Browse publications by year: 2017

  1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators
    Lancet, 2017 Sep 16;390(10100):1211-1259.
    PMID: 28919117 DOI: 10.1016/S0140-6736(17)32154-2
    BACKGROUND: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.
    METHODS: We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).
    FINDINGS: Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228).
    INTERPRETATION: The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.
    FUNDING: Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
    Malaysian collaborators: School of Medicine, Xiamen University Malaysia Campus, Sepang, Malaysia (Y J Kim PhD); School of Medical Sciences, University of Science Malaysia, Kubang Kerian, Malaysia (K I Musa MD); Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia (R Sahathevan PhD); Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia (C T Sreeramareddy MD)
    MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Cause of Death/trends*; Child; Child, Preschool; Communicable Diseases/mortality; Female; Disabled Persons/statistics & numerical data*; Humans; Infant; Infant, Newborn; Male; Middle Aged; Global Health/statistics & numerical data; Wounds and Injuries/mortality; Incidence; Prevalence; Age Distribution; Sex Distribution; Young Adult; Global Burden of Disease/statistics & numerical data*
  2. GBD 2016 Causes of Death Collaborators
    Lancet, 2017 Sep 16;390(10100):1151-1210.
    PMID: 28919116 DOI: 10.1016/S0140-6736(17)32152-9
    BACKGROUND: Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends.
    METHODS: We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016.
    FINDINGS: The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe.
    INTERPRETATION: The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems.
    FUNDING: Bill & Melinda Gates Foundation.
    Malaysian collaborators: School of Medicine, Xiamen University Malaysia Campus, Sepang, Malaysia (Y J Kim PhD); School of Medical Sciences, University of Science Malaysia, Kubang Kerian, Malaysia (K I Musa MD); Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia (R Sahathevan PhD); Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia (C T Sreeramareddy MD)
    MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Cause of Death/trends*; Child; Child, Preschool; Communicable Diseases/mortality; Disasters/statistics & numerical data; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Nutrition Disorders/mortality; Pregnancy; Pregnancy Complications/mortality; Socioeconomic Factors; Global Health/statistics & numerical data; Wounds and Injuries/mortality; Age Distribution; Young Adult; Global Burden of Disease/statistics & numerical data*
  3. Citation: The ninth report of the National Eye Database 2015. Goh PP, Salowi MA, Adnan TH, Sa'at N, editors. Kuala Lumpur: Clinical Research Centre; 2017
    MeSH terms: Eye Diseases; Humans; Malaysia; Registries
  4. MeSH terms: Adult; Asthma; Humans; Malaysia; Guidelines as Topic
  5. MeSH terms: Humans; Malaysia; Colorectal Neoplasms; Guidelines as Topic
  6. Yiengprugsawan V, Healy J, Kendig H, Neelamegam M, Karunapema P, Kasemsup V
    Health Syst Reform, 2017 Jul 03;3(3):171-181.
    PMID: 31157585 DOI: 10.1080/23288604.2017.1356428
    This paper explores whether middle-income Asian countries are reorienting their health services in response to non-communicable diseases (NCDs). Malaysia, Sri Lanka, and Thailand were selected as case studies of Asian societies experiencing rapid increases both in NCDs and an aging population. While NCD programs, especially those related to diabetes and stroke, are well-established in Thailand, health services struggle to respond to increasing numbers of people with chronic health problems. Health services at all levels must plan ahead for more patients with chronic and often multiple conditions who require better integrated health care.
    MeSH terms: Delivery of Health Care; Diabetes Mellitus; Health Services; Humans; Income; Malaysia; Sri Lanka; Thailand; Stroke
  7. Buang SN, Diana R, Jaafar S, Muhammad DI, Daud MSM, Jamaluddin J, et al.
    This review aims to profile the disease of thalassemia in Malaysia and to identify the challenges that have kept Malaysia from effectively reducing the birth rate of thalassemia patients. The success of thalassemia prevention programs in some countries have shown that more than 90% of the reduction of cases were achieved by using retrospective screening method (prenatal, premarital, retrospective counselling). However, in Malaysia any impact of the prevention program is yet to be visible, and a reduction in new births of thalassemia patients remains to be seen. The number of patients in the national thalassemia registry ( is increasing over the years from 3588 in 2008 to 4990 in 2010 and to 6624 in 2015. The provision of quality care and disease management imposes a huge economic burden on national health resources, which is why an effective prevention program is urgently needed. For Malaysia to reduce the burden of new thalassemia cases, it is vital to address gaps and limitations of the existing preventive strategies. The screening program has to be integrated into existing primary healthcare settings, promoted to every party including the higher ministry bodies and designed to adapt to the highly diverse local religious and cultural backgrounds. Through continuous support by the government, health care providers and the general public, there is hope that prevention and control of this disease may be achieved in the future.
