The concept of harta sepencharian1, a derivative of the Malay cultural custom (literally, adat) in Malaysia is now considered an integral element of shari'a secondary sources of 'Urf (customary laws). This concept - harta (Malay: property), sepencharian (Malay: jointly acquired) is the recognition of a married partner's share (both husband and wife) in property acquired during the material time of the marriage, regardless of whether the party in question (usually the wife) appears not to have contributed financially to its purchase or development, or even if the marriage ends through the death of either party. The article explores the evolution of the legal process that validates and promotes harta sepencharian to the level of 'Urf through the analysis of locally decided cases in both civil and shari'a court systems. This development signifies that the substantive and procedural dynamism of shari'a itself, and the uniqueness and applicability of Malay customary laws, transcend temporal and spatial differences. They particularly challenge the assumption that the local laws, including Islamic law, are passive.

Health-care quality control is a challenge that medical services and their information systems will deal with in the following years. Clinical Practice Guidelines are a structured set of recommendations for physicians to solve a medical problem. The correct fulfilment of a guideline seems to be a good indicator of health-care quality. However, the guideline fulfilment checking is an open clinical problem that requires collaborative efforts. In this sense, clinical workflows have demonstrated to be an effective approach to partially model a clinical guideline. Moreover, some efforts have been done in consistency checking and debugging management in order to obtain a correct description of the clinical processes. However, the clinical practice not always strictly fulfils clinical workflows, since patients require personalised care and unexpected situations occur. Therefore, in order to obtain a workflow fulfilment degree, it seems reasonable to compare a posteriori the evolution of the patient records and the clinical workflow, providing a flexible fulfilment measure. In this work we present a general framework to classify and study the development of these measures, and we propose a workflow fulfilment function, illustrating its suitability in the clinical domain by an example of a real medical problem.

Background The benefit of intravenous (i.v.) tissue plasminogen activator (tPA) in acute ischemic stroke (IS) is attributable to lysis of thrombus and restoration of perfusion to ischemic but not yet infarcted brain. Aims Our multicentre collaborative group prospectively implemented a protocol for transcranial Doppler assessment of intracranial recanalization with tPA treatment based on the CLOTBUST clinical trial (CLOTBUST-PRO). We aim to determine whether early recanalization (within 1 h from tPA bolus) is independently associated with better 3-month outcome in patients with intracranial arterial occlusions and correlates to a shorter time interval elapsed from symptom onset to tPA bolus. Subjects and methods Consecutive patients with acute IS due to intracranial arterial occlusions will be treated with standard i.v.-tPA and continuously monitored with 2 MHz Transcranial Doppler for arterial recanalization. Early recanalization will be determined with the previously validated Thrombolysis in Brain Ischemia flow-grading system within 60 min after tPA bolus. Power calculations are based on the assumption of α = 0·05 (two-sided test) and probabilities of functional independence at 3 months of 0·50 and 0·35 in patients with early complete recanalization and persisting occlusion, respectively. Detection of a 15% difference with a power of 0·824 requires an estimated sample of 480 patients of whom 25% are expected to achieve early recanalization while 75% will have persisting occlusion at 1 h after tPA bolus. We also plan to test prespecified secondary hypotheses within the projected study sample. Conclusions CLOTBUST-PRO is designed to determine if the timing (within 1 h from tPA bolus) of tPA-induced arterial recanalization is an independent determinant of 3-month functional recovery. We also seek to demonstrate that the sooner the tPA is given to stroke patients, the earlier the recanalization occurs and the greater is the likelihood of functional independence at 3 months. Introduction Intravenous (i.v.) tissue plasminogen activator (tPA) remains the only approved therapy for acute ischemic stroke (IS) with faster time to treatment being associated with better outcomes at 3 months ( 1 ). Although the benefit of tPA is attributable to lysis of thrombus and restoration of perfusion to ischemic but not yet infarcted brain ( 2 ), recanalization was not documented in pivotal tPA trials. This hypothesis is supported by both animal and smaller human studies showing that the duration of impaired perfusion is associated with final infarct volume and that early recanalization correlates with smaller infarct size ( 3 – 5 ).

