Overweight and obesity have become a serious health issue in worldwide and Malaysia is no exception. In view that obesity is one of the leading causes of non-communicable diseases, this systematic review aimed to explore whether Malaysian are getting fatter (overweight or obesity) and rounder (abdominal obesity). Searches of the published literature were conducted using 3 databases including EMBASE, MEDLINE, and PubMed. These were limited to cross-sectional or cohort studies in Malaysia. The databases provided the prevalence of overweight, obesity, and abdominal obesity among 15 years old and above Malaysian population from 2009 to 2015. In total, 47 articles were included in this review. Findings exhibit that the prevalence rates of overweight, obesity, and abdominal obesity range from 9.5% to 43.5%, 1.77% to 26.4% and 11.4% to 57.4%, respectively. Overweight is more predominant among males. However, obesity and abdominal obesity are more predominant among females. This means that more females are getting fatter and “rounder” as compared to males in Malaysia. The findings imply a lack of intervention programmes based on proper randomized controlled trials which are needed to adequately address the problem of obesity in Malaysia.
Phyllodes tumour (PT) of the breast is firstly described in literature as early as 1838. This article reports the youngest recorded case of giant complicated PT and the role of toilet mastectomy as a salvage surgery. A 19-year-old lady presented with a gigantic lump of the left breast for 6 months which was rapidly growing (20 x 20 cm) and complicated with a foul-smelling blackish discoloration of the breast skin and tissues. Toilet mastectomy was performed as a result. The specimen weighed 4.0 kg with histopathological report of the tumor being borderline phyllodes. Herein, we describe a case of PT, who presented with breast necrosis and we discuss its medico-social aspect of it.
Cryptococcal meningitis is a central nervous system infection cause by Cryptococcus neoformans. Although Cryptococcus is found in bird droppings, it has never been reported for those ranchers involved in the niche swiftlet ranching industry despite having close proximity with the bird droppings. We present here a case of a 41-year-old healthy swiftlet rancher who presents with a history of prolonged fever, headache and altered behaviour of a month duration. Cerebral spinal fluid analysis revealed the presence of Cryptococcus. He was treated with intravenous amphotericin B and flucytosine and discharged well with fluconazole consolidation therapy for 8 weeks, followed by maintenance therapy for 1 year. We believe this is the first reported case of Cryptococcal meningitis (CM) occurring in an immunocompetent swiftlet rancher. This case should highlight the needs to wear a proper personal protective equipment inside a swiftlet ranch due to the constant exposure to the potential cryptococcal-rich environment. A high index of suspicion, careful history taking and physical examination focusing on neurologic assessment is key to early diagnosis and timely management of CM.
Widespread use of the internet is a relatively recent phenomenon that is affecting different cultures worldwide in both positive and negative ways. This study aimed to determine the gender differences in the internet addiction among medical students in public university. Methods: 426 medical students from year one to four were invited to participate in the study. For data collection, we used a self-administered questionnaire consisting of socio-demographic and internet usage questions, the Internet Addiction Test (IAT) and the Depression Anxiety and Stress Scales 21 (DASS-21). Results: There were a total of 426 (270 female and 156 male) medical students included in this study. IA was high in both male and female students. There was a higher proportion of male students (44.9%) found to be addicted compared to female students (32.2%). There were positive correlations between the DASS-21 and IAT scores for both male and female students. For female students, longer hours spent online daily (p-value = 0.02), as well as high anxiety (p-value < 0.001) and depression scores (p-value = 0.037) were found to be most strongly associated with IA. Among male students, factors associated with IA were the availability of internet access at home (p-value=0.02) and high anxiety scores (p
Carpanenamase-producing Enterobacteriaceae (CPE) has emerged as a threat to hospitalized patients. Phenotypic test such as Modified hodge test was less sensitive and specific especially to detect blaNDM-1 which is the most predominant genotype in this region. Nucleic acid amplification technology offers improved specificity and sensitivity. Failed amplification due to the presence of inhibitors is a limitation. In this study, we tried to use previous method described by Villumseen et al with some modification using another DNA extraction kit. Methods: Ten mls of sterile whole blood taken from nearly expired blood bag from blood bank was spiked with 200 μl of 0.5mcFarland bacterial suspension from thirty-six confirmed isolates of blaNDM-1 carbapenamase-producing Klebsiella pneumoniae in an aerobic Bactec Plus and incubated until the growth was detected. The blood specimen was subjected to DNA extraction method using Macherey-Nachel, Nucleospin® Blood QuickPure followed with multiplex PCR. Results: Out of the 36 isolates, 12 isolates revealed blaNDM-1 , 9 isolates revealed blaNDM-1 and blaOXA-48, 7 isolates revealed blaNDM-1, blaVIM and blaKPC genotypes that were amplified at cycle threshold of less than 30. Another 8 isolates could not pick up any genotypes possibly due to pipetting error as all the internal control were amplified. Eight true negative gram negative isolates underwent same procedure and none amplified at a cycle threshold less than 30. Conclusion: This modified method was proved to give a high yield of CPE genotypes with the cycle threshold was set at less than or equal to 30 and able to overcome the presence of PCR inhibitors.
