Identification of cardiovascular risk factors among urban and rural Malaysian youths.

BACKGROUND: Coronary artery disease (CAD) is one of the major causes of morbidity and mortality worldwide. Early identification of the cardiovascular risk factors (CRF) among youths assists in determining the high-risk group to develop CAD in later life. In view of the modernised lifestyle, both urban and rural residing youths are thought to be equally exposed to various CRF. This study aimed to describe the common CRF including obesity, dyslipidaemia, hypertension, smoking and family history of hypercholesterolaemia and premature CAD in youths residing in urban and rural areas in Malaysia. METHODS: We recruited 942 Malaysian subjects aged 15-24 years old [(males = 257, and urban = 555 vs. rural = 387, (mean age ± SD = 20.5 ± 2.1 years)] from the community health screening programmes organised in both rural and urban regions throughout Malaysia. Medical history and standardised anthropometric measurements were recorded. Laboratory investigations were obtained for fasting serum lipid profiles and plasma glucose levels. RESULTS: A total of 43.7% from the total study population was either obese or overweight. Youths in the rural were more overweight and obese (49.4% vs. 42.7%, p < 0.044) and have higher family history of hypercholesterolaemia (16.3% vs. 11.3%, p < 0.036) than youths in the urban areas. Low-density lipoprotein (LDL-c) (2.8 vs. 2.7 mmol/L) and total cholesterol (TC) (4.7 vs. 4.5 mmol/L) were significantly higher in urban compared to rural youths (p < 0.019 and p < 0.012). Overall, more youth in this study has CRF rather than not (Has ≥ 1 CRF = 69.9%). Significantly more rural youths have at least one CRF compared to urban youths (rural = 74.2% vs. urban = 66.8%, p = 0.016). CONCLUSION: In conclusion, our study showed that a large number of youths had at least one or more CRF. Rural youths have significantly higher BMI with higher family history of hypercholesterolaemia compared to urban youths. However, urban youths have higher LDL-c and TC levels. Other coronary risk factors are not significantly different between urban and rural youths. Rural youths have more CRF compared to urban youths. A larger longitudinal study focusing on this population is important to better understand the effect of the area of residence on CRF in youth.

Relationship between serum and tear levels of tissue plasminogen activator and plasminogen activator inhibitor-1 in diabetic retinopathy.

BACKGROUND: Diabetic retinopathy (DR) is a serious complication of longstanding type 2 diabetes mellitus (T2DM), a leading cause of blindness and visual disability in the world. The aim of this study is to compare the activity of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) in tears and serum of patients with DR and those without DR. METHOD: Among the T2DM patients enrolled in this study, 26 patients had DR (n = 26) while 29 were without DR (n = 29). The blood and tear samples were obtained from all participants. The level of PAI-1 and tPA were measured in both the serum and tears. Anthropometric measurements, HbA1c, renal and lipid profile were also obtained. RESULTS: Patients with DR had significantly longer disease duration and higher systolic blood pressure compared to those without DR. Serum PAI-1 level was significantly higher in patients with DR compared to those without DR, 32.72 (IQR 32.52) vs 21.37 (IQR 14.93) ng/mL, respectively (p < 0.05). However, tear PAI-1 were comparable in both groups. Serum and tear tPA levels in both groups were also comparable (p > 0.05). Among patients with DR, there were no significant correlations between tear and serum of both biomarkers. Patients without DR showed a moderate positive correlation between serum and tear tPA levels with a coefficient of 0.363, albeit no statistical significance. Patients with DR demonstrated a significant positive correlation between levels of tears PAI-1 and BMI (r = 0.555, p = 0.026). In the group without DR, there was a statistically significant positive correlation between serum level of PAI-1 with urine albumin creatinine ratio (UACR) (r = 0.501, p = 0.013). CONCLUSION: The present study demonstrated a significantly greater serum PAI-1 levels in patients with DR compared to those without DR. No significant correlations between tears and serum PAI-1 and tPA were observed. Thus, the role of tear biomarkers remains relevant for further investigations.

Characteristics and determinants of loss to follow-up among tuberculosis (TB) patients who smoke in an industrial state of Malaysia: a registry-based study of the years 2013-2017.

