Introduction: Methadone Maintenance Treatment (MMT) is the commonly used intervention for opioid dependents among Malays in FELDA settlements. However, relapse is common. Since majority of Malays are Muslims, Islamic Rehabilitation Intervention Module (ISRIM) using Health Belief Model (HBM) can be implemented as an intervention for reduction of relapse among opioid dependents in FELDA community. The objective of this study were to develop, implement and evaluate the effectiveness of ISRIM in the reduction of relapse among opioids dependent Malay males in FELDA communities in Jengka, Pahang. Methods: A single blind, cluster randomized controlled trial utilizing simple randomization was conducted, involving 10 MMT clinics. Intervention group received ISRIM for one session per week for four consecutive weeks, while control group were put on wait-list. Outcome was relapse, measured monthly for 6 months follow-up by the positive urine for drugs rapid test. Generalized Estimating Equations (GEE) was used as the main effectiveness analysis. Intention-to-treat (ITT), per protocol (PP) analysis, interaction terms, construct terms and key assumption terms were utilized. Results: Individual participation rate was 88.3%. All group comparisons at baseline were not significant (p>0.05). Cumulative relapse after 6-months follow-up for intervention and control group was 13.8% and 31.2%. There was significant difference in relapse between baseline, post-inter-vention and 6-months follow-up within intervention and control group (Q=29.06 vs 61.39,p
Cancers of the oral cavity are more common worldwide in men than in women, and the same is true for cancer of the nasopharynx region, whereby nasopharyngeal carcinoma (NPC) incidence rate in men is 2.5 times that in women. Different risk factors, including environmental, lifestyle and genetic factors, come into play in terms of contributing towards the development of these cancers. The increased incidence of oral cancers in developed countries in recent years are attributable to rises in the consumption of tobacco and/or alcoholic beverages, in addition to the traditional practice of betel quid chewing in some communities. As for NPC, the risk factors include male sex, overconsump-tion of preserved salted fish and smoking. In terms of etiology due to microbial agents, the human papillomavirus (HPV) has been linked with oral cancers whereby HPV DNA was found in about 2 out of 3 oropharyngeal cancer cases. In contrast, the Epstein-Barr virus (EBV) has been closely associated with most cases of NPC. Specifically, NPC is categorized by the WHO into two main histological types—keratinizing squamous cell carcinoma (type I) and non-keratinizing squamous cell carcinoma (types II and III), and it is the non-keratinizing type (types II and III) which has very high percentage of EBV DNA. The oncogenicity of these viruses had been studied extensively, and they are now recognized as crucial early triggers of NPC and oral cancers. Genetic factors can also predispose a person to the development of either oral cancer or NPC. Certain HLA class I alleles are associated with increased risks for NPC. Genetic polymorphisms in genes encoding the cytochrome P450 enzymes and glutathione S-transferase had been identified as potential risk factors for NPC. In our studies, we had shown that polymorphism in the XPD gene which encodes a DNA helicase enzyme involved in nucleotide excision repair was linked to risk for NPC in Malaysian population. We also found that the combination of CGC allele from hOGG1, ITGA2 and XPD polymorphisms was significantly associated with increased odds of NPC. In oral cancers, studies by other researchers revealed that gene polymorphisms in HOTAIR gene and the interaction with betel quid chewing are linked to oral cancer risk. Specific COX-2 gene polymorphisms were also found to be associated with increased risk for oral cancer development and progression. Taken together, these studies show a strong correlation between viral etiology combined with the indi-vidual’s genetic background coupled with certain risky lifestyle behaviours which together contribute towards the development of oral cancer and NPC.
Accepted 8 February 2012.
Introduction Social norms, though an important contributing factor of adolescent smoking in developed countries, has not been extensively studied in Malaysia. The objective of this study was to determine the association between certain perceived norms regarding smoking with smoking status among Malaysian secondary school students in Kota Tinggi, Johor.
