Time Taken for Symptom Recognition, First Consultation, Diagnosis and First Definitive Treatment and Its Associated Factors among Women with Breast Cancer.

BACKGROUND: Breast cancer patients in Malaysia often present late, delaying diagnosis and treatment. Decisions on health-seeking behaviour are influenced by a complex interplay of several factors. Early detection and subsequent successful treatment are the main goal in order to reduce breast cancer mortality. The aims of this study were to identify the time taken by women with breast cancer for consultation, diagnosis and first definitive treatment and the factors associated with the initiation of definitive treatment. METHODS: In this cohort study, we interviewed 328 women with histologically confirmed breast cancer at five medical centres in Malaysia. Times were measured from recognition of symptoms to first consultation to diagnosis and to the first definitive treatment. The event was initiation of definitive treatment. Data was analysed using multivariable Cox proportional hazards regression. RESULTS: The mean age was 47.9 (standard deviation 9.4) years and 79.9% were ethnic Malays. The median follow-up time was 6.9 months. The median times for first doctor consultation, diagnosis and initiation of treatment were 2 months, 5.5 months and 2.4 weeks, respectively. The percentage of consultation delay more than a month was 66.8%, diagnosis delay more than three months was 73.2% and treatment delay more than one month was 11.6%. Factors associated with not initiating the definitive treatment were pregnancy (adjusted hazard ratio (AHR) 1.75; 95% Confidence Interval (CI): 1.07, 2.88), taking complementary alternative medicine (AHR 1.45; 95% CI: 1.15, 1.83), initial refusal of mastectomy (AHR 3.49; 95% CI: 2.38, 5.13) and undergoing lumpectomy prior to definitive treatment (AHR 1.62; 95% CI: 1.16, 2.28). CONCLUSIONS: Delays in diagnosis and consultation were more serious than treatment delays. Most respondents would accept treatment immediately after diagnosis. Respondents themselves were responsible for a large proportion of the delays. This study was successful in understanding the process of breast cancer patients' experience, from symptoms recognition to consultation, diagnosis and treatment.

Obesity determinants among Malaysian 12-year old school adolescents: findings from the HAT study.

BACKGROUND: Childhood obesity has been associated with increased odds of adult obesity and co-morbidities in later life. Finding the key determinants may help in designing the most appropriate and effective interventions to prevent obesity. This study aimed to identify the determinants of obesity among school adolescents in a sub-urban state of Malaysia. METHODS: This cross-sectional study involved 1,404 school adolescents aged 12 years (46% boys and 54% girls). Socio-demographic, dietary and physical activity data were collected using questionnaires whilst body weight and height were measured and body mass index was classified based on WHO BMI-for-age Z-scores cut-off. RESULTS: A multivariable linear regression model showed that BMI z-score was positively associated with parents' BMI (P<0.001), birth weight (P=0.003), and serving size of milk and dairy products (P=0.036) whilst inversely associated with household size (P=0.022). Overall, 13.1% of the variances in BMI Z-scores were explained by parents' BMI, birth weight, servings of milk and dairy products and household size. CONCLUSION: This study found important determinants of body weight status among adolescents mainly associated with family and home environmental factor. This evidence could help to form the effective and tailored strategies at the earliest stage to prevent obesity in this population.

The upper respiratory tract microbiome of indigenous Orang Asli in north-eastern Peninsular Malaysia.

Much microbiome research has focused on populations that are predominantly of European descent, and from narrow demographics that do not capture the socio-economic and lifestyle differences which impact human health. Here we examined the airway microbiomes of the Orang Asli, the indigenous peoples of Malaysia. A total of 130 participants were recruited from two sites in the north-eastern state of Terengganu in Peninsular Malaysia. Using 16S rRNA sequencing, the nasal microbiome was significantly more diverse in those aged 5-17 years compared to 50+ years (p = 0.023) and clustered by age (PERMANOVA analysis of the Bray-Curtis distance, p = 0.001). Hierarchical clustering of Bray-Curtis dissimilarity scores revealed six microbiome clusters. The largest cluster (n = 28; 35.4%) had a marked abundance of Corynebacterium. In the oral microbiomes Streptococcus, Neisseria and Haemophilus were dominant. Using conventional microbiology, high levels of Staphylococcus aureus carriage were observed, particularly in the 18-65 age group (n = 17/36; 47.2% 95% CI: 30.9-63.5). The highest carriage of pneumococci was in the <5 and 5 to 17 year olds, with 57.1% (4/7) and 49.2% (30/61), respectively. Sixteen pneumococcal serotypes were identified, the most common being the nonvaccine-type 23A (14.6%) and the vaccine-type 6B (9.8%). The prevalence of pneumococcal serotypes covered by pneumococcal conjugate vaccines support introduction into a Malaysian national immunisation schedule. In addition, the dominance of Corynebacterium in the airway microbiomes is intriguing given their role as a potentially protective commensal with respect to acute infection and respiratory health.