BACKGROUND: The increased risk of loss to follow-up among TB smokers raises concern over the secondary spread within the community. This study aimed to determine the factors associated with loss to follow-up among TB patients who smoke. METHODS: All registered TB patients who smoke in the state of Selangor between 2013 and 2017 via the Malaysian Tuberculosis Information System (MyTB) database were included for analysis. TB patients who smoke were considered those who are "current smoker" during the notification, while loss to follow-up was defined as a TB patient who had interrupted treatment for 2 months or longer. There were 3 main variable domains included for analysis: sociodemographic profiles, disease profiles, and comorbidities. Logistic regression analysis was used to identify determinants of loss to follow-up among TB patients who smoke. RESULTS: A total of 14.1% (N = 813) of TB patients who smoke loss to follow-up. The determinants of loss to follow-up among TB smokers were working age population aged 32-41 and 42-53 years old (AOR 1.08; 95%CI 1.23,2.08) and (AOR 1.44; 95%CI 1.11,1.87) respectively, Malaysian nationality (AOR 2.34; 95%CI 1.66,3.30), patients staying in urban area (AOR 1.55; 95% CI 1.23,1.97), income level less than RM2160 (AOR 1.59; 95% CI 1.14,2.20), un-employed (AOR 1.30; 95%CI 1.09-1.55), have low education level i.e., secondary school education, primary school education and no formal education (AOR 1.60; 95%CI 1.22,2.10), (AOR 1.73; 95%CI 1.16,2.57) and (AOR 2.29; 95% CI 1.57,3.33) respectively, previously treated TB cases (AOR 2.19; 95% CI 1.71,2.81), active TB case detection methods (AOR 2.06; 95%CI 1.40,3.02), moderate lesion x-ray (AOR 1.60; 95%CI 1.13,2.27) and HIV positive (AOR 1.36; 95%CI 1.02,1.82). All the significant factors gave rise to the final model of determinants, with a predictability of 67.2% (95% CI 65.0,69.3). CONCLUSIONS: The high proportion of loss to follow-up among TB patients who smoke highlight the importance of providing early risk detection that examines the three main domains of risk factors such as socioeconomic, disease profiles and comorbidities. Potential integrated intervention should aim to reduce the proportion of smoking among TB patients through the stop smoking programme together with directly observed therapy (DOT).

Validity and reliability of an adapted questionnaire measuring knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia.

BACKGROUND: Primary care physicians (PCP) play an important role in detecting Familial Hypercholesterolaemia (FH) early. However, knowledge, awareness and practice (KAP) regarding FH among Malaysian PCP are not well established, and there was no validated tool to assess their FH KAP. Thus, the aim of this study was to adapt an FH KAP questionnaire and determine its validity and reliability among Malaysian PCP. METHODS: This cross-sectional validation study involved Malaysian PCP with ≥ 1-year work experience in the primary care settings. In Phase 1, the original 19-item FH KAP questionnaire underwent content validation and adaptation by 7 experts. The questionnaire was then converted into an online survey instrument and was face validated by 10 PCP. In Phase 2, the adapted questionnaire was disseminated through e-mail to 1500 PCP. Data were collected on their KAP, demography, qualification and work experience. The construct validity was tested using known-groups validation method. The hypothesis was PCP holding postgraduate qualification (PCP-PG-Qual) would have better FH KAP compared with PCP without postgraduate qualification (PCP-noPG-Qual). Internal consistency reliability was calculated using Kuder Richardson formula-20 (KR-20) and test-retest reliability was tested on 26 PCP using kappa statistics. RESULTS: During content validation and adaptation, 10 items remained unchanged, 8 items were modified, 1 item was moved to demography and 7 items were added. The adapted questionnaire consisted of 25 items (11 knowledge, 5 awareness and 9 practice items). A total of 130 out of 1500 PCP (response rate: 8.7%) completed the questionnaire. The mean percentage knowledge score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (53.5, SD ± 13.9 vs. 35.9, SD ± 11.79), t(128) = 6.90, p < 0.001. The median percentage awareness score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 15.38), p = 0.030. The mean percentage practice score was significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (69.2, SD ± 17.62 vs. 54.4, SD ± 19.28), t(128) = 3.79, p < 0.001. KR-20 value was 0.79 (moderate reliability) and average Kappa was 0.796 (substantial agreement). CONCLUSION: This study has proven that the 25-item adapted FH KAP questionnaire is valid and reliable. It can be used to measure and establish FH KAP among PCP in Malaysia.

Relationship between self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting.

