This paper will present the socioeconomic profile and nutritional status of children aged 1-6 years in the rubber smallholdings of Peninsula Malaysia. A total of 323 households were involved in this study. The sociodemographic data were obtained through interviews with heads of households using a set of questionnaires. Anthropometric measurements were taken from 506 children aged 1-6 years from these households. The weight and height of the children were compared with the reference values of the National Center for Health Statistics (NCHS) and the nutritional status was classified based on the recommendations of WHO. The average age of the fathers was 39.9+/-8.6 years and 34.4+/-7.0 years for the mothers. The mean household size was 6.67+/-2.27. The majority (49.7%) of the heads of households received 4-6 years of formal education and 7.9% received no formal education. Based on the monthly per capita income, 24.0% were found to be in the hardcore poor category, 38.3% fall into the poor category and 37.7% in the above poverty income group. The prevalence of stunting and underweight among children between the ages of 1-6 years were highest among children from the hardcore poor, followed by the poor category and above the poverty line income group. Wasting was present in all income groups, with a prevalence of 4.2% found among the hardcore poor, 9.4% among the poor group and 8.4% in the above poverty income group. The Pearson Product Moment Correlation showed significant relationships between household total income and height-for-age (r = 0.131, P = 0.05) and weight-for-age (r = 0.127, P = 0.05). There were also significant correlations between monthly per capita income with height-for-age (r = 0.16, P < 0.01) and weight-for-age (r = 0.13, P < 0.05). The acreage of land utilised was correlated with height-for-age (r = 0.11, P < 0.05), weight-for-age (r = 0.17, P < 0.05) and weight-for-height (r = 0.16, P < 0.05). However, stepwise multiple regression analysis indicated that the predictor of height-for-age was monthly per capita income (R2 = 0.03, P < 0.01) and acreage of land utilised was a predictor for weight-for-age (R2 = 0.03, P < 0.01) and weight-for-height (R2 = 0.01, P < 0.01). Because income and acreage of land utilised have been shown to be associated with nutritional status, it is recommended that intervention programs that focus on generation of income and diversification of land utilisation should be undertaken. A multidiscipline approach involving the family, community and government agencies should be applied to any type of intervention program.
Aims: 1) To assess salivary leptin levels in normal-underweight versus overweight and obese healthy adult males aged 18-25 years old. 2) The relative contribution of anthropometric measurements, fat percentage, fat distribution (visceral versus subcutaneous) and total as well as regional muscle mass in arms, trunk and legs respectively in predicting salivary leptin levels. Methods: A total of 92 adult males were classified into two groups based on their body mass index (BMI): normal-underweight, BMI <24.9 kg/m2 (n=51); overweight-obese, BMI >25 kg/m2 (n=41). Anthropometric measurements such as BMI, waist circumference (WC), hip circumference (HC) and waist-hip ratio (WHR) were measured through standardised methods. Fat percentage, visceral fat level, subcutaneous fat and muscle mass (total and regional) were measured using Karada scan bioelectrical impedance method. Fasting saliva samples were collected and used for assessing salivary leptin concentrations using enzyme-linked immunosorbent assay. Results: Statistical analysis of the data showed a significant difference between the two groups in all of the parameters measured except height and salivary leptin levels. Multiple regression analysis showed that HC, WC and WHR were good predictors for salivary leptin levels in normal-underweight group. However, in the overweight-obese group, height was the most important independent variable that could predict salivary leptin levels as a dependent variable. Conclusions: Predictors for salivary leptin levels in adult healthy males are different in normal-underweight subjects from overweight-obese subjects. The most important predictor for salivary leptin levels is HC in normal weight subjects, while it is height in overweight and obese healthy adult males.
