A cross-sectional analysis of the PURE study on minerals intake among Malaysian adult population with hypertension.

Hypertension (HPT) is the leading modifiable risk factor for cardiovascular diseases and premature death worldwide. Currently, attention is given to various dietary approaches with a special focus on the role of micronutrient intake in the regulation of blood pressure. This study aims to measure the dietary intake of selected minerals among Malaysian adults and its association with HPT. This cross-sectional study involved 10,031 participants from the Prospective Urban and Rural Epidemiological study conducted in Malaysia. Participants were grouped into HPT if they reported having been diagnosed with high blood pressure [average systolic blood pressure (SBP)/average diastolic blood pressure (DBP) ≥ 140/90 mm Hg]. A validated food frequency questionnaire (FFQ) was used to measure participants' habitual dietary intake. The dietary mineral intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc was measured. The chi-square test was used to assess differences in socio-demographic factors between HPT and non-HPT groups, while the Mann-Whitney U test was used to assess differences in dietary mineral intake between the groups. The participants' average dietary intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, sodium, and zinc was 591.0 mg/day, 3.8 mg/day, 27.1 mg/day, 32.4 mg/day, 0.4 mg/day, 1431.1 mg/day, 2.3 g/day, 27.1 µg/day, 4526.7 mg/day and 1.5 mg/day, respectively. The intake was significantly lower among those with HPT than those without HPT except for calcium and manganese. Continuous education and intervention should be focused on decreasing sodium intake and increasing potassium, magnesium, manganese, zinc, and calcium intake for the general Malaysian population, particularly for the HPT patients.

Depressive symptoms among adults: Baseline findings of PURE Malaysia cohort study.

Introduction: In Malaysia, the prevalence of depression has increased from 1.8 % to 2.3 % within a decade. Thus, this study was performed to identify depressive symptoms and its associated factors among Malaysian adults. Methods: A cross-sectional study was conducted among the adult population aged 35-70 residing in rural and urban areas in Malaysia. Depressive symptoms were assessed using the short form Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Composite International Diagnostic Interview (CIDI) questionnaire. Logistic regression models were fitted to identify the associated factors related to depressive symptoms. Results: About 3.7 % (95 % CI: 2.33-4.83) of the respondents reported having depressive symptoms. Younger adults aged 35-40 years old (AOR: 3.087; 95 % CI: 2.021-4.717), females (AOR: 2.318; 95 % CI: 1.669-3.219), widows and divorcees (AOR: 2.294; 95 % CI: 1.085-4.848), smokers (AOR: 1.843; 95 % CI: 1.334-2.545) and alcohol consumers (AOR: 1.843; 95 % CI: 1.264-2.688) showed a higher odds compared to their other counterparts. Underweight individuals (AOR: 1.899; 95 % CI: 1.177-3.065) and those diagnosed either with hypertension (AOR: 1.442; 95 % CI: 1.11-1.873), diabetes (AOR: 1.554; 95 % CI: 1.133-2.13), angina (AOR: 2.73; 95 % CI: 1.596-4.67), COPD (AOR: 4.187; 95 % CI: 1.528-11.472) or asthma (AOR: 1.906; 95 % CI: 1.309-2.774) were more likely to have depressive symptoms. Additionally, individuals with difficulty trusting people (AOR: 1.477; 95 % CI: 1.024-2.13) and those reported to experience either home or work-related stress (AOR: 2.584; 95 % CI: 2.003-3.331) were more prone to have depressive symptoms. Conclusion: In this broad population-based study, about 3.7 % (95 % CI: 2.33-4.83) of respondents reported having depressive symptoms. Timely and well targeted collaborative intervention on the identified risk factors by the relevant authorities, would mitigate their effect on the quality of life and retard the progression into depression, especially among younger adults.

Prediction of Lung Function Status Using Handgrip Strength and Anthropometry among the Healthy Malay Population in Malaysia.

