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A retrospective analysis of oral and maxillofacial biopsied specimens in Malaysian newborns and infants

Binti Shuhairi NN, Bt Abdul Jalil A, Lau SH, Bt Mohd Ghazali S, Kee CC

Int J Paediatr Dent, 2021 Jul;31(4):496-503.
PMID: 32815206 DOI: 10.1111/ipd.12719

BACKGROUND: Globally, research on oral and maxillofacial lesions among newborns and infants remains limited.
AIM: To describe demographic patterns, histopathological findings, and locations of oral and maxillofacial lesions in newborns (birth-1 month) and infants (>1 month-2 years) reported over 51 years.
DESIGN: A retrospective cross-sectional study on histopathological records of newborns and infants was conducted. Patients' demographic characteristics (age, gender, and race), histopathological diagnosis, and lesion's location were gathered. Pearson's chi-square or Fisher's exact test was performed to determine associations between demographic characteristics and different categories of lesions.
RESULTS: Out of 66,546 specimens received, 0.44% (290 specimens) were from patients aged 2 years and younger (27 newborns and 263 infants). The most common category was inflammatory/reactive (44.2%), followed by tumour/tumour-like (42.0%), cystic/pseudocystic (6.6%), and miscellaneous lesions (5.5%). Mucous extravasation cysts (23.4%) and Langerhans cell histiocytosis (7.2%) were the most common histopathological diagnoses. Tumour/tumour-like lesions were significant in newborns (P = .021), and majority were congenital epulis (40.7%). Inflammatory/reactive lesions were significantly higher in male (P = .025) and infants (P =
Fulltext Secondhand smoke (SHS) exposure at home and at the workplace among non-smokers in Malaysia: Findings from the Global Adult Tobacco Survey 2011

Lim KH, Lim HL, Teh CH, Kee CC, Heng PP, Cheah YK, et al.

Tob Induc Dis, 2018;16.
DOI: 10.18332/tid/95188

Introduction: Understanding the prevalence of secondhand smoke (SHS) exposure and the associated factors is beneficial for the formulation of effective measures to reduce exposure to SHS. The purpose of this study was to determine SHS exposure at home and workplace, and its associated factors among non-smoker Malaysian adults. Methods: Data were extracted from the Global Adult Tobacco Survey-Malaysia (GATS-M) that involved a representative sample of 5112 Malaysian adults. Logistic regression analyses were performed to examine the association between SHS exposure, sociodemographic factors, knowledge on the danger of SHS, and smoking restrictions at home and at work among non-smokers. Results: Among non-smoker Malaysians, age ≥15 years, 27.9% (equivalent to approximately 4.21 million non-smokers) and 33.9% (equivalent to approximately 1.37 million non-smokers) reported that they were exposed to SHS at home and the workplace, at least once a month, respectively. Women (AOR=2.12, 95% CI: 1.61.2.78), young individuals (AOR=3.06, 95% CI: 1.48.6.33), Malays (AOR=2.39, 95% CI: 1.56.3.64) or other Bumiputra ethnic groups (AOR=2.40, 95% CI: 1.39.4.19) and those who worked as other than government employees were more likely to report SHS exposure at home (non-government employee: AOR=1.88, 95% CI: 1.06.3.36). Respondents with a total smoking restriction at home did not report any SHS exposure at home. Similarly, those whose workplace had smoking restrictions were less likely to report SHS exposure at the work compared to their counterparts whose workplace had partial (AOR=3.08, 95% CI: 1.84.5.15) or no smoking restrictions (AOR=15.33, 95% CI: 6.75.34.86). Conclusions: A substantial proportion of Malaysian adults were exposed to SHS at home and at work. The findings emphasize the need for policies on smoking restrictions at work and the need to promote the adoption of a completely smoke-free home, among the Malaysian population.
Study name: Global Adults Tobacco Survey (GATS-2011)
Fulltext Displace of smoking into the home and second-hand smoke exposure at home among Malaysian adults -findings from two national population-based studies in Malaysia