To determine the quality of life (physical health, psychological, social relationships and environment domains) among cancer patients undergoing chemotherapy in government hospitals in Peninsular Malaysia. Methods: The data were collected using self-administered questionnaires. Descriptive statistics were conducted to obtain frequency and percentage of variables. Independent sample T-test and One way ANOVA were used to determine the association between variables. Multiple linear regression model was used to determine the significant predictors. The predictors of each domain was analysed separately. Results: Quality of life among cancer patients undergoing chemotherapy in this study was determined by four domains which were physical health, psychological, social relationships and environment. The overall mean score for physical health was 52.60, psychological was 52.55, social relationships was 50.79 and environment was 51.16. The significant predictors of physical effect domain were monthly income, cancer stage, social support, nausea and vomiting. The significant predictors of psychological domain were race, marital status, cancer stage, nausea and vomiting. The significant predictors of social relationships domain were race, educational level, social support, nausea and vomiting. The significant predictors of environment domain were race, marital status, hopelessness level, nausea and vomiting. Conclusion: The quality of life among chemotherapy cancer patients is important to be observed. Based on the predictors found in this study, appropriate interventions can be taken to improve the quality of life outcomes and the response towards the treatment.
Melastoma is a genus that belongs to the Melastomataceae family and consists of 50–70 species distributed around India, Southeast Asia, Australia and the Pacific Island. Numerous species of this plant show potential therapeutic purposes. This review summarizes the scientific findings on the ethnobotanical uses, phytochemistry and pharma- cological activities of Melastoma sp. The leaves of Melastoma sp. was widely used by Asian as decoction for the remedy of gastrointestinal disorder apart from root, which was consumed as juice for skin diseases, fever and pain. Majority of the scientific studies focused on M. malabathricum showing high antimicrobial activity towards selected gram-negative and gram-positive bacteria from different parts of the plant. In vitro studies showed that Melastoma sp. possessed anti-coagulant, antioxidant, antiproliferative and immunomodulatory activities. Apart from in vitro, various in vivo studies have been conducted involving methanolic leaf extracts using Sprague Dawley rats for inhi- bition of anti-ulcer, anti-nociceptive, anti-inflammatory, anti-carcinogenic and anti-diabetic activities. Flavonoids, triterpenes, tannins, saponins and steroids are the main classes of secondary metabolites identified from Melastoma sp. Kaempferol derivatives exhibited significant main constituents from the flowers and leaves using various semi polar solvent extracts. Few phytosterols were also isolated from the leaves extract albeit the absence of alkaloids. This review shows that Melastoma sp. is an important genus of Melastomataceae family, however, the phytochemical and pharmacological findings of various species in this genus are still limited, indicating a great opportunity to explore new therapeutic activities with novel bioactive constituents.
This narrative review present and critically appraise the evidence of psychosocial interventions in enhancing post- traumatic growth (PTG) and spirituality in cancer patients and survivors. A comprehensive search of published En- glish language literatures which include both quantitative and qualitative studies was conducted via Google Scholar, PubMed, Medline, PsycINFO, EMBASE, Cochrane Library, Scopus and Web of Science up to September 2018. Out of an initial 17,000 articles, 10 studies were finally included in the review. There were three randomized controlled trials, two non-randomized comparison trials, three time series/pre and post-intervention designs, one mixed design study and one qualitative study which demonstrated psychosocial interventions enhanced PTG and spirituality in cancer patients and survivors. We concluded mindfulness-based interventions may be promising to enhance PTG and spirituality in cancer patients and survivors. On the contrary, evidence for psycho-spiritual therapy, cancer sup- port group, health behavioural change intervention and individual psychotherapy were lacking and poor.