Lung function depends primarily on the strength of the intercostal muscles and the diaphragm, which is indirectly related to handgrip strength (HGS). This study aims to determine the predictability of lung functions using HGS among healthy adults of Malay ethnicity in Malaysia. This study also aims to compare the equation using HGS with equations without HGS, such as the Global Lung Initiative (GLI). This study was carried out among adults between 35 to 70 years of age residing in urban and rural Malaysia. A series of standardized questionnaires were used to collect socio-demographic information. Lung functions were measured using a portable spirometer and HGS was measured using a Jamar dynamometer. The predictability of lung function indices (FEV1 and FVC) using HGS, age, and height was determined using multiple linear regression (MLR). Prediction of lung function indices was also generated using models without HGS for comparison with the equation that used HGS from this study. Pearson correlation analysis showed that both dominant (r = 0.49; p < 0.001) and non-dominant (r = 0.58; p < 0.001) HGS had a moderate significant correlation with lung function. In the MLR model, HGS was a significant (p < 0.001) predictor of lung function indices (FEV1 and FVC). The correlation of the predicted and measured lung indices using the equation generated in this study, which includes HGS, was higher compared with other lung function test equations that do not include HGS. The equations from MLR could be used to predict lung function indices among healthy Malay adults. The measurement of HGS may be used as a screening tool for lung function status when spirometry is unavailable.

New insights of minimum requirement on legumes (Fabaceae sp.) daily intake in Malaysia.

BACKGROUND: Despite their low energy density and high nutrient content, legumes may be under-recognised as a beneficial food for the prevention and management of obesity and related diseases, such as cardiovascular disease (CVD). This study aims to analyse the moderation effect of legume intake on the relationship between BMI and the prevalence of CVD among the Malaysian adult population. METHODS: This study addressed communities of urban and rural Malaysia, including adults aged between 35 and 70 years old at the baseline recruitment. A series of standardised questionnaires were used to assess legume intake, history of comorbidities and socio-demographic information. Resting blood pressure measurements and physical examinations were performed to collect blood pressure and anthropometric data. Bivariate analysis was completed to determine the association between legume intake, socio-demographic characteristics and CVD prevalence. Moderation analysis was used to quantify the moderation effect of minimum daily legume intake on the relationship between BMI and CVD prevalence. RESULTS: This study found that those who consume less than 3 servings of legumes per day benefit from protective effects against CVD risk (POR = 0.56, 95% CI = 0.37 - 0.85). Moderation analysis of a minimum of three servings/day for the relationship between BMI and CVD prevalence showed significant effects. The group that benefited the most from this effect was those with a BMI in the range of 26 to 34 kg/m2. CONCLUSIONS: This study provides new insights into the recommendation for legume intake according to the relationship between BMI and the prevalence of CVD in Malaysian adults. This study recommends that those with a BMI of 26 to 34 kg/m2 should consume at least 3 servings of legumes per day to reduce the risk of CVD. Further prospective research is warranted to affirm these findings throughout the Malaysian population.

Normative reference values and predicting factors of handgrip strength for dominant and non-dominant hands among healthy Malay adults in Malaysia.

INTRODUCTION: Handgrip strength (HGS) measures the maximum voluntary force of the hand, which has been used to assess individual health status indirectly. Although several factors related to HGS have been identified, studies among adults in Malaysia are lacking. This study aimed to provide the normative reference HGS values and determine its predictor factors among healthy adults of Malay ethnic in Malaysia. METHODOLOGY: This study was a part of the Prospective Urban Rural Epidemiology (PURE) study carried out among adults aged between 35 to 70 years old residing in urban and rural Malaysian communities. A standardised questionnaire was used to assess the socio-demographic information and physical activity level of respondents who provided written informed consent to participate in this study. HGS was measured using Jamar's dynamometer. A total of 3,446 healthy adults of Malay ethnic were included in this study. Descriptive data were used to derive the normative reference values for HGS using means and standard deviations stratified by age and gender. The predictors of HGS were determined using a general linear model (GLM). RESULTS: Mean HGS ranged from 38.48 (± 9.40) kg for the dominant hand of men aged 35-40 years to 16.53 (± 5.69) kg for the non-dominant hand of women aged 61-70 years. The ANOVA indicated that there was a significant descending trend of HGS as age increased for both genders (p < 0.05). The ANOVA also revealed that participants working in blue- or white-collar jobs had higher HGS than their counterparts who are homemakers (p < 0.05). The GLM shows that, age, occupation type, socio-economic status (SES), physical activity level and BMI significantly predicted dominant HGS among male and meanwhile, only age, SES and BMI significantly predicted dominant HGS among female. CONCLUSION: HGS normative values provided herein can serve as a guide for interpreting HGS measurements obtained from healthy Asian adults especially Malay ethnic. The clinicians and researcher can use the established HGS reference values as comparison in their patients or participants. Furthermore, during a rehabilitation process, the clinicians and researchers could use the normal score ranges to document the progress of HGS and provide feedback to the patients. Further study with prospective study design is needed to determine the causal effect association of the predictors and HGS.

