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Predictors of death among drug-resistant tuberculosis patients in Kuala Lumpur, Malaysia: A retrospective cohort study from 2009 to 2013

Mohd Shariff N, Shah SA, Kamaludin F

J Glob Antimicrob Resist, 2016 09;6:102-107.
PMID: 27530850 DOI: 10.1016/j.jgar.2016.04.005

The emergence of drug-resistant tuberculosis (TB) is a major public health threat. However, little is known about the predictors of death in drug-resistant TB in Malaysia. This study aimed to determine the predictors of death in drug-resistant TB patients, including multidrug-resistant TB (MDR-TB), in Kuala Lumpur, Malaysia. This study adopted a retrospective cohort study design and involved laboratory-confirmed drug-resistant TB patients (n=426) from January 2009 to June 2013. A Cox regression model and Kaplan-Meier curves were used to model the outcome measure. Data were analysed by using SPSS v.20.0 for Windows. In this study, 15.3% (n=65) of the patients died. Among the study patients, 70.9% were monoresistant TB cases, 9.4% were poly-resistant TB and 19.7% were MDR-TB. MDR-TB [adjusted hazard ratio (aHR)=2.23, 95% confidence interval (CI) 1.26-3.95], ethnicity [Malay (aHR=5.95, 95% CI 2.30-15.41), Chinese (aHR=4.01, 95% CI 1.38-11.66) and Indian (aHR=3.76, 95% CI 1.19-11.85)], coronary heart disease (aHR=6.82, 95% CI 2.16-21.50), drug abuse (aHR=3.79, 95% CI 2.07-6.93) and treatment non-compliance (aHR=1.81, 95% CI 1.01-3.27) were independent predictors of poorer survival in the multivariate Cox regression analysis. This study suggests that MDR-TB, local ethnicity, coronary heart disease, history of drug abuse and treatment non-compliance are factors predicting poor survival in drug-resistant TB patients. More emphasis should be given to the management of drug-resistant TB patients with these characteristics to achieve better treatment outcomes.
Fulltext Low Socioeconomic Status Associated with Poor Cancer Screening Perceptions in Malaysia: Analysis of Determinant of Health among General Population

Shah SA, Mahmood MI, Ahmad N

Asian Pac J Cancer Prev, 2020 Nov 01;21(11):3137-3144.
PMID: 33247668 DOI: 10.31557/APJCP.2020.21.11.3137

BACKGROUND: The recent data shows reduced uptake on cancer screening where the Perception towards cancer screening by the public is one of the favorable factor might influence the screening uptake. Therefore, this study aims to determine the predictors of poor cancer screening perceptions among the population in Johor, Malaysia.
METHODS: This was a cross sectional study of 1,312 respondents selected using a multistage design. Questionnaires relating to the demographic characteristics, socioeconomic profiles, social and physical environment, knowledge and perception of cancer screening were gathered. Multiple logistic regression models were used to examine the variables and their association with poor perceptions of cancer screening.
RESULTS: Overall, 871(66.4%) respondents had poor perceptions of cancer screenings; 68.4% among males and 64.4% among females. In the multivariable analysis in the category of income, the bottom 40% and lower middle 40%, had not subscribed to health insurance, had poor social support, absence of any family history of cancer or comorbid illnesses, no previous attendance for cancer screening and poor knowledge of cancer, all of which were associated with their poor cancer screening perceptions.
CONCLUSION: One way of developing cancer screening services to detect cancer in its early stage could include efforts to reach people with less awareness about cancer screening tests, lower socioeconomic status, and inadequate social support. Particular consideration should be taken to locate those who never had health insurance or attended cancer screening tests to provide the appropriate resources.
Fulltext Usage of Health Belief Model (HBM) in Health Behavior: A Systematic Review

Haryati Anuar, Shamsul Azhar Shah, Halim Gafor, Mohd Ihsani Mahmood, Hasanain Faisal Ghazi

Malaysian Journal of Medicine and Health Sciences, 2020;16(111):201-209.
MyJurnal