    MeSH terms: Humans; Thalassemia
  8. Saraswati LD, Pangestuti DR, Ginandjar P
    Malnutrition, HIV and tuberculosis (TB) disease is a triangle of death that should be given attention. This study was comparing nutritional status of HIV patients with and without TB in Semarang, Indonesia, to describe the effect of TB burden to their nutritional status. The study design was cross-sectional study. The study began with an examination of sputum and chest X-rays, then examined by anti- HIV antibodies using the method of screening of 3 times. About 56 subjects were recruited to the HIV group and 36 subjects to the HIV-TB. The anthropometric examination was carried out by using scales, microtoise, Mid Upper Arm Circumference ribbon, and Body Impedance Analyzer to measure body fat. Interviews were conducted to the subject on physical activity examination, 24 hours dietary recall and food frequency questionnaire. Data analysis using Independent t-test or Mann-Whitney test. The results showed that group of HIV- TB had worse nutritional status than those suffer from TB. Body weight, BMI, MUAC, BMR, and Vitamin A blood serum in HIV patients with TB was significantly lower than the HIV group. The nutritional status of HIV patients with TB was significantly more malnourished than counterparts (underweight: 25.7% vs 14.3%). Dietary intake of vitamin A, Fe, Zn, energy, protein and fat was better in HIV group compared to HIV-TB group. Respondents who are 19 years old on average were stunting, an indicator of malnourished in a long time. TB can worsen the nutritional status of HIV patients if not supported by good nutrition.
    MeSH terms: Adipose Tissue; Anthropometry; Arm; Attention; Body Weight; Cross-Sectional Studies; Diet; Growth Disorders; Humans; Indonesia; Nutritional Status; Surveys and Questionnaires; Sputum; Thinness; Tuberculosis; Vitamin A; X-Rays; Zinc; Exercise; HIV Antibodies; HIV Infections; Body Mass Index; Electric Impedance; Malnutrition; Serum
  9. Hazrin A, Maryam Z, Hizrri A, Mohd Shukri M, Norhidayah A, Samsuddin N
    The effects of children’s exposure on high concentration of airborne pollutants at schools often associated with increased rate of absenteeism, low productivities and learning performances, and development of respiratory problems. Recent studies have found that the presence of occupants in the classroom seems to give major effect towards the elevation of concentration of airborne pollutants in indoors. In order to evaluate and further understand on the significance of occupancy factor on IAQ, this study has been designed to determine and compare the level of selected physical (particulate matter (PM)) and chemical (carbon dioxide (CO2) and temperature) IAQ parameters and biological contaminants via colony forming unit (CFUm-3 ) for bacteria and fungi inside the selected classrooms during occupied and non-occupied period (first objective). The second objective is to describe the possible sources of airborne pollutants inside the classrooms at the selected primary schools around Kuantan, Pahang. Assessments of physical and chemical IAQ were done by using instruments known as DustMate Environmental Dust Detector and VelociCalc® MultiFunction Ventilation Meter 9565.The data were recorded every 30 minutes for 8 hours during schooldays and weekend at the selected sampling point in the classrooms. For microbial sampling, Surface Air System Indoor Air Quality (SAS IAQ) was used to capture the bacteria and fungi. The data obtained were compared with the established standard reference known as the Industrial Code of Practice on Indoor Air Quality (2010) constructed by the Department of Occupational Safety and Health (DOSH), Malaysia. This study has found that some of the IAQ parameters in the selected classrooms were exceeding the established standards during occupied period in schooldays compared to non-occupied period during weekend. Findings of this study provide the insights for future research including the site selection of school, arrangement of the classrooms and numbers of students per class.
