Purpose: Variability in accelerometry-data processing decisions limited data comparability across studies. We aimed to examine different accelerometry-data processing rules: varying bout lengths and allowance of 0- and 2-min interruptions on the total and bout-accumulated time spent in moderate-to-vigorous physical activity (MVPA) and sedentary behavior estimates, and describe the distribution of activity time based on counts per min (CPM) in granular categories. Method: Using the Singapore Health 2 survey, this study included 746 adults (41.8% women, median age 45.0 years) who provided valid ActiGraph GT3X+ accelerometer-data (≥4 valid days with ≥10-h/day). Quantile regression analysis adjusting for accelerometry daily wear time, age, and gender was performed to calculate the median and interquartile range of accelerometry estimates. Results: Median MVPA time accumulated in bouts of 1-min versus bouts of 10-min was 39.2 min/day and 6.0 min/day, respectively. MVPA time was higher when considering a 2-min interruption (range: 1.8-39.2 min/day) compared to 0-min interruption (range: 0-35.5 min/day) across bout lengths of 1- to 15-min. Participants were sedentary (≤100 CPM) for a daily median of 7.6 h/day. Median activities min/day on the lower-intensity activity spectrum (100-2499 CPM) decreased from 63.4 to 4.6 min/day, while on the higher-intensity activity spectrum (≥2500 CPM) was ≤2.9 min/day. Men generally spent more time in MVPA than women. Conclusions: This study highlights the differences in accelerometry estimates based on data processing decisions, and the importance of quantifying accelerometry-based activity time across the granular intensity spectrum. More studies are warranted to understand the determinants and health impact of these behaviors.
In a study with 113 Asian children in which phenobarbitone was used as the sole antiepileptic drug in 75 children, including Chinese, Malays, and Indians, the mean phenobarbitone dosage required to produce a plasma level of 15 micrograms/ml was 5.2 mg/kg/day. While the mean plasma level/dose ratio varied, the differences between the three ethnic groups were not statistically significant. Also of little difference were the ratios between the male and female groups. For those patients with poor seizure control, however, the mean plasma level/dose ratio was significantly lower than in those whose seizures were controlled. Using additional anticonvulsant drugs concurrently with phenobarbitone in 40 children raised the mean plasma level/dose ratios significantly in each ethnic group. Further, the greater age level in those given additional antiepileptic drugs might have contributed slightly to a higher mean plasma level/dose ratio.
The Malaysian Adults Nutrition Survey (MANS) was carried out between October 2002 and July 2003, involving 6,775 men and 3,441 women aged 18 - 59 years. Anthropometric assessment showed that the overall mean body weight and BMI were 62.65 kg (CI: 62.20, 63.09) and 24.37 kg/m2 (CI: 24.21, 24.53) respectively. Based on the WHO (1998) classification of BMI, 12.15% (CI: 11.26, 13.10) were obese (BMI > 30 kg/m2), and 26.71% (CI: 25.50, 27.96) overweight (BMI > 25 - 29.9 kg/m2). Significantly, more women were obese [14.66% (CI: 13.37, 16.04)] while significantly more men were overweight [28.55% (CI: 26.77, 30.40)]. Ethnicitywise, prevalence of obesity was highest among the Malays [15.28% (CI: 13.91, 16.77)] while overweight was highest for the Indians [31.01% (CI: 26.64, 35.76)]. Both obesity and overweight were highest among those aged 40 - 49 years. Obesity was highest for those whose household income was between RM1,500 - 3,500 while overweight was more prevalent for those whose household income exceeded RM3,500. The prevalence of overweight was highest for those with primary education [31.90% (CI: 29.21, 34.72)]. There was no significant urban rural differential in both obesity and overweight. The study found 9.02% (CI:8.82, 10.61) with chronic energy deficiency (CED) (BMI < 18.5 kg/m2). The prevalence of CED was relatively higher in the indigenous population (Orang Asli) [14.53% (CI: 5.14, 34.77)], subjects aged 18-19 years [26.24% (CI: 21.12, 32.09)], and with monthly household income of < RM1,500 [10.85% (CI: 9.63, 12.20)]. The prevalence of CED was not significantly different among the geographical zones and educational levels, and between urban/rural areas and sexes. The results call for priority action to address the serious problem of overweight and obesity among Malaysian adults as it poses a grave burden to the country's resources and development.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)
INTRODUCTION: Meal patterns have received little attention in nutrition studies. The aim of this study is to present the findings on general meal patterns of Malaysian adults.
