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  1. Krishna D, Mohd Zulkefli NA, Md Said S, Mahmud A
    BMC Public Health, 2019 Sep 18;19(1):1275.
    PMID: 31533790 DOI: 10.1186/s12889-019-7561-z
    BACKGROUND: Immunization is an effective public health intervention to reduce morbidity and mortality among children and it will become more effective if the child can receive the full course of recommended immunization doses. The objective of this study was to determine the prevalence of childhood immunization defaulters and its associated factors among children below 5 years attending registered child care centers in Petaling District, Selangor.

    METHODS: This was a cross-sectional survey among mothers with children below 5 years from 60 registered child care centers in District of Petaling, Selangor. Data was collected by a self-administered questionnaire from a total of 1015 mothers. Simple Logistic Regression, Chi-square or Fisher's exact test were performed to determine the association between individual categorical variables and childhood immunization defaulters. Multivariate logistic regression was used to determine the predictors of childhood immunization defaulters.

    RESULTS: The study showed that the prevalence rate for defaulting immunization was 20.7%. After adjusting all confounders, six statistically significant predictors of childhood immunization defaulters were determined. They were non-Muslims (aOR = 1.669, 95% CI = 1.173, 2.377, p = 0.004), mothers with diploma and below educational background (aOR = 2.296, 95% CI = 1.460, 3.610, p 

  2. Mohd Ariffin K, Abd Ghani F, Hussin H, Md Said S, Yunus R, Veerakumarasivam A, et al.
    Malays J Pathol, 2021 Apr;43(1):49-54.
    PMID: 33903305
    INTRODUCTION: Hedgehog (HH) pathway is an important signalling cascade for growth and patterning during embryonic development. Constitutive activation of Hedgehog pathway can be found in various types of malignancies including medulloblastoma, basal cell carcinoma, gastrointestinal, breast, pancreatic, prostate cancer and leukaemia. Little is known about the expression and role of Hedgehog signalling in bladder cancer.

    MATERIALS AND METHODS: The purpose of this study was to investigate the immunohistochemical expression of SMO in 112 bladder cancer cases and determine their association with demographic and clinicopathological parameters. Bladder cancer tissues were obtained from the Hospital Kuala Lumpur.

    RESULTS: SMO was expressed in the cytoplasm of all cases of bladder cancer. 6 cases (5.4%) showed low expression, while 106 cases (94.6%) showed high expression. Positive expression of SMO protein was correlated with a few variables which include grade and stage of tumour, lymph node metastasis and distant metastasis. SMO expression showed statistically significant association with higher grade (p=0.001) and higher stage (p=0.042) of bladder cancer. SMO expression also showed borderline association with lymph node metastasis (p=0.056).

    CONCLUSION: These findings indicate that SMO expression may be a poor prognostic marker in bladder cancer.

  3. Kang CY, Md Said S, Abdul Manaf R
    MyJurnal
    Introduction: The prevalence of diabetes mellitus among Malaysian aged ≥ 18 years increased from 11.6% (2006) to 17.5% (2015). Positive self–care behaviour leads to good glycaemic control. The objective of this study is to determine the self-care behaviour, its associated factors and predictors among type 2 diabetes mellitus (T2DM) patients in government health clinics at a district of Northern Peninsular Malaysia.
    Methodology: A cross-sectional study was conducted on 546 T2DM patients aged ≥ 18 years, recruited by simple random sampling method. A validated self-administered questionnaire including socio-demographic characteristics, diabetes profile, knowledge, Health Belief Model (HBM) and Summary of Diabetes Self-care Activity Scale (SDSCA) was used. Data were analysed using SPSS version 22.0. Self-care behaviour is the dependent variable.
    Results: The respondents practised 3.4 (SD = 1.11) days self-care behaviour past 1 week. The predictors of self-care behaviour were self-efficacy (standardized β = 0.257, p < 0.001), knowledge (standardized β = 0.112, p = 0.007), female (standardized β = 0.107, p = 0.010), combination oral hypoglycaemic agents (OHA) and insulin (standardized β = -0.182, p = 0.002), and monthly income < RM1,000 (standardized β = -0.129, p = 0.002). The entire group of variables significantly predicted self-care behaviour [F (6, 539) = 15.79, p < 0.001, adjusted R2 = 0.140] with total variance of 14.9%. Self-efficacy was the strongest predictor in self-care behaviour.
    Conclusion: The findings enable us to identify the specific groups with predicted lower self-care behaviour which are useful in future planning and implementation of intervention.
    Study site: Klinik Kesihatan, Malaysia
  4. Muhammed A, Shariff-Ghazali S, Md Said S, Hassan M, Lee K
    Birth, 2023 Sep;50(3):587-595.
    PMID: 36226886 DOI: 10.1111/birt.12681
    BACKGROUND: The majority of women in Sokoto, Nigeria prefer homebirths, but midwives are reluctant to provide care in the home setting. As such, many women continue to give birth at home alone or assisted by untrained attendants, which is associated with an increased risk for maternal and neonatal morbidity and mortality.