  10. Neupane SC, Kazi Rumana Ahmed, Faruquee M, Rabeya Yasmin, Shanta Dutta, Akhtar Ahmad S, et al.
    Arsenicosis, the illness due to chronic arsenic toxicity is prevalent in both Nepal and Bangladesh. The occurrence of arsenicosis depends upon many factors including food and nutrition. The objective of this study was to find out any difference of food habits among the arsenic exposed households of both countries and the relationship with the occurrence of arsenicosis. This was a cross-sectional comparative study, conducted among the arsenic exposed rural households of Nawalparasi district in Nepal and Faridpur district in Bangladesh. A total of 190 and 200 female rural households from Nepal and Bangladesh were selected respectively as the respondents. The majority of the respondents of both countries were under the age of 40 years. The prevalence of arsenicosis was found significantly low (χ2 = 8.847; p=.002) among the Nepalese households (7.3%) than that of Bangladeshi households (11.0%). As a staple food, rice, vegetables and pulses were more common among the Nepalese households in comparison to that of Bangladesh (χ2=5.739; p=.017). In addition to staple food Nepalese households were found to take significantly more (p
  11. Afzali A, Rashid M, Saniedanesh M
    Land filling is the most common disposal method in most parts of the world and landfill site has always been the final destination in solid waste management hierarchy. Thus, the selection of landfill site is always an essential part in the management of solid waste. Selecting an appropriate site for landfill minimizes any unwarranted ecological and socio-economic effects. Hence, landfill site selection requires a detailed analysis of the area that must be able to meet the local authority requirement and criteria. The present study presents a feasibility assessment of landfill establishment for Khomeynishahr city in Isfahan, applying a multi criteria evaluation (MCE) method using GIS technique. Information layers related to topography, soil, water table, sensitive habitats, land use and geology maps were prepared and superposed using Boolean logic in GIS environment. Essential analysis and regulation, criteria and site selection assessment showed that because of many limitations khomeynishahr city doesn’t have adequate conditions for landfill site establishment. Khomeynishahr city has a dense population and limited area and is not suitable for landfill establishment. In this case consideration of adjacent cities and finding a common landfill site between two or more cities could be a viable solution of solving this problem.
  12. Madihah Shukri, Nor Farid Mohd Noor
    Research examining whether psychological eating style is related to healthy or unhealthy eating patterns is required to explain the mechanisms underlying non-communicable diseases and obesity. The purpose of this study was to investigate whether eating style predicts thenature of food consumption. This was a cross-sectional study of 588 adults (males = 231 and females = 357). Eating style (i.e. restrained, emotional, external eating) was measured using the short version of the Dutch Eating Behaviour Questionnaire (DEBQ). The nature of food consumption was assessed using self-reports of consumption of fruits and vegetables, sweet foods, junk food, and snacks.The results revealed that restrained eating was higher in females and overweight participants. External eating,a higher frequency of snacking,and a higher frequency of junk food consumptionwere more prevalent among the younger participants. Consistent with previous Western studies, emotional eating was found to be the main predictor of consumption of less healthful foods (sweet foods, junk food, and snacks), whereas external eatingpredicted the intake of sweet foods. The intake of fruits and vegetableswas associated with restrained eating. In light of the significant associations between eating style and the nature of food consumption, acknowledging individuals’ eating styleshas implications for tailoring effective nutritional programs that address obesity and the chronic disease epidemic.
  13. Zhi Xiong Chong, Mustafa Alshagga, Khaled Ahmed Saed, Saba Kassim
    Khat leaves chewing/use, which imparts amphetamine like effects on the user, is widely practiced in parts of Africa, the Arabian Peninsula, and among the diaspora communities from these regions. Basic clinical and epidemiological studies from different settings have reported associations of acute coronary syndrome, heart failure, and cardiomyopathy, with khat chewing /use. This review aims to analyse the current evidence of the impact that khat, or its active constituent, cathinone, has on the cardiovascular system (CVS), particularly in two parameters, heart rate (HR) and blood pressure (BP). Subsequently, the possible mechanism of actions of how khat impacts these cardiovascular parameters is discussed, and different studies’ findings are summarised appropriately. The analysis of literature suggests that khat could influence HR and BP by most likely causing tachycardia and hypertension and the impacts might be dose-dependent and time-dependent. However, most of the studies involved different species and study designs, and had different limitations. Additionally, the underlying mechanisms of khat effects on these CVS parameters remain unclear. Therefore, more studies are needed to further support the current evidence of the impacts that khat has on the CVS parameters of HR and BP.
  14. Nahid Osman Ahmed, Sarah Fahad Alrebdi, Abdulghani MA, Mohammed Faez Baobaid
    The objective of this study is to explore physician’s perception toward clinical pharmacy services and role of clinical pharmacists in governmental hospitals at Al-Qassim region. An observational cross-sectional survey was conducted. Results: 150 males and 39 females participated giving 75.5% (189 of 250) response rate. Physicians perceptions were found to be high (equal or more than 90% of frequency) in some clinical pharmacy services such as patients’ education and counselling, monitoring of patients’ responses to drug therapy including toxicity/side effects and provision of drug information to healthcare professionals. The physicians showed low perception (less than 76%) in the taking of patients’ medication history on admission, by clinical pharmacists. Conclusion: Physicians’ perception toward clinical pharmacy services and the role of clinical pharmacists was not found to be completely favourable. The reason of this mixed responses and to the accommodating feelings of clinical pharmacy services in clinical setting appear to relate to the state of infrastructure and environments of hospitals. The infrastructure and environments of hospitals need to be updated for an improved accommodation clinical pharmacy services.
