Attitude Towards Anti-smoking Measures and Its Associated Factors Among Adults in Sub-urban Area, in Kuala Terengganu, Terengganu, Malaysia

@#Introduction: General population across different countries have shown an overall support for anti-smoking measures that vary significantly by certain population parameters. However, characteristics of the public attitude in a community who has been exposed to prolonged awareness campaigns and smoke-free area legislation is unclear. Consequently, we investigate residents who reside next to Batu Buruk beach in Kuala Terengganu city which has been gazetted as a smoke-free area since 2017. Methods: The cross-sectional study involves self-administered validated questionnaires. Multiple linear regression with forward method was applied to identify significant factors associated with the attitude towards anti-smoking measures. Results: A total of 295 residents participated. Most of them were Malays (96.6%), married (64.4%), attained up to the secondary school level (45.4%) and employed (59.7%). The mean value of the total attitude scores was 181.86 (range: 70-200). Multivariate analyses revealed those having higher monthly income had a higher total attitude scores (adjusted b: 6.91, 95% CI: 2.15, 11.66), while current daily smokers had a lower total attitude scores towards anti-smoking measures than non-smokers (adjusted b: -23.30, 95% CI: -29.55, -17.05). These findings highlight comparatively stronger and more consistent support for anti-smoking measures that may vindicate high-stake investment and legislation against smoking. Conclusion: The novel evidence may also better-inform the strategy to expand the initiatives further through profiling the target population with heightened emphasis on the economic standing and prevalence of current daily smokers. Future research may adopt experimental design to establish causality relationship between predictors and outcomes revealed in this community.

Determinants of Optimal Breastfeeding Practices in Indonesia: Findings From the 2017 Indonesia Demographic Health Survey / 예방의학회지

Objectives@#Understanding the factors influencing mothers’ decision to breastfeed their infants is essential to formulate effective breastfeeding interventions. This study explored the determinants of optimal breastfeeding indicators in Indonesia. @*Methods@#We used the 2017 Indonesia Demographic and Health Survey to analyze factors associated with early initiation of breastfeeding, exclusive breastfeeding (EBF), and continued breastfeeding at 1 year (CBF-1) and 2 years (CBF-2). Multivariate logistic regression models were used to examine bio-demographic, socio-cultural, and behavioral characteristics associated with breastfeeding after considering the survey design effect. @*Results@#The risk of delayed breastfeeding initiation was higher among infants who were born smaller, first-born children, were delivered via cesarean delivery, and did not have immediate skin-to-skin contact (p<0.01). Infant’s age, birth pattern, household wealth index, and the mother’s occupation and smoking status were predictors of EBF (p<0.05). CBF-1 was less common among first-time mothers and those working in the non-agricultural sector, mothers from wealthier families, and mothers who had cesarean deliveries (p<0.01). Infant’s age was negatively associated with CBF-2 (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.74 to 0.99). Mothers attending college were less likely to practice CBF-2 than those with no education or primary education (aOR, 0.45; 95% CI, 0.26 to 0.77). The absence of postnatal visits was a risk factor for CBF-1 and CBF-2 (p<0.05). @*Conclusions@#Breastfeeding interventions in Indonesia should pay particular attention to at-risk groups such as women from wealthier families, working outside the agricultural sector, and with a higher education level. Nutrition-sensitive programs (e.g., postnatal care and smoking cessation) should also be encouraged.

Mediating Role of Job Satisfaction in the Relationship between Job Performance and Organizational Commitment Components: A Study among Nurses at One Public University Hospital in Malaysia

@#Introduction: In light of the importance of the nurses’ performance in health services, this study was established to examine the relationship of job performance with organizational commitment components and job satisfaction among nurses. It is also, to examine the mediating effect of job satisfaction in the relationship between organizational commitment components and job performance among nurses. Methods: This was a cross-sectional study conducted among nurses at Hospital Universiti Sains Malaysia. A sample size of 192 staff was selected using stratified and systematic random sampling methods. The study data were collected using a questionnaire consists of three scales: the organizational commitment scale of Allen and Meyer, the job satisfaction scale of Van Wood, and the task performance scale of Williams and Anderson. Besides, respondents were asked about their demographic profiles. The response rate was 92% (n= 176). Regression analysis according to Baron and Kenny technique and Pearson correlation were conducted to get the study results. Results: The study results showed that all organizational commitment components positively and significantly correlated with job satisfaction and job performance. Further, there is a positive relationship was found between job satisfaction and job performance. Moreover, findings of regression analysis showed that job satisfaction partially mediates the relationship between all organizational commitment components and job performance. Conclusion: Improving organizational commitment and job satisfaction among nurses could increase their performance. Nurses’ managers should create suitable approaches and strategies to promote the organizational commitment and job satisfaction of nurses to the highest level, which in turn enhancing their job performance and the quality of care.