BACKGROUND: Self-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self-care behaviour and glycaemic control iii) determine the factors associated with glycaemic control. METHODS: This was a cross-sectional study involving patients with type 2 diabetes mellitus from two public primary care clinics in Malaysia. Self-efficacy and self-care behaviour levels were measured using previously translated and validated DMSES and SDSCA questionnaires in Malay versions, respectively. Glycaemic control was measured using HbA1c. RESULTS: A total of 340 patients with type 2 diabetes mellitus were recruited. The total mean (±SD) of self-efficacy and self-care behaviour scores were 7.33 (±2.25) and 3.76 (±1.87), respectively. A positive relationship was found between self-efficacy and self-care behaviour (r 0.538, P < 0.001). Higher self-efficacy score was shown to be correlated with lower HbA1c (r - 0.41, P < 0.001). Multiple linear regression analysis demonstrated that higher self-efficacy scores (b - 0.398; 95% CI: -0.024, - 0.014; P < 0.001), shorter duration of diabetes (b 0.177; 95% CI: 0.002, 0.007; P < 0.001) and smaller waist circumference (b 0.135; 95% CI: 0.006, 0.035; P = 0.006), were significantly associated with good glycaemic control. CONCLUSION: This study demonstrated that higher self-efficacy was correlated with improved self-care behaviour and better glycaemic control. Findings of this study suggest the importance of including routine use of self-efficacy measures in the management of type 2 diabetes mellitus in primary care.

Diagnostic performance of various familial hypercholesterolaemia diagnostic criteria compared to Dutch lipid clinic criteria in an Asian population.

BACKGROUND: Familial hypercholesterolaemia (FH) is a genetic disorder with a high risk of developing premature coronary artery disease that should be diagnosed as early as possible. Several clinical diagnostic criteria for FH are available, with the Dutch Lipid Clinic Criteria (DLCC) being widely used. Information regarding diagnostic performances of the other criteria against the DLCC is scarce. We aimed to examine the diagnostic performance of the Simon-Broom (SB) Register criteria, the US Make Early Diagnosis to Prevent Early Deaths (US MEDPED) and the Japanese FH Management Criteria (JFHMC) compared to the DLCC. METHODS: Seven hundered fifty five individuals from specialist clinics and community health screenings with LDL-c level ≥ 4.0 mmol/L were selected and diagnosed as FH using the DLCC, the SB Register criteria, the US MEDPED and the JFHMC. The sensitivity, specificity, efficiency, positive and negative predictive values of individuals screened with the SB register criteria, US MEDPED and JFHMC were assessed against the DLCC. RESULTS: We found the SB register criteria identified more individuals with FH compared to the US MEDPED and the JFHMC (212 vs. 105 vs. 195; p < 0.001) when assessed against the DLCC. The SB Register criteria, the US MEDPED and the JFHMC had low sensitivity (51.1% vs. 25.3% vs. 47.0% respectively). The SB Register criteria showed better diagnostic performance than the other criteria with 98.8% specificity, 28.6% efficiency value, 98.1% and 62.3% for positive and negative predictive values respectively. CONCLUSION: The SB Register criteria appears to be more useful in identifying positive cases leading to genetic testing compared to the JFHMC and US MEDPED in this Asian population. However, further research looking into a suitable diagnosis criterion with high likelihood of positive genetic findings is required in the Asian population including in Malaysia.

Factors associated with anxiety among elderly hypertensive in primary care setting.

BACKGROUND: There is increasing evidence showing that anxiety is associated with morbidity in the older age group. Factors contributing to anxiety may vary among different diseases and settings. AIMS: The aim of this study was to determine the factors associated with anxiety symptoms among elderly hypertensive at the primary care level. METHODS: A cross-sectional study and face-to-face interviews using Hospital Anxiety and Depression Scale (HADS) were conducted among elderly hypertensive. RESULTS: The mean (SD) age of subjects was 68.8 (6.76) years and comprised of 49.5% and 50.5% of males and females, respectively. The majority of respondents were Malays (76.1%), followed by Chinese (14.3%), and Indians (9.5%). The mean (SD) duration of hypertension was 8.44 (7.29) years and the prevalence of anxiety symptoms was 13.3% (95% CI: 9.9, 16.7). Multiple logistic regression analysis showed that elderly hypertensive with a past history of stroke (adjusted OR: 4.472; 95% CI: 1.754, 11.405; p = 0.002) and depression (adjusted OR: 3.715; 95% CI: 2.009, 6.872; p < 0.001) was significantly associated with the factors for anxiety. CONCLUSION: Elderly hypertensive with a history of stroke and having depressive symptoms are susceptible to get the anxiety. Therefore, screenings of risk factors and early intervention may improve the quality of life among elderly.