Introduction: The Health Belief Model has gained widespread popularity and acceptance in the community,
yet little is known about its effectiveness as a basis for health behavior intervention. The purpose of this
study is to systematically review the evidence on the use of the model in health behavior for
Chronic Kidney Disease and the effectiveness of Health Belief Model as a model intervention for
facilitating health-related behavioral changes. Methods: The databases were manually searched
for references and gray literature. Overall, the methodological quality of trials was variable, and there
was limited evidence for the effectiveness of Health Belief Model in improving health
behavior. Results: There are few new trials published that describe the application of
Health Belief Model. Limited evidence supports any benefits of Health Belief Model for improving
health behavior. Conclusion: Studies on the usage of Health Belief Model need to be explored in depth
to assess the importance of Health Belief Model.
Fulltext Chlorpyrifos blood level and exposure symptoms among paddy farmers in Sabak Bernam, Malaysia

Rozita Hod, Azimatun Noor Aizuddin, Shamsul Azhar Shah, Mohd Rohaizat Hassan, Nazarudin Safian, Mohd Hasni Jaafar

Int J Public Health Res, 2011;1(1):1-6.
MyJurnal

Accepted 21 July 2011.
Introduction The extensive and intensive use of pesticides in agricultural practices has exposed farmers to various hazards resulting in varying degrees of health
outcomes.
Methods We conducted a cross-sectional study among paddy farmers in Sabak Bernam district, Malaysia. The objective of this study was to gather baseline information on chlorpyrifos blood level and its relationship with pesticides exposure symptoms.
Results We detected chlorpyrifos in farmers’ blood in 7 percent of the respondents, with mean 7.29 nanogram per millilitre blood (sd 5.84 nanogram per millilitre). The percentage of farmers who experienced at least one pesticide exposure symptoms was 75 percent. However, we found no significant association between chlorpyrifos blood level and its exposure symptoms. The farmers had low scores on safe practice of pesticide use even though they have high marks on knowledge and attitude. We found no significant association between the scores on knowledge, attitude and practice on pesticide use and the chlorpyrifos blood level.
Conclusions The presence of pesticide exposure symptoms proved that most of the farmers were exposed to hazardous effects of pesticides. Specific trainings on safe use and handling of pesticides should be given on regular basis to these farmers to ensure they are protected from hazardous effects of pesticides exposure.
Fulltext Penggunaan aplikasi GIS dalam penyakit tuberkulosis di Cheras, Kuala Lumpur, Malaysia

Shamsul Azhar Shah, Md. Idris Mohd. Nor, Abdul Hadi Harman Shah, Tahir Aris

Malaysian Journal of Public Health Medicine, 2002;2(2):15-26.
MyJurnal

Tuberkulosis merupakan penyakit yang masih meigadi masalah kesihatan di seluruh dunia amnya dan di Malaysia khasnya. Kajian telah dilakukan ali Cheras, Kuala Lumpur menggunakan aplikasi GIS untuk mengenalpasti taburan geografi dan tren tuberkulosis daripada tahun 1996 sehingga tahun 2000. Kajian ini juga dilakukan untuk melihat kebolehan GIS sebagai alat surveilan penyakit beyangkit. Hasil kajian dengan menggunakan aplikasi GIS mendapati tren peningkatan tuberkulosis di kawasan·kawasan yang tertentu di Cheras. Penumpuan kes-kes tuberkulosis dapat dilihat di kawasan taburan penduduk yang kepadatan tinggi dan sederhana tinggi terutama di kawasan Kampung Pandan, kawasan penempatan Jalan Cheras dan Bandar Tun Razak. Kes—kes tersebut juga kebanyakannya adalah dalam lingkungan 100 meter ke 200 meter di antara satu sama lain. Kesimpulannya secara am, aplikasi GIS memberikan dimensi baru dalam kawalan penyakit dan ia pasti dapat digunakan dalam membantu aktiviti surveilan penyakit tuberkulosis.
Fulltext Students’ perception of schooling in associations with externalizing/internalizing syndromes and truancy

Nik Ruzyanei Nik Jaafar, Tuti Iryani Mohd, Shamsul Azhar Shah, Rozhan Shariff Mohamed Radzi, Hatta Sidi

ASEAN Journal of Psychiatry, 2008;9(2):85-92.
MyJurnal

Objectives: To determine the association of students’ perception of schooling with externalizing/internalizing scores; and to examine the different perceptions related to truancy. Methods:A total of 373 predominantly 16 year-old students attending three high risk schools in Pudu, Kuala Lumpur completed the questionnaires on schooling variables (four items) and externalizing/internalizing syndromes (Youth Self-Report, 112 items). Results: Certain negative perceptions (uncertainty of the schooling purpose, thinking schooling as time wasting) were significantly associated with higher internalizing (p
Fulltext Religious personality and smoking among form two students in rural schools in Malacca, Malaysia

Nor Afiah, M.Z., Rahmah, M.A., Salmiah, M.S., Fazilah, I., Shamsul Azhar, S.