Different reference ranges affect the prevalence of osteoporosis and osteopenia in an urban adult Malaysian population

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.

Prolonged Neonatal Jaundice with Deranged Thyroid Function Test

@#Congenital central hypothyroidism (CCH) is a rare disorder that results from deficient biosynthesis of thyroid hormone due to defective thyroid gland stimulation by thyroid stimulating hormone (TSH). Diagnosis is typically established biochemically by low free thyroxine (fT4) and inappropriately low or normal TSH levels after excluding all other causes of discordant thyroid function test (TFT). Here, we report a case of a baby girl who presented with prolonged jaundice at day 15 of life with normal cord blood TSH performed as routine screening for congenital hypothyroidism. Serial TFT revealed declining serum fT4 with normal TSH consistent with CCH. Her jaundice resolved prior to levothyroxine replacement. CCH is commonly missed on cord blood TSH-based newborn screening leading to a delay in diagnosis, potentially resulting in neurodevelopmental delay. Hence, although CCH has a lower incidence than congenital primary hypothyroidism, a high index of suspicion is essential for timely diagnosis.

Bone Turnover Markers and Sphingosine-1-phosphate levels among the Chinese Community in Selangor, Malaysia and its Correlation with Bone Density

@#Introduction: Prevention of osteoporotic fracture requires identification of individuals at high risk. Bone mineral density(BMD) is commonly used to estimate fracture probability despite inadequate predictive discrimination ability. Sphingosine-1-phosphate(S1P), a new marker of bone metabolism and bone turnover markers(BTM) such as procollagen-type-1 amino-terminal propeptide(P1NP) and C-terminal telopeptide of type I collagen(CTX) may complement current assessment. The study determined P1NP, CTX and S1P levels and their correlation with BMD, 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone(PTH) in selected subjects. Method: A cross-sectional study involving Malaysian Chinese men and women aged 50-90 years old from Puchong and Kajang, Selangor. Each subject had BMD determined by dual-energy x-ray absorptiometry and blood samples taken for 25(OH)D, PTH, P1NP, CTX and S1P. Results: A total of 131 subjects [45(34.4%) males and 86(65.6%) post-menopausal women] with median age of 65(IQR=17) were recruited. P1NP and CTX were significantly higher in post-menopausal women (P1NP=61.71 ng/ml, CTX=0.489 ng/ml) compared to men (P1NP=46.94 ng/ml, CTX=0.381 ng/ml). P1NP and CTX differed significantly according to BMD categories with values highest in osteoporosis. S1P between men (2.12±0.75 µmol/L) and post-menopausal women (1.96±0.68 µmol/L) did not differ significantly and did not differ according to BMD categories. S1P did not correlate with BMD, P1NP, CTX and 25(OH)D. P1NP and CTX negatively correlated with BMD at all measured sites but not 25(OH)D. Conclusion: CTX and P1NP, but not S1P negatively correlated with BMD. CTX and P1NP were highest in those with osteoporosis. In this group of Malaysian Chinese subjects, CTX and P1NP rather than S1P reflects bone health.

Derivation and Internal Validation of an Equation for Albumin-adjusted Calcium at a Tertiary Hospital in Selangor, Malaysia

@#Introduction: Total calcium concentration is widely used to assess body calcium status although limited by many confounding factors. Thus, this study aimed to derive and internally validate an albumin-adjusted calcium equation for a selected Malaysian population. Method: This cross-sectional study involved 1011 adults at an emergency department of a tertiary hospital. Patients who had total calcium, ionised calcium and albumin measurements taken simultaneously were included. Derivation of the albumin-adjusted calcium equation was based on the adjustment equation obtained from the Association for Clinical Biochemistry and Laboratory Medicine 2015 position paper. Additionally, the equation was internally validated and compared with ionised calcium (gold standard) and the conventional Payne’s equation. Results: The newly derived equation = total calcium + 0.017 (41.35 – albumin). Internal validation exhibited the amount of shrinkage of 0.049. It tends to overestimate the adjusted calcium by a mean difference of 0.029 mmol/L compared to Payne’s equation. The comparison between Payne’s equation and the new equation with ionised calcium reclassified 402 and 486 patients, respectively into different calcium status. When both equations were compared, calcium status classification significantly differed in all and hypoalbuminaemic subjects by 90 and 16 patients, respectively. Conclusion: Locally derived albumin-adjusted calcium equation differed statistically in calcium status classification when compared to the Payne’s equation. However, to confirm this significance, the result must be compared to ionised calcium under strict, controlled preanalytical conditions. In terms of clinical significance, there was no difference in classification of calcium status between Payne’s and the new equation at medical decision limits.