BACKGROUND Childhood idiopathic bronchiectasis (IB) unrelated to cystic fibrosis (CF) or known immunodeficiency remains a common problem among indigenous populations in developed and developing countries. The physical and transport properties of sputum among children with IB have not been described, and these properties may suggest therapies that would be particularly effective for this group of children. METHODS Sputum from children in stable condition with IB and chronic daily productive cough was collected to measure viscosity, elasticity, cohesivity, adhesivity, and mucociliary and cough transportability in vitro. The results were compared to banked data from the sputa of children with CF and adults with chronic bronchitis (CB) measured by the same methods. RESULTS Sputa from children with CF and adults with CB had similar values for viscosity, elasticity, frictional adhesion, cough transportability, and mucociliary transportability. The elasticity of sputum from children with IB was 12 to 20%, respectively, of the value of CB and CF sputum (p < 0.01). The viscosity of sputum from children with IB was 23 to 32%, respectively, of the value of CB and CF sputum (p < 0.02). The surface frictional adhesion for sputum from children with IB was 55% of the values from both CF and CB sputa (p < 0.0001). Cough transportability for sputum from children with IB was 43 to 54% greater, respectively, than that for sputum from CB and CF patients (p < 0.0001). Mucociliary transportability was similar for all three groups (p > 0.05). CONCLUSIONS The physical and transport properties of sputum from children with IB who are stable in the outpatient setting are substantially different and lead to improved cough transportability compared to sputum from children with CF or adults with CB. Therapies that focus on cough may be sufficient to improve airway mucus clearance in children with IB. Sputum properties may explain in part the different clinical course of children with IB compared to children with CF.

BACKGROUND:The relationship between atopic disease and serum IgE levels varies among populations and geographic regions. The close association of atopy with IgE may not occur in subarctic populations as it does in developed countries in temperate climates.OBJECTIVE:To evaluate the relationship between total and specific IgE concentrations and clinical atopy in 5- to 8-year-old Alaskan native children.METHODS:Medical record reviews, interviews, physical examinations, serum IgE measurements, and radioallergosorbent testing (RAST) were performed.RESULTS:The IgE geometric mean was 122.1 IU/mL. Fifty-eight percent of patients had IgE levels greater than 70 IU/mL, and 17% had levels greater than 1,000 IU/mL; 14% had RAST values greater than 0.35 kU/L. Both IgE levels greater than 70 IU/mL and greater than 1,000 IU/mL were associated with RAST values greater than 0.35 IU/L (P = .004) and early wheezing (P = .005) but not with current wheezing, asthma, eczema, or a history of allergies. A RAST value greater than 3.51 kU/L was associated with eczema (P = .04) but not with allergies or wheezing. Children with current wheezing were more likely to have allergies (P = .03) but not eczema, an IgE level greater than 70 IU/mL, or a positive RAST value. Children hospitalized with respiratory syncytial virus (RSV) were not more likely than controls to have current wheezing.CONCLUSIONS:Elevated serum IgE concentrations, including levels greater than 1,000 IU/mL, are common among Alaskan native children; positive RAST reactions to aeroallergens are not. The IgE levels do not relate to wheezing, eczema, a history of allergies, or past hospitalization for RSV infection but likely reflect infections other than RSV and environmental factors in subarctic indigenous populations.