METHODS: The Malaysian Adults Nutrition Survey (MANS), carried out in 2002 and 2003, involved 6,928 adults selected by stratified random sampling from all households by zone in Peninsular Malaysia, Sabah and Sarawak.
RESULTS: In general, the results showed that most respondents (74.16%) ate three meals per day; 89.20% of the respondents consumed breakfast, while 88.57% consumed lunch and 91.97% consumed dinner with no significant difference in terms of sex. In Peninsular Malaysia, the Northern Zone had the highest number of people consuming breakfast compared to other zones. Meanwhile, the population in Sarawak had the largest proportion of people consuming lunch and dinner, but the smallest proportion of people consuming breakfast. A significantly higher number of the rural population consumed breakfast and lunch than urbanites; however there was no significant difference in dinner consumption. Generally, breakfast consumption increased with age whereby significant difference existed between the 18 to 19 years age group and the age group of 30 years and older. Lunch intake among the age groups showed no significant difference. In contrast, dinner consumption was significantly lower among the 18 to 19 years age group compared to all other age groups. Comparison among the ethnic groups showed that the Indian population had the lowest percentage of having breakfast and lunch while the Orang Asli had the lowest percentage of consuming dinner. However, the Orang Asli recorded the highest percentage for taking breakfast and lunch while the Chinese had the highest percentage of taking dinner.
CONCLUSION: Considering that Malaysian adults consumed their conventional breakfast, lunch and dinner, these findings indicatethat Malaysians are maintaining their traditional meal patterns.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)
A cross sectional study on Type 2 diabetes patients seeking treatment in the Primary Health Care outpatient clinic of the University Malaya Medical Centre, Kuala Lumpur was undertaken. Two hundred and thirty-three subjects participated. They were asked questions on biodata and dietary intake using face-to-face interview techniques. Dietary intake was assessed using the 24-hour dietary recall. Anthropometric measurements including weight and height were taken and Body Mass Index (BMI) was computed to establish the extent of obesity. Of the 196 subjects, 66.8% were overweight (BMI ≥25 kg/m2) with 15.8% obese (BMI ≥30 kg/m2). The mean BMI of males and females were 25.9±4.3 kg/m2 and 27.2±4.7 kg/m2 respectively. The findings from the dietary survey showed that the mean energy intake of the subjects only achieved about 72% of the Recommended Daily Allowance (RDA) for Malaysia while protein intake of all subjects was adequate. The macronutreint contribution to the total calorie was consistent with the recommendation of the Malaysian Diabetic Association for a healthy diet for diabetes patients. The male subjects were found to meet the RDA requirements for all nutrients while the female subjects did not have sufficient intake of calcium, vitamin A and niacin. No consistent pattern in energy and nutrient intake was observed among different age groups. On the other hand, the Malay subjects seemed to have lower energy and all nutrient intake (except vitamin A and vitamin C) compared to the Chinese and Indian subjects. The Indian subjects seemed to have the highest intake of calcium compared to the others. Advice needs to be given to those who did not have adequate nutrient intake as well as those who need to reduce their weight.
Study site: Primary health care clinic, University Malaya Medical Centre (UMMC)
A case control study to determine the association of dietary fibre and cancer among Malaysians. It was conducted among 100 newly-diagnosed cancer patients admitted to the Radiotherapy and Oncology Ward, Hospital Kuala Lumpur. A total of 100 controls matched with the cases for age, sex and ethnic origin were selected from the Outpatient Health Clinic in Sentul. The subjects were interviewed to obtain information on their habitual dietary intakes and lifestyles. Family history of cancer, smoking habits, and alcohol consumption were found to be significant risk factors for cancer (p<0.05 for all parameters). The mean intake of total energy was higher among men with nasopharyngeal cancer and women with gastrointestinal cancer as compared to their controls (p<0.05 for both parameters). The percentage of energy contribution from fat was higher among cases (35%) than controls (32.1%). The mean dietary fibre intake among cases (10.86 ± 8.90 g/d) was apparently lower than the controls (13.22 ± 5.99 g/d), with significant differences noted for breast cancer and also nasopharyngeal cancer. Women with low fibre intake (<10g/d) had a 2.2 times higher risk of getting breast cancer. There is a need to educate the public to adhere to a wholesome diet, in particular to increase the consumption of high-fibre food for disease prevention.