International Medical Journal Malaysia, 2012;11(2):39-44.
MyJurnal

Introduction: There is an increasing trend in smoking among rural adolescents compared to urban adolescents in Malaysia. This study was to determine the relationship between religious personality and smoking among form two students from the rural schools in Malacca. Methods: This was an unmatched case-control study conducted from May 2010 to August 2010 among form two school children from rural area in Malacca. There were 484 cases, and 444 controls selected using randomized cluster sampling. The dependent variable was smoking, and the independent factors were religious personality. Validated and reliability-tested questionnaires were used for data collection. Results: The mean age (year) at which smoking was first tried among the cases was 11.39 + 2.107. There were eleven out of twenty three significant differences between religious personality statements in the cases and control group. Those were: reciting the Quran/Holy book/Scriptures even when busy, making efforts to deepen the understanding of the religion, trying to understand the teachings of the religion in the Holy book/Quran, inviting others to perform solat/prayer/religious service, making sure all the family members are following the teachings according to the religion, referring to the learned people when feeling uncertain about the rulings/teachings of the religion, performing work duties enthusiastically because of the religion/God, making efforts to remember death and afterlife often, making efforts to internalize the ethical conduct of the religion in daily life, setting aside money every year for religious purposes and looking for opportunities to give charity. Conclusion: Religious personality is an important factor which may influence adolescents volved in smoking.
Fulltext Factors influencing childhood immunization defaulters in Sabah, Malaysia

Shamsul Azhar, S., Rohaizat, H., Azimatun Noor, A., Rozita, H., Nazarudin, S., Nirmal, K.

International Medical Journal Malaysia, 2012;11(1):17-22.
MyJurnal

Introduction: The purpose of this study was to determine the prevalence of defaulters of immunization, and their associated risk factors among children age 12 to 24 months. Materials and Methods: A cross-sectional study was conducted in all government's maternal child health clinics in District of Kota Kinabalu, Sabah. Data was collected using a standardised questionnaire from July to November 2006. Results: The prevalence rate for defaulting immunization was 16.8% from the 315 respondents. Bivariable analysis showed various significant factors associated with defaulters such as mother’s employment status, family mobility, transportation and cost. Nonetheless, multivariable analysis showed only mother’s age, mother employment status and family size were the significant predictors for defaulting immunization. Immunization that had the highest rate of defaulters was DPT–OPV booster dose (56.6%), followed by MMR immunization (43.4 %) and
DPT-Hib/OPV and Hep B third dose (37.7%).Conclusion: Employed mothers with bigger family size should be more closely monitored and advised to reduce the chance of defaulting on the immunization. Health promotion activities also should focus to these groups of mothers.
Fulltext Smoking behaviour among adolescents in rural schools in Malacca, Malaysia - a case-control study

Nor Afiah, M.Z., Rahmah, M. A., Salmiah, M.S., Lye, M.S., Shamsul Azhar, S., Fazilah, I.