Pattern of macronutrients intake among type-2 diabetes mellitus (T2DM) patients in Malaysia.

BACKGROUND: The incidence of type 2 diabetes mellitus (T2DM) is rising rapidly in Malaysia. Modifying dietary intake is key to both the prevention and treatment of T2DM. This study aims to investigate the pattern of macronutrient intake among T2DM patients in Malaysia. METHODS: This study was carried out on adults aged between 35 and 70 years, residing in urban and rural Malaysian communities. A series of standardised questionnaires was used to assess the sociodemographic information, dietary intake and physical activity level of 15,353 respondents who provided informed consent to participate in this study. Blood sampling (finger prick test) and physical examination were performed to obtain blood glucose and anthropometric data, respectively. The Chi-square test was used to assess differences in the trends of macronutrient intake among T2DM patients. RESULTS: The total number of participants diagnosed with T2DM in this study was 2254. Of these, 453 (20.1%) were newly diagnosed, 1156 (51.3%) were diagnosed for ≤5 years and 645 (28.6%) were diagnosed for > 5 years. Male patients show that there were significant differences among the three groups of T2DM according to the following variables: age, BMI, residency, participant comorbidity of hypertension, family history of T2DM and hypertension, and active smoker. Meanwhile, female patients show significant differences among the three groups of T2DM according to the following variables: age, BMI, marital status, education level, residency, participant comorbidity of hypertension and family history of T2DM. Most of the male patients consumed appropriate proportions of carbohydrate (458, 60.7%) and protein (618, 81.9%). However, female patients did not show any significant differences of the macronutrients intake among the three groups of T2DM patients. CONCLUSIONS: The pattern of dietary intake among T2DM patients in this study showed consumption of carbohydrate and protein within the range of Malaysian RNI, coupled with high fat intake. Compliance with the Recommended Nutrient Intake (RNI) was satisfactory for both carbohydrate and protein but not for fat. The pattern indicated a preference for fat rather than protein when carbohydrate intake was restricted.

The Determinants of Undiagnosed Hypertension among Urban Community of Kuala Lumpur, Malaysia.

Background: The prevalence of undiagnosed hypertension in Malaysia is 17.2%, which is higher compared to the known case of hypertension (13.1%) reported in 2015. For every two people diagnosed with hypertension, there will be three persons with undiagnosed hypertension; the trend has not changed since 2011. This study aimed to determine the determinants of undiagnosed hypertension among urban community of Kuala Lumpur, Malaysia. Methods: This was a cross-sectional study conducted among 206 participants in Kuala Lumpur, Malaysia from the ongoing Prospective Urban Rural Epidemiology (PURE) project. The samples with complete variable data were taken from the second year of follow-up, starting Jan 2014 till Dec 2015, through convenience sampling. Data were analyzed using descriptive analysis, simple logistic regression, and multivariable logistic regression. Results: Multivariable logistic regression showed that only four determinants were associated with undiagnosed hypertension which were the age group of 35 to 49 yr old (aOR: 5.9, 95% CI: 1.8; 19.1), secondary education level (aOR: 2.3, 95% CI: 1.1; 4.6), normal BMI (aOR: 5.1, 95% CI: 1.5; 16.6), and non-diabetes mellitus (aOR: 5.5, 95% CI: 2.5; 12.0). Conclusion: The determinants of undiagnosed hypertension in this study showed that low-risk groups of hypertension were highly underdiagnosed. The low-risk group of hypertension was easily approached at their working place. Thus, routine health screening and awareness campaigns should be emphasized substantially at the working place to detect undiagnosed hypertension. Early detection will be beneficial as early management can be initiated to prevent further complications.

