Noorzurani Robson

Review Paper: Organ Transplants: Ethical, Social, and Religious Issues in a Multicultural Society

Recent advances in the fields of organ donation and organ transplant have introduced new hope for the treatment of serious diseases. However, this promise has been accompanied by several issues. The most common issue raised is ethical implications, but in a multicultural society like Malaysia, additional concerns arise pertaining to social and religious issues. These concerns needs to be addressed as attitudes toward and acceptability of organ donation varies according to social, culture, and religion. The diverse cultural, religious, and traditional concepts pertaining to organ donation may hamper its acceptability and cause a lack of willingness to donate organs. The purpose of this article is to briefly explore the ethical issues involved in organ transplant and the various religious opinions on organ donation. It is hoped that this knowledge and understanding may benefit both health care providers and patients in a multicultural society like Malaysia.

The transition to harm reduction: Understanding the role of non-governmental organisations in Malaysia

BACKGROUND The transition of drug policy from prohibition to harm reduction has never been easy. The deeply entrenched belief in prohibition shared by policy makers and religious leaders provided little room for alternatives, and change came only slowly. The non-governmental organisations (NGOs) in Malaysia played a pivotal role in effecting such a change. Understanding how they did so may be instructive for other similarly placed countries. METHODS Data collected via reviews of published secondary sources, media reports and in-depth interviews with pioneers of harm reduction drawn from NGOs, medical practitioners and the police were analysed to construct the paper. RESULTS The policy change was the outcome of competition between three groups in the drug policy subsystem--the state, the Muslim religious lobby and the NGOs. Developments such as the poor outcomes from the prohibition programmes and the outbreak of HIV/AIDS did not change policy but did lead to a rethink of core beliefs in the state alliance and spawned a state-NGO partnership. The subsequent failure to meet the Millennium Development Goal with respect to HIV/AIDS in 2005 was seen as a failure of the Health Ministry which then led the final charge for a policy change arguing that a health crisis was imminent. The NGOs played a pivotal role in this process by educating their partners in the state coalition, by drawing academics and medical practitioners into advocacy and by engaging the religious lobby (albeit with varying success). They were also frontline players in implementing harm reduction programmes and successfully deflected criticisms from unconvinced Islamic groups away from the state. CONCLUSION Given their central role in the needle-syringe exchange programme, the NGOs are well positioned to convince injecting drug users to opt for voluntary medical treatment. This can potentially reduce both the harm from drug use and the prevalence of it.

Treating heroin addiction: bridging the past and future- a Malaysian experience

Malaysia, with a population of 28.25 million, consists of Peninsular Malaysia and the Borneo states of Sarawak and Sabah. Substance abuse has been prevalent in Malaysia since the 19th century. In the early 20th century, the main drug of abuse was opium, which was primarily restricted to Chinese and Indian immigrant laborers who were introduced by British colonialists to work in Malaya (Noorzurani et al., 2008). However, the pattern of consumption changed in the 1970s when heroin became the abused substance of choice and Malays were the main ethnic group involved in heroin abuse compared to other ethnic groups, namely the Chinese and Indians (Noorzurani et al., 2008; Rusdi et al., 2008). By the 1980s, heroin use among Malaysian youth reached national crisis proportions (Navaratnam, 1988; Chawarski et al., 2006). A total of 194,897 drug dependents were registered by the National Anti-Drug Agency (NADA) in 1988; however, at the end of 2004, the numbers of drug dependents were estimated to be between 202,075 and 607,647 (Mahmood et al., 2005). By 2009, the cumulative number of confirmed drug addicts exceeded 300,000 (Sangeeth et al., 2009; Narayanan et al., 2011).

Nicotine-replacement therapy: a proven treatment for smoking cessation

Abstract Smoking is a major cause of cardiovascular diseases, respiratory diseases and cancer. Despite the high prevalence of smokers worldwide, smokers are often neglected and not offered effective assistance with quitting their habits. In order to overcome this public health burden, effective treatment is needed to help smokers stop smoking. Among the pharmacological treatments availabel, nicotine-replacement therapy (NRT), when prescribed in combination with behavioural support, has been proven to be effective in helping a wide range of smokers to quit. NRT helps smokers during the withdrawal process by replacing a proportion of the nicotine formerly obtained from cigarettes. NRT is availabel in many formulations. The commonly prescribed formulations are nicotine gum, nicotine patches, nicotine inhaler and nicotine nasal spray. The choice of which NRT to prescribe depends on the patients condition, established guidelines and protocols and availability. This article aims to review the role of NRT in smoking cessation.

Replantation and revascularization of amputated upper limb appendages outcome and predicting the factors influencing the success rates of these procedures in a tertiary hospital: An 8-year retrospective, cross-sectional study

Purpose: Worldwide advances in microsurgery have made salvaging of amputated hand via replantation and revascularization common procedures. The present study examines the outcome of these procedures in a tertiary hospital in Malaysia. Methods: Patients with hand amputation who underwent replantation or revascularization from 2005 to 2012 were identified and reviewed for patient characteristics, amputation characteristics and survival rates. Successfully treated patients were interviewed to assess the functional outcome using Quick Disability of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Statistical analysis was performed to evaluate outcome and elicit predictive factors. Results: Fifty-five patients were enrolled: 37 (67.3%) underwent replantation and 18 (32.7%) underwent revascularization. The overall success rate of 78% (n = 43) was within the range of previously reported data (61.6% to 96.0%). Ischaemic time <6 h provided significantly better survival rates (p < 0.05). Functional outcomes were successfully assessed in 34 patients (79%), at a mean follow-up of 40 months (range 11–93 months). The overall Quick-DASH and MHQ scores were 42.82 ± 23.69 and 60.94 ± 12.82, respectively. No previous reports of functional outcome were available for comparison. Both Quick-DASH (p = 0.001) and MHQ scores (p < 0.001) were significantly higher for finger injuries, followed by thumb, wrist and palm injuries. Conclusion: Ischaemic time and level of injury are important predictors of success rate of replantation and revascularization of amputated upper limb appendages.

Varenicline: a new pharmacotherapy for smoking cessation in primary care practice

Abstract Background: Cigarette smoking causes significant morbidity and mortality and is a major public health concern worldwide. Primary care doctors are in a unique position that enables them to promote smoking cessation, as smokers are more aware of their health at the time of their clinic visit. It is thus important to offer effective treatment to help smokers stop smoking. Methods: A search of PubMed was done up to 16 December 2009, using the keywords “varenicline” alone, “varenicline” and “family medicine”, and “varenicline” and “primary care”. The search produced 426 articles on varenicline. The articles that were chosen were case reports, meta-analyses, review articles and clinical trials published in English. Results: A new drug called varenicline has recently been introduced to assist smoking cessation. It is an α4β2 nicotinic acetylcholine receptor partial agonist. Varenicline has a unique action that relieves the cravings and withdrawal symptoms that occur during smoking abstinence, while blocking the receptor and preventing any reward from additional smoking. It has been shown to be efficacious for smoking cessation in normal smokers; however, its safety in smokers with mental health problems needs to be elucidated. Conclusion: The currently available data support the effectiveness of varenicline to treat nicotine dependence, but caution is needed in smokers with mental health problems. Thus, primary care doctors have a new pharmacological option to offer smokers who wish to stop smoking.