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Fulltext The negative impact of living environment on intelligence quotient of primary school children in Baghdad City, Iraq: a cross-sectional study

Ghazi HF, Isa ZM, Aljunid S, Shah SA, Tamil AM, Abdalqader MA

BMC Public Health, 2012;12:562.
PMID: 22839101 DOI: 10.1186/1471-2458-12-562

Environmental factors play a very important role in the child development process, especially in a situation like that of Iraq. Thirteen years of economic sanctions followed by the 2003 war and 8 years of unstable security have affected the daily life of Iraqi families and children. The objective of this study was to assess the associations between living environment domains and child intelligence quotient (IQ) score.
Relationship of maxillary incisors in complete dentures to the incisive papilla

Isa ZM, Abdulhadi LM

J Oral Sci, 2012;54(2):159-63.
PMID: 22790408

We investigated the relationship of the maxillary central incisors to the incisive papilla in wearers of complete dentures. First, image analyzer software was used to examine the relationship of the midpoint of the incisive papilla to the labial surface of the maxillary central incisors on occlusal photographs of 120 maxillary casts from dentate Malaysian adults. Then, an Alma denture gauge was used to identify the position of the labial surface of the maxillary central incisors in relation to the midpoint of the incisive papilla in complete dentures from 51 patients who requested replacement dentures at the Faculty of Dentistry, University of Malaya. The mean incisor distance to the incisive papilla in dentate adults was 9.59 ± 1.00 mm, while the mean incisor distance to the incisive papilla in complete dentures was 6.34 ± 1.87 mm. Thus, in our sample of edentulous patients, the anterior teeth in complete dentures were positioned approximately 3 mm closer to the incisive papilla, as compared with the position of the central incisors in natural dentition, and did not duplicate the position of the natural anterior teeth.
Fulltext The Relationship between the Neighborhood Safety and Nutritional Status of Children in Baghdad City, Iraq

Ghazi HF, Isa ZM, Shah SA, Abdal Qader MA, Hasan TN, Al-Abed AA

J Nutr Metab, 2014;2014:686934.
PMID: 25243083 DOI: 10.1155/2014/686934

Introduction. The neighborhoods where the children live play an important role in their development physically and mentally. The objective of this study was to assess the relationship between neighborhood safety and child nutritional status in Baghdad city, Iraq. Methods. A cross-sectional study was carried out in Baghdad city, Iraq, among 400 primary school children from 4 schools. BMI-for-age Z score was used to assess the nutritional status of the children. Newly developed questionnaires on neighborhood safety were distributed to the parents to answer them. Results. In this study, males were more predominant than females with 215 participants compared to 185 females. A total of 49% were normal weight, 38.8% either overweight or obese, and only 12.2% underweight. There was a significant relationship between father education, father and mother working status, family income, and children nutritional status (P = 0.10, 0.009, <0.001, 0.37), respectively. The association between neighborhood safety variables and child nutritional status was significant except for worrying about child safety and thinking of leaving the neighborhood (P = 0.082, 0.084), respectively. Conclusion. Nutritional status of school children continues to be a public health issue in Iraq especially Baghdad city. There was a significant association between neighborhood safety and children nutritional status.
Eight year survival among breast cancer Malaysian women from University Kebangsaan Malaysia Medical Centre

Al-Naggar RA, Isa ZM, Shah SA, Nor MI, Chen R, Ismail F, et al.