ABSTRACTS FOR INTERNATIONAL FAMILY HEALTH CONFERENCE 2019 (I-FaH 2019)
Introduction: As cervical cancer is the third most common cancer among women and ten percent of cervical cancer incidence among those 65 years and above, Pap smear is still relevant to be performed among older women. The aim of this study was to determine the determinants of Pap smear screening among older women in an urban setting.
Methods: This cross-sectional study was conducted among 515 women aged 50 and above in two urban health centres in Gombak, Selangor. The sampling technique conducted was random systematic sampling. The indepen-dent variables were age, marital status, employment status, gynaecological history (family history of cervical cancer, menopause, hysterectomy), obstetric history (number of live births, ever had contraception), presence of chronic diseases (hypertension, Diabetes Mellitus, heart disease). Results: Only 202 (39.2%) out of 515 undergone Pap smear screening. An estimated 80.7% of them had their last Pap smear a year ago. The mean age of the respondents was 58.83± 7.05 years old and 77.3% had one and more comorbidities. The respondents preferred health care person-nel as the source for the pap smear information compared to reading materials and internet. Married vs divorced (aOR=1.89,p=0.02); those with heart disease (aOR=0.32,p value=0.01; those with Diabetes Mellitus (aOR=0.57,p value=0.01; those who had hysterectomy (OR=2.89, p value=0.04) and those who had contraception (aOR=3.72, p value =
ABSTRACTS FOR INTERNATIONAL FAMILY HEALTH CONFERENCE 2019 (I-FaH 2019)
Introduction: Diabetes is a global epidemic and the public knowledge on this progressive disease is important to control the disease. This study aims to determine the diabetes knowledge of a community in Sungai Petani and the associated factors.
Methods: A cross-sectional study using multi-stage sampling was carried out in Sungai Petani, Kedah, Malaysia between April to May 2019, by a validated and reliable questionnaire. Data was analysed using IBM SPSS version 25.0. Mann-Whitney U and Kruskal Wallis test were used.
Results: Of 370 non-diabetic adults participated in this study with majority of them were females (61.9%), Malays (79.2%), had at least secondary education (53.5%), married (78.6%), overweight (34.6%), not-hypertensive (80.8%), had no family history of diabetes (52.2%) and not-smoking (86.8%). The mean ±SD age was 46.1 ±13. And median (IQR) monthly income was RM3037.40 ±3005.90. The diabetes knowledge median (IQR) score was 26.0 (9.0). Half of respondents did not know about items on “the different types of diabetes”, “diabetics should carry sweets when they are out” and “diabetics should not do-nate blood”. Diabetes knowledge was found to have significant association with diabetes screening uptake, income level, education level, marital status, BMI, family history of diabetes and smoking.
Conclusion: Diabetes knowledge among Sungai Petani community was found to be adequate but there is still misconception regarding diabetes and its management. Collective efforts should be taken to improve the general population’s knowledge on diabetes.
Introduction: Despite advancement of treatment modalities, Tuberculosis (TB) treatment interruption rate has glob- ally accelerating, calling for greater framework shifting towards psychosocial intervention. Similarly, Selangor state had reported the perturbing TB treatment interruption rate, which was figured persistently above 10% in the interval year of 2014 to 2018, thus signifies an empirical assessment on Information-Motivation-Behavioural skills (IMB) determinants of TB intensive phase treatment. This study aims to determine the time to intensive phase TB treatment interruption and its prognostic factors among newly diagnosed pulmonary Tuberculosis (PTB) smear positive patients in urban district Selangor. Methods: A multi-centric prospective cohort study will recruit 695 newly diagnosed PTB smear positive patients at treatment centres in urban districts, Selangor. This study will utilize validated self-admin- istered questionnaire and standardised data collection form (PROFORMA). At baseline, we will elicit information on IMB models constructs, additionally on socio-demographics, health service factors and clinical characteristics. Meanwhile, four points follow up will be executed to retrieve information on treatment status and time varying effects of body weight, treatment side effects, symptoms improvement and internalised stigma. Finally, survival analysis will be computed to identify the time to intensive phase treatment interruption and its prognostic factors. Conclusion: This study will enlighten IMB model determinants of intensive phase treatment interruption, hence to endeavour psychosocial elements in designing time relevant public health strategies in TB case management.