Stigma of major depressive disorder (MDD) is an important public health problem. This study aimed to examine the level of perceived stigma and its associated factors in MDD patients in five Asian countries, including China, Korea, Malaysia, Singapore, and Thailand. A total of 547 outpatients with MDD were included from Asian countries. We used the stigma scale of the Explanatory Model Interview Catalogue (EMIC) to assess stigma. The Montgomery-Asberg Depression Rating Scale (MADRS), Symptoms Checklist 90-Revised (SCL-90-R), Fatigue Severity Scale (FSS), Sheehan Disability Scale (SDS), 36-Item Short-Form Health Survey (SF-36), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess symptoms, clinical features, functional impairment, health status, and social support. The stigma scores of patients under 55 years old were significantly higher than those equal to or greater than 55 years old (P < 0.001). The stigma scores exhibited significant negative correlation with age; MSPSS scores of family, friends, and others; and SF-36 subscale of mental health, but significant positive correlation with MADRS, FSS, SDS, and SCL-90-R subscale scores of depression, interpersonal sensitivity, obsession-compulsion, psychoticism, and somatization. Multivariate regression analysis revealed that age, SCL-90-R interpersonal sensitivity, obsession-compulsion, psychoticism, MSPSS scores of friends and others, and SF-36 of mental health were significantly associated with the level of perceived stigma. These findings suggest that MDD patients who are young, have a high degree of interpersonal sensitivity and psychoticism, have low health-related quality of life, and have low social support are the target population for stigma interventions in Asia.
Soil properties are very crucial for civil engineers to differentiate one type of soil from another and to predict its mechanical behavior. However, it is not practical to measure soil properties at all the locations at a site. In this paper, an estimator is derived to estimate the unknown values for soil properties from locations where soil samples were not collected. The estimator is obtained by combining the concept of the ‘Inverse Distance Method’ into the technique of ‘Kriging’. The method of Lagrange Multipliers is applied in this paper. It is shown that the estimator derived in this paper is an unbiased estimator. The partiality of the estimator with respect to the true value is zero. Hence, the estimated value will be equal to the true value of the soil property. It is also shown that the variance between the estimator and the soil property is minimized. Hence, the distribution of this unbiased estimator with minimum variance spreads the least from the true value. With this characteristic of minimum variance unbiased estimator, a high accuracy estimation of soil property could be obtained.
The aim of this study was to evaluate the effects of a DVDdelivered mindfulness-based intervention for reducing stress among medical students in a Malaysian university. Methods: A total of 76 medical students participated in the intervention program (Mindful-Gym DVD). They were stratified according to year of studies and randomly allocated to intervention (N = 38) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Attention Awareness Scale, MAAS); perceived stress (with Perceived Stress Scale, PSS); mental distress (with Depression, Anxiety and Stress Scale, DASS); and self-efficacy (with General Selfefficacy Scale, GSE). Hierarchical multiple regression analyses were used to analyse the effect of group (Intervention vs. Control) on changes in the outcome variables. Results: One week after the intervention, participants in the intervention group reported significantly greater improvements with small to medium effect sizes in self-reported levels of mindfulness (β =0.19, ∆R2= 0.04, p = 0.028, f2= 0.07), perceived stress (β = -0.25, ∆R2=0.06, p = 0.006, f2= 0.11), mental distress (β = -0.27, ∆R2= 0.07, p =0.003, f2= 0.13), and self-efficacy (β = 0.27, ∆R2= 0.07, p = 0.003, f2= 0.13), compared to participants in the control group. The number needed to treat (NNT) to achieve ‘normal’ levels of depressive, anxiety, and stress symptoms (as indicated by the DASS scores) were 5, 8, and 6 respectively. Conclusions: This study found that the DVD-delivered mindfulness-based program is potentially a labour- and cost-effective and easily accessible stress reduction program for medical students.
BACKGROUND: Patients with type 2 diabetes mellitus (T2D) often experienced change in life, altered self-esteem and increased feelings of uncertainty about the future that challenge their present existence and their perception of quality of life (QoL). There was a dearth of data on the association between diabetes-related distress (DRD) and health-related quality of life (HRQoL). This study examined the determinants of HRQoL, in particular the association between DRD and HRQoL by taking into account the socio-demographic-clinical variables, including depressive symptoms (DS) in adult patients with T2D.
METHODS: This cross-sectional study was conducted in 2012-2013 in three public health clinics in Malaysia. The World Health Organization Quality of Life-Brief (WHOQOL-BREF), 17-items Diabetes Distress Scale (DDS-17), and 9-items Patient Health Questionnaire (PHQ-9) were used to measure HRQoL, DRD and DS, respectively. The aim of this research was to examine the association between the socio-demographic-clinical variables and HRQoL as well as each of the WHOQOL-BREF domain score using multivariable regression analyses.