Pertanika Journal of Science & Technology, 2015;23(1):13-28.
MyJurnal

Smoking among rural adolescents in Malaysia is on the rise with a significant difference seen between urban and rural youths. Therefore, this study was carried out to determine a predictive model of smoking among the rural-school adolescents population in Malacca, Malaysia. An unmatched case-control study was conducted in 2010 involving 484 cases and 444 controls of Form Two students in Malacca, Malaysia, using cluster sampling. Smoking was the dependent factor of this study while the independent factors were individual, family, school and environment. Data were obtained through a self-administered questionnaire. The response rate of the study was 100% whereas the smoking prevalence was 20.9%. Binary logistic regression was used to determine the smoking predictive model. Strong predictors of smoking behaviour were: influenced by artistes who smoke (Adjusted OR=8.67, 95% CI 5.53-13.58); the male gender (Adjusted OR=6.7, 95% CI 4.14-10.83); Muslim (Adjusted OR=4.46, 95% CI 2.36-8.44); and the belief that smoking is not dangerous when the teacher is seen smoking as well (Adjusted OR=3.95, 95% CI 2.19-7.10). Other predictors were: being offered cigarettes by friends (Adjusted OR=2.81, 95% CI 1.79-4.42); the belief that smoking will relax the mind (Adjusted OR=2.45, 95% CI 1.33-4.51); having friends who smoke (Adjusted OR=2.32, 95% CI 1.29-4.81); forced by friends to smoke (Adjusted OR=2.17, 95% CI 1.15-4.12); have heard of the national No-Smoking Campaign (Adjusted OR=1.89, 95% CI 1.06-3.37); have problems with the school management (Adjusted OR=1.75, 95% CI 1.07-2.88); parental consent to watch sexual activities, drug use or violence on television or at the cinema (Adjusted OR=1.73, 95% CI 1.06-2.83); and have lunch in school (Adjusted OR=1.58, 95% CI 1.04-2.41). This paper ends with the recognition of the need for intervention in dismantling the predictors that can lead to the development of smoking among Malaysian adolescents in rural schools. of different pathological entities.
Fulltext Prevalence and risk factors of premature coronary artery disease: a comparative cross-sectional study between two time frames in Malaysia

Shamsul Azhar Shah, Lee, Jing, Muhammad Syahmi Khalid, Fatimah Najid, Intan Sabrina Haniff, Azmee Mohd Ghazi

Malaysian Journal of Public Health Medicine, 2015;15(3):157-166.
MyJurnal

Limited studies on prevalence and risk factors of Premature Coronary Artery Disease (PCAD) were done in Malaysia, primarily on lipid profile. This cross sectional study aims to identify any changing patterns in prevalence and risk factors of Premature CAD between 2000 and 2012. From 2000 to 2012 we included 21862 patients who underwent the first Percutaneous Coronary Intervention (PCI). Analysis of risk factors was done to 1660 and 2098 patients from year 2007 and 2012 respectively. Age of less than 45 years was taken as PCAD. Data was collected from PCI database of National Heart Institute (NHI), NHI TrakCare System, and patients’ medical records. PCAD significantly decreased from 18.8% (2000) to 11.6% (2012). Malay ethnicity showed increasing trend over the years from 55.1% to 66.9%. Multiple logistic regression analysis in 2007 showed that smoking had the higher risk (AOR=2.52), followed by male gender (AOR=2.06), family history of PCAD (AOR=1.96), Indian ethnicity, (AOR=1.65), triglycerides level (AOR=1.20) and BMI (AOR=1.06). In 2012, family history of PCAD had the highest risk (AOR=2.00) followed by smoking (AOR=1.91) and BMI (AOR=1.11). There are changes in risk factors patterns of premature CAD between 2007 and 2012. Most of them are preventable at earlier stage.
Spatial analysis of environmental factors influencing typhoid endemicity in Kelantan, Malaysia

Shamsul Azhar Shah, Suzuki H, Mohd Rohaizat Hassan, Saito R, Nazarudin Safian, Shaharudin Idrus

Sains Malaysiana, 2012;41:911-919.

The determination of the high-risk area and clusters of typhoid cases is critical in typhoid control. The purpose of this study was to identify and describe the epidemiology and spatial distribution of typhoid in four selected districts in Kelantan using GIS (geographical information system). A total of 1215 (99%) of the cases were coordinated with GPS (global positioning system) and mapping was done using ArcGIS 9.2. Spatial analysis was performed to determine the cluster and high-risk area of typhoid. Results showed that typhoid incidence was not associated with race and sex. Most affected were from the age group of 5-14 followed by 15-24 year olds. Nine sub-districts were categorized as highly endemic. In addition typhoid has shown a significant tendency to cluster and a total of 22 hotspots were found in Kota Bharu, Bachok and Tumpat with a few sub districts identified as high risk for typhoid. No significant relationships between the treated water ratio and flood risk area were found with the cluster of cases. The cluster of typhoid cases in the endemic area did not appear to be related to environmental risk factors. Understanding the characteristics of these clusters would enable the prevention of typhoid disease in the future.
Fulltext Risk factors of insulin refusal among type 2 diabetes mellitus patients with poor glycaemic control at Tanglin Health Clinic, Kuala Lumpur

Puvanese Rebecca Pillai Simon, Salmiah Md. Said, Ahmad Zaid Fattah, Shamsul Azhar Shah