OBJECTIVES:The prevalence of asthma has been increasing throughout the world, but the reasons for the increase are unclear. Some have hypothesized that the increase is due to industrial and agricultural pollutants in urban and rural areas, respectively. The objective of this research was to determine if the prevalence of asthma has increased in a remote area of Alaska where the population lives a subsistence lifestyle and is not exposed to such pollution.STUDY DESIGN:Retrospective review of medical records to determine the prevalence of asthma.METHODS:We reviewed medical records of 1200 children, aged 0-10 years, who lived in the Yukon-Kuskokwum Delta (YKD) region of western Alaska between 1990 and 1999. The entire YKD population receives health care from a single medical system, so records provide a complete picture of each patient's health care. Data collected from the medical records included demographics, and the presence or absence of a diagnosis of asthma or reactive airway disease (RAD).RESULTS:Over the 10-year period from 1990-1999, there was no significant change in the percentage of children who had a diagnosis of asthma (2.0% in 1990 and 3% in 1999), or RAD (9.6% in 1990 and 9.6% in 1999).CONCLUSIONS:In a population of children not exposed to urban industrial, or rural agricultural pollutants, there was no change in the prevalence of wheezing or asthma between 1990 and 1999.

Our objective was to determine if a different presentation of asthma among Eskimo children in southwest Alaska influenced treatment for asthma. Data regarding symptoms, medication use, and hospitalization were obtained from the medical records of 58 Eskimo children diagnosed with asthma. Half of the children also had a diagnosis of chronic lung disease (CLD), and 57% had a history of allergies. CLD was associated with significantly more visits for wheeze (P=0.02), asthma (P <0.005), and lower respiratory tract illnesses (P <0.005), and a greater incidence (P <0.005) and frequency (P <0.005) of hospitalizations. Allergy status showed no similar relation with utilization of health services. Inhaled corticosteroids were prescribed for a minority (38%) of these asthmatic children. Allergic children tended to be more likely to receive inhaled steroids, and they received significantly more prescriptions for inhaled steroids compared to children without allergies. Those with CLD only were no more likely to receive inhaled steroids than other children, despite their higher incidence of hospitalization. Although the proportion of children with CLD or allergy did not differ significantly by village, there were significant regional differences in healthcare utilization and medication use. In conclusion, while CLD was the primary determinant of healthcare utilization among these native children with asthma, only allergic children with CLD were more likely to receive inhaled steroids.

BACKGROUND:Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region.METHODS:We conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, and isolate relatedness was determined by use of pulsed-field gel electrophoresis (PFGE).RESULTS:Case patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P=.01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7-12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P<.001). The majority of MRSA isolates were closely related by PFGE.CONCLUSION:Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska.

Rationale The prevalence of atopy among children in subarctic regions has been described in Norway, Sweden, and Russia but not among native populations. Methods We studied the prevalence of atopy and aeroallergen sensitization in 206 5-8 year old Alaska Native children, part of a 517 infant cohort enrolled in a study to assess the sequelae of severe RSV infection. History, physical findings, review of all medical records, total IgE, H. pylori IgG, Mycoplasma serology, and RAST tests to 12 aeroallergens were compiled for each child. Results 58% of all children had IgE levels >70 IU/ml; 16% had IgE levels >1000 IU/ml. 62% had positive IgG levels to H. pylori and 22% had Mycoplasma+ serology in both groups. Only 7% of children had 1 or more + RAST Class III to aeroallergens. One aeroallergen affected >5% of the children ( D. pteronyssinus ). There was no association between IgE status and family history of asthma, wheezing the past year, productive cough, serum cotinine levels, or Mycoplasma or H. pylori serology. IgE levels were associated with pooled positive RAST tests. Conclusions Elevated IgE levels are common among Alaska Native children. Sensitization to aeroallergens is uncommon. IgE levels are not associated with smoke exposure, H. pylori or Mycoplasma infections or chronic respiratory symptoms.

