biopsy might prevent unnecessary referrals.

[Potential of fMRI for the Functional Assessment of the Pathological Visual System]. / Potenzial von fMRT für die Funktionsüberprüfung des pathologischen Sehsystems.

Current developments in functional magnetic resonance imaging (fMRI) of the human visual system have generated a set of powerful approaches that are of great promise for modern ophthalmology. These make it possible to perform an objective spatially resolved test of visual function in patients with strong visual impairment and even to investigate the functional organisation of the visual cortex in the blind. As a consequence, they open a broad field of applications for functional assessment in ophthalmology and provide fundamental insights into the interplay of pathology and plasticity in the human visual system. This is highlighted by current studies investigating patients with acquired or congenital defects of the macula, or with visual pathway abnormalities, extended retinal damage, and complete blindness. Therapeutic approaches targeting the restoration of visual input are expected to benefit from these fMRI applications, either for the estimation of the success rate of a planned retinal therapy or as an objective high-level biomarker for the readout of therapy success.

The validity of the Menopause-specific Quality of Life questionnaire in women with type 2 diabetes.

OBJECTIVES: To examine the validity and reliability of the Menopause-specific Quality of Life (MENQOL) questionnaire in a sample of women with diabetes in Malaysia, with the secondary aim of determining whether MENQOL domain scores were associated with depression and diabetes. METHODS: A total of 337 postmenopausal women (241 with diabetes, 96 controls) were evaluated. Construct validity was evaluated using principal components analysis (PCA) and comparing scale items against the mental component score of the Short Form-12 (SF-12 MCS), and against the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10). Consistency assessment was conducted using Cronbach's α. RESULTS: The internal consistencies for the physical (PHS), psychosocial (PS), sexual (VSS) and vasomotor domains were 0.86, 0.79, 0.79 and 0.70, and 0.90 for the full scale of MENQOL. PCA revealed a four-factorial model. Diabetes and non-diabetes subjects experienced their first period (13.25 vs. 13.10 years, p = 0.680) and achieved menopause around the same age (49.35 vs. 48.87 years, p = 0.426). We found significant variations in the MENQOL's PHS and PS domain scores that could be explained by SF-12 PCS (25%) and SF-12 MCS (20%) sub-scales. The validity of the MENQOL domains was demonstrated through significant associations with the equivalent SF-12 MCS and PCS subscales. The PS domain of the MENQOL also predicted the likelihood of symptoms of depression (1.42, 95% confidence interval 1.01-2.02). CONCLUSIONS: This study confirms the validity and internal consistency of the MENQOL questionnaire for measuring quality of life in postmenopausal women with diabetes, suggesting that the instrument can be used to screen people for menopausal symptoms.

The psychometric properties of an Iranian translation of the Work Ability Index (WAI) questionnaire.

BACKGROUND: This study was carried out to evaluate the psychometric properties of an Iranian translation of the Work Ability Index (WAI) questionnaire. METHODS: In this methodological study, nurses and healthcare workers aged 40 years and older who worked in educational hospitals in Ahvaz (236 workers) in 2010, completed the questionnaire and 60 of the workers filled out the WAI questionnaire for the second time to ensure test-retest reliability. Forward-backward method was applied to translate the questionnaire from English into Persian. The psychometric properties of the Iranian translation of the WAI were assessed using the fallowing tests: Internal consistency (to test reliability), test-retest analysis, exploratory factor analysis (construct validity), discriminate validity by comparing the mean WAI score in two groups of the employees that had different levels of sick leave, criterion validity by determining the correlation between the Persian version of short form health survey (SF-36) and WAI score. RESULTS: Cronbach's alpha coefficient was estimated to be 0.79 and it was concluded that the internal consistency was high enough. The intraclass correlation coefficient was recognized to be 0.92. Factor analysis indicated three factors in the structure of the work ability including self-perceived work ability (24.5% of the variance), mental resources (22.23% of the variance), and presence of disease and health related limitation (18.55% of the variance). Statistical tests showed that this questionnaire was capable of discriminating two groups of employees who had different levels of sick leave. Criterion validity analysis showed that this instrument and all dimensions of the Iranian version of SF-36 were correlated significantly. Item correlation corrective for overlap showed the items tests had a good correlation except for one. CONCLUSION: The finding of the study showed that the Iranian version of the WAI is a reliable and valid measure of work ability and can be used both in research and practical activities.