Study site: Radiotherapy and Oncology Ward, Hospital Kuala Lumpur and Outpatient Health Clinic in Sentu
Eating patterns such as eating frequency, skipping of breakfast, and frequency of meals eaten away from home might influence school-going children's nutritional status, which will then influence their health and academic performance. This article reports the findings of a survey on the eating patterns of the school children and adolescents in Kuala Lumpur. A total of 3620 school children studying in Primary 5, Secondary 2 and Secondary 4 were selected using multi-stage sampling. The students were surveyed using a pre-tested questionnaire while their weights and heights were measured in the field. It was found that 19.9% skipped at least one meal a day with the youngest group having the lowest prevalence. The most frequently missed meal is breakfast (12.6%) followed by lunch (6.7%) and dinner (4.4%). The school is an important provider of breakfast and lunch for the students. As the students' age increased, the prevalence of eating breakfast and lunch in school increased. The youngest age group had the highest prevalence of snacking and taking of nutritional supplements (p<0.05). Fast food and local hawker food were also consumed by about 60-70% of the students. Logistic regression analysis showed that skipping of breakfast is significantly associated with age, sex, BMI and taking of nutritional supplements. Promotion of healthy eating should be targeted at students in primary and secondary schools as they tend to depend on outside food.
Introduction: Self-efficacy for eating predicts successful weight loss and maintenance in Type 2 Diabetes Mellitus (T2DM) individuals. The Weight Efficacy
Lifestyle (WEL) questionnaire determines self-efficacy for controlling eating. This study aims to validate the Malay-translated version of the WEL questionnaire and
to establish the cut-off scores to define the level of eating self-efficacy in Malaysian T2DM individuals.
Methods: A total of 334 T2DM individuals, aged 55.0±9.0 years, were recruited from a primary healthcare clinic based on sampling ratio. Medical records were reviewed for eligibility. Inclusion criteria included BMI ≥23kg/m2, and no severe diabetes complications. The WEL questionnaire assessed eating resistance during negative emotions, food availability, social pressure, physical discomfort and positive activities, and was back translated into Malay language. Self-efficacy was rated on a 0-9 scale with higher WEL scores indicating greater self-efficacy to resist eating. Factor analysis established the factor structure of the WEL questionnaire. Inter-item and item-total correlations determined construct validity while internal consistency described the reliability of the structure.
Results: A two-factor structure accounting for 49% of variance was obtained, and it had adequate reliability, as indicated by Cronbach’s α of 0.893 and 0.781 respectively. Item-total correlations of r>0.700, p<0.01 and inter-item correlations of r<0.500, p<0.01 demonstrated construct validity. Cut-off scores of ≥44 and ≥32, respectively for factor one and two defined high eating self-efficacies in T2DM individuals.
Conclusion: The Malaytranslated version of the WEL questionnaire appears to be a valid and reliable tool to assess self-efficacy for controlling eating behaviour in Malaysian T2DM population.
Keywords: Diabetes, eating self-efficacy, Malay, reliability, validity
Little is known of Malaysian older people’s participation in physical activities, and the purpose of this pilot study is to explore their participation and the barriers. A self-administered questionnaire was given to 80 eligible respondents at the Kuala Lumpur Health Clinic of which 70 responded. Thirty-six (51.4%) were males and 34 (48.6%) were females. There were 26 (37.1%) Malays, 20 (28.6%) Chinese, 18 (25.7%) Indians and 6 (8.6%) of other ethnic groups. Forty (57.1%) took part in some form of physical activities and the remaining 30 (42.9%) reported no participation at all. The Chinese participated actively in physical activities (90%), followed by Indians (66.7%) and Malays (30.8%). The five common activities were walking (60%), tai chi (20%), gardening (12.5%), stretching (2.5%) and cycling (5.0%). Identified barriers to physical activities were lack of time (26.7%), having health problems (26.7%), was already fit (26.7%), no companion to exercise with (13.3%) and no exercise knowledge (6.7%). These findings indicated that emphasis should be given to the females and the Malay ethnic group when planning physical activity education for the older people as they were identified to be the least active groups.
Study site: Klinik Kesihatan Kuala Lumpur, Wilayah Persekutuan, Malaysia
The maximum oxygen consumption (VO2 max) of 421 healthy adult males from three ethnic groups (Chinese, Malay and Indian), aged 25-54 years, was assessed from direct analyses of their expired respiratory gases during all-out runs on a treadmill as a measure of aerobic fitness. The subjects were divided into three age groups: group 1, 25-34 years; group 2, 35-44 years; group 3, 45-54 years. Each group was further subdivided into non-exercisers (NE), non-regular exercisers (NRE) and regular exercisers (RE). Consistently within each age group, regular exercisers produced significantly higher VO2 max values compared to non-regular exercisers and non-exercisers. They also met the VO2 max requirements for heavy physical work and compared favourably with the standards of the National Physical Fitness Award of Singapore and Cooper's aerobic fitness classification standards based on North American males. Non-regular exercisers and non-exercisers only met the VO2 max requirements for moderate physical work and compared poorly in both of the aerobic fitness standards.