    METHODS: A randomized controlled trial was conducted among 226 midwives from 10 health care facilities. The intervention group received an educational program on home birth. A validated questionnaire that evaluated knowledge, attitudes, norms, perceived control, and intention to provide planned home birth care was given at baseline, immediately after the intervention, and at three-months follow-up. Data were analyzed using linear mixed-effect model statistics.

    RESULTS: Following the intervention, the intervention group demonstrated higher knowledge and more positive attitudes, norms, perceived control, and intention to provide planned home birth care compared with the control group (P  0.05).

    DISCUSSION: Educating midwives on planned home birth increases their willingness to provide planned home birth care. Health system administrators, policymakers, and researchers may use similar interventions to promote skilled home birth attendance by midwives. Increasing the number of midwives who are willing to attend planned home births provides women at low risk for medical complications with safer options for labor, delivery, and postpartum care.

  5. Mansor N, Ahmad N, Md Said S, Tan KA, Sutan R
    J Med Internet Res, 2023 Oct 20;25:e48968.
    PMID: 37862090 DOI: 10.2196/48968
    BACKGROUND: Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become a public health concern. Surveys in Malaysia show a high prevalence of young adults engaged in sexting. Given that sexting is associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior needs intervention to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults.

    OBJECTIVE: This study aimed to develop and implement a sexting intervention module guided by the prototype willingness model (PWM), delivered using web-based animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext, while the secondary outcomes were knowledge, attitude, perceived norms, and prototype perceptions of sexting.

    METHODS: This 2-armed, parallel, single-blinded cluster randomized controlled trial was conducted in a public higher educational institution in the state of Melaka, Malaysia. Diploma students from 12 programs were randomly allocated into intervention and control groups. Both groups answered a self-administered web-based questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the PWM in the form of 5 animated videos posted on a private YouTube platform, while the control group was put on the waitlist. The intervention group was encouraged to discuss any issues raised with the researchers via WhatsApp private chat after viewing the videos. All participants were observed immediately and 3 months postintervention. Data analysis was performed with SPSS (version 26; IBM Corp). A generalized linear mixed model was used to determine the effectiveness of the intervention.

    RESULTS: There were a total of 300 participants with an attrition rate of 8.3% (n=25). After adjusting for age, sex, relationship status, and the amount of time spent on the web, there were significant differences in the intention to sext (β=-.12; P=.002; Cohen d=0.23), willingness to sext (β=-.16; P