[Management and follow-up of renal injury-a 10-year experience at a Swiss level 1 trauma center]. / Therapie und Nachsorge traumatischer Nierenverletzungen ­ 10 Jahre Erfahrung eines Schweizer Level­1-Traumazentrums.

INTRODUCTION: The objective was to analyze patterns of injury, management, imaging, and follow-up care of renal trauma at a Swiss level 1 trauma center. METHODS: We examined 138 patients (>16 years) with renal organ injuries who presented to our institution between January 2008 and March 2018. Data on demographics, patterns of injury, clinical presentation, management, and follow-up were recorded. RESULTS: The injury grade of the 142 injured kidneys was grade 1 in 25% (n = 36), grade 2 in 16% (n = 23), grade 3 in 32% (n = 46), grade 4 in 24% (n = 34), and grade 5 in 2% (n = 3). The predominant injury mechanism was winter sports (45%). Conservative management was successful in all grade 1 renal injuries, and 91%, 86%, 35%, and 33% of grade 2, 3, 4, and 5 injuries, respectively. Early follow-up with CT or MRI scan was performed in 23% of grade 1-3 injuries and 57% of grade 4-5 injuries with clinical signs of complications as the most frequent indication for grade 1-3 injuries and routine follow-up imaging for grade 4-5 injuries, respectively. In follow-up care (1-9 months after injury) imaging showed persistent pathologies in 39% of grade 1-3 renal injuries and 62% of grade 4-5 injuries. CONCLUSIONS: Most minor renal injuries (grade 1-3) can be successfully managed conservatively. Early follow-up imaging is indicated for patients showing clinical signs of complications. Routine repeat imaging may not be justified for high-grade renal injuries without clinical symptoms. Re-imaging in follow-up care still lacks evidence-based recommendations.

Bone mineral density, osteoporosis, and osteoporotic fractures: a genome-wide association study.

BACKGROUND: Osteoporosis is diagnosed by the measurement of bone mineral density, which is a highly heritable and multifactorial trait. We aimed to identify genetic loci that are associated with bone mineral density. METHODS: In this genome-wide association study, we identified the most promising of 314 075 single nucleotide polymorphisms (SNPs) in 2094 women in a UK study. We then tested these SNPs for replication in 6463 people from three other cohorts in western Europe. We also investigated allelic expression in lymphoblast cell lines. We tested the association between the replicated SNPs and osteoporotic fractures with data from two studies. FINDINGS: We identified genome-wide evidence for an association between bone mineral density and two SNPs (p<5x10(-8)). The SNPs were rs4355801, on chromosome 8, near to the TNFRSF11B (osteoprotegerin) gene, and rs3736228, on chromosome 11 in the LRP5 (lipoprotein-receptor-related protein) gene. A non-synonymous SNP in the LRP5 gene was associated with decreased bone mineral density (rs3736228, p=6.3x10(-12) for lumbar spine and p=1.9x10(-4) for femoral neck) and an increased risk of both osteoporotic fractures (odds ratio [OR] 1.3, 95% CI 1.09-1.52, p=0.002) and osteoporosis (OR 1.3, 1.08-1.63, p=0.008). Three SNPs near the TNFRSF11B gene were associated with decreased bone mineral density (top SNP, rs4355801: p=7.6x10(-10) for lumbar spine and p=3.3x10(-8) for femoral neck) and increased risk of osteoporosis (OR 1.2, 95% CI 1.01-1.42, p=0.038). For carriers of the risk allele at rs4355801, expression of TNFRSF11B in lymphoblast cell lines was halved (p=3.0x10(-6)). 1883 (22%) of 8557 people were at least heterozygous for these risk alleles, and these alleles had a cumulative association with bone mineral density (trend p=2.3x10(-17)). The presence of both risk alleles increased the risk of osteoporotic fractures (OR 1.3, 1.08-1.63, p=0.006) and this effect was independent of bone mineral density. INTERPRETATION: Two gene variants of key biological proteins increase the risk of osteoporosis and osteoporotic fracture. The combined effect of these risk alleles on fractures is similar to that of most well-replicated environmental risk factors, and they are present in more than one in five white people, suggesting a potential role in screening.

Definitive repair of a stab wound to the right ventricle with skin staples in emergency.