Assessing Factors Associated with Non-Fatal Injuries from Road Traffic Accidents among Malaysian Adults: A Cross-Sectional Analysis of the PURE Malaysia Study.

Non-fatal injuries (NFIs) due to road traffic accidents (RTAs) are a public health problem worldwide that significantly impacts the population morbidity and healthcare costs. As the demands for vehicles in developing countries, such as Malaysia, is increasing annually, the present study aims to determine the prevalence and factors associated with NFIs due to RTAs among Malaysia's adult population. METHODS: This was a cross-sectional study involving 15,321 participants from the Prospective Urban and Rural Epidemiological (PURE) study conducted in Malaysia. Participants reported whether they had experienced an NFI that limited their normal activities within the past 12 months. Data on risk factors for NFIs were elicited. Multiple logistic regression models were fitted to identify the associated factors. RESULTS: Overall, 863 participants (5.6% of 15,321) reported at least 1 NFI in the past 12 months, with 303 caused by RTAs (35.1%), 270 caused by falls (31.3%) and 290 attributed to other causes (33.6%). The factors associated with higher odds of sustaining an NFI due to an RTA were being male (adjusted odd ratio (AOR) 2.08; 95% CI 1.33-3.26), having a primary (2.52; 1.40-4.55) or secondary (2.64; 1.55-4.49) level of education, being overweight to obese (1.40; 1.01-1.94), being currently employed (2.03; 1.31-3.13) and not practicing a noon nap/siesta (1.38; 1.01-1.89). CONCLUSIONS: The occurrence of NFIs due to RTAs is highly preventable with strategic planning aimed at reducing the risk of RTAs among the Malaysian population. Interventions focusing on protecting road users, especially those who drive two-wheelers, with proactive road safety awareness and literacy campaigns, combined with strict enforcement of the existing traffic laws and behavioural modifications, may reduce the risk of NFIs following RTAs.

Dietary sodium intake and its association with hypertension: A cross-sectional study in Selangor, Malaysia.

OBJECTIVE: To identify the prevalence of hypertension and its relationship with dietary sodium intake among the Malay population in Selangor, Malaysia. METHODS: Respondents were recruited from the year 2013 to 2015 from households in Klang Valley (urban area) and several settlements of the Federal Land Development Authority (FELDA) in Selangor (rural area). Data were collected using two questionnaires, a sociodemographic questionnaire and a food frequency questionnaire. RESULTS: A total of 3,453 adults participated in this study. The mean age of the respondents was 50.9 (±10.23) years. The prevalence of hypertension was 23.3%. Mean dietary sodium consumption was 3.6 (±6.63) grams/day, 1.6 grams higher than the current WHO recommendation. The prevalence of hypertension was higher among males aged 60 years and older; among rural population with low education level; among housewives and those with high dietary sodium intake. After adjusting for age, gender and marital status in a multiple logistic regression analysis, rural location (OR = 5.81) and high sodium intake (OR = 2.33) have been shown to affect the incidence of hypertension. CONCLUSIONS: A substantial proportion of Malay population in Selangor was hypertensive with a higher sodium intake than the WHO recommendation. Hypertension was associated with rural location and high sodium intake. Sustainable and cost-effective population-based health promotion and prevention interventions using a multi-sectoral approach are needed to ensure sufficient community sodium intake.

Application of Fuzzy Delphi in the Selection of COPD Risk Factors among Steel Industry Workers.

BACKGROUND: The Delphi method has been widely applied in many study areas to systematically gather experts' input on particular topic. Recently, it has become increasingly well known in health related research. This paper applied the Fuzzy Delphi method to enhance the validation of a questionnaire pertaining chronic obstructive pulmonary disease (COPD) risk factors among metal industry workers. MATERIALS AND METHODS: A detailed, predefined list of possible risk factors for COPD among metal industry workers was created through a comprehensive and exhaustive review of literature from 1995 to 2015. The COPD questionnaire were distributed among people identified as occupational, environmental, and hygiene experts. Linguistic variable using Likert scale was used by the expert to indicate their expert judgment of each item. Subsequently, the linguistic variable was converted into a triangular fuzzy number. The average score of the fuzzy number will be used to determine whether the item will be removed or retained. RESULTS: Ten experts were involved in evaluating 26 items. The experts were in agreement with most of the items, with an average fuzzy number range between 0.429 and 0.800. Two items were removed and three items were added, leaving a total 26 items selected for the COPD risk factors questionnaire. The experts were in disagreement with each other for items F10 and F11 where most of the experts claimed that the question is too subjective and based on self-perception only. CONCLUSION: The fuzzy Delphi method enhanced the accuracy of the questionnaire pertaining to COPD risk factors, and decreased the length of the established tools.