Asian Pac J Cancer Prev, 2009;10(6):1075-8.
PMID: 20192587

Survival after diagnosis of cancer is one of the major outcome measurements and a key criterion for assessing quality of cancer control related to both the preventive and the therapeutic level. The purpose of this study was to determine the 8-year survival time in Malaysia based on socio-demographic and clinical characteristics. A retrospective study of 472 Malaysian women with breast cancer from the Medical Record Department at University Kebangsaan Malaysia Medical Centre (UKMMC) was therefore performed with survival analysis carried out using the Kaplan-Meier with log-rank test for univariate analysis and Cox-regression for multivariate analysis. Women who had cancer or family history of cancer had a longer 8-year survival time (p = 0.008) compared with others who did not have such a history. Tamoxifen use, positive oestrogen receptor status, and race were prognostic indicators for 8-year survival time (p = 0.036, p = 0.018, p = 0.053, respectively) in univariate analysis. Multivariate analysis showed that being Malays and having no family history of cancer were independent prognostic factors for shorter survival time (p = 0.008, p = 0.012, respectively). In conclusion, being Chinese and having a family history of cancer are predictors of longer survival among the Malaysian breast cancer women.
Effect of iodized oil supplementation on thyroid hormone levels and mental performance among Orang Asli schoolchildren and pregnant mothers in an endemic goitre area in Peninsular Malaysia

Isa ZM, Alias IZ, Kadir KA, Ali O

Asia Pac J Clin Nutr, 2000 Dec;9(4):274-81.
PMID: 24394503

Although endemic goitre is no longer a major public health problem in Malaysia, iodine deficiency still remains a significant problem in a few remote settlements. The aim of this study was to determine the effectiveness of iodized oil intervention in the prevention of endemic goitre among the indigenous people in Malaysia. A pretest and post-test controlled trial was conducted among primary schoolchildren and pregnant mothers in Lasah, Sungai Siput and Perak. Legap Post and Yum Post were selected as the intervention areas, while Perwor Post and Poi Post were taken as controls. The variables studied included thyroid hormone concentrations, thyroid volume, urinary iodine excretions and mental performance. A baseline and two follow-up visits were conducted in both intervention and control areas. Intervention subjects were given iodized oil in the form of capsules which were taken orally (Laboratoire Guerbet, Paris, France). There was a significant increase in serum thyroxine hormone (T4) concentrations (p<0.0001) and a significant decrease in thyroid stimulating hormone (TSH) concentrations (p<0.05) in the schoolchildren following the intervention, however, pregnant mothers did not show any significant changes in T4 and TSH concentrations. Thyroid size was significantly reduced in both groups (p<0.05). Urinary iodine excretions showed a significant increase in both groups following the intervention (p<0.01). However, mental performance in schoolchildren was not affected. In conclusion, iodized oil (oral) is effective in reducing thyroid size, as well as improving the supply of iodine among schoolchildren and pregnant mothers in endemic goitre areas; however, its long-term effects need to be monitored closely. This method can be considered as an alternative while awaiting national coverage for the salt iodization program.
Fulltext Indoor Particulate Matters, Microbial Count Assessments, and Wheezing Symptoms among Toddlers in Urban Day Care Centers in the District of Seremban, Malaysia

Khamal R, Isa ZM, Sutan R, Noraini NMR, Ghazi HF

Ann Glob Health, 2019 01 22;85(1).
PMID: 30741516 DOI: 10.5334/aogh.2425

INTRODUCTION: Indoor air quality in day care centers (DCCs) is an emerging research topic nowadays. Indoor air pollutants such as particulate matter (PM) and microbes have been linked to respiratory health effects in children, particularly asthma-related symptoms such as night coughs and wheezing due to early exposure to indoor air contaminants.
OBJECTIVE: The aim of this study was to determine the association between wheezing symptoms among toddlers attending DCCs and indoor particulate matter, PM10, PM2.5, and microbial count level in urban DCCs in the District of Seremban, Malaysia.
METHODS: Data collection was carried out at 10 DCCs located in the urban area of Seremban. Modified validated questionnaires were distributed to parents to obtain their children's health symptoms. The parameters measured were indoor PM2.5, PM10, carbon monoxide, total bacteria count, total fungus count, temperature, air velocity, and relative humidity using the National Institute for Occupational Safety and Health analytical method.
RESULTS: All 10 DCCs investigated had at least one indoor air quality parameter exceeding the acceptable level of standard guidelines. The prevalence of toddlers having wheezing symptoms was 18.9%. There was a significant different in mean concentration of PM2.5 and total bacteria count between those with and those without wheezing symptoms (P = 0.02, P = 0.006).
CONCLUSIONS: Urban DCCs are exposed to many air pollutants that may enter their buildings from various adjacent sources. The particle concentrations and presence of microbes in DCCs might increase the risk of exposed children for respiratory diseases, particularly asthma, in their later life.
Fulltext Environmental air pollutants as risk factors for asthma among children seen in pediatric clinics in UKMMC, Kuala Lumpur

Idris IB, Ghazi HF, Zhie KH, Khairuman KA, Yahya SK, Abd Zaim FA, et al.