Penetrating cardiac injuries represent a challenge to surgeons. Several surgical techniques for repair of these injuries have been described. The authors report on the use of skin staples for a right ventricular stab wound in a patient in extremis.

Paraclinical evaluation of side-effects of Taxanes on auditory system.

Ototoxicity is one of the major causes of hearing loss and balance system disorders. Taxanes are a new group of anti-neoplastic agents used for chemotherapy; examples include Paclitaxel and Docetaxel. In this study, ototoxicity of these drugs has been evaluated in order to provide a means of adjusting the doses to avoid these complications. A prospective analytical study was carried out on 103 known cases of breast and ovarian cancer, during 2004 to 2006 (20 months), in the Otolaryngology, Head and Neck Surgery Department of Ahwaz University of Medical Sciences of Tehran. All patients (mean age 45 +/- 2.3 years) were treated with Taxanes. The first evaluation of hearing (using pure tone audiometery) was performed before starting treatment, the second in the middle of the treatment period and the last at the end of treatment. Results showed that nausea and vomiting were the most common side-effects of the drugs used. No significant side-effects of Taxanes, on the audiovestibular system, were observed. In conclusion, little information concerning the ototoxic effect of Taxanes has been reported in other studies, and, in the present investigation, no significant effect on the auditory system was found.

Brain MR Imaging Findings in Woodhouse-Sakati Syndrome.

BACKGROUND AND PURPOSE: Woodhouse-Sakati syndrome is a rare autosomal recessive disorder characterized by hypogonadism, alopecia, diabetes mellitus, and progressive extrapyramidal signs. The disease is caused by biallelic pathogenic variants in the DCAF17 gene. The purpose of this study was to describe the spectrum of brain MR imaging abnormalities in Woodhouse-Sakati syndrome. MATERIALS AND METHODS: We reviewed brain MR images of 26 patients with a clinical and genetic diagnosis of Woodhouse-Sakati syndrome (12 males, 14 females; age range, 16-45 years; mean age, 26.6 years). Follow-up studies were conducted for 6 patients. RESULTS: All patients had abnormal MR imaging findings. The most common abnormalities were a small pituitary gland (76.9%), pronounced basal ganglia iron deposition (73%), and white matter lesions in 69.2%. White matter lesions showed frontoparietal and periventricular predominance. All white matter lesions spared subcortical U-fibers and were nonenhanced. Prominent perivascular spaces (15.3%) and restricted diffusion in the splenium of the corpus callosum (7.6%) were less frequent findings. Follow-up studies showed expansion of white matter lesions with iron deposition further involving the red nucleus and substantia nigra. Older age was associated with a more severe degree of white matter lesions (P < .001). CONCLUSIONS: Small pituitary gland, accentuated iron deposition in the globus pallidus, and nonenhancing frontoparietal/periventricular white matter lesions were the most noted abnormalities seen in our cohort. The pattern and extent of these findings were observed to correlate with older age, reflecting a possible progressive myelin destruction and/or axonal loss. The presence of pituitary hypoplasia and white matter lesions can further distinguish Woodhouse-Sakati syndrome from other neurodegenerative diseases with brain iron accumulation subtypes.

Protective effects of boron and vitamin E on ethylene glycol-induced renal crystal calcium deposition in rat.

OBJECTIVES: Kidney stone disease is a common form of renal disease. Antioxidants, such as vitamin E (Vit E) and boron, are substances that reduce the damage caused by oxidation. METHODS: Adult male rats were divided into 5 groups (n=6). In group 1, rats received standard food and water for 28 days (control group); in group 2, standard rodent food and water with 0.75% ethylene glycol/d (dissolved in drinking water) (EG Group); in group 3, similar to group 2, with 3 mg of boron/d (dissolved in water) (EG+B Group); in group 4, similar to group 2, with 200 IU of vitamin E injected intraperitoneally on the first day and the 14th day, (EG+Vit E Group); in group 5, mix of groups 3 and 4, respectively (EG+B+Vit E Group). RESULTS: Kidney sections showed that crystals in the EG group increased significantly in comparison with the control group. Crystal calcium deposition score in groups of EG+B (160), EG+Vit E, and EG+B+Vit E showed a significant decrease compared to EG group. Measurement of the renal tubules area and renal tubular epithelial histological score showed the highest significant dilation in the EG group. Tubular dilation in the EG+B+Vit E group decreased compared to the EG+B and EG+Vit E groups. CONCLUSIONS: Efficient effect of boron and Vit E supplements, separately and in combination, has a complimentary effect in protection against the formation of kidney stones, probably by decreasing oxidative stress.