Lim KH, Mohd Ghazali S, Lim HL, Kee CC, Teh CH, Lim JH

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):198-205.
MyJurnal

Introduction: Expansion of smoke-free areas in public domains is suspected to displace smoking into the home. However, the scarcity of such information in Malaysia warrants an investigation to determine SHS exposure at home among adults in Malaysia.
Methods: This study studied 4,250 and 21,445 adults who participated in the 2011 Global Adult Tobacco Survey-Malaysia (GATS-M) and, the National Health and Morbidity Survey (NHMS) 2015, respectively. Multivariable logistic regression modelling was used to compare the odds of SHS exposure at home among adults in 2011 (GATS-M) to odds of SHS exposure at home among adults in 2015 (NHMS 2015).
Results: Approximately one third of respondents were exposed to SHS at home in 2011 (38.4%) and 2015 (37.9%). MLR analysis revealed the odds of SHS exposure at home was not significantly different from 2011 [AOR 1.14, 95 % CI (0.99-1.31). 2015 exposure to SHS as reference]. This study also indicates no significant displacement of smoking into the home by socio-demographic and smoking status between 2011 and 2015.
Conclusion: The findings suggest that smoking has not been displaced into the home in the past four years although the number of smoke-free public areas have increased. More public smoke free areas should be established.
Study name: 2011
Global Adult Tobacco Survey-Malaysia (GATS-M); National Health and Morbidity Survey (NHMS-2015)
Fulltext Does Awareness of Malaysian Healthy Plate Associate with Adequate Fruit and Vegetable Intake among Malaysian Adults with Non-Communicable Diseases?

Tan LK, Chua EH, Mohd Ghazali S, Cheah YK, Jayaraj VJ, Kee CC

Nutrients, 2023 Dec 08;15(24).
PMID: 38140302 DOI: 10.3390/nu15245043

The healthy eating plate concept has been introduced in many countries, including Malaysia, as a visual guide for the public to eat healthily. The relationship between Malaysian Healthy Plate (MHP) and adequate fruit and vegetable (FV) intake among morbid Malaysian adults is unknown. Hence, we investigated the relationship between awareness of the MHP and FV intake among morbid Malaysian adults. National survey data on 9760 morbid Malaysian adults aged 18 years and above were analyzed. The relationship between awareness of MHP and FV intake among Malaysian adults with obesity, diabetes mellitus, hypertension, and hypercholesterolemia were determined using multivariable logistic regression controlling for sociodemographic characteristics and lifestyle risk factors. Our data demonstrated that MHP awareness is associated with adequate FV intake among the Malaysian adults with abdominal obesity (adjusted odds ratio (aOR): 1.86, 95% confidence interval (CI): 1.05-3.29), diabetes mellitus (aOR: 4.88, 95% CI: 2.13-22.18), hypertension (aOR: 4.39, 95% CI: 1.96-9.83), and hypercholesterolemia (aOR: 4.16, 95% CI: 1.48-11.72). Our findings indicated the necessity for ongoing efforts by policymakers, healthcare professionals, and nutrition educators to promote the concept of MHP and ensure that morbid Malaysian adults consume a sufficient intake of FV or adopt a healthy eating pattern to achieve and maintain optimal health.
The discriminative ability of waist circumference, body mass index and waist-to-hip ratio in identifying metabolic syndrome: Variations by age, sex and race

Kee CC, Mohd Ghazali S, Lim KH, Subenthiran S, Teh CH, Lim KK, et al.

Diabetes Metab Syndr, 2015 Apr-Jun;9(2):74-8.
PMID: 25819369 DOI: 10.1016/j.dsx.2015.02.006

OBJECTIVES: Many studies have suggested that there is variation in the capabilities of BMI, WC and WHR in predicting cardiometabolic risk and that it might be confounded by gender, ethnicity and age group. The objective of this study is to examine the discriminative abilities of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) to predict two or more non-adipose components of the metabolic syndrome (high blood pressure, hypertriglyceridemia, low high density lipoprotein-cholesterol and high fasting plasma glucose) among the adult Malaysian population by gender, age group and ethnicity.
METHODS: Data from 2572 respondents (1044 men and 1528 women) aged 25-64 years who participated in the Non Communicable Disease Surveillance 2005/2006, a population-based cross sectional study, were analysed. Participants' socio-demographic details, anthropometric indices (BMI, WC and WHR), blood pressure, fasting lipid profile and fasting glucose level were assessed. Receiver operating characteristics curves analysis was used to evaluate the ability of each anthropometric index to discriminate MetS cases from non-MetS cases based on the area under the curve.
RESULTS: Overall, WC had better discriminative ability than WHR for women but did not perform significantly better than BMI in both sexes, whereas BMI was better than WHR in women only. Waist circumference was a better discriminator of MetS compared to WHR in Malay men and women. Waist circumference and BMI performed better than WHR in Chinese women, men aged 25-34 years and women aged 35-44 years.
CONCLUSIONS: The discriminative ability of BMI and WC is better than WHR for predicting two or more non-adipose components of MetS. Therefore, either BMI or WC measurements are recommended in screening for metabolic syndrome in routine clinical practice in the effort to combat cardiovascular disease and type II diabetes mellitus.
Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
KEYWORDS: Adult; Body mass index; Metabolic syndrome; Waist circumference; Waist–hip ratio
Study name: Malaysia Non-Communicable Disease Surveillance-1 (MyNCDS-1) survey
Agreement between the Fagerström test for nicotine dependence (FTND) and the heaviness of smoking index (HSI) for assessing the intensity of nicotine dependence among daily smokers

Lim KH, Cheong YL, Sulaiman N, Yah XY, Mahadzir ME, Lim JH, et al.