Anthropometry Measurements to Determine Nutritional Status Among Cerebral Palsy Children: A Scoping Review

@#This article aimed to review the available anthropometry measurements used in the assessment of nutritional status among Cerebral Palsy (CP) children. Searched journals were from Medline, PubMed and Ovid published from 2015 to 2018. The search identified 443 articles, and eight studies met the criteria. Anthropometric measurements included weight, height, recumbent length, knee height, tibia length, Dual-energy X-ray absorptiometry (DXA), Bioelectrical impedance (BIA), Mid arm circumference (MUAC) subscapular skinfold (SFT), Triceps skinfold (TSF) and prediction equations. Body fat composition can be obtained by DXA, BIA, skinfold measurement, and also prediction equation. The predictive equation is the most reported method to determine nutritional status among CP. This review found that TSF and SFT are more accurate to determine body fat percentage when using together with the predictive equation. Besides, predictive equations using segmental length are reliable in estimating the height and can be used to evaluate the nutritional status using the specific CP growth chart.

Verification of the Reliability and Validity of the Short Form 36 Scale in Indonesian Middle-aged and Older Adults / 예방의학회지

Objectives@#The Short Form 36 (SF-36) questionnaire is increasingly being used to measure health-related quality of life (HRQoL) in Indonesia. However, evidence that it is valid for use in Indonesian adults is lacking. This study assessed the validity and reliability of the SF-36 in Indonesian middle-aged and older adults. @*Methods@#Adults aged 46-81 years (n=206) in Yogyakarta, Indonesia completed the SF-36, another measure of HRQoL (the EuroQoL visual analogue scale [EQ-VAS]), and measures assessing their demographic characteristics. Fifty-four percent (n=121) completed the SF-36 measure again 1 week later. Confirmatory factor analysis was conducted to confirm the factor structure of the SF-36. Internal consistency reliability was estimated using Cronbach’s alpha, and test-retest reliability was assessed using intraclass correlations. Convergent and discriminant validity were assessed by computing correlations among SF-36 subscales, between subscales and the 2 component scores, and between component scores and EQ-VAS scores. @*Results@#Most scaling assumptions were met. The hypothetical factor structure fit the data poorly (root mean square error of approximation [RMSEA]=0.108) and modification was required for a good fit (RMSEA=0.060). Scores on all subscales demonstrated acceptable internal consistency (α>0.70) and test-retest reliability (r>0.70). Divergent validity was supported by weak to moderate interscale correlations (r=0.19 to 0.64). As expected, the 2 summary scores were moderately to strongly correlated with the EQ-VAS (r>0.60). @*Conclusions@#The findings adequately support the use of SF-36 in Indonesian middle-aged and older adults, although the optimal algorithm for computing component scores in Indonesia warrants further investigation.

Clinical assessment and grading of back pain in horses

Background@#The clinical presentation of horses with back pain (BP) vary considerably with most horse's willingness to take part in athletic or riding purpose becoming impossible.However, there are some clinical features that are directly responsible for the loss or failure of performance. @*Objectives@#To investigate the clinical features of the thoracolumbar region associated with BP in horses and to use some of the clinical features to classify equine BP. @*Methods@#Twenty-four horses comprised of 14 with BP and 10 apparently healthy horses were assessed for clinical abnormality that best differentiate BP from normal horses. The horses were then graded (0–5) using the degree of pain response, muscular hypertonicity, thoracolumbar joint stiffness and overall physical dysfunction of the horse. @*Results@#The common clinical features that significantly differentiate horses with BP from non-BP were longissimus dorsi spasm at palpation (78.6%), paravertebral muscle stiffness (64.3%), resist lateral bending (64.3%), and poor hindlimb impulsion (85.7%). There were significantly (p < 0.05) higher scores for pain response to palpation, muscular hypertonicity, thoracolumbar joint stiffness and physical dysfunction among horses with BP in relation to non-BP. A significant relationship exists between all the graded abnormalities. Based on the cumulative score, horses with BP were categorized into mild, mild-moderate, moderate and severe cases. @*Conclusions@#BP in horse can be differentiated by severity of pain response to back palpation, back muscle hypertonicity, thoracolumbar joint stiffness, physical dysfunctions and their cumulative grading score is useful in the assessment and categorization of BP in horses.