  6. How V, Hashim Z, Ismail P, Md Said S, Omar D, Bahri Mohd Tamrin S
    J Agromedicine, 2014;19(1):35-43.
    PMID: 24417530 DOI: 10.1080/1059924X.2013.866917
    Children are the vulnerable group in the agricultural community due to their early exposure to pesticides through the dynamic interplay between genetic predisposition, environment, and host-related factors. This study aims to identify the possible association between the depression in blood cholinesterase level and genotoxic effect among farm children. The results of micronuclei assay and comet assay showed that the reduced blood cholinesterase level from organophosphate pesticide exposure is significantly associated with an increase in chromosome breakage and DNA strand breaks. These genotoxicity end points suggest that farm children's cells experience early DNA damage that may lead to uncontrolled cell proliferation during their adulthood. Thus, farm children who grow up near pesticide-treated farmland have a higher probability of developing cancer than children with minimal or zero exposure to pesticides.
  7. Lim FL, Hashim Z, Md Said S, Than LT, Hashim JH, Norbäck D
    J Asthma, 2016 Mar;53(2):170-8.
    PMID: 26300213 DOI: 10.3109/02770903.2015.1077861
    OBJECTIVE: There are few studies on fractional exhaled nitric oxide (FeNO) and respiratory symptoms among adults in tropical areas. The aim was to study associations between FeNO and selected personal factors, respiratory symptoms, allergies, office characteristics and indoor office exposures among office workers (n = 460) from a university in Malaysia.
    METHODS: Information on health was collected by a questionnaire, skin prick test and FeNO measurement. Temperature, relative air humidity, carbon monoxide and carbon dioxide were measured in the offices. Settled dust was vacuumed in the offices and analyzed for endotoxin, (1,3)-β-glucan and house dust mites allergens, namely Dermatophagoides pteronyssinus (Der p 1) and Dermatophagoides farinae (Der f 1). Two-level linear mixed models and multiple logistic regression were used to analyze the associations.
    RESULTS: One-fourth (25.9%) of the office workers had elevated FeNO level (≥ 25 ppb) and 61.5% had HDM, cat, seafood or pollen allergy. Male gender (p < 0.001), current smoking (p = 0.037), height (p < 0.001) and atopy (p < 0.001) were associated with FeNO. The amount of vacuumed dust was associated with FeNO among atopic subjects (p = 0.009). Asthma and rhinitis symptoms were associated with FeNO (p < 0.05), especially among atopic subjects. In particular, a combination of atopy and elevated FeNO were associated with doctor-diagnosed asthma (p < 0.001), rhinitis (p < 0.001) and airway symptoms last 12 months (p < 0.001).
    CONCLUSION: Gender, smoking, height and atopy are important risk factors for elevated FeNO levels. A combination of allergy testing and FeNO measurement could be useful in respiratory illness epidemiology studies and patient investigations in tropical areas.
    KEYWORDS: Adults; Malaysia; allergy; office; respiratory symptoms; rhinitis; tropical areas
  8. Akhtari-Zavare M, Lattif LA, Juni MH, Md Said S, Ismail IZ
    J Obstet Gynaecol Res, 2015 Dec;41(12):1982-7.
    PMID: 26554636 DOI: 10.1111/jog.12819
    Abstract
    AIM:
    Breast cancer is the most common cancer among women worldwide, including Malaysia. In developing countries, predictors affecting breast self-examination (BSE) practice are different. This cross-sectional study was conducted to determine the prevalence of BSE practice and the predictors affecting BSE practice among undergraduate female students in Klang Valley, Malaysia.

    MATERIAL AND METHODS:
    A cross-sectional study was conducted among 820 female undergraduate students to assess the BSE performance and related determinants of BSE practice in Klang Valley, Malaysia. Data were collected via a self-administered structured questionnaire that was developed for this study.

    RESULTS:
    The mean age of the respondents was 21.7 ± 1.2 years old. Most of them were single (96.8%), Malay (91.9%) and 19.6% of the participants performed BSE regularly. Multivariate logistic regression modeling revealed that BSE performance was more likely among women who have checked their breast with a doctor (odds ratio = 2.04, P = 0.00), and women who have personal history of breast disease (odds ratio = 4.43, P = 0.03).

    CONCLUSION:
    The findings showed a low BSE practice rate among young Malaysian women. Hence, the community's breast health awareness is needed to improve breast cancer prevention among young Malaysian women.