  15. Zafirah S, Amrizal Muhd Nur, Sharifa Ezat W, Syed Mohamed Aljunid
    Clinical coding creates a rich database that can be used for administrative functions including planning for health service programmes and preparing budget of hospitals with appropriate use of disease and procedure classification system. Clinical coding errors may occur in the diagnoses or procedure codes. The errors can be happen at any of the digits use in the classification codes. Errors in clinical coding can give a huge implication on hospital’s income if the coding system is used for reimbursement. This study aims to determine incidence of clinical coding errors among 464 patient’s medical records (PMR). An independent senior coder was appointed to review the selected PMRs and the clinical codes. Post-audit evaluation shows that 89.4%(415/464) of the records contained at least one coding error in the assignment of diagnosis or procedure codes. Error in secondary diagnosis code was the highest comprising 81.3% (377/464) of the records. Coding errors were particularly found in O&G discipline comprising 94.8% (110/116) of the selected records. These errors caused a potential loss of RM 666,461 for the hospital. The highest pre-and post audit variance of potential income was RM 568,403 for paediatric discipline. The hospital should carry out regular monitoring of quality of clinical coding in order to prevent loss of income in the future when the reimbursement of services is linked to coding of diagnosis and procedures.
  16. Mohd Rohaizat Hassan, Hasanain Faisal Ghazi, Mohamed AS, Saladina Jaszle Jasmin
    Breast Self-Examination (BSE) is a process whereby women examine their breasts regularly to detect any abnormal swelling or lumps in order to seek prompt medical attention. The purpose of this study was to investigate the knowledge and practice of BSE among female non-medical students in UKM, Bangi. A cross-sectional study was conducted using self-administered and validated questionnaire among 364 students. The results showed that only 37.1% performs BSE and 45% of the students have good knowledge. Age, marital status, using internet and pamphlets as source of information, personal, and family history of BC, were significantly associated with knowledge level of students. Practice of BSE was significantly associated with knowledge level. From multivariate analysis, BSE was more likely to be done among students with family history, students who using internet and pamphlet as sources of information, also among students with good knowledge. As conclusions, the practice of BSE is inadequate among the respondents in spite of most of them had heard about BSE. The results suggest the need of providing continuing educational programs to increase the knowledge level on BSE which in turn will have a positive effect on students to practice and motivate to perform BSE.
    MeSH terms: Attention; Breast; Cross-Sectional Studies; Female; Humans; Motivation; Pamphlets; Surveys and Questionnaires; Students; Multivariate Analysis; Breast Self-Examination; Marital Status; Internet
  17. Suhaina Sulaiman, Mohd Razif Shahril, Ahmad Zailani Hatta, Fuad Ismail
    Increasing physical activity level during and after treatment is recommended by the American Cancer Society because of the many benefits namely reducing fatigue and improves psychological distress which leads to an improvement in the quality of life. This study is aimed to compare physical activity level and body composition between oncology patients who are still undergoing treatment and those on medical follow-up. Patients were recruited based on convenience sampling from the Oncology Outpatient Clinics of Universiti Kebangsaan Malaysia Medical Center (UKMMC). Anthropometric measurements and body compositions were measured using calibrated tools while physical activity level were assessed using Global Physical Activity Questionnaire (GPAQ). Medical treatment history was obtained from patients medical records. A total of 53 patients (n=38 were undergoing treatment and n=15 was on follow-up) consisting of Malays (54.7%) and Chinese (45.3%) and with mean age of 55.3 ± 9.3 years. Most patients were previously diagnosed with ovarian cancer (39.6%) and colon cancer (18.9%) patients and they were at cancer stage III (18.8%). Body mass index (BMI) and percent fat mass were significantly different (p<0.05) between patients undergoing treatment (22.8 ± 2.7 kg/m2, 28.7 ± 7.2%) and on follow-up (26.2 ± 5.5 kg/m2, 37.1 ± 11.9%). Majority of the patients undergoing treatment were categorized under low physical activity compared to those on follow-up (p<0.05). Physical activity level measured as METS-minutes/week is also found to be significantly different (p<0.05) between patients on treatment and follow-up. As a conclusion, cancer patients undergoing treatment have low physical activity, with lower BMI and fat mass compared to those on follow-up. This is consistent with their nature of living where during treatment the patients will resting while coping with side effects of treatments.