Comparison of nickel doped Zinc Sulfide and/or palladium nanoparticle loaded on activated carbon as efficient adsorbents for kinetic and equilibrium study of removal of Congo Red dye.

In this study, the efficiency of nickel doped Zinc Sulfide nanoparticle loaded on activated carbon (Ni-ZnS-NP-AC) and palladium nanoparticles loaded on activated carbon (Pd-NP-AC) for the removal of Congo Red (CR) from aqueous solution was investigated. These materials were fully identified and characterized in term of structure, surface area and pore volume with different techniques such XRD, FE-SEM and TEM analysis. The dependency of CR removal percentage to variables such as pH, contact time, amount of adsorbents, CR concentration was examined and optimum values were set as: 0.03g Ni-ZnS-NP-AC and 0.04g of Pd-NP-AC at pH of 3 and 2 after mixing for 22 and 26min for Ni-ZnS-NP-AC and Pd-NP-AC, respectively. Subsequently, it was revealed that isotherm data efficiency can be correlated Langmuir with maximum monolayer adsorption capacities of 286 and 126.6mgg(-1) at room temperature for Ni-ZnS-NP-AC and Pd-NP-AC, respectively. Investigation of correlation between time and rate of adsorption reveal that the CR adsorption onto both adsorbents followed pseudo second order and interparticle diffusion simultaneously.

Molecular mimicry: the geographical distribution of immune responses to Klebsiella in ankylosing spondylitis and its relevance to therapy.

The discovery that HLA-B27 is linked to ankylosing spondylitis (AS) and HLA-DR1/DR4 to rheumatoid arthritis (RA) has provided new approaches to the study of the possible causation of these diseases. Several theories have been proposed to explain these associations but only one, namely "molecular mimicry", has provided a specific aetiological agent for each of these diseases. Molecular mimicry between HLA-B27 and two molecules in Klebsiella microbes: nitrogenase and pullulanase D has been reported whilst in Proteus microbes, the haemolysin molecule shows sterochemical similarity to HLA-DR1/DR4. Elevated immune responses to Klebsiella microbes have been demonstrated in AS patients from 10 different countries and this wide geographical distribution suggests that the same aetiological agent is probably acting in producing this condition. Furthermore RA patients show similar immune responses to Proteus microbes. Whether AS or RA are caused by these bacteria can only be resolved by tissue typing all rheumatological patients early, in the course of their disease and then assessing their response to antibiotic chemotherapy in longitudinal studies involving double-blind crossover trials. It is possible that in the future, the course of AS or even RA could be modified by adequate antibiotic chemotherapy or even diets which affect the substrates on which these bacteria grow.

The experience of being hospitalized: stress, social support and satisfaction.

In this paper, an exploratory study, relationships among patient stress, social support and satisfaction are discussed. During 1980, 100 medical patients on two companion units of a large northeastern teaching medical center were given the Volicer Hospital Stress Scale. Several questions about satisfaction and the support of family/friends and other patients were asked. Other variables descriptive of the experience of being hospitalized are also looked at. Stress scores for patients on both units were high. Black patients, specifically those on one unit, had higher mean stress scores than whites; items on which the racial groups differed focused upon environment and staff-patient interaction. Relationships were found between (a) the potential social support of family/friends and of other patients, (b) family/friends' support and overall satisfaction level and (c) other patients' support and stress. Other relationships among descriptive variables of the hospitalization experience were also identified. It is recommended that the identified race-stress, family/friends' support-satisfaction and patients' support-stress relationships be further explored.

The newly hired hospital staff nurse's professionalism, satisfaction and alienation.