Introduction: There is an emergent increase of ultra-processed food consumption in developing countries including Malaysia which carries a likelihood towards the increase of obesity. However, few studies have been done in relating between ultra-processed consumption and obesity, especially in Malaysia. Therefore, this study aims to determine the consumption of ultra-processed foods and its relationship with BMI and body fat percentage among university committee in Kuala Nerus, Terengganu. Methods: A cross-sectional study was performed among 167 individuals aged 18 to 59 years old in Kuala Nerus. Data were collected using a researcher-administered questionnaire which consisted of three different sections: socio-demographic profile, two days 24-hour dietary recall, and nutritional status assessment on BMI and body fat percentage. Consumption of ultra-processed foods were determined by classifying two days 24-hour dietary recall based on ultra-processed food classification. Data were analyzed using SPSS version 21.0 with p
Introduction: Minimizing smoking initiation among adolescents has been identified as a strategy to reduce the preva- lence of tobacco induced diseases among Malaysian adults. The aims of this study were to investigate the prevalence and factors associated with smoking among secondary school- going adolescents in the state of Kelantan, Malaysia. Methods: A school-based survey was carried out in Kelantan to determine the prevalence and associated factors of smoking among Kelantanese adolescents. Two-stage cluster sampling was used to ensure the representativeness of the sample. A self-administered validated questionnaire was utilised to obtain data from the selected respondents. Multiple logistic regression analysis was used to determine the factors associated with smoking behaviour among school-going adolescents. Results: The study revealed that 10.1% (95 CI 8.5-11.9%) of the selected respondents were current smokers. The prevalence of male who smoked was significantly higher compared to female. MLR revealed that, males, respondents with at least one smoking parent/guardian, as well as the respondents with less supportive parents/ guardian were more likely to smoke. However, by having a few numbers of close friends and helpful peers in the school had shown no significant association for being the current smokers. Conclusion: The study showed that the prevalence of smoking was a bit lower than the national prevalence, and smoking behaviour was predominant among male adolescents in Kelantan state. Comprehensive measures with the involvement of parents/guardians were imperative to tackle smoking habits among adolescents by targeting high-risk groups identified in the study.
Introduction: Since 1978, Rohingya refugees have fled from their native nation, Myanmar to escape ethnic prose- cution. They comprise of the Muslim minority ethnic group originating from the Rakhine state in Myanmar. In many host countries, they may have difficulty to access health care services. The Islamic Association of Malaysia (IMAM) Response and Relief Team (IMARET) have taken many initiatives to provide healthcare services to the refugees through their volunteer-led mobile clinics. Therefore, this study aims to evaluate the utilisation of drugs among type 2 diabetes mellitus (T2DM) patients visiting this clinic. Methods: This was a cross-sectional study among Rohingya refugees with T2DM that visited the IMARET mobile clinics from August until November 2017. Convenient sampling method was used. Data were collected through patient’s interview, review of the patient’s prescriptions and their HbA1c readings. Results: A total of 29 T2DM patients were included in this study. The majority were female (75.9%) and aged below 65 years old (75.9%). The most commonly prescribed anti-diabetic agent was metformin (72.2%), followed by glibenclamide (22.2%) and gliclazide (5.6%). Metformin as a monotherapy (31%) was the most frequent treatment prescribed. More patients had controlled T2DM (62.1%) compared to those with uncontrolled DM. We found 90.9% of patients who were treated according to the recommended DM guidelines achieved a good blood glucose control (p=0.02). Conclusion: In Rohingya refugees having T2DM who were treated in the IMARET mobile clinic, the percentage having good control DM status is higher in those whose treatment regimen adheres to the clinical practice guidelines.