    KEYWORDS:
    Malaysia; breast self-examination; predictors
  9. Lim FL, Hashim Z, Md Said S, Than LT, Hashim JH, Norbäck D
    Sci Total Environ, 2015 Dec 1;536:353-61.
    PMID: 26225741 DOI: 10.1016/j.scitotenv.2015.06.137
    There are few studies on sick building syndrome (SBS) including clinical measurements for atopy and fractional exhaled nitric oxide (FeNO). Our aim was to study associations between SBS symptoms, selected personal factors, office characteristics and indoor office exposures among office workers from a university in Malaysia. Health data were collected by a questionnaire (n=695), skin prick test (SPT) (n=463) and FeNO test (n=460). Office settled dust was vacuumed and analyzed for endotoxin, (1,3)-β-glucan and house dust mites (HDM) allergens group 1 namely Dermatophagoides pteronyssinus (Der p 1) and Dermatophagoides farinae (Der f 1). Office indoor temperature, relative air humidity (RH), carbon monoxide (CO) and carbon dioxide (CO2) were measured by a direct reading instrument. Associations were studied by two-levels multiple logistic regression with mutual adjustment and stratified analysis. The prevalence of weekly dermal, mucosal and general symptoms was 11.9%, 16.0% and 23.0% respectively. A combination of SPT positivity (allergy to HDM or cat) and high FeNO level (≥25 ppb) was associated with dermal (p=0.002), mucosal (p<0.001) and general symptoms (p=0.05). Der f1 level in dust was associated with dermal (p<0.001), mucosal (p<0.001) and general (p=0.02) symptoms. Among those with allergy to D. farinae, associations were found between Der f 1 levels in dust and dermal (p=0.003), mucosal (p=0.001) and general symptoms (p=0.007). Office-related symptoms were associated with Der f 1 levels in dust (p=0.02), low relative air humidity (p=0.04) and high office temperature (p=0.05). In conclusion, a combination of allergy to cat or HDM and high FeNO is a risk factor for SBS symptoms. Der f 1 allergen in dust can be a risk factor for SBS in the office environment, particularly among those sensitized to Der f 1 allergen.
  10. Lim FL, Hashim Z, Than LT, Md Said S, Hisham Hashim J, Norbäck D
    PLoS One, 2015;10(4):e0124905.
    PMID: 25923543 DOI: 10.1371/journal.pone.0124905
    A prevalence study was conducted among office workers in Malaysia (N= 695). The aim of this study was to examine associations between asthma, airway symptoms, rhinitis and house dust mites (HDM) and cat allergy and HDM levels in office dust. Medical data was collected by a questionnaire. Skin prick tests were performed for HDM allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae) and cat allergen Felis domesticus. Indoor temperature and relative air humidity (RH) were measured in the offices and vacuumed dust samples were analyzed for HDM allergens. The prevalence of D. pteronyssinus, D. farinae and cat allergy were 50.3%, 49.0% and 25.5% respectively. Totally 9.6% had doctor-diagnosed asthma, 15.5% had current wheeze and 53.0% had current rhinitis. The Der p 1 (from D. pteronyssinus) and Der f 1 (from D. farinae) allergens levels in dust were 556 ng/g and 658 ng/g respectively. Statistical analysis was conducted by multilevel logistic regression, adjusting for age, gender, current smoking, HDM or cat allergy, home dampness and recent indoor painting at home. Office workers with HDM allergy had more wheeze (p= 0.035), any airway symptoms (p= 0.032), doctor-diagnosed asthma (p= 0.005), current asthma (p= 0.007), current rhinitis (p= 0.021) and rhinoconjuctivitis (p< 0.001). Cat allergy was associated with wheeze (p= 0.021), wheeze when not having a cold (p= 0.033), any airway symptoms (p= 0.034), doctor-diagnosed asthma (p= 0.010), current asthma (p= 0.020) and nasal allergy medication (p= 0.042). Der f 1 level in dust was associated with daytime breathlessness (p= 0.033) especially among those with HDM allergy. Der f 1 levels were correlated with indoor temperature (p< 0.001) and inversely correlated with RH (p< 0.001). In conclusion, HDM and cat allergies were common and independently associated with asthma, airway symptoms and rhinitis. Der f 1 allergen can be a risk factor for daytime breathlessness.
  11. Balami AD, Md Said S, Mohd Zulkefli NA, Bachok N, Audu B
    BMC Pregnancy Childbirth, 2020 Nov 25;20(1):726.
    PMID: 33238901 DOI: 10.1186/s12884-020-03388-8
    BACKGROUND: Studies on uptake of first dose of intermittent preventive treatment in pregnancy (IPTp) are lacking, despite it being a predictor of subsequent doses. This study aimed at assessing the determinants of uptake of first dose of IPTp among pregnant women at the State Specialist Hospital, Maiduguri.

    METHODS: A cross-sectional study was conducted, in which respondents were selected using a systematic random sampling method, and structured questionnaires were used to obtain information from them. Chi-squared test was used to determine factors associated with uptake of first IPTp dose, while a further multivariate logistic regression was performed to determine its predictors.