Metal dust exposure and lung function deterioration among steel workers: an exposure-response relationship.

BACKGROUND: Metallic dust is a heterogeneous substance with respiratory sensitizing properties. Its long term exposure adversely affected lung function, thus may cause acute or chronic respiratory diseases. METHODS: A cross-sectional study was conducted in a steel factory in Terengganu, Malaysia to assess the metal dust exposure and its relationship to lung function values among 184 workers. Metal dust concentrations values (Co, Cr, and Ni) for each worker were collected using air personal sampling. Lung function values (FEV1, FVC, and %FEV1/FVC) were determined using spirometer. RESULTS: Exposure to cobalt and chromium were 1-3 times higher than permissible exposure limit (PEL) while nickel was not exceeding the PEL. Cumulative of chromium was the predictor to all lung function values (FEV1, FVC, and %FEV1/FVC). Frequency of using mask was positively associated with FVC (Adj b = 0.263, P = 0.011) while past respiratory illnesses were negatively associated with %FEV1/FVC (Adj b = -1.452, P = 0.026). Only few workers (36.4%) were found to wear their masks all times during the working hours. CONCLUSIONS: There was an exposure-response relationship of cumulative metal dust exposure with the deterioration of lung function values. Improvement of control measures as well as proper and efficient use or personal protection equipment while at work could help to protect the respiratory health of workers.

Pesticides Exposure and Cardiovascular Hemodynamic Parameters Among Male Workers Involved in Mosquito Control in East Coast of Malaysia.

BACKGROUND: Research findings have linked exposure to pesticides to an increased risk of cardiovascular (CVS) diseases. Therefore, this study aimed to assess the impact of chronic mix-pesticides exposure on CVS hemodynamic parameters. METHODS: A total of 198 male Malay pesticide-exposed and 195 male Malay nonexposed workers were examined. Data were collected through exposure-matrix assessment, questionnaire, blood analyses, and CVS assessment. Explanatory variables comprised of lipid profiles, paraoxonase 1 (PON1), and oxidized low-density lipoprotein (ox-LDL). Outcome measures comprised of brachial and aortic diastolic blood pressure (DBP) and systolic BP (SBP), heart rate, and pulse wave velocity (PWV). Linear regressions identified the B coefficient showing how many units of CVS parameters are associated with each unit of covariates. RESULTS: Diazoxonase was significantly lower and ox-LDL was higher among pesticide-exposed workers than the comparison group. The final multivariate linear regression model revealed that age, body mass index (BMI), smoking, and pesticide exposure were independent predictors of brachial and aortic DBP and SBP. Pesticide exposure was also associated with heart rate, but not with PWV. Lipid profiles, PON1 enzymes, and ox-LDL showed no association with any of the CVS parameters. CONCLUSIONS: Chronic mix-pesticide exposure among workers involved in mosquito control has possible association with depression of diazoxonase and the increase in ox-LDL, brachial and aortic DBP and SBP, and heart rate. This study raises concerns that those using pesticides may be exposed to hitherto unrecognized CVS risks among others. If this is confirmed by further studies, greater efforts will be needed to protect these workers.

The Malay Version of the Perceived Stress Scale (PSS)-10 is a Reliable and Valid Measure for Stress among Nurses in Malaysia.