Methods Data were collected from 2311 respondents consisting of 1379 male and 923 female secondary school students in Kota Tinggi district via a self administered questionnaire. Five perceived norms regarding smoking were assessed, namely: perceived peer smoking prevalence, perceived parental reaction towards adolescent smoking, perceived public perception of adolescent smoking, ever noticed peers smoking inside and outside school and perceived enforcement of anti-smoking policy in school and their association with smoking status. Multiple logistic regressions controlling for gender, peer smoking and family smoking was performed.
Results Of the five perceived norms, four were associated with smoking status, (perceived peer smoking prevalence (p
Microbial keratitis is one of the most challenging complications of contact lens (CL) wear. Proper CL practice plays an important role to reduce the risk for contact lens related microbial keratitis (CLRMK). Methods: This multi-centre case-control study was conducted from January 2008 until June 2009 to determine the risk factors associated with CLRMK. Cases were defined as respondents who were treated for CLRMK, whilst controls were respondents who were contact lens wearers without microbial keratitis. Ninety four cases were compared to 94 controls to determine the risk factors for
CLRMK. Results: The predictors for CLRMK were: Not washing hands with soap before handling CL (aOR 2.979, CI 1.020, 8.701 p=0.046), not performing rubbing technique whilst cleaning the CL (aOR 3.006, CI 1.198, 7.538 p=0.019) and, not cleaning the lens case with multipurpose solution daily (aOR 3.242 CI 1.463, 7.186 p=0.004). Sleeping overnight with the CL in the eye (aOR 2.864, CI 0.978, 8.386 p=0.049) and overall non-compliance with lens care procedures (aOR 2.590, CI 1.003, 6.689 p=0.049) contributed significantly to CLRMK. Conclusion: Health education and promotion in contact lens care are important and should be conducted by eye care practitioners to reduce the occurrence of CLRMK.
Introduction: Worm infection is one of the major global public health problems especially among rural communities.
Objectives: to determine the prevalence of intestinal worm infection and factors associated among Semai Aboriginal
children aged between 6 to 13 years in Tapah, Malaysia. Methods: A cross-sectional study design was used in this
study. The estimated sample size was 508. Data was collected using a validated pretested questionnaire. Faecal
samples were also examined. Data was analysed using SPSS version 22. Results: The response rate was 80.9%.
The overall mean age of the 411 respondents was 10.1 years(95% CI = 9.89, 10.22). Majority (71.5%) were poor.
Prevalence of intestinal worm infections was 60.8% and 57.2% had multiple infections. The multiple logistic
regression analysis showed that those with poor hygiene practices were 2.18 times the odds of worm infection
when compared with children with good hygiene practices (95% CI = 1.4, 3.4). Similarly, poor attitudes towards
prevention of worm infection increased the odds of having worm infection by 1.62 times among Orang Asli children.
Children living without toilets had 2.45 times higher odds as compared with those who had proper toilets. Absence
of river near by these areas where there is no safe water supply also increases the risk of worm infection among
children by 1.84 times among Orang Asli children. Conclusions: the prevalence of worm infection is still very
high among rural Aboriginal community. Current control measures should be reassessed to enable introduction of
effective measures to reduce the worm infection among Orang Asli children.