Socio-demographic and psychosocial correlates of erectile dysfunction among hypertensive patients.

OBJECTIVE: The main aim of the study was to estimate the prevalence of ED and the associated socio-demographic and psychological correlates among hypertensive patients from a rural multiethnic community in Malaysia. METHODS: A cross-sectional study was conducted among hypertensive patients attending rural primary care clinics. The socio-demographic, health characteristics, erectile function and levels of depression, anxiety and stress were recorded and analysed. The International Index of ErectileFunction-5 (IIEF-5) questionnaire and the Depression, Anxiety and Stress Scale (DASS-21) were used to assess erectile function and the levels of depression, anxiety and stress, respectively. RESULTS: A total of 253 hypertensive patients comprising 178 (70.4%) Malays, 56 (22.1%) Chinese and 18 (7.5%) Indians participated. The mean age of participants was 59.8 ± 10.62 years. Overall, the prevalence rate of ED was 62%: 90 (35%) with moderate and 69 (27%) with severe ED. The prevalence rate of ED among those aged 65 years or older (83.1%) was significantly higher than those less than 65 years (51.8%), (p<0.001). Higher prevalence rates were also noted among the Chinese (78.6%) compared to Malays (59.6%) and Indians (50%) (p=0.021); lower education level (69.1%) (p=0.026), among hypertensive patients with concomitant diabetes mellitus (70.6%) (p=0.026) and WHR ≥ 0.9 (31.3%) (p=0.021). However, no significant association was found between depression, anxiety and stress scores with IIEF-5 score. CONCLUSION: The prevalence rate of ED among Malaysian hypertensive patients is high. The rate increases significantly with age, Chinese ethnicity, concomitant diabetes mellitus, lower education level, WHR and the number of pack years of smoking. ED should be properly recognized and managed in hypertensive patients.

Public stigma towards patients with schizophrenia of ethnic Malay: a comparison between the general public and patients' relatives.

BACKGROUND: The stigma attached to mental disorders has been recognized as a major concern in healthcare services across societies. AIMS: To compare the stigmatizing attitude towards patients with schizophrenia between the general public, relatives of patient with schizophrenia and relatives of patient with neurotic illnesses. METHOD: The study sample of 600 subjects of Malay families was equally divided into three groups. The sample was selected using convenience sampling. Each subject completed a seven-item Social Distance Scale (SDS) and a six-item stereotypical beliefs (SB) scale of people with schizophrenia. Appropriate statistical analysis was then conducted to compare the differences in SDS and SB scores between the groups. RESULTS: The scores of both SD and SB were consistent with each other, which reflected that far social distance and more negative attitudes were strongly adopted by the general public. There were significant differences in the total and most of the individual item scores of the SDS and the SB between the general public and the two relatives groups. However, the difference in the SDS scores between the relatives of patient with schizophrenia and neurotic illnesses was not significant. Among the socio-demographic factors, educational status had a stronger influenced on stigma than age and sex. CONCLUSIONS: The stigma towards patients with schizophrenia among the Malay community was strong. Individuals who had been exposed to patient with schizophrenia or neurotic illnesses tended to have better perceptions towards schizophrenia than the general public. The contact that promotes familiarity with mental illness, which may diminish prejudicial attitudes, attributed to the improvement.

Construct Validity and Test-Retest Reliability of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF): A Tripartite Perspective of Worksite-Specific Determinants in Healthcare Settings.

Introduction: Among available workplace violence (WPV) interventions, only data-driven, worksite-based, and risk-based approach WPV interventions had moderate evidence for effectiveness in decreasing the risk of WPV. The Questionnaires to Assess Workplace Violence Risk Factors (QAWRF) had been previously developed to determine the level of WPV risk factors in each healthcare setting based on the tripartite perspective of key stakeholders to enable effective WPV interventions. This study aimed to determine the construct validity and test-retest validity of QAWRF. Methods: QAWRF, a three-component instrument consisting of QAWRF-Administrators, QAWRF-Workers, and QAWRF-Clients, had previously undergone content validation, face validation, and internal consistency reliability testing. 965 respondents were recruited to examine the construct validity of QAWRF, and a subset of these (n = 90) were retested again at an interval of three weeks to assess its test-retest reliability. Confirmatory factor analysis (CFA) was performed, and fitness indices, average variance extracted, correlation coefficient, composite reliability, and intraclass correlation coefficient were determined. Results: QAWRF-Administrator, QAWRF-Worker, and QAWRF-Client had acceptable factor loadings (≥0.6), absolute fit (Root Mean Square Error of Approximation > 0.1), incremental fit (Confirmatory Fit Index and Tucker Lewis Index > 0.9), parsimonious fit (Chi-square/degree of freedom < 5), correlation coefficient between construct (≤0.85), discriminant validity index, and construct reliability (≥0.6). CFA supported a four-factor model for QAWRF-Administrator and QAWRF-Worker, and a two-factor model for QAWRF-Client. Conclusion: QAWRF holds good construct validity and test-retest reliability. By using QAWRF, healthcare managers can identify specific WPV risk factors that are perceived by stakeholders as prevalent at a particular workplace, and these findings can contribute towards data-driven, worksite-specific, and targeted WPV interventions in healthcare settings that are expected to be resource-efficient and more effective than general WPV interventions.