    RESULTS: Three hundred and eighty respondents answered the survey, whose ages ranged from 15 to 45 years, and 86.8% were multigravid. Sixty five percent of them were aware of IPTp, and 34.7% believed that IPTp could be harmful to their pregnancies. Over a half of the respondents (52.9%) believed that taking all their IPTp medicines was very good for their pregnancies, while 45.0% felt that taking their IPTp medicines was very pleasant. Only two respondents (0.5%) stated that it was very untrue that their significant others thought that they should take all their IPTp medicines. Half of the respondents said it was very easy for them to take all their IPTp medicines even if they were experiencing mild discomforts while taking them. Less than a half (42.37%) had received their first dose of IPTp. In bivariate as well as multivariate analysis, only higher level of knowledge was significantly associated with uptake of first IPTp dose. Those with better knowledge of IPTp were about twice more likely to have taken their first dose of IPTp, compared to those with lower knowledge of IPTp (AOR = 1.85; 95% CI: 1.17-2.92).

    CONCLUSIONS: Knowledge of IPTp as well as its uptake, were sub-optimal in this study. Since knowledge of IPTp significantly predicts uptake of the first dose of IPTp, there is the need to implement health education campaigns to raise the awareness of pregnant women and their families on the need to receive and comply with it.

  12. Lim FL, Hashim Z, Than LTL, Md Said S, Hashim JH, Norbäck D
    Int J Tuberc Lung Dis, 2019 11 01;23(11):1171-1177.
    PMID: 31718753 DOI: 10.5588/ijtld.18.0668
    OBJECTIVE: To examine the associations between endotoxin and (1,3)-β-glucan concentrations in office dust and respiratory symptoms and airway inflammation among 695 office workers in Malaysia.METHODS: Health data were collected using a questionnaire, sensitisation testing and measurement of fractional exhaled nitric oxide (FeNO). Indoor temperature, relative air humidity (RH) and carbon dioxide (CO₂) were measured in the offices and settled dust was vacuumed and analysed for endotoxin and (1,3)-β-glucan concentrations. Associations were analysed by two level multiple logistic regression.RESULTS: Overall, 9.6% of the workers had doctor-diagnosed asthma, 15.5% had wheeze, 18.4% had daytime attacks of breathlessness and 25.8% had elevated FeNO (≥25 ppb). The median levels in office dust were 11.3 EU/mg endotoxin and 62.9 ng/g (1,3)-β-glucan. After adjusting for personal and home environment factors, endotoxin concentration in dust was associated with wheeze (P = 0.02) and rhinoconjunctivitis (P = 0.007). The amount of surface dust (P = 0.04) and (1,3)-β-glucan concentration dust (P = 0.03) were associated with elevated FeNO.CONCLUSION: Endotoxin in office dust could be a risk factor for wheeze and rhinoconjunctivitis among office workers in mechanically ventilated offices in a tropical country. The amount of dust and (1,3)-β-glucan (a marker of indoor mould exposure) were associated with Th2 driven airway inflammation.
  13. Suliman Q, Lim PY, Md Said S, Tan KA, Mohd Zulkefli NA
    Sci Rep, 2022 01 14;12(1):745.
    PMID: 35031658 DOI: 10.1038/s41598-021-04742-2
    TB treatment interruption has resulted in delayed sputum conversion, drug resistance, and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction. To date, there are limited studies investigating the physico-social risk factors for early treatment interruptions. This prospective multicenter cohort study aimed to investigate the risk factors for early treatment interruption among new pulmonary tuberculosis (TB) smear-positive patients in Selangor, Malaysia. A total of 439 participants were recruited from 39 public treatment centres, 2018-2019. Multivariate Cox proportional hazard analyses were performed to analyse the risk factors for early treatment interruption. Of 439 participants, 104 (23.7%) had early treatment interruption, with 67.3% of early treatment interruption occurring in the first month of treatment. Being a current smoker and having a history of hospitalization, internalized stigma, low TB symptoms score, and waiting time spent at Directly Observed Treatment, Short-course centre were risk factors for early treatment interruption. An appropriate treatment adherence strategy is suggested to prioritize the high-risk group with high early treatment interruption. Efforts to quit smoking cessation programs and to promote stigma reduction interventions are crucial to reduce the probability of early treatment interruption.
  14. Yeap SS, Thambiah SC, Suppiah S, Md-Said S, Appannah G, Samsudin IN, et al.
    PLoS One, 2021;16(7):e0255069.
    PMID: 34293028 DOI: 10.1371/journal.pone.0255069
    OBJECTIVE: This study aimed to determine the prevalence of vertebral fractures (VF) in a selected urban population in Malaysia and to explore possible variables associated with VF in the study population.

