Risk perception and its predictors towards type 2 diabetes mellitus among students in Universiti Kebangsaan Malaysia.

Type 2 diabetes mellitus (T2DM) has become increasingly prevalent among young adults. Risk perception is believed to be an important determinant of preventive health behaviors; however, young adults remain unaware of the benefits. The current study aimed to examine Malaysian public university students' perceived risk of developing T2DM and its predictors. This cross-sectional study involved a total of 1078 healthy students at Universiti Kebangsaan Malaysia (UKM). The validated Malay version of the Questionnaire on Risk Perception of Developing Non-Communicable Diseases in Malaysia was used to assess their perceived risk of developing T2DM in the future. Multiple logistic regression was used to analyze the data regarding the predictors of perceived risk to obtain the final model after controlling the potential confounders. . It was found that the majority of respondents (83.8%) perceived low risk of developing T2DM. Results from the multiple logistic regression indicated that respondents from non-health related faculties (OR, 1.71: 95% CI 1.162, 2.515), smoking (OR, 8.43: 95% CI 1.108, 64.130), consume fast food ≥ 3 times/month (OR, 1.56: 95% CI 1.104, 2.207), and snacking ≥ 3 times/week (OR, 1.79: 95% CI 1.262, 2.550) were significant positive predictors while family history of diabetes was a negative predictor (OR, 0.50: 95% CI 0.350, 0.695). Students who self-rated themselves as practising healthy lifestyles and actively seeking health information perceived a low risk of developing diabetes in the future. . The findings indicate that students perceived their risk as low even though they have the risk. This creates an urgent need to emphasize the necessity of diabetes prevention education, especially on socio-behavioral factors, to address the widespread misunderstandings among university students regarding diabetes risk factors to reduce diabetes incidence.

Survival Rate and Prognostic Factors of Localised Prostate Cancer in Southeast Asian Countries: A Systematic Review with Meta-Analysis.

Prostate cancer (Pca) is one of the most prevalent health conditions affecting men, particularly older men, and cases have increased in recent years. OBJECTIVE: This review examined the survival rate and prognostic factors of patients with Pca in Southeast Asia (SEA). METHODS: We conducted a systematic search of three databases (PubMed, Scopus, Web of Science) and a manual search until April 1, 2022. The selected papers were evaluated using the Newcastle-Ottawa Quality Assessment Form for Cohort Studies. The review protocol was registered with PROSPERO (CRD42022326521). Pooled prevalence rates were calculated using the programme R version 4.2.1. Heterogeneity was assessed using the I2 statistic and p-value. A narrative approach was used to describe prognostic factors. Studies were selected and finalised based on the review question. The quality of the included studies was assessed. RESULTS: A total of 11 studies were included in this review. The 1-, 3-, 5- and 10-year survival rates of SEA Pca cases were 80.8%, 51.9%, 66.1% (range 32.1-100) and 78% (range 55.9-100), respectively. Prognostic factors for Pca were discussed in terms of sociodemographic, disease-related and treatment-related aspects. The predictors of significantly lower survival were age more than 75 years, cancer detected during transurethral resection of the prostate, Gleason score more or equal to eight, high-risk group, metastases and no adjuvant radiotherapy. A meta-analysis on the pooled HR of prostate cancer could not be performed due to the heterogeneity of prognostic factors. The pooled prevalence of localised and metastatic prostate cancer in SEA countries was 39% 95% CI [20-62] and 40% 95% CI [28-53], respectively. CONCLUSION: The survival rate in SEA countries can be determined by prognostic factors, which can be divided into sociodemographic, disease-related and treatment-related factors. Therefore, further studies are needed to improve the understanding and treatment of Pca in the region SEA.

Prevalence and Associated Factors of E-Cigarette Use among Adolescents in Southeast Asia: A Systematic Review.

The use of e-cigarettes in adolescents remains a major public health concern. Like other tobacco products, e-cigarettes pose health risks to adolescents. Understanding the magnitude of this problem and identification of its associated factors will serve as a guide for development of preventive interventions. This systematic review aims to identify and discuss current epidemiological data on the prevalence and associated factors of e-cigarette use among adolescents in Southeast Asia. The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original English-language articles published between 2012 and 2021. A total of 10 studies were included in this review. The prevalence of current e-cigarette uses ranges from 3.3% to 11.8%. Several associated factors of e-cigarette use were identified, including sociodemographic factors, traumatic childhood experience, peer and parental influence, knowledge and perception, substance use, and accessibility of e-cigarettes. These factors should be addressed though multifaceted interventions which simultaneously target multiple factors. Laws, policies, programs, and interventions must be strengthened and tailored to the needs of adolescents at risk of using e-cigarettes.