Ann Glob Health, 2016 6 22;82(1):202-8.
PMID: 27325078 DOI: 10.1016/j.aogh.2016.01.021

The prevalence of asthma is increasing, especially among children in Malaysia, with environmental factors as one of the main preventable contributors. The aim of this study was to determine the association between environmental air pollutants and the occurrence of asthma among children seen in pediatric clinics in Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur. An unmatched case control study among children who attended the pediatric clinic was carried out from May to August 2015. A total of 223 children who were diagnosed with asthma (105 cases) and who did not have asthma (118 controls) were included in this study. Their parents or caregivers were interviewed using questionnaires modified from the International Study of Asthma and Allergies in Childhood. Data obtained were analyzed using SPSS software version 20. There was a higher risk of asthma in those who had carpet at home (OR = 2.15 CI [1.25-3.68]), those who lived within 200 m of heavy traffic (OR = 1.72 CI [1.01-2.93]), and those who were exposed to lorry fumes (OR = 2.61. CI [1.38-4.93]). Environmental air pollutants increased the risk of asthma among children in Malaysia. Exposure to congested roads, lorry fumes, and indoor carpet were associated with asthma among children in this study. Parents or caretakers of children with asthma should be given adequate education on the prevention of asthmatic attack among these children.
Study site: Paediatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Relationship between vehicle count and particulate air pollution in Amman, Jordan

Alnawaiseh NA, Hashim JH, Isa ZM

Asia Pac J Public Health, 2015 Mar;27(2):NP1742-51.
PMID: 22899706 DOI: 10.1177/1010539512455046

The main objective of this cross-sectional comparative study is to observe the relationship between traffic-related air pollutants, particularly particulate matter (PM) of total suspended particulate (TSP) and PM of size 10 µm (PM10), and vehicle traffic in Amman, Jordan. Two study areas were chosen randomly as a high-polluted area (HPA) and low-polluted area (LPA). The findings indicate that TSP and PM10 were still significantly correlated with traffic count even after controlling for confounding factors (temperature, relative humidity, and wind speed): TSP, r = 0.726, P < .001; PM10, r = 0.719, P < .001). There was a significant positive relationship between traffic count and PM level: TSP, P < .001; PM10, P < .001. Moreover, there was a significant negative relationship between temperature and PM10 level (P = .018). Traffic volume contributed greatly to high concentrations of TSP and PM10 in areas with high traffic count, in addition to the effect of temperature.
Fulltext Do indoor environments influence asthma and asthma-related symptoms among adults in homes?: a review of the literature

Jie Y, Ismail NH, Jie X, Isa ZM

J Formos Med Assoc, 2011 Sep;110(9):555-63.
PMID: 21930065 DOI: 10.1016/j.jfma.2011.07.003

This review summarizes the results of epidemiological studies focusing on the detrimental effects of home environmental factors on asthma morbidity in adults. We reviewed the literature on indoor air quality (IAQ), physical and sociodemographic factors, and asthma morbidity in homes, and identified commonly reported asthma, allergic, and respiratory symptoms involving the home environment. Reported IAQ and asthma morbidity data strongly indicated positive associations between indoor air pollution and adverse health effects in most studies. Indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke. Environmental exposure may increase an adult's risk of developing asthma and also may increase the risk of asthma exacerbations. Evaluation of present IAQ levels, exposure characteristics, and the role of exposure to these factors in relation to asthma morbidity is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity.
Fulltext Knowledge and barriers towards cervical cancer screening among young women in Malaysia

Al-Naggar RA, Low WY, Isa ZM

Asian Pac J Cancer Prev, 2010;11(4):867-73.
PMID: 21133593

OBJECTIVES: This study examined the level of knowledge and barriers towards cervical cancer screening of female university students.