RESULTS: The response rate was 93.1% (700/752). The mean (SD) for age was 56.9 (10.18). The majority of the patients were female (52.8%), Malay (53.1%) and married (79.1%). About 60% of the patients had good overall HRQoL. The mean (SD) for Overall QoL, Physical QoL, Psychological QoL, Social Relationship QoL and Environmental QoL were 61.7 (9.86), 56.7 (10.64), 57.9 (11.73), 66.8 (15.01) and 65.3 (13.02), respectively. The mean (SD) for the total DDS-17 score was 37.1 (15.98), with 19.6% (136/694) had moderate distress. DDS-17 had a negative association with HRQoL but religiosity had a positive influence on HRQoL (B ranged between 3.07 and 4.76). Women, especially younger Malays, who had diabetes for a shorter period of time experienced better HRQoL. However, patients who were not married, had dyslipidaemia, higher levels of total cholesterol and higher PHQ-9 scores had lower HRQoL. Macrovascular complications showed the largest negative effect on the overall HRQoL (adjusted B = -4.98, 95% CI -8.56 to -1.40).
CONCLUSION: The majority of primary care adult with T2D had good overall HRQoL. Furthermore, the independent determinants for HRQoL had also concurred with many past studies. In addition, the researchers found that DRD had negative effects on HRQoL, but religiosity had positive influence on HRQoL. Appropriate support such as primary care is needed for adult patients with T2D to improve their life and their HRQoL.
TRIAL REGISTRATION: NMRR-12-1167-14158.
This study examines the level of quality initiatives commitment among public hospital managers and its determinants in view of limited study :0 date and a decline in self-initiated quality initiatives activities in Sarawak, Malaysia. This is a cross-sectional study with universal sampling method conducted in all the Z1 public iwspimls in Sarawak. The study population were the senior, middle and lower level managers. The research wal was self-administered structured questionnaire. A total of 382 managers responded, corresponding ta a response irate of 8 7. 2%. As a complement, four focus group discussions were conducted, consisting 31 participants. It was found that the level of quality initiatives commitment 0f managers was generally high (mecm= 4.23, SD=O.45). The regression analysis indicated that empowerment, communication and procedural justice (promotion) accounted for 38.9%, 346% and 1.2% respectively of the variation in commitment level. Dissatisfaction with resources, top management commitment and peer influence are among others being identified by participants of focus groups as important determinants of quality initiatives commitment. It is strongly recommended that there should be greater empowerment of hospital managers, more structured and effective communication, greater transparency in procedure for promotion and commitment of resources to quality efforts.
The objective of this article is to study the influence of exposure and socio-economic variables on the blood lead level of Malaysian school children. Data on respirable lead and blood lead of 346 school children were obtained from Kuala Lumpur (urban), Kemaman (semi-urban) and Setiu (rural). Respirable lead and blood lead were highest for Kuala Lumpur (95 ng/m3 and 5.26 micrograms/dL) followed by Kemaman (27 ng/m3 and 2.81 micrograms/dL) and Setiu (15 ng/m3 and 2.49 micrograms/dL), and the differences were statistically significant. The percentage of school children with excessive blood lead of 10 micrograms/dL or greater was 6.36% overall, and highest for Kuala Lumpur (11.73%). Regression analyses show that urban children are at higher risk of exhibiting excessive blood lead levels. Kuala Lumpur's school children have a 25 times greater risk of having excessive blood lead levels when compared to Kemaman's and Setiu's school children. Respirable and blood lead were correlated (r = 0.999, p = 0.021). Urban school children acquire higher blood lead levels than their rural and semi-urban counterparts, even after controlling for age, sex, parents' education and income levels. In conclusion, it is time that lead in the Malaysian environment and population be monitored closely, especially its temporal and spatial variability. Only then can a comprehensive preventive strategy be implemented.