Malaysian Journal of Medicine and Health Sciences, 2019;15(2):84-92.
MyJurnal

Introduction: The number of patients with poor glycaemic control who refuse insulin therapy is alarming. Factors that contribute to insulin refusal are important to study to identify high risk groups so that appropriate measures can be taken to prevent progression of uncontrolled diabetes. The objective of this study is to determine the risk factors of insulin refusal among type 2 diabetes mellitus patients with poor glycaemic control at Tanglin Health Clinic, Kuala Lumpur, Malaysia. Methods: A case control study was conducted among 216 cases and 230 controls using stratified sampling method. Cases were defined as patients with HbA1C more than 7.5% but not on insulin therapy despite being offered by the doctor whereas controls consist of patients with HbA1C of more than 7.5% but already on insulin therapy. Data was collected from April until May 2018, using a self-administered questionnaire. Analysis was done via IBM SPSS version 23.0. Results: Response rate for cases was 93.9% and response rate for controls was 100%. Risk factors of insulin refusal among poor glycaemic control includes age above 60 years old, tertiary level education, duration of diabetes less than 10 years, poor level of knowledge on insulin, fear on injection pain and fear to bruising due to injections. Conclusion: Hence, efforts must be taken to tackle the modifiable factors such as knowledge on insulin and diabetes, and fear on injections and bruises.
Fulltext Prevalence and factors associated with overweight and obesity among healthcare workers in Pejabat Kesihatan Daerah Melaka Tengah

Syafiq Taib, Siti Nor Mat, Norzaher Ismail, Fairuz Rahmat, Noor Aizam Said, Shamsul Azhar Shah

Int J Public Health Res, 2019;9(2):117-1126.
MyJurnal

Overweight and obesity are a serious public health problem globally. Healthcare workers in some countries have been reported to be having a high prevalence of being overweight despite them being well informed of the aetiology and risks of excessive body weight. However, the problem of being overweight and obese among Malaysian healthcare workers is still poorly understood. The aim of this study is to assess the prevalence and factors associated with overweight and obesity among healthcare workers in Pejabat Kesihatan Daerah (PKD) Melaka Tengah.
Fulltext Internal consistency study of EORTC QLQ-C30 and QLQ-PR25 questionnaires for quality of life assessment among prostate cancer patients in a University Hospital, Kuala Lumpur, Malaysia

Norzaher Ismail, Shamsul Azhar Shah, Nazarudin Safian, Syafiq Taib, Siti Nor Mat

Int J Public Health Res, 2020;10(1):1158-1165.
MyJurnal

Prostate cancer is forth most common diagnosed tumors in Malaysian male. The use of a self-reported, quality of life assessment is important for clinical practice, care taker and researcher to evaluate the level of quality of life. The aim of this study was to measure the internal consistency of the translated Malay Language EORTC QLQ-C30 and EORTC PR-25 questionnaires among prostate cancer patient at National University of Malaysia hospital in Kuala Lumpur, Malaysia.
Fulltext Neighbourhood factors on mental health questionnaire: development, validity, and reliability among Malaysian adolescents

Zahir Izuan Azhar, Shamsul Azhar Shah, Tan, Susan, M.K., Syed Sharizman Syed Abdul Rahim

Int J Public Health Res, 2016;6(1):713-718.
MyJurnal

Introduction The risk factors associated with mental health among adolescents are usually
described by researchers at an individual level. Neighbourhood factors and
health have opened a new insight into the field of epidemiology. The aim of
this study was to assess the reliability and validity of a newly developed
Neighbourhood Factors on Mental Health Questionnaire among Malaysian
adolescents.

Methods A cross-sectional study was conducted in four secondary schools in Kuala
Lumpur, Malaysia using a newly developed questionnaire which comprised
of two main domains and seven items. Exploratory factor analysis and
Cronbach‟s alpha were used to measure the instrument‟s construct validity
and reliability.