Does Exercise Improve Health-Related Quality of Life of Colorectal Cancer Survivors? A Systematic Review and Meta-Analysis.

INTRODUCTION: Early diagnostic and treatment advances have resulted in prolonged cancer survivorship. Therefore, exercise intervention in survivorship management is essential for enhancing cancer survivors' health-related quality of life (HRQoL). OBJECTIVE: The systematic review and meta-analysis in this study aimed to explore the effect of exercise intervention on health-related quality of life of colorectal cancer survivors. METHODS: The current study followed guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) to identify relevant literature. Comprehensive searches were conducted using EBSCOhost, Web of Science (WOS), Scopus, Science Direct, and PubMed. The inclusion criteria included are randomised control trials studies written in English, with no restrictions for the time of publication that reported the effects of exercise intervention on health-related quality of live among colorectal cancer survivors. Meta-analysis was conducted by pooling the mean and standard deviation of post-intervention scores across randomised control trial studies using a random effects model. RESULT: A total of 467 articles were identified but only seven articles were randomised control trials (RCT) (n = 7) with PEDro scores ranging from 6 to 9 showing good internal validity were included in the review. The results of the meta-analysis of pooled data from six RCTs studies on HRQoL showed no significant effect of exercise intervention on HRQoL in the intervention group compared to control group [SMD = 0.25; 95% CI; -0.0, 0.51; Z = 1.88; p = 0.06; I2 = 30.8%]. CONCLUSION: This meta-analysis provides key insights into the effect of exercise on the health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. Therefore, more experimental studies should be carried out with rigorous methodology to evaluate the effectiveness of exercise interventions before it is recommended as a routine activity in post-treatment management for CRC survivors.

Development and Validation of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF): A Tripartite Perspective of Worksite-Specific Determinants in Healthcare Settings.

Introduction: Workplace violence (WPV) incidences are prevalent in healthcare, and existing WPV interventions have only moderate evidence for effectiveness. This study aimed to develop and validate an instrument to assess worksite-specific WPV risk factors in healthcare settings based on a tripartite perspective of key stakeholders to facilitate improved interventions. Methods: Three questionnaires were developed to get the responses from healthcare administrators, workers, and clients, representing the three components of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF). The domains of the questionnaires were developed based on The Chappell and Di Martino's Interactive Model of Workplace Violence, and the items were generated from 28 studies identified from a systematic review of the literature. Six experts, 36 raters, and 90 respondents were recruited to assess the content validity, face validity, and usability and reliability of the QAWRF respectively. Item and Scale Level Content Validity Index, Item and Scale Level Face Validity Index, and Cronbach's alpha values were determined for QAWRF-administrator, QAWRF-worker, and QAWRF-client. Results: The psychometric indices for QAWRF are satisfactory. Conclusion: QAWRF holds good content validity, face validity, and reliability, and findings from QAWRF can contribute towards worksite-specific interventions that are expected to be resource efficient and more effective than general WPV interventions.

Prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in urban Selangor, Malaysia: a cross-sectional study.