Introduction: Atopic dermatitis (AD) and its severity has been inconsistently associated with lower vitamin D levels as multiple other factors that influence vitamin D status were not always assessed. Methods: A case control study involving AD patients and controls 18 years old was performed. Exclusion criteria were systemic immunosuppres- sion 4 weeks prior to recruitment, renal or hepatic impairment, parathyroid diseases and vitamin D or calcium supplementation. Healthy controls were matched for age, gender, ethnicity, Fitzpatrick skin type and body mass index (BMI). Sun exposure, a 3-day, 24-hour dietary recall and serum 25-hydroxyvitamin D were measured. Re- sults: 38 AD patients and 38 controls participated. Majority had Fitzpatrick skin type IV. Vitamin D was lower in AD [15.9(9.9-24.0)ng/ml] than controls [17.3(14.4-27.2)ng/ml], p= 0.028. It was sufficient in 16(42.1%) AD and 15(39.5%) controls, insufficient in 7(18.4%) AD and 22(57.9%) controls and deficient in 15(39.5%) AD compared to 1(2.6%) control. Sun exposure was similar in both groups. AD had significantly higher dietary vitamin D intake [1.5(0.6-3.1) vs 0.6 (0.3-1.0)µg]. AD was an independant risk for vitamin D deficiency with OR 17.52; 95%CI:1.4-
212.7 and vitamin D insufficiency OR 0.26;95%CI:0.07-0.95. Vitamin D levels did not correlate with AD severity. Conclusion: AD is a risk for vitamin D deficiency despite higher dietary intake and similar skin type, BMI and sun exposure as controls.
Introduction: Diabetic control depends partially on self-management. Diabetes self-care is reported to be a strong predictor of glycemic control in Type 2 Diabetes Mellitus (T2DM) patients. Factors contributing to better self-care include self-efficacy and social support. We aim to determine effects of these factors on glucose control in T2DM patients in a primary care clinic. Methods: This study utilised data from a bigger study looking into factors affecting social support and self-efficacy and their correlation in T2DM patients. This study was done among 329 T2DM pa- tients attending a primary care clinic in Selangor, Malaysia between November 2013- January 2014. Systematic ran- dom sampling was used. Instruments used were the MOS Social Support Survey and the Diabetic Management Self Efficacy Scale (DMSES). Patients’ socio-demographic data and glucose monitoring records were obtained. The asso- ciation between social support and self-efficacy with blood glucose control was determined using logistic regression. Results: The mean age of the respondents is 54.6 (+11.2), mostly female (55.3%) and Malay ethnicity (63.5%). Being older and retired were predictors for good glucose control (OR=1.05,p=0.01 and OR=2.2,p=0.023) respectively. There is also significant correlations between number of close friends/relatives with social support and self-efficacy (r=0.162,p=0.030 and r=0.190,p=0.01) respectively. The correlation of social support and self-efficacy with HbA1c levels are r= -0.044(p=0.426) and r= -0.08(p= 0.744) respectively. Conclusion: There were no correlations between social support and self-efficacy with the level of HbA1c among patients with T2DM in this study. We found older aged and retired patients to have better HbA1c levels.
Introduction: Information on sick leave duration among employees with the first episode of acute coronary syndrome (ACS) throughout the world was limited. The aims of the study were to determine the sick leave duration and its predictive factors among employees diagnosed with the first episode of ACS. Methods: A cohort study was conduct- ed among employees who were admitted to the cardiology centre in the public hospitals in northeastern Malaysia. Data was collected using a designed proforma. The respondents were interviewed, and their medical records were reviewed on the second day of hospital admission. Information on sick leave duration was obtained from sick leave book in the wards. Multiple linear regression analysis was applied to determine the predictive factors for sick leave duration. Results: A total of 78 respondents participated in this study. The mean (SD) age of the respondents was
47.5 (7.31) year old. The majority were male (92.3%), married (94.9%) and had a low level of education (62.8%). The sick leave duration ranged from 4 to 180 days with the median (IqR) of 35.5 (32) days. The predictive factors for sick leave duration were smoking (Adjusted b=20.1, 95% CI: 7.4, 32.8), not attending cardiac rehabilitation after discharge (Adjusted b=19.9, 95% CI: 6.7, 33.6) and presence of complication during admission (Adjusted b=28.6, 95% CI: 15.1, 42.0). Conclusion: The sick leave duration was relatively low and being a smoker, having a complica- tion during admission and not attending cardiac rehabilitation after discharged predicts a longer sick leave duration.