In a previously reported panel study [Speedling et al. (1981). Int. J. Nurs. Stud. 18, 217-225], 180 Registered Nurses, three-quarters new graduates, were given questionnaires at time of hire and a year later. Using the panel study data, relationships among bureaucratic-professional role conception, actual situation and role discrepancy, and importance of job factors, job satisfaction and alienation, as well as age and length of stay at termination for time of hire only, are explored in this follow-up report. Mean bureaucratic actual situation (t = -5.18, P less than 0.001), bureaucratic role discrepancy (t = -2.77, P less than 0.01) and alienation (t = -2.36, P less than 0.05) increased, while professional actual situation (t = 3.39, P less than 0.01) and importance of job factors (t = 2.33, P less than 0.05) decreased during this first year of employment. In correlational analysis, at the time of hiring relationships were found between numerous variables, including: bureaucratic role conception with alienation (r = 0.17, P less than 0.05); bureaucratic actual situation with alienation (r = 0.19, P less than 0.05); professional role conception with alienation (r = -0.20, P less than 0.05) and with job satisfaction (r = -0.35, P less than 0.001); professional actual situation with job satisfaction (r = -0.19, P less than 0.05); and professional role discrepancy with job satisfaction (r = 0.23, P less than 0.01). A year after hiring, many relationships were found, including professional actual situation with job satisfaction (r = 0.26, P less than 0.05) and alienation with job satisfaction (r = -0.33, P less than 0.01). In stepwise regression analysis, age accounted for 8% of the variance in the importance of job factors (P less than 0.05), professional role conception for 28% of the variance in job satisfaction (P less than 0.001) at time of hire. A year after hiring, alienation and job satisfaction accounted for 12% of the variance in each other (P less than 0.01). As in the correlational analysis, there were many relationships among the bureaucratic-professional variables. Professional socialization theory was utilized in this study, helping to clarify the relationships among staff nurse professionalism, satisfaction and alienation.

Controlled trial of maintenance treatment of intravenous buprenorphine dependence.

BACKGROUND: Buprenorphine dependence is a relatively novel addiction. AIMS: To compare the treatment outcome in three groups over 12-weeks of treatment. METHODS: Two hundred and four intravenous (i.v.)-buprenorphine-dependent patients were randomised into three groups. Subjects received 50 mg oral methadone tablet, or 5 mg sublingual buprenorphine tablet, or 50 mg oral naltrexone, and a weekly 30-minute clinical counselling session. RESULTS: The majority (80%) had a history of opium or heroin dependency before they were introduced to i.v. buprenorphine. The main source of buprenorphine for misusers was street sale (91%). The mean duration of buprenorphine dependence was 1.9 years and the mean dose per day was 3.9 ampoules (1 ampoule contains 0.3 mg of buprenorphine in 1 ml). Overall 59% of the patients completed the 12-week study. Retention in the 50 mg methadone group was significantly better than the 5 mg dose buprenorphine group (p=0.001) and the 50 mg dose naltrexone group (p=0.000). Retention in the 5 mg buprenorphine group was significantly better than the 50 mg naltrexone dose group (p=0.000). CONCLUSIONS: These results support the efficacy and safety of oral methadone and sublingual buprenorphine tablets for injection buprenorphine-dependent patients.

Suicidal behaviors among Connecticut youth.

In the United States, youth (15-24 years) suicide rates increased 191% between 1950 and 1986. This paper presents data regarding suicidal ideation and attempts, suicide-related hospitalizations, and completed suicides among Connecticut youth, comparing them with data from other states and the United States. Girls have higher rates of attempts and hospitalization, boys of completed suicide. Firearms are the suicidal method of choice for both sexes. Nonmetropolitan areas had higher rates than metropolitan. Reported suicidal ideation among students ranged from 10% to as high as 66%, while attempts range from 3% to 15%. The authors stress that caution is necessary when comparing rates, pointing to the need for standardized data collection and analysis. Reported rates of suicidal behavior are lower among Connecticut youth compared to their counterparts in other states, but suicide is increasing among young males in Connecticut and remains a major issue for health care providers.

Effects of social influences and waiting on time judgment.

Utilizing social judgment theory, the relationships of three social cues to time judgment under low physical temporal-cue conditions were explored. These social influences were as follows: being free to interact with another person, being told by the experimenter to expect to wait a specified period of time, and seeing another person's time judgment. 72 college students, randomly assigned to conditions of free social interaction (alone-interactive) and of waiting expectancy (expected-unexpected), made time estimates after 4 min., 7 sec. Each person under interactive conditions made another judgment after seeing a partner's judgment. Mean estimation was lower alone than under interactive conditions and lower under expected than unexpected waiting conditions. Under interactive conditions, correlations were positive between the individual's first and second judgments, between the partners' second judgments, and between the individual's second and the partner's first judgments. Social cues may influence time judgment.