To determine and compare the distribution of the FcgammaRIIIa 176 F/V polymorphism across three ethnically distinct populations (Chinese, Asian Indians and Malays) in Singapore.
The present study aimed to determine the factors associated with CKD stage 3b among type 2 diabetics attending primary care follow-up, specifically the role of angiotensin blockade dosage. This was a pilot unmatched case-control study conducted in a teaching primary care centre. Clinical data of 25 cases of diabetic patients with CKD stage 3b (GFR 30-45ml/min/1.73m2) in 2012 were selected for this study, as well as 103 controls who were diabetic patients with GFR more than 45ml/min/1.73m2 in 2012. Systematic random sampling was employed. Data was obtained from patients’ diabetic records, computerised clinical medical information system and medical case notes. Univariate analysis was done using Chi-square, t-test, Fisher’s exact test and Mann-Whitney U-test. Multiple logistic regression was used to determine the associated factors for development of CKD stage 3b. Cases and controls were different in terms of age, duration of diabetes, use and dosage of angiotensin blockade medications, systolic blood pressure and baseline GFR. Multiple logistic regression revealed that systolic blood pressure (Adjusted OR= 1.08, 95% CI= 1.02-1.14, p=0.013) and baseline GFR (Adjusted OR= 0.90, 95% CI= 0.85-0.95, p
HIV/AIDS is a global issue and the fourth biggest killer worldwide. Report from Ministry Of Health Malaysia showed factory workers are among the social group that are mostly infected (10.4%). A cross~sectional study was carried out to determine the socio-demographic factor and its relationship with knowledge, attitude and HIV-related risk behavior among factory workers in Selangor, Negeri Sembilan and MaIacca. This study involved 3300 factory workers selected randomly and were given self-guided questionnaire. With response rate about 95.4% (3148), the level of knowledge was high (97.3%) and the attitude was positive (81 %). However there was still an amount of fear towards HIV/AlDS patient. Logistic regression showed significant difference (p<0.05) between level of knowledge and ethnic group, income and level of education and between attitude and income and level of knowledge. About 27.7% of respondents smoked cigarette. 4.2% involved with drugs of which 0.7% administered intravenously, 2.3% were homosexuals, 2.5% were bisexuals and 3.1% were hererosexuals. HIV/AIDS prevention and control intervention should take into consideration the local socio-cultural factors and commitment from the top level management in the factory·
A cross sectional study was carried out to identify and compare factors that contribute to patient satisfaction towards the medical care services provided at the outpatient clinic in government health clinics and private clinics in Mulcim Labu, Sepang, Selangor. Systematic sampling for government clinic and universal sampling for private clinics were done and data was collected via face-to-
face interview based on a validated Patient Satisfaction Questionnaire (PSQ). A total of 181 patients aged 15 to 75 years old were selected, comprising 90 patients from the government clinics and 91 patients from private clinics. The majority of the patients were males (62.4%), Malay (79.0%), aged between 25 to 34 years with a mean age of 34.6 years and acutely ill (80.7%). Generally, all patients were satisfied with the services provided in both government and private sectors. Patients in private clinics, however, had a significantly higher satisfaction score as compared to the respondents in government clinics. There was signilqcant correlation between patient satisfaction score and household income in government and private clinics. Significant correlation was also found between patient satisfaction score and age in government clinic. Patients in private clinics were more satisfied towards the interpersonal manners, availability and continuity of care of the clinic compared to patienw in government clinics. Whereas patients in government clinics were more satisfied towards the service charges. This study provides important in ormation that could be used by roviders o health care services to monitor and im roved the ualit o medical care in the respective sectors.
Introduction: Help-seeking pathway in psychiatry is the important link between the onset of a mental disorder and mental health service provision. Understanding of the help-seeking pathway can help us to device more effective strategies for early detection and treatment.
Objectives: To determine the help-seeking pathways and treatment delaying factors of in-patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV - Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and treatment delaying factors were determined through face-to-face interview and semi-structured questionnaires.
Results: The number of non-psychiatric helpseeking
contacts prior to first consultation with psychiatric service ranged from 0 to 10. The mean number of contacts was 2.3 ( 2.6), and median was 1 (IQR = 0 to 3). About a third of them (32%) had three or more non-psychiatric contacts. The most common point of first non-psychiatric contact was with traditional healer 24 (48%), followed by general practitioners 12 (24%), and only 14 (28%) of them sought help directly from psychiatric service. The most common reason reported for delay in seeking psychiatric treatment was, “not aware that changes were related to mental illness” (74%).