STUDY OBJECTIVES:To quantify the prevalence and impact of chronic respiratory symptoms among predominantly Alaska Native (AN)/American Indian (AI) middle school students.DESIGN:School-based prevalence assessment using the International Study of Asthma and Allergy in Children survey, with supplemental video material and added questions about productive cough, exposure to tobacco smoke, and the functional impact of symptoms.SETTING:The Yukon-Kuskokwim delta region of western Alaska.PARTICIPANTS:A total of 466 children in the sixth to ninth grades, 81% of whom are AN/AI (377 children).INTERVENTIONS:No study intervention.RESULTS:Among the 377 AN/AI children, 40% reported one of the following three categories of chronic respiratory disease: physician-diagnosed asthma, 7.4%; asthma-like symptoms (ALS) without an asthma diagnosis, 11.4%; and chronic productive cough (CPC) without asthma diagnosis or symptoms, 21.5%. Symptom prevalence differed substantially between the largest town in the region and rural villages. After an adjustment for demographic factors, exposure to environmental tobacco smoke, active tobacco smoking, and self-report of atopy, village residents were 63% less likely to have ALS (p = 0.009), and had a twofold greater risk of CPC (p < 0.001) compared to children living in the town. Children with respiratory symptoms experienced sleep disturbances and accessed clinic visits for respiratory problems more often than did asymptomatic children.CONCLUSIONS:Chronic respiratory symptoms are very common among AN children. CPC is an important nonasthmatic respiratory condition in this population. The differing patterns of respiratory illness within this region may help to elucidate the specific risk factors for asthma and chronic bronchitis in children.

Bronchiectasis among children living in developing regions is associated with respiratory infections during early childhood, but specific risk factors that precede childhood bronchiectasis are not fully characterized. We hypothesized that severe respiratory syncytial viral (RSV) infection in infancy would increase the risk of bronchiectasis among Alaska Native children in rural Alaska. This was a follow-up cohort study of a 1993-1996 case-control study of RSV-hospitalized case patients and their controls. For each 5-8-year-old former case-patient and control subject, we reviewed medical records, interviewed parents, performed physical examinations and spirometry, collected sera, and analyzed all historical chest radiographs. Ten (11%) RSV cases and 10 (9%) controls had radiographic evidence of bronchiectasis. The mean age at radiographic diagnosis of bronchiectasis was 3.3 years (range, 1.2-6.1 years). Children were more likely to develop bronchiectasis if their chest radiographs, when they were < 2 years of age, showed lung parenchymal densities (RR = 3.9, P < 0.013), persistent parenchymal densities > 6 months' duration (RR = 3.0, P = 0.02), or infiltrates on multiple episodes (test for trend, P = 0.003). Radiographic features of hyperinflation and atelectasis among children < 2 years old were not associated with eventual bronchiectasis. A single severe infection with RSV alone did not predispose Alaska Native infants to bronchiectasis. Childhood bronchiectasis was associated with lung and hence airway injury, manifested on radiographs by parenchymal densities or "pneumonia" rather than by hyperinflation or atelectasis.

OBJECTIVE:We investigated a large outbreak of community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections in southwestern Alaska to determine the extent of these infections and whether MRSA isolates were likely community acquired.DESIGN:Retrospective cohort study.SETTING:Rural southwestern Alaska.PATIENTS:All patients with a history of culture-confirmed S. aureus infection from March 1, 1999, through August 10, 2000.RESULTS:More than 80% of culture-confirmed S. aureus infections were methicillin resistant, and 84% of MRSA infections involved skin or soft tissue; invasive disease was rare. Most (77%) of the patients with MRSA skin infections had community-acquired MRSA (no hospitalization, surgery, dialysis, indwelling line or catheter, or admission to a long-term-care facility in the 12 months before infection). Patients with MRSA skin infections were more likely to have received a prescription for an antimicrobial agent in the 180 days before infection than were patients with methicillin-susceptible S. aureus skin infections.CONCLUSIONS:Our findings indicate that the epidemiology of MRSA in rural southwestern Alaska has changed and suggest that the emergence of community-onset MRSA in this region was not related to spread of a hospital organism. Treatment guidelines were developed recommending that beta-lactam antimicrobial agents not be used as a first-line therapy for suspected S. aureus infections.