To examine a possible association between lipoprotein(a) [Lp(a)] levels and diabetic retinopathy in patients with type 2 diabetes mellitus. 100 type 2 diabetic patients were assessed with the following parameters: age, body mass index, duration of diabetes, blood pressure, fasting plasma glucose, total cholesterol, HDL-cholesterol, triglycerides, blood urea nitrogen, creatinine, Lp(a), and albumin excretion rate (AER). Retinopathy was classified as normal retina (NR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) by an ophthalmologist. The PDR group had higher cholesterol (t=-2.24, p<0.05) and creatinine (z=-2.547, p<0.05) levels than the NPDR group. The PDR group had a higher value of AER (z=-2.439, p<0.01) than the NR group. The possibility of developing diabetic retinopathy after 10 years of diabetes was found to be 6.5 fold high (OR; 6.57, 95% CI 1.74-24.79; p<0.05). The Lp(a) levels were similar in the patients with retinopathy and those without retinopathy. In the study, there was no evidence for a relationship between the serum Lp(a) levels and diabetic retinopathy in type 2 diabetic patients.
Study site: diabetic outpatient clinic at Haydarpasa Numune Education and Research Hospital in Istanbul, Turkey.
A new approach based on the integration of the free liquid membrane (FLM) into electrokinetic supercharging (EKS) was demonstrated to be a new powerful tool used in order to enhance online preconcentration efficiency in capillary electrophoresis (CE). A small plug of water immiscible organic solvent was used as a membrane interface during the electrokinetic sample injection step in EKS in order to significantly enhance the analyte stacking efficiency. The new online preconcentration strategy was evaluated for the determination of paraquat and diquat present in the environmental water samples. The optimised FLM-EKS conditions employed were as follows: hydrodynamic injection (HI) of 20mM potassium chloride as leading electrolyte at 50mbar for 75s (3% of the total capillary volume) followed by the HI of tris(2-ethylhexyl) phosphate (TEHP) as FLM at a 1mm length (0.1% of the capillary volume). The sample was injected at 10kV for 360s, followed by the HI of 20mM cetyl trimethylammonium bromide (CTAB) as terminating electrolyte at 50mbar for 50s (2% of the total capillary volume). The separation was performed in 12mM ammonium acetate and 30mM NaCl containing 20% MeOH at +25kV with UV detection at 205nm. Under optimised conditions, the sensitivity was enhanced between 1500- and 1866-fold when compared with the typical HI at 50mbar for 50s. The detection limit of the method for paraquat and diquat was 0.15-0.20ng/mL, with RSDs below 5.5%. Relative recoveries in spiked river water were in the range of 95.4-97.5%. A comparison was also made between the proposed approach with sole preconcentration of the field-enhanced sample injection (FASI) and EKS in the absence of the FLM.
Estimation of age from microscopic examination of human bone utilizes bone remodeling. This allows 2 regression equation to be determined in a specific population based on the variation in osteon turnover in different populations. The aim of this study was to provide age estimation for Malaysian males. Ground undecalcified cross sections were prepared from long limb bones of 50 deceased males aged between 21 and 78 years. Ten microstructural parameters were measured and subjected to multivariate regression analysis. Results showed that osteon count had the highest correlation with age (R = 0.43), and age was estimated to be within 10.94 years of the true value in 98% of males. Cross validation of the equation on 50 individuals showed close correspondence of true ages with estimated ages. Further studies are needed to validate and expand these results.
To explore the association between social
support and stress levels in preclinical and clinical dental
students in Malaysia. Method: A cross sectional survey
of dental undergraduate students was conducted at the
Faculty of Dentistry, University of Malaya, Universiti
Kebangsaan Malaysia and Universiti Sains Malaysia.
Stress was measured using the Dental Environment Stress
(DES) questionnaire. A DES-32 item was used to measure
stress for the clinical students and DES-16 item for the
preclinical students. Four questions were used to measure
social support. The total stress scores were standardized
for comparison purposes. Results: A total of 357 (79.7%)
preclinical and 417 (71.8%) clinical undergraduate dental
students responded to the questionnaires. The clinical
students experienced higher stress [mean standardized
DES score = 72.63, SD = 10.64] than preclinical students
[mean standardized DES score = 70.19, SD=12.01]. The
two most stressful items reported by preclinical students
were “fear of failing” and “examination and grades”.
Among clinical students, the two most stressful items related
to academic were “completing course requirement” and
“fear of failing course” and items related to clinical session
were “fear of being barred due to the clinical schedule”
and “patients late or absent”. Multiple regression analyses
revealed that low stress levels among preclinical students
were significantly associated to a lot of contact with
students of the same course. Conclusion: To some extent,
social support does play a role in explaining differences in
perceived stress, in particular among preclinical students.