Hypercholesterolemia in the Malaysian Cohort Participants: Genetic and Non-Genetic Risk Factors.

Hypercholesterolemia was prevalent in 44.9% of The Malaysian Cohort participants, of which 51% were Malay. This study aimed to identify the variants involved in hypercholesterolemia among Malays and to determine the association between genetic and non-genetic risk factors. This nested case-control study included 25 Malay participants with the highest low-density lipoprotein cholesterol (LDL-C, >4.9 mmol/L) and total cholesterol (TC, >7.5 mmol/L) and 25 participants with the lowest LDL-C/TC. Genomic DNA was extracted, and whole-exome sequencing was performed using the Ion ProtonTM system. All variants were annotated, filtered, and cross-referenced against publicly available databases. Forty-five selected variants were genotyped in 677 TMC Malay participants using the MassARRAY® System. The association between genetic and non-genetic risk factors was determined using logistic regression analysis. Age, fasting blood glucose, tobacco use, and family history of hyperlipidemia were significantly associated with hypercholesterolemia. Participants with the novel OSBPL7 (oxysterol-binding protein-like 7) c.651_652del variant had 17 times higher odds for hypercholesterolemia. Type 2 diabetes patients on medication and those with PCSK9 (proprotein convertase subtilisin/kexin type 9) rs151193009 had low odds for hypercholesterolemia. Genetic predisposition can interact with non-genetic factors to increase hypercholesterolemia risk in Malaysian Malays.

Efficacy of topical tranexamic acid to reduce bleeding in endoscopic sinus surgery for chronic rhinosinusitis with polyposis.

PURPOSE: To evaluate the efficacy of topical tranexamic acid (TXA) in reducing intraoperative and immediate postoperative bleeding during functional endoscopic sinus surgery (FESS) among patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODS: This is a double-blind randomized clinical trial, involving 26 patients with CRSwNP, who underwent FESS for failed medical therapy. The intervention nostril was packed with ribbon gauze soaked in 500 mg/5 ml TXA. The control nostril was packed with ribbon gauze soaked in Moffett's solution, containing 2 ml 10% cocaine, 1 ml adrenaline 1:1000, and 4 ml 0.9% sodium bicarbonate. Both nostrils were packed for 15 min before FESS. Intraoperative bleeding was recorded in the initial 30 min after commencing the surgery. The recordings were reviewed by two surgeons using Boezaart's scoring system. The scores were taken at 15 and 30 min of surgery. The mean score was then calculated. At the end of the surgery, the intervention nostril was packed with Merocel® soaked in 500 mg/5 ml TXA and the control nostril was packed with Merocel® soaked in normal saline. The amount of bleeding within 24 h post-surgery was evaluated using a bolster gauze. RESULTS: There was no significant difference in intraoperative bleeding between the intervention (1.54 ± 0.71) and control nostrils (1.69 ± 0.55) with p = 0.172. The amount of bleeding in the postoperative period was significantly reduced in the intervention nostril (1.33 ± 0.55) compared to the control nostril saline (1.81 ± 0.48) with p = 0.001. CONCLUSIONS: We found that the nasal packing soaked in TXA reduced intraoperative and immediate postoperative bleeding. It is a safe, efficacious and cost-effective alternative to Moffett's solution during FESS and also an alternative to normal saline post-surgery among patients with CRSwNP. TRIAL REGISTRATION NUMBER: FF-2015-232, 2015.

Genetic Factors for Coronary Heart Disease and Their Mechanisms: A Meta-Analysis and Comprehensive Review of Common Variants from Genome-Wide Association Studies.