METHODOLOGY: A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty's registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13.

RESULTS: The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents was having more than one sex partner (77.5%), whereas the lowest was the relationship between HPV and cervical cancer (51.2%). Age, marital status, ethnicity, monthly family income and faculty were significantly associated with knowledge of cervical cancer screening (p=0.003; p=0.001; p=0.002; p=0.002; p=0.001 and p=0.002; respectively). The most common barriers of cervical cancer screening were the Pap smear test will make them worry (95.8%) whereas the least common barrier reported among participants was no encouragement from the partner (8.8%).

CONCLUSION: Some misconceptions and barriers in uptaking Pap smear test are still serious problems among young women. Although knowledge about cervical cancer screening is adequate they have a very poor practice of Pap smear test. The introduction of reproductive health subjects is warranted for all university students.
Fulltext Perception and opinion of medical students about Pap smear test: a qualitative study

Al-Naggar RA, Isa ZM

Asian Pac J Cancer Prev, 2010;11(2):435-40.
PMID: 20843130

OBJECTIVE: the objective of this study is to explore the perceptions of medical students regarding the Pap smear test.

METHODOLOGY: Focus group discussion was held with twenty three medical students. The students were divided into three focus groups; two groups of female participants consisting of 9 and 8 students; respectively. The third group consisted of 6 male students. Questions regarding Pap smear testing included barriers that prevented women from taking the test, gender preference for the physician to conduct the cervical screening test, willingness to suggest Pap smear test to the family or friends. The data obtained were classified into various categories and analyzed manually.

RESULTS: Most of the study participants mentioned that the main barriers for women to not perform Pap smear test is lack of awareness 16 (70%), followed by shyness 12 (52%) and the cost of the test 12 (52%). Most agreed that the gender of the physician will affect the women decision to do Pap smear test. All mentioned that the advantage of a regular Pap smear test is to detect the abnormality at the early stage of cervical cancer. Some of the participants 9 (39%) mentioned that the disadvantages are expense, possible injury in the vagina due to the test procedures 8 (35%), associated infection 7(30.4%) and pain 7(30.4%) . The majority, 20 (87%) mentioned that the most effective prevention methods for cervical cancer are having sex only after getting married with the spouse only, HPV vaccination 15 (65%) and Pap smear 14 (61%).

CONCLUSION: The main barriers for women to not perform Pap smear test is lack of awareness, shyness and the cost of the test. Gender of the physician will affect the women decision to do Pap smear test.
Fulltext Genotoxicity following Organophosphate Pesticides Exposure among Orang Asli Children Living in an Agricultural Island in Kuala Langat, Selangor, Malaysia

Sutris JM, How V, Sumeri SA, Muhammad M, Sardi D, Mohd Mokhtar MT, et al.

Int J Occup Environ Med, 2016 01;7(1):42-51.
PMID: 26772597 DOI: 10.15171/ijoem.2016.705

BACKGROUND: Agriculture is an important sector for the Malaysian economy. The use of pesticides in agriculture is crucial due to its function in keeping the crops from harmful insects. Children living near agricultural fields are at risk of pesticide poisoning.
OBJECTIVE: To evaluate the genotoxic risk among children who exposed to pesticides and measure DNA damage due to pesticides exposure.
METHODS: In a cross-sectional study 180 Orang Asli Mah Meri children aged between 7 and 12 years were studied. They were all living in an agricultural island in Kuala Langat, Selangor, Malaysia. The data for this study were collected via modified validated questionnaire and food frequency questionnaire, which consisted of 131 food items. 6 urinary organophosphate metabolites were used as biomarkers for pesticides exposure. For genotoxic risk or genetic damage assessment, the level of DNA damage from exfoliated buccal mucosa cells was measured using the comet assay electrophoresis method.
RESULTS: Out of 180 respondents, 84 (46.7%) showed positive traces of organophosphate metabolites in their urine. Children with detectable urinary pesticide had a longer tail length (median 43.5; IQR 30.9 to 68.1 μm) than those with undetectable urinary pesticides (median 24.7; IQR 9.5 to 48.1 μm). There was a significant association between the extent of DNA damage and the children's age, length of residence in the area, pesticides detection, and frequency of apple consumption.
CONCLUSION: The organophosphate genotoxicity among children is associated with the amount of exposure (detectability of urinary pesticide) and length of residence in (exposure) the study area.
Fulltext Nutritional status of women and children in Malaysian rural populations