Acute Necrotizing Encephalopathy of Childhood: A Severe Case with Fatal Outcome

@#Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition which is important for clinicians to recognize as it has a high mortality rate and can result in significant neurological morbidities. It presents as acute encephalopathy with radiological findings of symmetrical brain lesions in bilateral thalami, putamen, brain stem tegmentum, internal capsule, periventricular white matter and cerebellar medulla. Intravenous methylprednisolone is the mainstay of treatment. Immunoglobulin therapy and therapeutic hypothermia may be used as adjunctive therapy in cases with severe clinical and neuroradiological presentation. We present a case of severe ANEC and discuss the clinical manifestations, neuroimaging and management options.

Misleading Free Thyroxine (FT4): A Case Report

@#Interpretation of thyroid function test (TFT) is often straightforward but in certain scenarios, discordance between the clinical impression and the laboratory results exists. A 50-year-old woman with a ten years history of hypothyroidism on levothyroxine presented with a recent notable change in TFT [elevated free thyroxine (FT4) and thyroid-stimulating hormone (TSH)], in an otherwise clinically euthyroid and previously stable TFT, leading to levothyroxine being withheld. This case report highlights the possibility of assay interference as a cause of discordant TFT. It also draws the importance of close collaboration between clinicians and the laboratory to avoid unnecessary investigations and inappropriate management of such a case.

Demographic study of brain tumour in a neurosurgical department in Terengganu, Malaysia

@#patients, families as well as the surrounding communities,especially the healthcare services. It can be classified intoeither a benign slow growing tumour (non-cancerous) andmalignant tumour (cancerous). The purpose of this studywas to determine the incidence and pattern of brain tumouradmitted to the Neurosurgery Department in HospitalSultanah Nurzahirah (HSNZ), Terengganu, Malaysia.Methods: This is a retrospective study of incidence andpattern of BT admitted to the Neurosurgery Department inHSNZ. Data was collected from the yearly census of BTregistered from 2013 to 2018.Results: A total number of 386 new cases of primary BT wereregistered. The number of cases of BT was found to belowest among children (0 to 10 years old) with only 4.4% butat peak among elderly aged between 51 to 60 years old(26.2%). As for gender, males constituted about 44.5%(n=172) whereas females accounted for 55.5% (n= 214) of thecases. In total, meningioma was found to have the highestincidence (27.2%) followed by metastases brain tumour(18.1%) and glioma (17.4%). Conclusions: This study has shown that the incidence of BTwas led by meningioma which had a high prevalence amongthe elderly population, followed by metastasis BT andgliomas.

Hyalinizing Clear Cell Carcinoma of the Soft Palate - A Case Report

@#Hyalinizing clear cell carcinoma presents as a painless submucosal mass commonly located at the palate and base of tongue. It is a rare tumour and has often been misdiagnosed for other more common tumours with clear cytoplasm, such as acinic cell carcinoma, clear cell oncocytoma or mucoepidermoid carcinoma. HCCC has been reported as a low grade malignant tumour with a high rate of cervical metastases. Due to its rarity, there is no treatment protocol. However, the treatment of choice is wide local excision and the neck disease is treated with neck dissection or radiotherapy or both with no conclusive outcome as incidence is too low or underreported with no long term follow up. Our case highlights the diagnosis difficulties in such rare cases, and the need for longer follow up post excision to determine outcome and recurrence rates.

Factors Influencing Malaysian Men’s Perceptions of Gender Equity in Family Planning

@#Introduction: Various factors influence men’s perceptions regarding gender equity in family planning (FP). Identifying these factors can contribute to a deeper understanding of the roles that men play in family planning and ultimately leads to women’s reproductive health outcomes. Objectives: This paper aims to investigate factors influencing Malaysian men’s perceptions of gender equity in family planning. To achieve this, the effects of sociodemographic characteristics (age, education, and marital status), masculine traits, and attitudes towards domestic violence are investigated. Methodology: This is a cross-sectional study undertaken by administrating questionnaires to a sample of 168 men in Malaysia. The data are analyzed by applying partial least squares–structural equation modeling (PLS-SEM) and by using WarpPLS 6.0. Results: The results confirmed the significant effects of masculine traits and attitudes supporting domestic violence on perceived gender equity in family planning. In other words, the results showed that men’s masculine traits and attitudes supporting domestic violence negatively influenced gender equity in family planning. The hypothesized effects of sociodemographic characteristics on perceived gender equity in family planning could not be verified. Conclusions: This study suggests some practical implications for local authorities to implement interventions that take a gender transformative approach to reduce men’s masculine traits and improve their attitudes towards domestic violence to enhance gender equity in family planning.