Effects of Watercress (Nasturtium nasturtium) extract on selected immunological parameters of rainbow trout (Oncorhynchus mykiss).

Watercress (Nasturtium nasturtium) is a medical plant containing diverse chemically-active substances with biological properties. The present study was conducted to investigate the immunomodulatory effects of watercress extract on immunological and hematological parameters of rainbow trout (Oncorhynchus mykiss). Fish were fed for 21 days with diet supplemented with 0.1% and 1% of watercress extract per 1 kg food and with a normal diet as control. Hematological parameters such as red blood cells (RBC) and white blood cells (WBC), hematocrit (Hct), hemoglobin (Hb), RBC index like mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) as well as immunological parameters such as peroxidase, lysozyme and complement activities, total protein, albumin and globulin levels were measured after 21 days of watercress extract treatment. The results indicated that oral administration of 1 % watercress extract in fish may enhance some hematological and immunological parameters including Hb and MCHC, lysozyme and complement activities, total protein and globulin levels, compared to the controls after 21 days of experimental period. In conclusion, on the basis of these results, oral administration of watercress extract may be useful to improve fish's immune system.

First Detection of Nosema ceranae, a Microsporidian Protozoa of European Honeybees (Apis mellifera) In Iran.

BACKGROUND: Nosemosis of European honey bee (Apis mellifera) is present in bee colonies worldwide. Until recently, Nosema apis had been regarded as the causative agent of the disease, that causes heavy economic losses in apicultures. Nosema ceranae is an emerging microsporidian parasite of European honeybees, A. mellifera, but its distribution is not well known. Previously, nosemosis in honeybees in Iran was attributed exclusively to N. apis. METHODS: Six Nosema positive samples (determined from light microscopy of spores) of adult worker bees from one province of Iran (Savadkouh- Mazandaran, northern Iran) were tested to determine Nosema species using previously- developed PCR primers of the 16 S rRNA gene. As it is difficult to distinguish N. ceranae and N. apis morphologically, a PCR assay based on 16 S ribosomal RNA has been used to differentiate N. apis and N. ceranae. RESULTS: Only N. ceranae was found in all samples, indicating that this species present in Iran apiaries. CONCLUSION: This is the first report of N. ceranae in colonies of A. mellifera in Iran. It seems that intensive surveys are needed to determine the distribution and prevalence of N. ceranae in different regions of Iran.

Understanding of and attitudes toward epilepsy among the urban Chinese population in Malaysia.

INTRODUCTION: People with epilepsy are socially discriminated against on the grounds of widespread negative public attitudes, misunderstandings and defensive behaviour. The primary purpose of this study was to evaluate the public understanding of and attitudes toward epilepsy among the Chinese population in Malaysia. METHODS: A validated, self-administered questionnaire comprising 23 questions was utilised to evaluate the understanding of and attitudes toward epilepsy among randomly approached respondents from the Chinese population living in the urban areas of Penang, Klang Valley, Kuala Lumpur and Sibu in Malaysia. RESULTS: Out of 1,000 people approached, 697 (69.7 percent) respondents agreed to participate in the study. When asked whether people with epilepsy are slow learners and have intellectual functioning below normal, 448 (64.3 percent) respondents answered 'no'. This positive answer was mainly provided by female (35.6 percent) as compared to male (28.6 percent) respondents. Moreover, more than half responded positively to the following statements: people with epilepsy should not be isolated from the normal population; epileptics can perform daily activities; epileptics can receive academic education; and epileptics can become useful members of society. In addition, significant associations were discovered between the education level of the respondents and several statements, including whether epileptics are as intelligent as everyone else (p-value is 0.009), whether epilepsy can be treated with drugs (p-value is 0.037) and whether epileptics can be as successful as other people in their chosen career (p-value is 0.009). Positive responses were mainly acquired from those with secondary education and above. A large number of the respondents felt that people with epilepsy should not be employed as lorry drivers, firefighters, doctors and army personnel. CONCLUSION: The general Chinese population in the urban areas of Malaysia had, at the time of the investigation, a relatively high level of understanding and positive attitudes toward certain aspects of epilepsy, although a minority of the study population demonstrated prejudice and discriminatory behaviours toward people with epilepsy.