Introduction: A hospital based case control study was
conducted in government hospitals on contact lens patients
diagnosed with microbial keratitis. Methods: The objective of
this study is to determine the visual outcomes of contact lens
related microbial keratitis. The visual outcomes which
comprised of visual acuity, keratometry readings, corneal
topography findings and contrast sensitivity examinations was
determined after three months from the first presentation at the
hospitals. Results: The mean LogMAR visual acuity during
presentation was 0.96 ± 0.73 or a Snellen equivalent 6/60 (n=76)
and mean LogMAR visual acuity after three months was 0.10 ±
0.48 or a Snellen equivalent 6/7.5 (n=76) with a significant
difference (t=11.22, df=78, p=0.001). Best fit curve for the cases
had a regression coefficient, r=0.350 ± 0.063 (95% CI = 0.224,
0.447, df=78, p=0.001. The visual acuity in cases and controls
was 0.10 ± 0.48 and -0.10 ± 0.14 respectively (t= -3.61, df=154
p=0.001) after three months which showed improvement. There
was a reduction in the corneal uniformity index and corneal
asphericity in the cases. The Corneal Uniformity Index (CU
index) in cases was 63.03 ± 26.38 (n=76) and in controls, 80.13
± 11.30 (n=77), (t= -5.22, df=151, p=0.001). There was also a
reduction in the contrast sensitivity function at all spatial
frequencies in the cases which was significantly different.
Conclusion: Microbial keratitis reduced the vision, corneal
uniformity index, asphericity and contrast sensitivity after three
months in eyes of patients diagnosed with the condition.
Introduction: Statins have several pleiotropic effects including its primary effect of lipid lowering that is important to prevent cardiovascular disease (CVD). Subjects often have heterogeneous responses to statin. This study aims to determine the biochemical effects of statins on lipid parameters among newly diagnosed dyslipidaemia subjects.
Methods: This was a prospective observational study involving 118 newly diagnosed adults with dyslipidaemia from three government health clinics in Selangor, Malaysia. Biochemical analyses including fasting lipid profile [triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and apolipoproteins (apoA1, apoB) were taken at baseline and follow-up after a month on statin.
Results: Majority of subjects (61.9%) were prescribed with lovastatin, with the rest on simvastatin. At baseline, the median values for all lipid profile parameters (TC, LDL-C, HDL-C) and non-conventional lipid parameters (LDL-C:HDL-C ratio, non-HDL-C, TC:HDL-C ratio, apoB:apoA1 ratio) were deranged except for TG and apoA1. On follow up, all parameters showed median values within the reference range except for HDL-C, non-HDL-C and TC:HDL-C ratio. There was significant difference in the effect of statins on lipid parameters including predictors of cardiovascular risk, simvastatin having better effects.
Conclusions: Different statins have varying effects on lipid parameters. Simvastatin showed significantly better effects compared to lovastatin. Non-HDL value should be included in the standard lipid profile report given its ease of use and implementation as it’s both a marker of coronary artery disease (CAD) risk stratification as well as an established determinant of goal attainment during therapy.
This analytical cross-sectional study examined the nutrient intakes, dietary compliance, dietary supplementation and traditional remedy usage in type 2 diabetes mellitus (T2DM) patients from selected tertiary hospitals in multi-racial Malaysia. We compared the different characteristics of T2DM patients with and without cardiovascular disease (CVD). Socio-demographic status, dietary intakes, dietary supplementation, traditional remedy use, medical history, anthropometric measurements and clinical characteristics were obtained from face-to-face interviews. A total of 313 patients who were treated for T2DM participated in this study, in which 36.1% of them had CVD. The mean age of study subjects was 55.7 ± 9.2 years; mean diabetes duration was 10.1 ± 8.1 years; 52.1% were females; and 47.0% were Malays. The mean total energy intake of the subjects was 1674 ± 694 kcal/day, and patients with CVD consumed higher total calories (p = 0.001). Likewise, the mean carbohydrate, protein and total fat intake of CVD patients were significantly higher than non-CVD patients (p < 0.05), while mean intakes of cholesterol, fibre, minerals and all vitamins were comparable between CVD and non-CVD patients. Regardless of CVD status, a notably high proportion of the subjects did not meet the recommendations of the Medical Nutrition Therapy Guidelines for Type 2 Diabetes for total energy, carbohydrate, protein, total fat, and fibre intakes. Meanwhile, 52.4% used at least one dietary supplement and 12.1% took single traditional remedy or in various combinations. Traditional remedies and supplement intake did not differ between CVD and non-CVD subjects. It is suggested that T2DM patients should be educated based on their personalized dietary intake, dietary supplementation and traditional remedy usage. The recommendations for T2DM patients shall be met to achieve the optimal metabolic goals and minimize the potential diabetic complications.