Results A total of 106 adolescents participated in this research. The majority of
adolescents were 13 years old (40.6%), female (55.7%), Malays (68.9%),
have parents who only studied until secondary school (66.0%) and lived in
flats (32.1%). Bartlett‟s Test of Sphericity was significant (Chi-square =
258.361, p
Preferences of Malaysian cancer patients in communication of bad news

Eng TC, Yaakup H, Shah SA, Jaffar A, Omar K

Asian Pac J Cancer Prev, 2012;13(6):2749-52.
PMID: 22938453

BACKGROUND: Breaking bad news to cancer patients is a delicate and challenging task for most doctors. Better understanding of patients' preferences in breaking bad news can guide doctors in performing this task.
OBJECTIVES: This study aimed to describe the preferences of Malaysian cancer patients regarding the communication of bad news.
METHODOLOGY: This was a cross-sectional study conducted in the Oncology clinic of a tertiary teaching hospital. Two hundred adult cancer patients were recruited via purposive quota sampling. They were required to complete the Malay language version of the Measure of Patients' Preferences (MPP-BM) with minimal researcher assistance. Their responses were analysed using descriptive statistics. Association between demographic characteristics and domain scores were tested using non-parametric statistical tests.
RESULTS: Nine items were rated by the patients as essential: "Doctor is honest about the severity of my condition", "Doctor describing my treatment options in detail", "Doctor telling me best treatment options", Doctor letting me know all of the different treatment options", "Doctor being up to date on research on my type of cancer", "Doctor telling me news directly", "Being given detailed info about results of medical tests", "Being told in person", and "Having doctor offer hope about my condition". All these items had median scores of 5/5 (IQR:4-5). The median scores for the three domains were: "Content and Facilitation" 74/85, "Emotional Support" 23/30 and "Structural and Informational Support" 31/40. Ethnicity was found to be significantly associated with scores for "Content and Facilitation" and "Emotional Support". Educational status was significantly associated with scores for "Structural and Informational Support".
CONCLUSION: Malaysian cancer patients appreciate the ability of the doctor to provide adequate information using good communication skills during the process of breaking bad news. Provision of emotional support, structural support and informational support were also highly appreciated.
Fulltext Improvement of quality of life following 6 months of methadone maintenance therapy in Malaysia

Baharom N, Hassan MR, Ali N, Shah SA

Subst Abuse Treat Prev Policy, 2012;7:32.
PMID: 22853701 DOI: 10.1186/1747-597X-7-32

BACKGROUND: Methadone Maintenance Therapy (MMT) is one of the popular choices for drug substitution therapy and is fairly new in Malaysia. Aside from its role in harm reduction against HIV infection, MMT programme may potentially enhances clients' quality of life. This study aims to identify the impact of MMT programme on clients' quality of life after 6 months in treatment and to explore factors that may be associated with changes in their quality of life.
METHODS: In this retrospective report review, 122 subjects from 2 government MMT clinics were selected from the district of Tampin, Negeri Sembilan, Malaysia. The raw score from the WHO Quality of Life questionnaire (WHOQOL-BREF), at baseline and 6 months after therapy were collected and converted to 0-100 scale form to give quality of life scores for four domains; physical, psychological, social relationships and environment. Other variables of interest were socio-demography, age when joining MMT programme, age and duration of illicit drug use, HIV and Hepatitis C status, and the Opiate Treatment Index (OTI) score on drug use, sexual and social aspect at the baseline. Statistical analysis used the SPSS version 16.
RESULTS: There was significant improvement in all four domains of quality of life, after 6 months of MMT. The largest improvement was for psychological domain (mean score difference 15.54 ± 20.81). Multivariable linear regression analysis showed that, for the physical domain, there was no significant predictor. For both the psychological and social domains, having tertiary education is a significant predictor for improvement in both aspects of quality of life. Negative HIV status is associated with improvement for the environment domain.
CONCLUSIONS: There was a significant short term improvement in the quality of life of MMT clients who stayed in the programme for at least 6 months in the district of Tampin, Negeri Sembilan, Malaysia.
Study site: MMT clinic, Tampin, Negeri Sembilan, Malaysia.
Fulltext A case-control study on the association between environmental factors and the occurrence of acute leukemia among children in Klang Valley, Malaysia

Abdul Rahman HI, Shah SA, Alias H, Ibrahim HM

Asian Pac J Cancer Prev, 2008 Oct-Dec;9(4):649-52.
PMID: 19256754

BACKGROUND: In Malaysia, acute leukemia is the most common cancer among children below the age of 15. A case-control study was here conducted for cases from the Klang Valley, Malaysia, who received treatment at the National University of Malaysia Hospital (HUKM) and Kuala Lumpur General Hospital (GHKL). The main objective was to determine any association with environmental factors.