Ali O, Isa ZM

Asia Pac J Clin Nutr, 1995 Sep;4(3):319-24.
PMID: 24394359

This study was conducted to investigate the nutritional status of the rural population in Malaysia, especially women and children. A total of 262 women aged 18 and over and 183 children aged 2-6 years were selected using multistage cluster sampling from four locations in rural areas. It was found that the prevalence of malnutrition among children 2-6 years old ranged between 25.5% in the Malays Felda settlement scheme to 80% in the Orang Asli settlement. Malnutrition was associated with worm infestations, bottle feeding and early weaning. More than 30% of Orang Asli women were malnourished compared to less than 15% of Malay Felda settlement women. On the other hand, Malay women in the land settlement scheme had a higher risk of developing overweight and diabetes. Goitre was found among 11.5% of children; however, no cretinism was found. Breast feeding was still a common practice among rural mothers, but inadequate health education tended to reduce the duration of breast feeding and increased early weaning. Upgrading women's status in the rural areas will ultimately improve the nutritional and health status of the children and community as a whole.
FeNO level and allergy status among school children in Terengganu, Malaysia

Ma'pol A, Hashim JH, Norbäck D, Weislander G, Hashim Z, Isa ZM

J Asthma, 2020 08;57(8):842-849.
PMID: 31155989 DOI: 10.1080/02770903.2019.1614614

Background: Almost one third of the world population suffers from allergic conditions. Respiratory symptoms are common in Malaysian children but there are few studies on fractional exhaled nitric oxide (FeNO), inclusive of field clinical test for asthma among children in Malaysia. The aim was to provide insight on factors related to level of FeNO among students in Terengganu, Malaysia.Methods: In total, 487 randomly selected students from eight secondary schools participated (13-14 years old). A Standardized questionnaire was used to obtained information on doctors' diagnosed asthma, current asthma and respiratory symptoms. FeNO measurement and skin prick test (SPT to common allergen) were conducted.Results: The geometric mean FeNO was 16.7 ppb. Totally, 38.4% of students had elevated FeNO level (>20 ppb) and 40.3% had had positive SPT to house dust mites allergens (HDM), Dermatophagoides pteronyssinus (Der p 1), Dermatophagoides farinae (Der f 1) or Felis domisticus (cat). Male gender, height, parental history of allergy, self-reported allergy, and atopy were associated with FeNO. In particular, a combination of sensitization to HDM or cat and elevated FeNO were associated with doctor-diagnosed asthma and self-reported allergy to food, pollen and cat.Conclusion: Asthma, respiratory symptoms and sensitization to HDM and cat are common among students and presence of elevated FeNO levels indicate ongoing airway inflammation.
Women's Attitude and Its Influence on Violence During Pregnancy in Northern State of Peninsular Malaysia: Cross-Sectional Study

Haron K, Shaffie Z, Ghazi HF, Isa ZM

J Interpers Violence, 2021 03;36(5-6):NP2576-NP2600.
PMID: 29624110 DOI: 10.1177/0886260518759059