Nurul Salwana Abu Bakar, Jabrullah Abdul Hamid, Sharifah Zawani Syed Ahmad Yunus, Nurul Syarbani Eliana Musa, Roslinda Abu Sapian, Nur Hidayati Abdul Halim, et al.
Introduction: Electronic medical records from hospital information system (HIS) offer a major potential for secondary data analysis which can improve the efficiency of healthcare delivery. This study describes an initiative to use HIS data to explore the level of diabetic care in patients with T2DM in a hospital-based outpatient clinic, the advantages and challenges in utilising HIS data. Methods: Patients age of 18 and above who received any diabetes medication in 2013 were retrospectively identified from HIS of Serdang Hospital. Demographic characteristics, anti-diabetic agent (ADA) dispensed, and glycaemic measures were quantified. Data was extracted using structured query lan- guage (SQL) and descriptive statistical analyses were conducted using Stata Version 12. Results: Prevalence of T2DM patients in the hospital was 7.5%. Male had slightly higher prevalence and patient at age of 61-70 years old. About 62% of patients were prescribed with metformin and 5% of newer combination of oral hypoglycemic agent. In pre- scribing pattern, stratification by age group, showed that patient age 41 to 70 years received mostly monotherapy, whilst 61.1% continue their regime for the year. Only 18% obtained good glycaemic control. Conclusion: Hospital Information system is a critical instrument in providing data as a platform in diabetic care in an outpatient care. Moving forward, steps to improve HIS should be taken to seize its potential as a tool to increase the efficiency of healthcare delivery.
Introduction: Children with visual impairment are reported to be at higher risk of poor oral health. They faced dif- ficulties in basic skills including oral care. For this reason, they may develop dental caries and periodontal disease. The aim of this study was to assess the oral health status of a group of visually impaired school children in Kuala Lumpur. Methods: A cross-sectional study was carried out on students from a Special Education School in Kuala Lumpur. Oral examination was conducted to determine caries experience and oral hygiene status. Caries was mea- sured using DMFT index and simplified oral hygiene index (OHI-S) for oral hygiene status. Oral examination was based on modified World Health Organization (WHO) oral health assessment criteria for children. Chi-square test was used to determine associations between demographic variables and oral health status. Results: A total of 91 visually impaired students (41 blind, 50 low vision) within the age group of 13 to 17 years old participated in this study. The mean OHI-S score was 1.68 (SD 0.87) with majority of students had fair oral hygiene (39.6%) and 29.7% with poor and very poor oral hygiene. The mean DMFT score of total students were 0.80 (SD 1.62). Male students demonstrated significantly better oral health status than female in relation to prevalence and mean score of dental caries. Conclusion: Most of the visually impaired children in this study showed fair oral health status. Regular oral health education is recommended to improve the oral hygiene especially in the totally blind group.
Introduction: Adolescent aggression is an important public health concern with escalating prevalence of juvenile cases and violence among these age groups including robbery, homicide, and gang fights. The objectives of this study protocol are to determine the biopsychosocial predictors and explore the contextual factors of adolescent ag- gression among secondary school students in Hulu Langat. Methods: Explanatory mixed method study design will be used, consist of quantitative cross-sectional study followed by basic qualitative study. Proportionate population sampling among Form 4 secondary school students from selected public secondary schools in Hulu Langat will be executed. Questionnaires will be distributed to 481 students on aggression as the dependent variable, and several independent variables: demographic (ethnicity, family income), biological (sex, head injury, nutritional deficiency, breakfast skipping), psychological (attitude and normative beliefs, personality trait, emotional intelligence), and so- cial factors (family environment, single parent status, domestic violence, peer deviant affiliation, alcohol, smoking, substance abuse). Subsequently, participants with moderate to high aggression scores will be further explored on the contextual factors of adolescent aggression by in-depth interview. Multiple linear regression will be executed using SPSS to determine significant predictors whereas thematic analysis will be applied for qualitative data analysis on the context of adolescent aggression. Both findings will be further integrated and discussed to give comprehensive description on the phenomena. Conclusion: Better knowledge and understanding on adolescent aggression may generate new framework to drive more effective preventive strategies and unravel adolescent aggressive related Pub- lic Health problems.