BACKGROUND: The Perceived Stress Scale-10 (PSS-10) is widely used to assess stress perception. The aim of this study was to translate the original PSS-10 into Malay and assess the reliability and validity of the Malay version among nurses. METHODS: The Malay version of the PSS-10 was distributed among 229 nurses from four government hospitals in Selangor State. Test-retest reliability and concurrent validity was conducted with 25 nurses with the Malay version of the Depression Anxiety Stress Scales (DASS) 21. Cronbach's alpha, confirmatory factor analysis (CFA), intraclass correlation coefficient and Pearson's r correlation coefficient were used to determine the psychometric properties of the Malay PSS-10. RESULTS: Two factor components were yielded through exploratory factor analysis with eigenvalues of 3.37 and 2.10, respectively. Both of the factors accounted for 54.6% of the variance. CFA yielded a two-factor structure with satisfactory goodness-of-fit indices [x2/df = 2.43; comparative fit index (CFI) = 0.92, goodness-of-fit Index (GFI) = 0.94; standardised root mean square residual (SRMR) = 0.07 and root mean square error of approximation (RMSEA) = 0.08 (90% CI = 0.07-0.09)]. The Cronbach's alpha coefficient for the total items was 0.63 (0.82 for factor 1 and 0.72 for factor 2). The intraclass correlation coefficient (ICC) was 0.81 (95% CI: 0.62-0.91) for test-retest reliability testing after seven days. The total score and the negative component of the PSS-10 correlated significantly with the stress component of the DASS-21: (r = 0.61, P < 0.001) and (r = 0.56, P < 0.004), respectively. CONCLUSION: The Malay version of the PSS-10 demonstrated a satisfactory level of validity and reliability to assess stress perception. Therefore, this questionnaire is valid in assessing stress perception among nurses in Malaysia.

Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries.

IMPORTANCE: Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. OBJECTIVE: To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of 153,996 adults (complete data for this analysis on 142,042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper-middle-income and low-middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC). MAIN OUTCOMES AND MEASURES: Hypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure-lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg. RESULTS: Among the 142,042 participants, 57,840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26,877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23,510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure-lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries. CONCLUSIONS AND RELEVANCE: Among a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment.

Urban vs. rural factors that affect adult asthma.

In this review, our aim was to examine the influence of geographic variations on asthma prevalence and morbidity among adults, which is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity. Asthma is a complex inflammatory disease of multifactorial origin, and is influenced by both environmental and genetic factors. The disparities in asthma prevalence and morbidity among the world's geographic locations are more likely to be associated with environmental exposures than genetic differences. In writing this article, we found that the indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke in both urban and rural areas. Asthma and asthma-related symptoms occurred more frequently in urban than in rural areas, and that difference correlated with environmental risk exposures, SES, and healthcare access. Environmental risk factors to which urban adults were more frequently exposed than rural adults were dust mites,high levels of vehicle emissions, and a westernized lifestyle.Exposure to indoor biological contaminants in the urban environment is common.The main risk factors for developing asthma in urban areas are atopy and allergy to house dust mites, followed by allergens from animal dander. House dust mite exposure may potentially explain differences in diagnosis of asthma prevalence and morbidity among adults in urban vs. rural areas. In addition, the prevalence of asthma morbidity increases with urbanization. High levels of vehicle emissions,Western lifestyles and degree of urbanization itself, may affect outdoor and thereby indoor air quality. In urban areas, biomass fuels have been widely replaced by cleaner energy sources at home, such as gas and electricity, but in most developing countries, coal is still a major source of fuel for cooking and heating, particularly in winter. Moreover, exposure to ETS is common at home or at work in urban areas.There is evidence that asthma prevalence and morbidity is less common in rural than in urban areas. The possible reasons are that rural residents are exposed early in life to stables and to farm milk production, and such exposures are protective against developing asthma morbidity. Even so, asthma morbidity is disproportionately high among poor inner-city residents and in rural populations. A higher proportion of adult residents of nonmetropolitan areas were characterized as follows:aged 55 years or older, no previous college admission, low household income, no health insurance coverage, and could not see a doctor due to healthcare service availability, etc. In rural areas, biomass fuels meet more than 70% of the rural energy needs. Progress in adopting modern energy sources in rural areas has been slow. The most direct health impact comes from household energy use among the poor, who depend almost entirely on burning biomass fuels in simple cooking devices that are placed in inadequately ventilated spaces. Prospective studies are needed to assess the long-term effects of biomass smoke on lung health among adults in rural areas.Geographic differences in asthma susceptibility exist around the world. The reason for the differences in asthma prevalence in rural and urban areas may be due to the fact that populations have different lifestyles and cultures, as well as different environmental exposures and different genetic backgrounds. Identifying geographic disparities in asthma hospitalizations is critical to implementing prevention strategies,reducing morbidity, and improving healthcare financing for clinical asthma treatment. Although evidence shows that differences in the prevalence of asthma do exist between urban and rural dwellers in many parts of the world, including in developed countries, data are inadequate to evaluate the extent to which different pollutant exposures contribute to asthma morbidity and severity of asthma between urban and rural areas.