Characteristics Of Cognitive Status Of Epilepsy Patients Treated With Monotherapy Of First-Generation Antiepileptic Drugs

@#Epilepsy is one of the main health problems in neurology that can lead to cognitive decline. Generally, the epilepsy-associated cognitive decline is influenced by demographic, clinical, and treatment characteristics. This study aimed to determine the characteristics of cognitive status of epilepsy patients who received monotherapy using first-generation antiepileptic drugs (AEDs), namely phenytoin, carbamazepine, and valproic acid. It involved 93 epilepsy patients of Mutiara Sukma Mental Hospital (n=38) and Mataram General Hospital (n=55). Besides, 93 healthy patients were assigned as healthy control group (HC) subjects (n=93). Demographic characteristics collected from epilepsy and HC groups were age, gender, and years of education. Clinical characteristics taken from both groups were MoCA-Ina score. Clinical characteristics taken from epilepsy group were age at epilepsy onset, type of seizure (partial vs generalized), etiology (idiopathic vs structural), first-generation AED used, years of treatment, and cognitive status. The result of the study revealed that there were no significant different between the two groups in the means of age and years of education as well as the frequency of male gender (p>0.05). The mean of MoCA-Ina score of epilepsy group was significantly lower compared with HC group (p<0.05). The frequency of cognitive decline among epilepsy patients was 75.3%. The cognitive functions of epilepsy patients using monotherapy with carbamazepine, phenytoin, or valproic acid was significantly lower compared with healthy subjects. We conclude that there was high prevalence of epilepsy-associated cognitive impairment which was associated with male gender.

Inflammation of the Gums

@#An 18-year-old woman presented to the clinic with painless bleeding of her gums upon brushing her teeth. The bleeding stopped spontaneously, and there was no other bleeding tendency. On further questioning, the patient had irregular menses and was taking the oral contraceptive pills (OCP) Diane-35ED® to regulate her menses. She had been on this medication for four months. She was not on any other medication and had no chronic illness.

Bluish swelling on the foor of the mouth

@#A healthy, six-year-old girl presented to the clinic with a three-day history of swelling on the foor of her mouth (Figure 1). Te swelling was painless and was not associated with discharge or bleeding inside her mouth. She also denied any fever, signifcant loss of weight or appetite, halitosis, dysphagia, and odynophagia. Tere was no other neck or chest swelling. On physical examination, her face and neck appeared normal and symmetrical. Cervical and submandibular lymph nodes were not palpable. However, there was an ill-defned, rounded, bluish swelling approximately 2 cm in diameter on the left foor of the mouth lateral to the frenulum. Te swelling was soft with a smooth surface but non-tender upon palpation. Tere was no bleeding or discharge noted in the oral cavity. Other oral structures appeared normal despite multiple caries on her deciduous teeth.

Preventive Practice On Secondhand Smoke And Its Associated Factors Among Adults In A Suburban Community In Kuala Terengganu

@#Secondhand smoke (SHS) carries many health risks and is associated with diseases and premature deaths among nonsmoking adults and children. Despite many health promotions and legislative measures executed by the government to protect the public from SHS, the prevalence of SHS exposure is still high. Personal appropriate practices to avoid exposure are crucial especially at home or private area. Therefore, the current study focused on describing individual preventive practices on SHS and determining its associated factors. A cross sectional study was conducted among 250 adults in a village, Kuala Terengganu. Data were collected using self-administered questionnaires. Multiple logistic regression analysis was performed to determine the association between all independent variables and the SHS preventive practice status. The prevalence of SHS exposure was 66.0%. Majority of the respondents (77.2%) has good knowledge on SHS. Nevertheless, despite having good knowledge, a large proportion of them showed poor attitude toward SHS (77.6%) and poor preventive practices (61.2%). Poor preventive practices on SHS were significantly associated with being older (OR­adj: 1.0206, 95% CI: 1.0004, 1.0412), female (OR­adj: 2.0644, 95% CI: 1.0753, 3.9635), smoker (OR­adj: 12.1107, 95% CI: 4.0630, 36.0991), not having existing tobacco-related morbidity (OR­adj: 3.6795, 95% CI: 1.1795, 11.4786), and poor attitude towards SHS (OR­adj: 4.1871, 95% CI: 2.0955, 8.3665). The preventive practices of SHS among the villagers were poor despite showing acceptable level of knowledge. Hence, health awareness on the potential impact of SHS to the public as well as instilling appropriate behavior for them to avoid SHS and educate smokers need to be emphasized.

Different reference ranges affect the prevalence of osteoporosis and osteopenia in an urban adult Malaysian population

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.