A prospective survey on 14 consecutive cases with tuberculous drug induced hepatitis was done at our chest clinic in a state general hospital over a period of 15 months. There were 30 controls chosen randomly from the chest clinic register. The cases had lower mean body mass index (P<0.008), serum albumin (P<0.005) and higher serum globulin (P<0.04). Serum liver transaminases and total bilirubin rose significantly during the acute episode of drug induced hepatitis. Among the risk factors studied, only chronic hepatitis B carrier status was found to be more prevalent among the cases. There was one death (7.1%) over the whole study period.
Study site: Chest clinic, Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, Malaysia
Asthma is a chronic condition of great public health concern globally. The associated morbidity, mortality and healthcare utilisation place an enormous burden on healthcare infrastructure and services. This study demonstrates a multistage quantile regression approach to predicting excess demand for health care services in the form of asthma daily admissions in London, using retrospective data from the Hospital Episode Statistics, weather and air quality. Trivariate quantile regression models (QRM) of asthma daily admissions were fitted to a 14-day range of lags of environmental factors, accounting for seasonality in a hold-in sample of the data. Representative lags were pooled to form multivariate predictive models, selected through a systematic backward stepwise reduction approach. Models were cross-validated using a hold-out sample of the data, and their respective root mean square error measures, sensitivity, specificity and predictive values compared. Two of the predictive models were able to detect extreme number of daily asthma admissions at sensitivity levels of 76 % and 62 %, as well as specificities of 66 % and 76 %. Their positive predictive values were slightly higher for the hold-out sample (29 % and 28 %) than for the hold-in model development sample (16 % and 18 %). QRMs can be used in multistage to select suitable variables to forecast extreme asthma events. The associations between asthma and environmental factors, including temperature, ozone and carbon monoxide can be exploited in predicting future events using QRMs.
This cross-sectional study investigated the use of alternative medications to alleviate menopause-related symptoms among Malay, Chinese, and Indian women of Ipoh city. The prevalence, types, effectiveness, and associated factors were determined. The prevalence of alternative medication use was 41.4%. Evening primrose oil (EPO) was the most popular medication used (18.1%), followed by soy-based products (12.3%), green tea (6.8%), and gingko (5.8%). The medication was reported to be highly effective by 58.3% of soya bean diet users and 41.1% of EPO users. Significant variables associated with the use were Chinese or Indian ethnicity (P < .001), age between 50 and 54 years (P < .01), lower self-health rating (P < .05), education level of diploma or professional degree (P < .05), employment as professionals or entrepreneurs (P < .05), and the use of hormone replacement therapy (P < .05). Regression analysis showed that Chinese and Indians had significantly higher odds for the use than Malays (Chinese: odds ratio [OR] = 4.33, 95% confidence interval [CI] = 2.392-7.837; Indians: OR = 3.248, 95% CI = 1.586-6.654).
The objectives of the Asian Osteoporosis Study (AOS) were to determine risk factors for hip fracture in men and women in four Asian countries, that is, Singapore, Malaysia, Thailand, and the Philippines. A total of 451 men and 725 women (aged 50 years and over) with hip fractures were compared with an equal number of community controls. A standardized questionnaire was administered by interview. The following relative risks (RRs) were found in women and men by multiple logistic regression: dietary calcium intake < 498 mg/day, 2.0 for women (95% CI, 1.5-2.8) and 1.5 for men (95% CI, 1.0-2.2); no load bearing activity in the immediate past, 2.0 for women (95% CI, 1.4-2.7) and 3.4 for men (95% CI, 2.3-5.1); no vigorous sport activities in young adulthood, 7.2 for women (95% CI, 4.0-13.0) and 2.4 for men (95% CI, 1.6-3.6); cigarette smoking, 1.5 for men (95% CI, 1.0-2.1); alcohol consumption 7 days a week, 2.9 for women (95% CI, 1.0-8.6) and 1.9 for men (95% CI, 1.1-3.2); fell twice or more in the last 12 months, 3.0 for women (95% CI, 1.8-4.8) and 3.4 for men (95% CI, 1.8-6.6); a history of fractures after 50 years of age, 1.8 for women (95% CI, 1.1-2.9) and 3.0 for men (95% CI, 1.6-5.6); a history of stroke, 3.8 for women (95% CI, 2.0-7.1) and 3.6 for men (95% CI, 1.8-7.1); use of sedatives, 2.5 for women (95% CI, 1.0-6.3) and 3.0 for men (95% CI, 1.0-9.7); and use of thyroid drugs, 7.1 for women (95% CI, 2.0-25.9) and 11.8 for men (95% CI, 1.3-106.0). Women who were 1.56 m or taller had an RR of 2.0 (95% CI, 1.3-3.0) for hip fracture and men who were 1.69 m or taller had an RR of 1.9 (95% CI, 1.2-3.1) for hip fracture. Based on these findings, primary preventive programs for hip fracture could be planned in Asia.