The objective of this study was to determine the prevalence of men's violence against pregnant women and whether it is influenced by women's attitude. A cross-sectional study was carried out in a hospital in northern state of Peninsular Malaysia. A total of 1,200 postnatal women aged 18 years and above who had been admitted to the hospital were recruited in the study. Universal sampling was performed, and participants were interviewed face-to-face by using a validated Malay version of WHO Women's Health and Life Experiences Questionnaire. The main outcome measures in the study were emotional, physical or sexual violence. The study results showed that more than one third of women (35.9%; confidence interval [CI] = [0.33, 0.39]) had experienced any type of violence during pregnancy with the commonest was psychological violence (29.8%; CI = [0.27, 0.32]) followed by physical (12.9%; CI = [0.11, 0.15]) and sexual violence (9.8%; CI = [0.08, 0.12]). Women who were drug users, had an exposure to violence during childhood, had higher parity, and had inadequate antenatal care were at greater risk. Agree that husband is justified to hit his wife in certain conditions and agree that women has a right to refuse sex in certain conditions were among violence-supporting attitudes. It can be concluded that men's violence against pregnant women is extremely prevalent. Sensitive assessment, attitude modification, and intervention (primary, secondary, and tertiary) are of great value in combating men's violence against pregnant women.
Fulltext Heavy metal transport with adsorption for instantaneous and exponential attenuation of concentration

Liang R, Isa ZM

Sci Rep, 2024 Jan 04;14(1):537.
PMID: 38177226 DOI: 10.1038/s41598-023-50754-5

Heavy metal pollutant is a serious problem in environmental pollution, and it is very difficult to eradicate once it enters the soil. As heavy metal adsorption has been proven to occur, the heavy metal's behaviour can be modeled as a transport equation with adsorption. Previous adsorption term mostly due to the concentration alone, while in here, the desorption effect given by the rate of change of the concentration is also included. Also, the heavy metals are frequently considered to enter the soil after being dumped into the soil for a certain period of time. But, quick dumping onto the soil can introduce heavy metal instantaneously. Heavy metals entering the soil through leaching or when their concentration in the soil is influenced by chemical reactions, can all lead to the exponential decay of heavy metals entering the soil. Based on two-dimensional advection diffusion equation (ADE) with the new adsorption term, analytical solutions are obtained for the cases of instantaneous and exponential attenuation of heavy metals emission to soil by the method of Laplace transform. The results highlight the significant influence of emission type on the peak concentrations. If heavy metals are instantaneously enter the soil, the peak occurs in the range of 1-3 m radius from the point of emission on the first day, while for exponential attenuation the peak occurs close to the point of emission. Furthermore, there exists a correlation between retardation factors and heavy metal concentrations, where a decrease in retardation factors leads to an increase in heavy metal concentration. It is essential to investigate both types of heavy metals emission to provide valuable information for proper pollution management, effective environmental regulations and enforcement.
Urban vs. rural factors that affect adult asthma

Jie Y, Isa ZM, Jie X, Ju ZL, Ismail NH

Rev Environ Contam Toxicol, 2013;226:33-63.
PMID: 23625129 DOI: 10.1007/978-1-4614-6898-1_2