METHODS: Case subjects were children aged below 15 years and diagnosed with acute leukemia in HUKM and GHKL between January 1, 2001 and May 30, 2007. Control subjects were children aged below 15 years who were diagnosed with any non-cancerous acute illnesses in these hospitals. A total of 128 case subjects and 128 control subjects were enrolled in this study. The information was collected using a structured questionnaire and a global positioning system (GPS) device. All factors were analyzed using unmatched logistic regression.

RESULTS: The analysis showed that the occurrence of acute leukemia among children was strongly determined by the following factors: family income (odds ratio (OR) 0.19, 95% confidence interval (CI): 0.09-0.42), father with higher social contact (OR 7.61, 95% CI: 3.78-15.4), number of elder siblings (OR 0.36, 95% CI: 0.18-0.77), father who smokes (OR 2.78, 95% CI: 1.49-5.16), and the distance of the house from a power line (OR 2.30, 95% CI: 1.18-4.49).

CONCLUSIONS: Some socioeconomic, demographic, and environmental factors are strong predictors of the occurrence of acute leukemia among children in Klang Valley, Malaysia. In terms of environmental factors, it is recommended that future housing areas should be developed at least 200 m away from power lines.
Fulltext Parental perception of their children's weight status, and its association with their nutrition and obesity knowledge

Muhammad NA, Omar K, Shah SA, Muthupalaniappen L, Arshad F

Asia Pac J Clin Nutr, 2008;17(4):597-602.
PMID: 19114396

BACKGROUND: Worldwide the prevalence of overweight and obesity in children is escalating. Parents’ recognition of overweight or obesity in their own children is very important for a successful intervention in these children. This study examined parental perception of their children’s weight status, and its association with their knowledge on nutrition and obesity.
MATERIALS AND METHODS: This was a cross sectional study of parents with children aged 9 to 12 years, in a primary school of Kuala Lumpur. Parents responded to a self-administered questionnaire which contains parental perception of their child weight status as well as knowledge on nutrition and obesity. The parents’ perception of the children’s weight status was then compared with the actual measured weight status.
RESULTS: There were 204 parents who participated in the study. Parents were found to underestimate their child weight status and 38.2% were inaccurate in their perception. The mean score of knowledge on nutrition and obesity was 78.5±14.4; and this did not associate with the accuracy of their perception on the child weight status. Parents showed inadequate knowledge in food pyramid and preparation of low fat meals.
CONCLUSION: The Malaysian Health Campaigns had resulted in overall good knowledge on nutrition and obesity in the parents except in few domains. However, this was insufficient to make the parents recognize the growing overweight and obesity problem in their children.
Key Words: overweight, obesity, children, parental perception, knowledge
Cancer Screening Perception Scale: development and construct validation

Mahmood MI, Shah SA, Ahmad N, Rosli NM

J Cancer Educ, 2018 04;33(2):269-277.
PMID: 27448613 DOI: 10.1007/s13187-016-1081-7

The aim of this study was to demonstrate the construct validity of a newly developed cancer screening perception scale as a measure of the perception of cancer screening in general among high-risk but healthy asymptomatic groups.The cancer screening perception scale (CSPS) was developed based on extensive literature reviews guided by The Health Belief Model. Fifty-five written items were initially pooled, reviewed by experts for face validity, pretested by 25 healthcare workers and translated into Malay using simple back translation. The scale was then distributed to 300 respondents from two health clinics for construct validation purposes. The obtained data were analyzed using the varimax rotation method for exploratory factor analysis (EFA). The data was submitted for further confirmatory factor analysis using AMOS software.Based on EFA, the results produced five constructs as predicted: perceived severity, perceived susceptibility, perceived benefits, perceived barriers, and cues for action. Two items with low factor loading and unrelated to the recovered domains were removed. Perceived barriers and cues for action had three and two sub-domains respectively which were further confirmed to fit the measurement and structural models. CFA demonstrated the scale fitted GFI = 0.936, CFI = 0.935, RMSEA = 0.076, NORMEDCHISQ = 2.162. The scale discriminated between the domains. Cronbach's alpha for perceived severity, perceived susceptibility, perceived benefits, perceived barrier, and cues for action were 0.907, 0.877, 0.940, 0.864 and 0.938, respectively.The cancer screening perception scale with its promising psychometric properties is now available to measure risks to high-risk but healthy, asymptomatic groups aged 18 and above and can also be used for larger scale study purposes.

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