  18. Sakinah Harith, Aryati Ahmad, Noor Aini Mohd Yusoff, Khor Wei Xin, Shariza Abdul Razak
    The main objective of the study was to determine the factors associated with blood cholesterol level among staff in Universiti Sains Malaysia (USM). The study was a cross-sectional. One-hundred staff between 23 and 59 years of age were recruited in this study using convenient sampling at USM Health Campus. A questionnaire which includes sociodemographic characteristics, medical history, and red meat intake was used in the study. Anthropometric and biochemical assessment were measured. Blood cholesterol level was divided into two categories which were known as healthy range (<5.2mmol/L) and slight risk/high risk range (≥5.2mmol/L). The gender distribution of respondents for this study comprised of 40 male and 60 female. The age group (18 to 39) years and (40 to 59) years had a total of 40.3% and 63.2% of slightly risk or high risk blood cholesterol respectively; with the significant association between age group and blood cholesterol level (χ²=4.916,p=0.027). Besides, normal BMI group had 66.7% of respondents achieved healthy blood cholesterol level whereas underweight, overweight and obese group had 39.7% achieved healthy blood cholesterol with the significant association between BMI and blood cholesterol level (χ²=7.112,p=0.008). Moreover, daily or weekly intake of red meat showed that 65.0% of total respondents had a healthier blood cholesterol level compared to 51.0% of monthly, rarely, or none red meat intake group which achieved healthy blood cholesterol level. The result also showed a significant association between red meat intake and blood cholesterol (χ²=5.229, p=0.022), which indicating less red meat consumption is linked to high level of blood cholesterol level. Therefore, further investigation and future studies are needed to gain a clearer understanding of the association between these variables and blood cholesterol level.
  19. Laila Ruwaida Mohd Zainuddin, Nor Syamimi Zakarai, Noor Aini Mohd Yusoff, Aryati Ahmad, Mohd Razif Shahril, Suhaina Sulaiman
    A balanced dietary intake plays an important role in the prognosis of breast cancer and is one of the modifiable factors in preventing cancer recurrence. This study aims to determine the dietary intake among breast cancer survivors in East Coast of Peninsular Malaysia. A total of 125 breast cancer survivors, aged 37 to 72 years, with mean duration of survivorship of 6.1 ± 3.9 years were recruited from two main referral hospitals in Terengganu and Kelantan. Majority of the respondents were Malay (94.4%) with a mean BMI of 27.7 ± 5.07 kg/m², and were diagnosed with stage II cancer (66.0%). Dietary intake was estimated using a semi-quantitative food frequency questionnaire (FFQ). The results show that the mean daily intake of energy was 1764 ± 378 kcal/day, protein was 72.38 ± 33.6 g/day (16.5% of energy), carbohydrate was 243.0 ± 62.2 g/day (55% of energy) and fat was 55.8 ± 15.6 g/day (28% of energy). Overall, breast cancer survivors in this study had an adequate daily intake of vitamins and minerals according to Malaysian Recommended Nutrient Intakes (RNI) except for dietary fibre (10.6 ± 4.2 g/day), monounsaturated fatty acids (20.7 ± 5.7 g/day), polyunsaturated fatty acids (8.0 ± 2.2 g/day), calcium (561.0 ± 257.1 mg/day), iron (18.3 ± 7.2 mg/day) and potassium (1813.4 ± 531.1 mg/day) which was lower than the recommendation. Meanwhile, intake of sodium (2592 ± 1697 mg/day), protein (80.4 ± 33.6 g/day), saturated fatty acids (26.9 ± 14.2 g/day), vitamin B2 (1.9 ± 1.1 mg/day) and vitamin C (151.1 ± 149.3 mg/day) exceeded the recommendation by 135.0%, 139.0%, 166.9%, 154.6% and 152.0%, respectively. There was no significant difference in dietary intake between cancer survivors who were diagnosed in the past five years and those who were diagnosed more than five years ago (p>0.05) except for fat (p<0.001), saturated fatty acid (p=0.006), monounsaturated fatty acid (p=0.005) and polyunsaturated fatty acid (p=0.003). As a conclusion, breast cancer survivors in East Coast of Peninsular Malaysia had an adequate intake of most nutrients except for dietary fibre, monounsaturated fatty acids, polyunsaturated fatty acids, calcium, iron and potassium which was below the recommendation and sodium, protein, saturated fatty acids, vitamin B2, vitamin C which was above the recommendation. The intakes between long-term and short-term survivors were also comparable showing sustained dietary intake throughout survivorship.
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