Conclusions: History of contacts with traditional healers was common among in-patients with first episode psychosis in HKL. Treatment delay was mainly contributed by factors related to lack of awareness on psychosis. More strategic mental health education program is needed for early detection and treatment of psychosis.
Introduction : The aim of this study was to determine the prevalence and the pattern of falls in community dwelling older people attending a primary care clinic in Kuala Lumpur, Malaysia.
Methods : A cross sectional study was conducted in an urban primary care clinic. Participants aged 60 years and older were included in the study. A structured questionnaire, assessing socio-demographic variables, medical and falls history was administered by one investigator over a 3-month period in 2004.
Results : A total of 151 respondents participated in this study with a response rate of 72%. The prevalence of falls was 47.0% over the previous 12-months period. Fifty-seven percent reported experiencing recurrent falls. Majority (61%) of falls occurred in the home and the two most common places were the bathroom (27%) and stairs (27%). Sixty-one percent of older people who fell, sustained an injury and most sought medical attention.
Conclusion : In conclusion, falls are common amongst older people attending this primary care clinic. It occurred commonly in the home in the bathroom and near stairs. However, a larger local community study is warranted to determine the prevalence and risk factors for falls in Malaysia.
Study site: primary care clinic in Kuala Lumpur, Malaysia
Chronic kidney disease (CKD) is a major health concern worldwide. There are limited studies which look into the actual knowledge level of CKD among the general population both locally and internationally. This study aims to assess the knowledge level of CKD among patients in a secondary hospital in Malaysia.
Study site: medical outpatient clinic of
Hospital Pakar Sultanah Fatimah
This study aimed to determine the perceptions and opinions of medical students about food allergy. Universal sampling was used to conduct focus group discussions. The majority of the participants 40 (67%) mentioned that the common symptoms of food allergy are: skin rashes, swollen lips, diarrhea, vomiting, bronchospasm, redness, itchiness, difficulty in breathing, stomach ache and fever. Majority of participants mentioned that seafood is the food that can cause most food allergies 52 (87%), followed by tree nuts 25 (42%), peanuts and dairy products 19 (32%). Regarding the most allergenic food named by the participants are seafood 23 (38%); followed by milk and dairy products 5 (8%) and nuts 5 (8%). The majority of participants mentioned that food allergy can be fatal 48 (80%), a child can catch food allergy 57 (95%), and 10 of 100 people would have food allergy 31 (52%). Half of the participants 30 (50%) mentioned that it is very hard to care for children with food allergy. The majority of participants mentioned that food allergies do run in families 50 (83%), avoiding allergenic food is the best preventive methods 36 (60%) and that food allergy can be treated and will go away and 32 (53%). This study showed that in spite of sufficient knowledge among medical students about food allergy, some misconceptions still exist such as the high prevalence of food allergy and that food allergy can be treated and will go away. Therefore, there is a need for improving the continuous medical education among medical students with regard to food allergy because they are our future physicians.
Family planning is an important practice for women as it can help to improve financial and social status. Unwanted pregnancy has negative effects for husband and financial. However, couples married at a late age may not practice family planning because they want to have kids. The aims of this study were to determine the prevalence, factors associated with
husband’s socio demography and decision making in family planning practices among women in reproductive age who attended a polyclinic in Serdang, Malaysia. A cross sectional study was conducted on 245 women with a systematic random sampling. Descriptive analysis, Fisher exact and Chi-square tests were conducted to identify the influence of husband’s socio demographic factors and decision making in family planning practices. The prevalence of family planning practices among married women was moderate (53.9%). Family planning practices among women showed significant relationship with the husband’s socio demography which were husband’s race (p = 0.018), religion (p = 0.008) and making decision in family planning (p = 0.002). The husband’s socio demography showed a significant relationship with the prevalence of the wife practicing family planning. This clearly indicates that the husband is the individual that influence the wife to use contraceptive method. Decision making in family planning by both the husband and wife is important in choosing to use contraceptive method. Health promotion in the concept of health education for male contraceptive method such as pamphlet and booklet is important to promote husband involvement in family planning.
Study site: Klinik Kesihatan Seri Kembangan, Serdang, Selangor, Malaysia
A survey of colour vision deficiency among 1427 medical students and healthcare personnel in Seremban revealed a prevalence of 3.2% with a marked male predominance (males 6.7%, females 0.4%). In view of the potential difficulties faced by such personnel in clinical works, early detection of this deficiency allowed appropriate counselling.