Questionnaire development and validity to measure sexual intention among youth in Malaysia.

BACKGROUND: From the Theory of Planned Behaviour perspective, sexual intention is determined by a permissive attitude, perception of social norms and perceived self-efficacy in performing sexual activity. The aim of this study was to develop and validate the Youth Sexual Intention Questionnaire (YSI-Q), which was designed to measure sexual intention among youths in Malaysia. METHODS: A total of 25 items were developed based on literature reviews encompassing four main constructs: sexual intention, attitude, social norms and self-efficacy. The YSI-Q then underwent a validation process that included content and face validity, exploratory factor analysis (EFA), reliability analysis, and confirmatory factor analysis (CFA). This study was conducted on unmarried youths aged 18 to 22 years who were studying in colleges around Klang Valley, Malaysia. RESULTS: EFA supported the four factor structure, but five items were removed due to incorrect placement or low factor loading (<0.60). Internal reliability using Cronbach's alpha ranged between 0.89 and 0.94. The CFA further confirmed the construct, convergent and discriminant validity of the YSI-Q with χ 2 = 392.43, df = 164, p < 0.001, χ 2/df = 2.40, CFI = 0.93 and TLI = 0.92 and RMSEA = 0.08. CONCLUSION: The final set of YSI-Q consisted of 20 items measuring sexual intention (five items), attitude (five items), social norms (six items) and self-efficacy (four items) of practicing sexual activity. YSI-Q was shown to be a reliable and valid tool to be used among Malaysian youths.

Body weight status of school adolescents in Terengganu, Malaysia: a population baseline study.

BACKGROUND: Body weight is highly associated with overall health status. Being severely thin or obese may impose the risk of many health problems. Early detection of body mass index (BMI) status may help to reduce the associated comorbidities. Although many studies in the literature have investigated the BMI of school adolescents in Malaysia, the data on status of body weight among school adolescents in suburban states like Terengganu is limited. This study aimed to describe the body weight status of the whole population of school adolescents in all seven districts in Terengganu, Malaysia. METHODS: Using a cross-sectional study design, body weight and height were measured, and BMI was calculated and classified using WHO BMI-for-age Z-score. Data was obtained using the National Fitness Standard (SEGAK) assessment, which was uploaded in a specific Health Monitoring System (HEMS). RESULTS: From a total of 62,567 school adolescents, 50.7% were boys and 49.3% were girls. Girls had significantly higher BMI than boys in age groups of 13 to 15 and 16 to 17 years old. Among boys and girls, there were significant differences in mean BMI of school adolescents between rural and urban school locations in all age groups (p < 0.001). There were also significant differences in BMI between boys and girls in all districts in Terengganu, except Kemaman and Kuala Terengganu, for all age groups (p < 0.001). Overall, the prevalence of thinness, normal, overweight and obesity were 8.4, 64.6, 15.0 and 12.0%, respectively. There were significant differences between BMI categories and genders in total participants, and within rural and urban school locations (p < 0.05). In all districts except Marang and Dungun, significant difference was also found between BMI categories and genders. CONCLUSION: The prevalence of thinness, overweight and obesity in Terengganu were substantial. In this study, BMI category was associated with gender, age, school location and district. However, the actual effects of these factors on the prevalence of thinness and obesity among this population demand further investigation.

Antenatal calcium intake in Malaysia.

AIM: To determine the adequacy of antenatal calcium intake in Malaysia, and the influencing factors. METHODS: A cross-sectional study was conducted among postnatal women who delivered in two tertiary hospitals. Data were collected from antenatal cards, hospital documents and diet recall on daily milk and calcium intake during pregnancy. SPSS version 19.0 was used for statistical analyses. RESULTS: A total of 150 women were studied. The total daily calcium intake was 834 ± 43 mg (mean ± standard error of the mean), but the calcium intake distribution curve was skewed to the right with a median intake of 725 mg daily. When calcium intake from milk and calcium supplements was excluded, the daily dietary calcium intake was only 478 ± 25 mg. Even with inclusion of milk and calcium supplements, more than a third (n=55 or 36.7%) of the women consumed less than 600 mg calcium in their daily diet. The adequacy of daily calcium intake was not influenced by maternal age, ethnicity, income or maternal job or educational status as well as parity. CONCLUSION: The daily dietary calcium intake of the Malaysian antenatal population is far from adequate without the addition of calcium supplements and milk.