    METHODS: A cross-sectional study involving community-living, healthy subjects aged between 45-90 years from the state of Selangor, Malaysia, were invited to attend a bone health check-up. Subjects with diseases known to affect bone metabolism or were on treatment for osteoporosis (OP) were excluded. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA). Lateral and antero-posterior view lumbar spine x-rays were performed and VF was determined by the semi-quantitative Genant method.

    RESULTS: A total of 386 subjects were studied. Asymptomatic morphometric VF were found in 44 (11.4%) subjects. T12 was the most common vertebrae to be fractured. The prevalence of VF was significantly higher in menopausal women (12.4%) compared to non-menopausal women, in those above the age of 60 (18.5%), in those of Chinese ethnicity (16.5%), in those with a low body fat percentage (17.1%) and among those with OP (27.0%). The mean (standard deviation) 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in those with VF compared to those without VF, 67.64 (23.50) and 57.47 (21.71) nmol/L, respectively. However, after multiple regression analysis, age over 60 years and OP on DXA BMD measurement were the only significant associated factors for VF.

    CONCLUSION: Overall, 11.4% of a selected Malaysian urban population had asymptomatic morphometric VF. Age over 60 years and OP on DXA BMD measurement, but not 25(OH)D levels, were associated with VF.

  15. Mhd Noor MT, Kadir Shahar H, Baharudin MR, Syed Ismail SN, Abdul Manaf R, Md Said S, et al.
    PLoS One, 2022;17(11):e0271258.
    PMID: 36441735 DOI: 10.1371/journal.pone.0271258
    Floods occur when a body of water overflows and submerges normally dry terrain. Tropical cyclones or tsunamis cause flooding. Health and safety are jeopardized during a flood. As a result, proactive flood mitigation measures are required. This study aimed to increase flood disaster preparedness among Selangor communities in Malaysia by implementing a Health Belief Model-Based Intervention (HEBI). Selangor's six districts were involved in a single-blinded cluster randomized controlled trial Community-wide implementation of a Health Belief Model-Based Intervention (HEBI). A self-administered questionnaire was used. The intervention group received a HEBI module, while the control group received a health talk on non-communicable disease. The baseline variables were compared. Immediate and six-month post-intervention impacts on outcome indicators were assessed. 284 responses with a 100% response rate. At the baseline, there were no significant differences in ethnicity, monthly household income, or past disaster experience between groups (p>0.05). There were significant differences between-group for intervention on knowledge, skills, preparedness (p<0.001), Perceived Benefit Score (p = 0.02), Perceived Barrier Score (p = 0.03), and Cues to Action (p = 0.04). GEE analysis showed receiving the HEBI module had effectively improved knowledge, skills, preparedness, Perceived Benefit Score, Perceived Barrier Score, and Cues to Action in the intervention group after controlling the covariate. Finally, community flood preparedness ensured that every crisis decision had the least impact on humans. The HEBI module improved community flood preparedness by increasing knowledge, skill, preparedness, perceived benefit, perceived barrier, and action cues. As a result, the community should be aware of this module. Clinical trial registration: The trial registry name is Thai Clinical Trials Registry, trial number TCTR20200202002.
  16. Mohamad Ismuddin S, Thambiah SC, Appannah G, Samsudin IN, Md Said S, Yeap SS, et al.
    Malays J Pathol, 2022 Dec;44(3):477-490.
    PMID: 36591715
    INTRODUCTION: Cardiovascular disease and osteoporosis (OP) have been shown to have similar risk factors but studies have demonstrated contradictory results with regards to their associations. This study evaluated relationships between bone characteristics and cardiovascular risk factors among adults in selected urban areas in Malaysia.

    MATERIALS AND METHODS: A cross-sectional study was performed involving 331 subjects between 45-90 years recruited at a health screening programme. Sociodemographic and clinical characteristics were recorded. Biochemical analyses on fasting blood samples and dual energy X-ray absorptiometry scan to determine bone mineral density (BMD) were performed.

    RESULTS: Increased waist circumference (WC) was protective for abnormal BMD status (osteopenia and OP). Males with increased high-density lipoprotein cholesterol (HDL) were more likely to be osteoporotic. WC, fasting blood glucose (FBG) and triglyceride (TG) were positively associated with BMD at all sites but was gender specific. In contrast, WC was negatively associated with trabecular bone score (TBS) for females but this association became attenuated when adjusted for fat percentage. HDL and MetS were negatively and positively associated with BMD, respectively in males.