Crimes forecasting is an important area in the field of criminology. Linear models, such as regression and econometric models, are commonly applied in crime forecasting. However, in real crimes data, it is common that the data consists of both linear and nonlinear components. A single model may not be sufficient to identify all the characteristics of the data. The purpose of this study is to introduce a hybrid model that combines support vector regression (SVR) and autoregressive integrated moving average (ARIMA) to be applied in crime rates forecasting. SVR is very robust with small training data and high-dimensional problem. Meanwhile, ARIMA has the ability to model several types of time series. However, the accuracy of the SVR model depends on values of its parameters, while ARIMA is not robust to be applied to small data sets. Therefore, to overcome this problem, particle swarm optimization is used to estimate the parameters of the SVR and ARIMA models. The proposed hybrid model is used to forecast the property crime rates of the United State based on economic indicators. The experimental results show that the proposed hybrid model is able to produce more accurate forecasting results as compared to the individual models.
The health benefits of breastfeeding to infants and mothers have been well recognised. This study applies linear regression analysis to assess the determinants of breastfeeding duration of first born using data from the Second Malaysian Family Life Survey. The proportion of women who breastfed their first child is 82 percent, of which 97 percent reported their breastfeeding duration. The distribution of breastfeeding duration has a mean of 5.7 months and a median of two months. Important determinants of breastfeeding duration include maternal age, ethnicity, period of first birth, husband's occupation and work status of the woman.
The optical properties of blood play crucial roles in medical diagnostics and treatment, and in the design of new medical devices. Haemoglobin is a vital constituent of the blood whose optical properties affect all of the optical properties of human blood. The refractive index of haemoglobin has been reported to strongly depend on its concentration which is a function of the physiology of biological cells. This makes the refractive index of haemoglobin an essential non-invasive bio-marker of diseases. Unfortunately, the complexity of blood tissue makes it challenging to experimentally measure the refractive index of haemoglobin. While a few studies have reported on the refractive index of haemoglobin, there is no solid consensus with the data obtained due to different measuring instruments and the conditions of the experiments. Moreover, obtaining the refractive index via an experimental approach is quite laborious. In this work, an accurate, fast and relatively convenient strategy to estimate the refractive index of haemoglobin is reported. Thus, the GA-SVR model is presented for the prediction of the refractive index of haemoglobin using wavelength, temperature, and the concentration of haemoglobin as descriptors. The model developed is characterised by an excellent accuracy and very low error estimates. The correlation coefficients obtained in these studies are 99.94% and 99.91% for the training and testing results, respectively. In addition, the result shows an almost perfect match with the experimental data and also demonstrates significant improvement over a recent mathematical model available in the literature. The GA-SVR model predictions also give insights into the influence of concentration, wavelength, and temperature on the RI measurement values. The model outcome can be used not only to accurately estimate the refractive index of haemoglobin but also could provide a reliable common ground to benchmark the experimental refractive index results.
The increase in the number of fatalities caused by road accidents involving heavy vehicles every year has raised the level of concern and awareness on road safety in developing countries like Malaysia. Changes in the vehicle dynamic characteristics such as gross vehicle weight, travel speed, and vehicle classification will affect a heavy vehicle's braking performance and its ability to stop safely in emergency situations. As such, the aim of this study is to establish a more realistic new distance-based safety indicator called the minimum safe distance gap (MSDG), which incorporates vehicle classification (VC), speed, and gross vehicle weight (GVW).