Validation of the Malay Version of the Parental Bonding Instrument among Malaysian Youths Using Exploratory Factor Analysis.

BACKGROUND: Parenting behaviour is culturally sensitive. The aims of this study were (1) to translate the Parental Bonding Instrument into Malay (PBI-M) and (2) to determine its factorial structure and validity among the Malaysian population. METHODS: The PBI-M was generated from a standard translation process and comprehension testing. The validation study of the PBI-M was administered to 248 college students aged 18 to 22 years. RESULTS: Participants in the comprehension testing had difficulty understanding negative items. Five translated double negative items were replaced with five positive items with similar meanings. Exploratory factor analysis showed a three-factor model for the PBI-M with acceptable reliability. Four negative items (items 3, 4, 8, and 16) and item 19 were omitted from the final PBI-M list because of incorrect placement or low factor loading (< 0.32). Out of the final 20 items of the PBI-M, there were 10 items for the care factor, five items for the autonomy factor and five items for the overprotection factor. All the items loaded positively on their respective factors. CONCLUSION: The Malaysian population favoured positive items in answering questions. The PBI-M confirmed the three-factor model that consisted of care, autonomy and overprotection. The PBI-M is a valid and reliable instrument to assess the Malaysian parenting style. Confirmatory factor analysis may further support this finding. KEYWORDS: Malaysia, parenting, questionnaire, validity.

Factors influencing insulin acceptance among type 2 diabetes mellitus patients in a primary care clinic: a qualitative exploration.

BACKGROUND: Many Type 2 Diabetes Mellitus (T2DM) patients refuse insulin therapy even when they require this modality of treatment. However, some eventually accept insulin. This study aimed to explore the T2DM patients' reasons for accepting insulin therapy and their initial barriers to use insulin. METHODS: This qualitative study interviewed twenty-one T2DM patients at a primary care clinic who had been on insulin for more than a year through three in-depth interviews and three focus group discussions. A semi structured interview protocol was used and the sessions were audio-recorded. Subsequently, thematic analysis was conducted to identify major themes. RESULTS: The participants' acceptance of insulin was influenced by their concerns and beliefs about diabetes and insulin. Concerns about complications of poorly controlled diabetes and side effects of other treatment regime had resulted in insulin acceptance among the participants. They also had a strong belief in insulin benefits and effectiveness. These concerns and beliefs were the results of having good knowledge about the diabetes and insulin, experiential learning, as well as doctors' practical and emotional support that helped them to accept insulin therapy and become efficient in self-care management. These factors also allayed their negative concerns and beliefs towards diabetes and insulin, which were their barriers for insulin acceptance as it caused fear to use insulin. These negative concerns were related to injection (self-injection, needle phobia, injection pain), and insulin use (inconvenience, embarrassment, lifestyle restriction, negative social stigma, and poor self-efficacy), whereas the negative beliefs were 'insulin could cause organ damage', 'their diabetes was not serious enough', 'insulin is for life-long', and 'insulin is for more severe disease only'. CONCLUSIONS: Exploring patients' concerns and beliefs about diabetes and insulin is crucial to assist physicians in delivering patient-centered care. By understanding this, physicians could address their concerns with aim to modify their patients' misconceptions towards insulin therapy. In addition, continuous educations as well as practical and emotional support from others were found to be valuable for insulin acceptance. TRIAL REGISTRATION: Universiti Kebangsaan Malaysia FF-214-2009.

Sociodemographic determinants of leisure participation among elderly in Malaysia.

Leisure participation has been proven to be beneficial and has a positive link to successful ageing. This study aims to explore the sociodemographic determinants of leisure participation among the Malaysian elderly. A cross-sectional study was conducted among persons aged 60 years and above, purposively selected from eight health clinics in the state of Selangor. Leisure participation was measured using a validated Leisure Participation Questionnaire specific for Malaysian elderly, consisting of 25 activities, categorized into 4 categories, namely recreational (physical), cognitive, social and productive. Frequency of such participation was measured on a 6-point scale. Its association with sociodemographic variables was examined using inferential and regression analysis. 268 participants were involved in this study (response rate = 100%). The most common daily leisure activities were having conversations while relaxing (78.7%), watching television (74.6%) and reading (63.4%). The least frequently done leisure activities were from the recreational and cognitive categories. The activities were weakly correlated to each other, reflecting the lack of diversity of leisure activities among respondents. Education was the main predictor for leisure participation among elderly, with higher educational level is associated with high RAS (B = 1.020, P < 0.05), CAS (B = 1.580, P < 0.05) and SAS (B = 1.276, P < 0.05). Education level, marital status and locality were important determinants of leisure participation among elderly, with education being the main predictor. Further studies exploring the effective method of educating the ageing society are recommended.