Tob Induc Dis, 2022;20:105.
PMID: 36474605 DOI: 10.18332/tid/155376

INTRODUCTION: Measuring the level of nicotine addiction among smokers is an integral part of enhancing smoking cessation as nicotine dependence is one of the barriers to smoking cessation. In this study, we compared the level of agreement between FTND and HSI in detecting high nicotine dependence among daily smokers.
METHODS: We collected data from participants of a public smoking cessation clinic in Selangor. A trained pharmacist conducted face-to-face interviews with 152 daily smokers using a structured validated questionnaire. Respondents were classified as having high nicotine dependence using both the HSI (score ≥4) and the FTND (score ≥6), and concordance between the two measures, kappa statistics and sensitivity, specificity of the HSI were then determined with the FTND classification as the reference standard.
RESULTS: The HSI had a substantial agreement with the FTND (Cohen's kappa=0.72) in measuring high levels of nicotine addiction, with good sensitivity (83.3%) and specificity (89.4%).
CONCLUSIONS: The findings suggest that the HSI can be used instead of the FTND in clinical-based investigations to screen for high nicotine dependence among daily smokers in the clinical setting.
Validity and reliability of the Malay language Perception Towards Smoking Questionnaire (BM-PTSQ) among secondary school adolescents: Further validation using Confirmatory Factor Analysis

Lim KH, Cheong YL, Lim HL, Cheong KC, Hashim MHM, Marine AA, et al.

Tob Induc Dis, 2024;22.
PMID: 38268983 DOI: 10.18332/tid/176164

INTRODUCTION: Perception is an essential factor influencing smoking among adolescents. Thus, a valid tool for measuring perception is a requisite in smoking studies. This study further establishes the validity and reliability of a Malay language version of the Perception Towards Smoking Questionnaire (BM-PTSQ) for assessing the perception of smoking among secondary school-going adolescents in Malaysia.
METHODS: We administered the BM-PTSQ to 669 secondary school students selected through multistage sampling; 60% of respondents were male (n=398), and 69.9% (n=463) were from rural areas. Respondents were aged 13-16 years, 36.4% (n=241) were 13 years, 40.0% (n=265) were 14 years, and 23.6% (n=156) were 16 years old. We used parallel and exploratory factor analysis (EFA) to determine the domains of the questionnaire. In addition, we also employed EFA, confirmatory factor analyses (CFA), and Cronbach's alpha to evaluate the construct validity and reliability of the BM-PTSQ.
RESULTS: EFA and parallel analysis identified two domains in the BM-PTSQ that accounted for 62.9% of the observed variance, and CFA confirmed the two-domain structure. The two domains' internal consistency scores ranged from 0.702 to 0.80, which suggested adequate reliability.
CONCLUSIONS: The BM-PTSQ has acceptable psychometric validity and is appropriate for assessing smoking perception and intention among Malaysian secondary school-aged youth. Researchers should further evaluate this tool's applicability in a more sociodemographically diverse population.
Fulltext Association between Availability of Neighborhood Fast Food Outlets and Overweight Among 5⁻18 Year-Old Children in Peninsular Malaysia: A Cross-Sectional Study

Chee Cheong K, Yoon Ling C, Kuang Hock L, Mohd Ghazali S, Chien Huey T, Che Ibrahim MK, et al.

Int J Environ Res Public Health, 2019 02 18;16(4).
PMID: 30781699 DOI: 10.3390/ijerph16040593

A growing number of fast-food outlets in close proximity to residential areas raises a question as to its impact on childhood overweight and obesity. This study aimed at determining the relationship between the availability of fast-food outlets that were in close proximity to residential areas and overweight among Malaysian children aged 5 to 18 years. Measurement data on the weight and height of 5544 children (2797 boys, 2747 girls) were obtained from the National Health and Morbidity Survey 2011. Overweight (including obesity) is defined as BMI-for-age z-score > +1 SD based on the WHO growth reference. Geographic information system geospatial analysis was performed to determine the number of fast-food outlets within 1000 m radius from the children's residential address. Multiple logistic regression was conducted to examine the association between the availability of fast-food outlets (none or more than one outlet) and overweight with adjustment for age, sex, ethnicity, monthly household income, parental educational level, residential area and supermarket density. Our results showed that the prevalence of overweight was 25.0% and there was a statistically significant association between the density of fast-food outlets and overweight (odds ratio: 1.23, 95% confidence interval: 1.03, 1.47). Our study suggested that the availability of fast-food outlets with close proximity in residential areas was significantly associated with being overweight among children. Limiting the number of fast-food outlets in residential areas could have a significant effect in reducing the prevalence of overweight among Malaysian children.
Fulltext Smoking among school-going adolescents in selected secondary schools in Peninsular Malaysia- findings from the Malaysian Adolescent Health Risk Behaviour (MyaHRB) study

Lim KH, Lim HL, Teh CH, Kee CC, Khoo YY, Ganapathy SS, et al.