INTRODUCTION: The aim of this study was to evaluate the health-related quality of life (HRQoL) of Malaysian patients with type 2 diabetes mellitus (T2DM) who have cardiovascular disease (CVD), as well as identify the determinants of HRQoL among this cohort of patients.
METHODS: This study was an analytical cross-sectional study involving 313 patients aged 30-78 years (150 men, 163 women; mean age 55.7 ± 9.2 years) who were diagnosed with T2DM (mean duration of T2DM 10.1 ± 8.1 years) at two tertiary Malaysian government hospitals. The patients' sociodemographic, lifestyle, clinical and laboratory data were collected prospectively from medical records and via face-to-face interviews. HRQoL was assessed using the 15D instrument - a generic, 15-dimensional and standardised measure of HRQoL that can be used as both a profile and a single index score measure.
RESULTS: T2DM patients with CVD were found to have significantly lower 15D HRQoL scores than their nonCVD counterparts (p < 0.001). The HRQoL of T2DM patients with CVD was significantly lower than those without CVD (p < 0.05) in all of the 15 dimensions of the 15D instrument. Multinomial logistic regression analysis using backward stepwise method revealed a significant association between CVD and impaired HRQoL (odds ratio [OR] 11.746, 95% confidence interval [CI] 4.898-28.167). Age (OR 1.095, 95% CI 1.054-1.137), duration of T2DM (OR 1.085, 95% CI 1.032-1.140), ethnicity (OR 0.411, 95% CI 0.187-0.903), body mass index (OR 1.074, 95% CI 1.006-1.148), and physical activity level (OR 3.506, 95% CI 1.415-8.689) were also significant predictors of HRQoL.
CONCLUSION: In T2DM patients, the presence of CVD was significantly associated with a lower HRQoL. Therefore, the importance of tertiary prevention to minimise the potential deterioration of the HRQoL of T2DM patients with CVD should be highly emphasised.
Metabolic syndrome (MetS) is common among patients with type 2 diabetes mellitus (T2DM) and increases the risk of cardiovascular disease (CVD) and all-cause mortality. The objective of this study was to investigate the association between the components of MetS and the prevalence of CVD among patients with T2DM. We studied 313 patients aged > or = 30 years diagnosed with T2DM at two tertiary care hospitals. Patients were recruited by systematic random sampling. Clinical data was obtained using an interviewer-administered structured questionnaire and from a review of their medical records. MetS was diagnosed using NCEP ATP III, WHO, IDF and the new Harmonized definitions. Specific MetS components such as BMI, waist circumference, waist-to-hip ratio, hypertension, HDL-C and triglyceride levels were evaluated to determine if they had an association with CVD. Thirty-six point one percent of the subjects had CVD. The mean age of the subjects was 55.7 +/- 9.2 years and the mean duration of having diabetes was 10.1 +/- 8.1 years. The overall prevalences of MetS (> or = 3 of 5 components) (95% CI) were 96.1% (94.0-98.3), 95.8% (93.6-98.1), 84.8% (80.8-88.9) and 97.7% (96.1-99.4) using NCEP ATP III, WHO, IDF and Harmonized definitions, respectively. Patients with MetS had a higher prevalence of CVD using NCEP ATP III (98.2% vs 93.5%), WHO (98.2% vs 93.0%), IDF (87.6% vs 82.0%) and Harmonized criteria (98.2% vs 96.0%). The greater the number of MetS components, the greater the chance of having CVD using three definitions for diagnosing MetS: WHO, IDF and Harmonized (p < 0.05). MetS and the combination of the individual components of MetS were significantly associated with CVD among type 2 diabetic patients in Malaysia. Aggressive treatment of MetS components is required to reduce cardiovascular risk in T2DM.