In this review, our aim was to examine the influence of geographic variations on asthma prevalence and morbidity among adults, which is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity. Asthma is a complex inflammatory disease of multifactorial origin, and is influenced by both environmental and genetic factors. The disparities in asthma prevalence and morbidity among the world's geographic locations are more likely to be associated with environmental exposures than genetic differences. In writing this article, we found that the indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke in both urban and rural areas. Asthma and asthma-related symptoms occurred more frequently in urban than in rural areas, and that difference correlated with environmental risk exposures, SES, and healthcare access. Environmental risk factors to which urban adults were more frequently exposed than rural adults were dust mites,high levels of vehicle emissions, and a westernized lifestyle.Exposure to indoor biological contaminants in the urban environment is common.The main risk factors for developing asthma in urban areas are atopy and allergy to house dust mites, followed by allergens from animal dander. House dust mite exposure may potentially explain differences in diagnosis of asthma prevalence and morbidity among adults in urban vs. rural areas. In addition, the prevalence of asthma morbidity increases with urbanization. High levels of vehicle emissions,Western lifestyles and degree of urbanization itself, may affect outdoor and thereby indoor air quality. In urban areas, biomass fuels have been widely replaced by cleaner energy sources at home, such as gas and electricity, but in most developing countries, coal is still a major source of fuel for cooking and heating, particularly in winter. Moreover, exposure to ETS is common at home or at work in urban areas.There is evidence that asthma prevalence and morbidity is less common in rural than in urban areas. The possible reasons are that rural residents are exposed early in life to stables and to farm milk production, and such exposures are protective against developing asthma morbidity. Even so, asthma morbidity is disproportionately high among poor inner-city residents and in rural populations. A higher proportion of adult residents of nonmetropolitan areas were characterized as follows:aged 55 years or older, no previous college admission, low household income, no health insurance coverage, and could not see a doctor due to healthcare service availability, etc. In rural areas, biomass fuels meet more than 70% of the rural energy needs. Progress in adopting modern energy sources in rural areas has been slow. The most direct health impact comes from household energy use among the poor, who depend almost entirely on burning biomass fuels in simple cooking devices that are placed in inadequately ventilated spaces. Prospective studies are needed to assess the long-term effects of biomass smoke on lung health among adults in rural areas.Geographic differences in asthma susceptibility exist around the world. The reason for the differences in asthma prevalence in rural and urban areas may be due to the fact that populations have different lifestyles and cultures, as well as different environmental exposures and different genetic backgrounds. Identifying geographic disparities in asthma hospitalizations is critical to implementing prevention strategies,reducing morbidity, and improving healthcare financing for clinical asthma treatment. Although evidence shows that differences in the prevalence of asthma do exist between urban and rural dwellers in many parts of the world, including in developed countries, data are inadequate to evaluate the extent to which different pollutant exposures contribute to asthma morbidity and severity of asthma between urban and rural areas.
Mammography screening: Female doctors'attitudes and practice in Sana'a, Yemen

Al-Naggar RA, Isa ZM, Shah SA, Chen R, Kadir SY

Asian Pac J Cancer Prev, 2009;10(5):743-6.
PMID: 20104962

A cross-sectional study was conducted at the main hospitals in Sana'a, Yemen to determine the attitude and practice of Yemen female doctors on mammography screening. Study subjects were all female doctors who were on duty during the questionnaire distribution. Those who agreed to participate were given the questionnaire to complete. Descriptive statistics were used to analyse socio-demographic variables and variables related to general health. Participants in this study were 105 female doctors with mean age of 32.1 years (SD = 7.17). Thirty-four respondents (36.6%) did not send asymptomatic women for mammography screening. The reasons were because of high cost (58.0%, n= 25), availability of other methods (23.3%, n= 10), instrument not available (11.6%, n= 5) and high risk of radiation (7.0%, n= 3). Twenty-five participants (26.9%) sent patients on regular basis if there was a family or personal history of breast cancer. Twenty-three participants (24.7%) sent the patients for mammogram screening every year regardless of the patients'history or symptoms. Although most doctors (36.5%) do not refer patients for mammography screening, seventy-seven (74.0%) indicated that they would refer patients for mammography screening on personal request by the patients. This study showed a low percentage of doctors who referred patients for routine mammography. The major reason given was the high cost of the procedure.
Spot urine potassium as a potential screening test for aldosterone breakthrough

Sakthiswary R, Wong M, Isa ZM, Nor Azmi K

Clin Ter, 2012;163(3):195-8.
PMID: 22964690

Treatment with angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) may suppress aldosterone production only in the initial phase of treatment and subsequently lead to a rising level of aldosterone to baseline or higher. This phenomenon is described as aldosterone breakthrough. Apart from serial plasma aldosterone levels, there are no other test to identify this condition. The purpose of this study was to evaluate the role of spot urine potassium as a potential screening test for aldosterone breakthrough.
Regression methods to investigate the relationship between facial measurements and widths of the maxillary anterior teeth

Isa ZM, Tawfiq OF, Noor NM, Shamsudheen MI, Rijal OM

J Prosthet Dent, 2010 Mar;103(3):182-8.
PMID: 20188241 DOI: 10.1016/S0022-3913(10)60028-5

In rehabilitating edentulous patients, selecting appropriately sized teeth in the absence of preextraction records is problematic.

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