Genome-wide association studies (GWAS) have discovered 163 loci related to coronary heart disease (CHD). Most GWAS have emphasized pathways related to single-nucleotide polymorphisms (SNPs) that reached genome-wide significance in their reports, while identification of CHD pathways based on the combination of all published GWAS involving various ethnicities has yet to be performed. We conducted a systematic search for articles with comprehensive GWAS data in the GWAS Catalog and PubMed, followed by a meta-analysis of the top recurring SNPs from ≥2 different articles using random or fixed-effect models according to Cochran Q and I2 statistics, and pathway enrichment analysis. Meta-analyses showed significance for 265 of 309 recurring SNPs. Enrichment analysis returned 107 significant pathways, including lipoprotein and lipid metabolisms (rs7412, rs6511720, rs11591147, rs1412444, rs11172113, rs11057830, rs4299376), atherogenesis (rs7500448, rs6504218, rs3918226, rs7623687), shared cardiovascular pathways (rs72689147, rs1800449, rs7568458), diabetes-related pathways (rs200787930, rs12146487, rs6129767), hepatitis C virus infection/hepatocellular carcinoma (rs73045269/rs8108632, rs56062135, rs188378669, rs4845625, rs11838776), and miR-29b-3p pathways (rs116843064, rs11617955, rs146092501, rs11838776, rs73045269/rs8108632). In this meta-analysis, the identification of various genetic factors and their associated pathways associated with CHD denotes the complexity of the disease. This provides an opportunity for the future development of novel CHD genetic risk scores relevant to personalized and precision medicine.

Coronary Heart Disease in Type 2 Diabetes Mellitus: Genetic Factors and Their Mechanisms, Gene-Gene, and Gene-Environment Interactions in the Asian Populations.

Asians are more susceptible to type 2 diabetes mellitus (T2D) and its coronary heart disease (CHD) complications than the Western populations, possibly due to genetic factors, higher degrees of obesity, insulin resistance, and endothelial dysfunction that could occur even in healthy individuals. The genetic factors and their mechanisms, along with gene-gene and gene-environment interactions associated with CHD in T2D Asians, are yet to be explored. Therefore, the objectives of this paper were to review the current evidence of genetic factors for CHD, summarize the proposed mechanisms of these genes and how they may associate with CHD risk, and review the gene-gene and gene-environment interactions in T2D Asians with CHD. The genetic factors can be grouped according to their involvement in the energy and lipoprotein metabolism, vascular and endothelial pathology, antioxidation, cell cycle regulation, DNA damage repair, hormonal regulation of glucose metabolism, as well as cytoskeletal function and intracellular transport. Meanwhile, interactions between single nucleotide polymorphisms (SNPs) from different genes, SNPs within a single gene, and genetic interaction with environmental factors including obesity, smoking habit, and hyperlipidemia could modify the gene's effect on the disease risk. Collectively, these factors illustrate the complexities of CHD in T2D, specifically among Asians.

Current e-cigarette use among in-school adolescents in West Malaysia: Examining the interactions between sociodemographic characteristics and lifestyle risk behaviours.

BACKGROUND: Adolescent e-cigarette use has increased dramatically. Most e-cigarette liquids contain nicotine, which can harm the developing adolescent brain. Local studies examining the risk factors of adolescent e-cigarette use and interactions between its risk factors are limited. This study was aimed at determining the prevalence of current e-cigarette use and its associated factors among in-school adolescents in West Malaysia. We also examined the possible sociodemographic characteristic, lifestyle risk behaviour and parental factor interactions that affect the probability of current e-cigarette use. METHODS: We conducted a cross-sectional study using data from the National Health and Morbidity Survey 2017. Respondents aged 13-18 years were included in the study. The data were analysed using STATA (v.15). RESULTS: The prevalence of current e-cigarette use was 9.1%. Male gender, older age, Malay ethnicity, schooling in urban area, current smoking, current alcohol use, current drug use, having parents that are not married and living together and parental tobacco product use were significantly associated with current e-cigarette use. There were significant interactions between: i) gender with age, ethnicity, current smoking, current alcohol use and current drug use, ii) ethnicity with current smoking and current alcohol use, iii) locality with ethnicity, current smoking and current alcohol use, iv) current drug use with age, ethnicity, current smoking and current alcohol use, v) parental marital status with gender, age and ethnicity, and vi) parental tobacco use with ethnicity and current smoking. CONCLUSION: Our findings identify significant associations between sociodemographic characteristics, lifestyle risk behaviours and parental factors with current e-cigarette use. They also provide new insight into the interactions between these factors that affect the probability of current e-cigarette use among West Malaysian adolescents. Efforts to tackle e-cigarette use in Malaysian adolescents should target sociodemographic characteristics, lifestyle risk behaviours and parental factors such as smoking cessation intervention for parents.

The Prevalence and Risk Factors of Hypertension among the Urban Population in Southeast Asian Countries: A Systematic Review and Meta-Analysis.