Objective. In 1993-1996, we conducted a nested case-control study to determine risk factors for hospitalization with respiratory syncytial virus (RSV) infection among Alaska Native infants and young children. In the current study, we returned to former RSV case-patients and their control subjects during 1999-2001 to determine whether children who are hospitalized with RSV at <2 years of age are more likely to develop chronic respiratory conditions.Methods. For each former RSV case-patient and control subject from remote villages in southwest Alaska, we reviewed medical records, interviewed parents, performed physical examinations and spirometry, collected sera, and analyzed chest radiographs. Case-patients were identified through surveillance for RSV hospitalization, and matched control subjects without lower respiratory infection (LRI)-related hospitalization were identified.Results. Hospitalization for RSV infection was associated with a significant increase in wheezing, LRIs, and asthma diagnosis during the first 4 years of life. The association decreased with age and was no longer significant by 5 years of age. However, hospitalization for RSV infection was associated with increased respiratory symptoms and increased chronic productive cough at 5 to 8 years of age. Children who were hospitalized with RSV were not more likely at follow-up to have allergies, eczema, or a positive family history of asthma.Conclusions. Severe RSV infection in infancy may produce airway injury, which is manifested in chronic productive cough with or without wheezing and recurrent LRIs. Although the association of RSV infection with wheezing seems to be transient, children remain at higher risk for chronic productive cough at 5 to 8 years of age. RSV prevention modalities may prevent sequelae that occur early and later in childhood.

Research Article| February 01 2002 Malaysia in 2001: An Interlude of Consolidation Patricia Martinez Patricia Martinez Search for other works by this author on: This Site PubMed Google Scholar Asian Survey (2002) 42 (1): 133–140. https://doi.org/10.1525/as.2002.42.1.133 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Patricia Martinez; Malaysia in 2001: An Interlude of Consolidation. Asian Survey 1 February 2002; 42 (1): 133–140. doi: https://doi.org/10.1525/as.2002.42.1.133 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAsian Survey Search This content is only available via PDF. © Regents of the University of California Article PDF first page preview Close Modal You do not currently have access to this content.

Research Article| February 01 2001 MALAYSIA IN 2000 A Year of Contradictions Patricia Martinez Patricia Martinez Search for other works by this author on: This Site PubMed Google Scholar Asian Survey (2001) 41 (1): 189–200. https://doi.org/10.1525/as.2001.41.1.189 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Patricia Martinez; MALAYSIA IN 2000 A Year of Contradictions. Asian Survey 1 February 2001; 41 (1): 189–200. doi: https://doi.org/10.1525/as.2001.41.1.189 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAsian Survey Search This content is only available via PDF. © Regents of the University of California Article PDF first page preview Close Modal You do not currently have access to this content.

Endoscopic landmarks were clearly defined on all patients to identify an abnormal esophageal segment. Age of patients at time of confirmed IM was noted and patients were divided into groups based on decade of age. Results: 116 patients were confirmed to have SSBE based on endoscopic landmarks and histology confirmation. Mean age at diagnosis was 60.1 6 1.0 with mean length of SSBE being 1.5 6 0.05 cms. The prevalence of SSBE was highest in seventh decade (n 5 45). There was no evidence of increasing length of SSBE with increasing age. Conclusions:Length of SSBE does not increase linearly with increasing age.

Although bronchiectasis has become a rare condition in U.S. children, it is still commonly diagnosed in Alaska Native children in the Yukon Kuskokwim Delta. The prevalence of bronchiectasis has not decreased in persons born during the 1980s as compared with those born in the 1940s. We reviewed case histories of 46 children with bronchiectasis. We observed that recurrent pneumonia was the major preceding medical condition in 85% of patients. There was an association between the lobes affected by pneumonia and the lobes affected by bronchiectasis. Eight (17%) patients had surgical resection of involved lobes. We conclude that the continued high prevalence of bronchiectasis appears to be related to extremely high rates of infant and childhood pneumonia. Pediatr Pulmonol. 2000;29:182-187. Published 2000 Wiley-Liss, Inc.