BACKGROUND: Cyberbullying is a growing public health concern with clear, negative impacts on the mental, physical and social health of targeted victims. Previous research on cyberbullying has largely focused on examining its occurrence among children and adolescents. The present study aims to examine the prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in Selangor, Malaysia. METHODS: A cross-sectional study was conducted in a locality within Selangor, sampling a total of 1449 young adults. The Cyberbullying and Online Aggression Survey was used to measure cyberbullying victimisation. The Family APGAR scale, General Health Questionnaire, Pittsburgh Sleep Quality Index and single-item measures were used to assess family dysfunction, psychological distress and health behaviour, respectively. RESULTS: The 1-month prevalence of cyberbullying victimisation among young adults was 2.4%. The most common cyberbullying act experienced was mean or hurtful comments about participants online (51.7%), whereas the most common online environment for cyberbullying to occur was social media (45.8%). Male participants (adjusted OR (AOR)=3.60, 95% CI=1.58 to 8.23) had at least three times the odds of being cyberbullied compared with female participants. Meanwhile, participants with higher levels of psychological distress had increased probability of being cyberbullied compared with their peers (AOR=1.13, 95% CI=1.05 to 1.21). CONCLUSIONS: As evident from this study, cyberbullying victimisation prevails among young adults and is significantly related to gender and psychological distress. Given its devastating effects on targeted victims, a multipronged and collaborative approach is warranted to reduce incidences of cyberbullying and safeguard the health and well-being of young adults.

Relationship of Self Efficacy in Medication Understanding with Quality of Life among Elderly with Type 2 Diabetes Mellitus on Polypharmacy in Malaysia.

Self-efficacy (SE) has been shown to be positively correlated with quality of life (QOL) among patients with type 2 diabetes mellitus (T2DM). Medication understanding (MU) on the other hand, leads to good adherence that indirectly improves QOL. Measuring self-efficacy in medication understanding is useful to ascertain patient's confidence in medication adherence. However, there is a lack of studies on the relationship between self-efficacy in medication understanding with QOL. This study aimed to determine the relationship between self-efficacy in medication understanding and QOL, and the factors associated with QOL in elderly with T2DM on polypharmacy. A cross-sectional study was conducted on these populations at primary care specialist clinic. Malay version of MU in SE questionnaire (MUSE) was used. Higher scores showed a better understanding. A revised Version Diabetic Quality of Life-13 (RVDQOL-13) questionnaire was used with lower scores indicating higher QOL. A total of 321 patients participated, with the majority being male (58.3%), Malay (84.7%), a predominant age group of 60−69 (75.7%) with mean age (±SD) of 66.7 (±0.286) years old. The median (IQR) of MUSE was high­30 (4)­while the RVDQOL-13 was low­19 (8)­which demonstrated high QOL. Inverse correlation was found between MUSE and QOL (r −0.14, p < 0.01). Multiple linear regression analysis demonstrated that MUSE score (ß −0.282; 95% CI: (−5.438, −2.581); p < 0.001), low-income group (ß −0.144; 95% CI: (−3.118, −0.534); p = 0.006) and duration of medications ≥240 days (ß −0.282; 95% CI: (−5.438, −2.581); p < 0.001) were associated with better QOL, while medications ≥10 (ß 0.109; 95% CI: 0.214, 4.462; p = 0.031) and those with pills and insulin (ß 0.193; 95% CI: 1.206, 3.747; p < 0.001) were associated with poor QOL. In conclusion, higher MUSE is associated with better QOL. Findings suggest emphasizing self-efficacy in medication understanding in the management of elderly with T2DM on polypharmacy to improve QOL.

Obesity and its associated factors among older adults: MyHEBAT (Malaysian HEalth and Well-Being AssessmenT) study.

Background: Despite being a preventable disease, the prevalence of obesity is rising progressively worldwide. However, the prevalence of obesity and its associated factors among older adults remains unclear in Malaysia. The aim of this study was to determine the prevalence of obesity and its associated factors among older adults who voluntarily attended the health screening programs, which were part of the Malaysian HEalth and Well-Being AssessmenT (My-HEBAT) Study. Methods: Cross-sectional study was conducted among Malaysian adults, aged ≥60 years. A standardized self-administered questionnaire was used to gather information regarding socio-demographic status, personal, family and medical history. Anthropometric indices, blood pressure and physical examinations were conducted on site. Venous blood samples were collected for lipid profile and blood glucose analysis. Participants with BMI of ≥30 kg/m2 or < 30kg/m2 were classified as obese or non-obese respectively. Age was categorized into three subgroups: 60-69, 70-79, and ≥80 years old. The factors associated with obesity among older adults were then identified using multiple logistic regression. Results: A total of 716 older adults aged ≥60 years (mean ± SD: 66.6 ± 6.0 years) were recruited. The prevalence of obesity among older adults was 15.8%, while higher prevalence was found among females (42.9%) compared to males (38.3%). The prevalence of obesity decreased with increasing age (48.5% in 60-69 years, 20.8% in 70-79 years, and 11.8% in ≥80 years). Conclusion: The prevalence of obesity among Malaysian population is higher than that of worldwide prevalence. Current national health promotion and educational programs should focus on identifying factors associated with obesity, and promotion of healthy lifestyle with obesity should be improved and modified, particularly for older adults in Malaysia.