Do indoor environments influence asthma and asthma-related symptoms among adults in homes?: a review of the literature.

This review summarizes the results of epidemiological studies focusing on the detrimental effects of home environmental factors on asthma morbidity in adults. We reviewed the literature on indoor air quality (IAQ), physical and sociodemographic factors, and asthma morbidity in homes, and identified commonly reported asthma, allergic, and respiratory symptoms involving the home environment. Reported IAQ and asthma morbidity data strongly indicated positive associations between indoor air pollution and adverse health effects in most studies. Indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke. Environmental exposure may increase an adult's risk of developing asthma and also may increase the risk of asthma exacerbations. Evaluation of present IAQ levels, exposure characteristics, and the role of exposure to these factors in relation to asthma morbidity is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity.

Serum selenium level and other risk factors for breast cancer among patients in a Malaysian hospital.

OBJECTIVE: The aim of this study is to investigate the association between breast cancer and serum selenium level as well as other risk factors for breast cancer. METHODS: A matched case-control study was conducted in a hospital in Malaysia from July 2000 to January 2001 and from May 2001 to June 2001. Sixty-two newly diagnosed breast cancer patients were selected as the cases. Each control, selected from the same hospital population was matched to each case according to age, ethnic group, and menopausal status. RESULTS: The mean selenium concentration among the cases was significantly lower than that among the control. There was a significant association (p<0.05) between breast cancer and low selenium serum level, nulliparity (OR=5.5,95% CI=1.22 to 24.81), exposure to cigarette smoke (OR=2.2, 95% CI=1.04 to 4.65) and use of oral contraceptives (OR=3.0, 95% CI=1.09 to 8.25) as determined by the McNemar test. Multivariate analysis showed that nulliparity (OR=10.08, 95% CI=1.48 to 68.52) and use of oral contraceptives (OR=3.66, 95% CI=1.36 to 9.87) were associated with increased breast cancer risk. An increased selenium concentration contributes to a reduced risk of breast cancer (OR=0.89, 95% CI=0.84 to 0.94). CONCLUSION: The results suggest that use of oral contraceptive pills, being nulliparous, and a low serum selenium level are associated with breast cancer.

Implication of the prevalence of needlestick injuries in a general hospital in Malaysia and its risk in clinical practice

<p><b>OBJECTIVES</b>To determine the prevalence of cases and episodes of needlestick injury among three groups of health care workers in the past one-year, the level of knowledge on blood-borne diseases and universal precautions and the practice of universal precautions. Other factors associated with the occurrence of needlestick injuries and the reporting of needlestick injuries were also analysed.</p><p><b>METHODS</b>A cross-sectional study was conducted in May 2003 to study the needlestick injuries among 285 health care workers (doctors, nurses, medical students) in a public teaching hospital in Negeri Sembilan, Malaysia.</p><p><b>RESULTS</b>The prevalence of needlestick injuries among the respondents was 24.6% involving 71 cases i.e. 48.0% among doctors, 22.4% among medical students, and 18.7% among nurses and the difference was statistically significant (p<0.001). There were a total of 174 episodes of needlestick injury. Prevalence of episode of needlestick injuries was highest among doctors (146%), followed by nurses (50.7%) and medical students (29.4%). Cases of needlestick injuries attained lower scores on practice of universal precautions compared to non-cases (p<0.001). About 59% of cases of needlestick injury did not report their injuries.</p><p><b>CONCLUSIONS</b>The study showed that needlestick injuries pose a high risk to health care workers and it is underreported most of the time. Many needlestick injuries can be prevented by strictly following the practice of universal precautions.</p>