The trend of global prevalence for hypertension has been dramatically increasing for the past two decades in Southeast Asian countries. A systematic review aiming to assess the prevalence of hypertension and its risk factors among the urban population in Southeast Asian countries was conducted. We performed database searches of PubMed and Web of Science and performed meta-analysis to determine the pooled prevalence estimate. The overall pooled prevalence estimate of hypertension for Southeast Asian urban population was 33.82%. Among this, 33.98% of hypertension was reported in the community and 32.45% among adolescents in school. The common risk factors that we found were male, ethnicity, education and socioeconomic level, body mass index, waist circumference, smoking, and dyslipidaemia. The review indicates an urgent need for primary and secondary prevention activities. Therefore, a multisectoral and intersectoral approach and collaboration should be undertaken to improve the overall health outcomes of all populations in all Southeast Asian countries.

Sex-related differences in smear-positive pulmonary tuberculosis patients in Kuala Lumpur, Malaysia: Prevalence and associated factors.

Smear-positive pulmonary tuberculosis (PTB) is more infectious compared to smear-negative PTB and have great significance for epidemiology and infection control. The prevalence of smear-positive PTB rarely affects males and females equally. Hence, we aimed to identify the sex-related differences in the prevalence of smear-positive PTB and its associated factors in Kuala Lumpur, Malaysia. A cross-sectional study was conducted using data from the National Tuberculosis Information System (TBIS) from 1 January, 2015, to 31 December, 2019. The study population was selected using simple random sampling from the list of registered PTB patients in TBIS. The criteria for inclusion were all Malaysian adults aged ≥18 years residing in Kuala Lumpur and registered as PTB in TBIS. Factors associated with smear-positive PTB in male and female patients were determined using multiple logistic regression analysis. Overall prevalence of smear-positive PTB was 68.6%, and male patients predominated (71%). The male:female prevalence ratio of smear-positive PTB was 2.4:1. Male patients who worked as machine operators and elementary workers (adjusted odds ratio (aOR) 2.23, 95% confidence interval (CI) 1.24-4.02, p = 0.007), were self-employed (aOR 2.58, 95% CI 1.46-4.56, p = 0.001), lived in a residence categorized as 'other' (aOR 2.49, 95% CI 1.28-4.86, p = 0.007) and were smokers (aOR 1.37, 95% CI 1.01-1.87, p = 0.045) had higher odds for smear-positive PTB. Meanwhile, female patients with diabetes mellitus had higher odds for smear-positive PTB (aOR 1.92, 95% CI 1.05-3.54, p = 0.035), while female patients who were healthcare workers had lower odds (aOR 0.33, 95% CI 0.12, 0.94, p = 0.039). The prevalence of smear-positive PTB is higher in males compared to females. The factors associated with smear-positive PTB differed based on sex. The current TB control program, especially on smear-positive PTB, should likely be strategized and stratified by sex.

Low Socioeconomic Status Associated with Poor Cancer Screening Perceptions in Malaysia: Analysis of Determinant of Health among General Population.

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

Self-reported smoking among adolescents: How accurate is it with the urine cotinine strip test?

BACKGROUND & OBJECTIVE: In the local setting, the prevalence of smoking among adolescents varies, as it is based only on self-reporting without biomarker validation. The objective of the present study was to determine the accuracy of self-reported smoking among adolescents as compared to that of the urine cotinine strip test. METHODS: We performed a cross-sectional study of 314 adolescents aged 16 years from February 2015 to April 2015 in Putrajaya, Malaysia. The accuracy of self-reporting was assessed using a data collection sheet and was validated by the urine cotinine strip test. Three schools were chosen by the simple random method, where all Form 4 students constituted the sample unit. The kappa statistic was used for determining agreement between self-reporting and urine cotinine strip testing. RESULTS: There was a substantial agreement between self-reporting and the urine cotinine strip test (kappa = 0.757, 95% confidence interval [CI]: 0.63, 0.88); there was 95.86% overall agreement. The prevalence of self-reported smoking was 8% (95% CI: 7.47, 8.53) and that of urine cotinine strip testing was 10.8% (95% CI: 10.20, 11.41). There was a discrepancy with the results of the urine cotinine strip test in 8% of self-reported smokers and 3.8% of self-reported nonsmokers. Self-reporting had 67.6% sensitivity and 99.3% specificity as compared to those of urine cotinine strip testing and had 92% positive predictive value and 96.2% negative predictive value. CONCLUSION: Self-reporting can be used to assess smoking status but should be used with care among adolescents. Urine cotinine strip test validation of self-reporting enables the measurement of the true prevalence of smoking among adolescents.

Cancer Screening Perception Scale: Development and Construct Validation.

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