Characteristics and Determinants of the Presence of Respiratory Symptoms among Sewage Workers in Malaysia.

Background: The purpose of this study was to determine the relationships of PM 2.5 and H2S exposure with the presence of work-related respiratory symptoms among sewage workers. Methods: A cross-sectional study was conducted in eleven sewage plants located in the central region of Peninsular Malaysia. One hundred ninety-one sewage workers were assessed using the British Medical Research Council (BMRC) questionnaire. Area air sampling was performed in three different sewage plants to measure the following parameters: physical air quality and concentration of PM 2.5 and H2S. Result: Chronic cough (34.0%) was reported as the most common symptom, followed by chronic phlegm (26.2%), shortness of breath (7.9%), and chest tightness (3.7%). There were five significant determinants of the presence of respiratory symptoms among the sewage workers: shift work (AOR 23.50, 95% CI: 1.90-616.52), working at a sludge treatment facility (STF) (AOR 25.46, 95% CI: 2.06-314.29), a longer duration of working years (AOR 1,21, 95% CI: 1.01-1.44), individual cumulative exposure to PM 2.5 (AOR 9.01, 95% CI: 1.98-83.33), and individual cumulative exposure to H2S (AOR 1.04, 95% CI: 1.01-1.07). The majority of STF and non-STF workers had higher exposure to PM 2.5 and H2S concentrations in the air than office workers. Conclusion: Sewage workers working at non-STFs or STFs reported a significantly higher prevalence of work-related respiratory symptoms and exposure to PM 2.5 and H2S compared with office workers. Exposure-response relationships were also found in sewage workers' cumulative exposure to PM 2.5 and H2S and the presence of respiratory symptoms.

Association of zinc level with DNA methylation and its consequences: A systematic review.

Background: DNA methylation is an effective epigenetic process that is frequently linked to changes in gene expression. Zinc is a vital micronutrient that plays a crucial role in DNA methylation. Therefore, abnormal zinc levels may cause aberrant DNA methylation and other diseases. Objectives: To investigate the influence of zinc on gene-specific and global DNA methylation in humans and rodents, their tissues and their cells. Method: Systematic literature searches were conducted using Medline, Scopus, Google Scholar, and Web of Science databases. Studies that met the inclusion criteria and were published in English language were included. Data including the first author, sample size, subjects, targeted genes, tissue types or cells analysed, zinc level, molecular techniques, DNA methylation outcomes, and consequences were extracted. Results: From a total of 2360 articles screened by title and abstract, 15 met the inclusion criteria. Qualitative analysis indicates that there are associations between zinc deficiency and gene-specific hypomethylation in humans and between zinc deficiency and hypermethylation in rodents. Zinc did not influence LINE-1 methylation in humans. Depending on cell type, zinc could have a positive or negative effect on global methylation in humans and rodents. As predicted, in general, gene expression was elevated by DNA hypomethylation and the corresponding protein levels were also upregulated. However, some studies showed that zinc deficiency led to reduced gene expression or no alteration in mRNA levels and corresponding protein levels. Conclusion: Our study shows links between zinc levels and DNA methylation. However, greater significance may be achieved if more than one independent investigator analyses the same set of genes in the same cell type. Therefore, gene-cell and animal-specific investigations are recommended to reduce variability and allow comparisons across studies.

A Review of Polychlorinated Biphenyls (PCBs) Pollution in the Air: Where and How Much Are We Exposed to?

Polychlorinated biphenyls (PCBs) were widely used in industrial and commercial applications, until they were banned in the late 1970s as a result of their significant environmental pollution. PCBs in the environment gained scientific interest because of their persistence and the potential threats they pose to humans. Traditionally, human exposure to PCBs was linked to dietary ingestion. Inhalational exposure to these contaminants is often overlooked. This review discusses the occurrence and distribution of PCBs in environmental matrices and their associated health impacts. Severe PCB contamination levels have been reported in e-waste recycling areas. The occurrence of high PCB levels, notably in urban and industrial areas, might result from extensive PCB use and intensive human activity. Furthermore, PCB contamination in the indoor environment is ten-fold higher than outdoors, which may present expose risk for humans through the inhalation of contaminated air or through the ingestion of dust. In such settings, the inhalation route may contribute significantly to PCB exposure. The data on human health effects due to PCB inhalation are scarce. More epidemiological studies should be performed to investigate the inhalation dose and response mechanism and to evaluate the health risks. Further studies should also evaluate the health impact of prolonged low-concentration PCB exposure.