Tob Induc Dis, 2017;15:9.
PMID: 28163668 DOI: 10.1186/s12971-016-0108-5

BACKGROUND: A multitude of studies have revealed that smoking is a learned behaviour during adolescence and efforts to reduce the incidence of smoking has been identified as long-term measures to curb the smoking menace. The objective of this study was to determine the prevalence as well as the intra and inter-personal factors associated with smoking among upper secondary school students in selected schools in Peninsular Malaysia.
METHODS: A study was carried out in 2013, which involved a total of 40 secondary schools. They were randomly selected using a two-stage clustering sampling method. Subsequently, all upper secondary school students (aged 16 to 17 years) from each selected school were recruited into the study. Data was collected using a validated standardised questionnaire.
RESULTS: This study revealed that the prevalence of smoking was 14.6% (95% CI:13.3-15.9), and it was significantly higher among males compared to females (27.9% vs 2.4%, p
Fulltext Modelling the Effectiveness of Epidemic Control Measures in Preventing the Transmission of COVID-19 in Malaysia

Gill BS, Jayaraj VJ, Singh S, Mohd Ghazali S, Cheong YL, Md Iderus NH, et al.

Int J Environ Res Public Health, 2020 Jul 30;17(15).
PMID: 32751669 DOI: 10.3390/ijerph17155509

Malaysia is currently facing an outbreak of COVID-19. We aim to present the first study in Malaysia to report the reproduction numbers and develop a mathematical model forecasting COVID-19 transmission by including isolation, quarantine, and movement control measures. We utilized a susceptible, exposed, infectious, and recovered (SEIR) model by incorporating isolation, quarantine, and movement control order (MCO) taken in Malaysia. The simulations were fitted into the Malaysian COVID-19 active case numbers, allowing approximation of parameters consisting of probability of transmission per contact (β), average number of contacts per day per case (ζ), and proportion of close-contact traced per day (q). The effective reproduction number (Rt) was also determined through this model. Our model calibration estimated that (β), (ζ), and (q) were 0.052, 25 persons, and 0.23, respectively. The (Rt) was estimated to be 1.68. MCO measures reduce the peak number of active COVID-19 cases by 99.1% and reduce (ζ) from 25 (pre-MCO) to 7 (during MCO). The flattening of the epidemic curve was also observed with the implementation of these control measures. We conclude that isolation, quarantine, and MCO measures are essential to break the transmission of COVID-19 in Malaysia.
Fulltext Forecasting the effects of vaccination on the COVID-19 pandemic in Malaysia using SEIRV compartmental models

Lim MC, Singh S, Lai CH, Gill BS, Kamarudin MK, Md Zamri ASS, et al.

Epidemiol Health, 2023;45:e2023093.
PMID: 37905314 DOI: 10.4178/epih.e2023093

OBJECTIVES: This study aimed to develop susceptible-exposed-infectious-recovered-vaccinated (SEIRV) models to examine the effects of vaccination on coronavirus disease 2019 (COVID-19) case trends in Malaysia during Phase 3 of the National COVID-19 Immunization Program amidst the Delta outbreak.
METHODS: SEIRV models were developed and validated using COVID-19 case and vaccination data from the Ministry of Health, Malaysia, from June 21, 2021 to July 21, 2021 to generate forecasts of COVID-19 cases from July 22, 2021 to December 31, 2021. Three scenarios were examined to measure the effects of vaccination on COVID-19 case trends. Scenarios 1 and 2 represented the trends taking into account the earliest and latest possible times of achieving full vaccination for 80% of the adult population by October 31, 2021 and December 31, 2021, respectively. Scenario 3 described a scenario without vaccination for comparison.
RESULTS: In scenario 1, forecasted cases peaked on August 28, 2021, which was close to the peak of observed cases on August 26, 2021. The observed peak was 20.27% higher than in scenario 1 and 10.37% lower than in scenario 2. The cumulative observed cases from July 22, 2021 to December 31, 2021 were 13.29% higher than in scenario 1 and 55.19% lower than in scenario 2. The daily COVID-19 case trends closely mirrored the forecast of COVID-19 cases in scenario 1 (best-case scenario).
CONCLUSIONS: Our study demonstrated that COVID-19 vaccination reduced COVID-19 case trends during the Delta outbreak. The compartmental models developed assisted in the management and control of the COVID-19 pandemic in Malaysia.

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