    CONCLUSION: The cardiovascular risk factors of raised WC, FBG, TG and low HDL were significantly associated with increased BMD with skeletal site and gender specific differences after adjusting for confounders. However, a higher WC was associated with a weaker skeletal microstructure reflected by lower TBS in females driven by fat percentage. A higher BMD was demonstrated among MetS individuals. These findings suggest that adiposity may have a protective effect on BMD.

  17. Abang Abdullah AF, Muhamad NA, Ab Ghani RM, Maamor NH, Leman FN, Too CL, et al.
    JMIR Res Protoc, 2023 Jun 26;12:e46816.
    PMID: 37358892 DOI: 10.2196/46816
    BACKGROUND: Allergic diseases affect around 40% of the pediatric population worldwide. The coexistence of asthma, allergic rhinitis, eczema, and food allergy renders allergy treatment and prevention challenging. Infant feeding strategies recommend avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens during weaning in infants aged 4-6 months could result in food tolerance, thus reducing the risk of developing allergies.

    OBJECTIVE: The aim of this study is to systematically review and carry out a meta-analysis of evidence on the outcome of early food introduction for preventing childhood allergic diseases.

    METHODS: We will conduct a systematic review of interventions through a comprehensive search of various databases including PubMed, Embase, Scopus, CENTRAL, PsycINFO, CINAHL, and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to the latest available studies in 2023. We will include randomized controlled trials (RCTs), cluster RCTs, non-RCTs, and other observational studies that assess the effect of early food introduction to prevent childhood allergic diseases.

    RESULTS: Primary outcomes will include measures related to the effect of childhood allergic diseases (ie, asthma, allergic rhinitis, eczema, and food allergy). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines will be followed for study selection. All data will be extracted using a standardized data extraction form and the quality of the studies will be assessed using the Cochrane Risk of Bias tool. A summary of findings table will be generated for the following outcomes: (1) total number of allergic diseases, (2) rate of sensitization, (3) total number of adverse events, (4) improvement of health-related quality of life, and (5) all-cause mortality. Descriptive and meta-analyses will be performed using a random-effects model in Review Manager (Cochrane). Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023.

    CONCLUSIONS: The results acquired from this study will contribute to the existing literature and harmonize recommendations for infant feeding with regard to the prevention of childhood allergic diseases.

    TRIAL REGISTRATION: PROSPERO CRD42021256776; https://tinyurl.com/4j272y8a.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/46816.

  18. Yeap SS, Thambiah SC, Samsudin IN, Appannah G, Zainuddin N, Mohamad-Ismuddin S, et al.
    Osteoporos Sarcopenia, 2020 Dec;6(4):168-172.
    PMID: 33426304 DOI: 10.1016/j.afos.2020.11.005
    OBJECTIVES: To determine the prevalence of osteopenia (OPe) and osteoporosis (OP) in an urban adult population in Malaysia, and to compare the change in the prevalence when using a Caucasian compared to an Asian reference range.

    METHODS: A cross-sectional random sample of the population aged between 45 and 90 years from the state of Selangor, Malaysia, was invited to attend a bone health check-up. Participants with diseases known to affect bone metabolism or who were on treatment for OP were excluded. Bone mineral density was measured using dual energy X-ray absorptiometry. Based on the World Health Organization definitions, the prevalence of OPe and OP was calculated using the Asian and Caucasian T-scores.

    RESULTS: A total of 342 subjects (222 females, 120 males), with a mean age of 59.68 (standard deviation: 8.89) years, who fulfilled the study criteria were assessed. Based on the Asian reference range, there were 140 (40.9%) subjects with OPe and 48 (14.0%) with OP. On applying the Caucasian reference range, there were 152 (44.4%) subjects with OPe and 79 (23.1%) with OP, with significant increases in males, females, and Chinese ethnic groups. Overall, 75 (21.9%) of subjects had a change in their diagnostic status. T-scores were consistently lower when the Caucasian reference range was used.

    CONCLUSIONS: In a healthy urban Malaysian population, the prevalence of OP is 14.0% and OPe is 40.9%. Application of a Caucasian reference range significantly increased the number of subjects with OP and may potentially lead to over-treatment.

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