Undertreatment and Underachievement of LDL-C Target among Individuals with High and Very High Cardiovascular Risk in the Malaysian Community.

Dyslipidaemia is a major cause of morbidity and mortality. The aims of this study are to determine the prevalence of dyslipidaemia subtypes, the proportions of lipid-lowering therapy (LLT) use, and the achievement of low-density lipoprotein cholesterol (LDL-C) treatment targets for high-risk (HR) and very high-risk (VHR) Malaysians. This cross-sectional study involves 5279 participants across 11 states in Malaysia. The data were obtained through a standardised questionnaire, anthropometric measurements, venous glucose and lipid profile. The participants with existing cardiovascular disease (CVD) or diabetes with at least one of the other major risk factors (smoking, hypertension or dyslipidaemia) were grouped into the VHR category. Other participants were risk-categorised using the Framingham General CVD Risk Score (FRS-CVD). The prevalence of elevated LDL-C, LLT use and LDL-C target were set according to respective risk categories. Pearson's chi-squared test was used to test the difference in the proportions. The mean ± standard deviation (SD) age was 41.1 ± 14.8 years, and 62.2% (3283/5279) of the group were females. Within the participant group, 51.5% were found to have elevated total cholesterol, 28.8% had low HDL-C, and 33.8% had high triglyceride. As for elevated LDL-C, 9.8% were in VHR, 8.6% in HR, 5.8% in MR and 34.9% in LR categories. Among the VHR group, 75.8% were not on LLT, and only 15.9% achieved the LDL-C target. As for the HR category, 87.7% were not on LLT, and only 16.1% achieved the LDL-C target. Dyslipidaemia is highly prevalent among Malaysians. The majority of VHR and HR participants were not on LLT and did not achieve LDL-C treatment targets. Proactive programs are warranted to combat dyslipidaemia-associated CVD events in these groups.

Familial hypercholesterolaemia and coronary risk factors among patients with angiogram-proven premature coronary artery disease in an Asian cohort.

BACKGROUND: Familial hypercholesterolaemia (FH) patients have elevated levels of low-density lipoprotein cholesterol, rendering them at high risk of premature coronary artery disease (PCAD). However, the FH prevalence among angiogram-proven PCAD (AP-PCAD) patients and their status of coronary risk factors (CRFs) have not been reported in the Asian population. OBJECTIVES: This study aimed to (1) determine the prevalence of clinically diagnosed FH among AP-PCAD patients, (2) compare CRFs between AP-PCAD patients with control groups, and (3) identify the independent predictors of PCAD. METHODS: AP-PCAD patients and FH patients without PCAD were recruited from Cardiology and Specialist Lipid Clinics. Subjects were divided into AP-PCAD with FH (G1), AP-PCAD without FH (G2), FH without PCAD (G3) and normal controls (G4). Medical records were collected from the clinic database and standardised questionnaires. FH was clinically diagnosed using Dutch Lipid Clinic Network Criteria. RESULTS: A total of 572 subjects were recruited (males:86.4%; mean±SD age: 55.6±8.5years). The prevalence of Definite, Potential and All FH among AP-PCAD patients were 6%(19/319), 16% (51/319) and 45.5% (145/319) respectively. G1 had higher central obesity, family history of PCAD and family history of hypercholesterolaemia compared to other groups. Among all subjects, diabetes [OR(95% CI): 4.7(2.9,7.7)], hypertension [OR(95% CI): 14.1(7.8,25.6)], FH [OR(95% CI): 2.9(1.5,5.5)] and Potential (Definite and Probable) FH [OR(95% CI): 4.5(2.1,9.6)] were independent predictors for PCAD. Among FH patients, family history of PCAD [OR(95% CI): 3.0(1.4,6.3)] and Definite FH [OR(95% CI): 7.1(1.9,27.4)] were independent predictors for PCAD. CONCLUSION: Potential FH is common among AP-PCAD patients and contributes greatly to the AP-PCAD. FH-PCAD subjects have greater proportions of various risk factors compared to other groups. Presence of FH, diabetes, hypertension, obesity and family history of PCAD are independent predictors of PCAD. FH with PCAD is in very-high-risk category, hence, early management of modifiable CRFs in these patients are warranted.