Moy Foong Ming

Abstract: The International Physical Activity Questionnaire (IPAQ) was developed to assess the physical activity patterns in populations. The authors aim to examine the reliability and validity of the Malay version of IPAQ (IPAQ-M). The IPAQ-M was self-administered twice at a 1-week interval to assess its test�retest reliability. Criterion validity was assessed between the IPAQ-M and a 7-day physical activity log (PA-Log). A total of 81 Malay adults participated in the study. Intraclass correlation coefficients (ICC), kappa (κ), correlation coefficients (�), and Bland�Altman plot were used for data analyses. The ICC scores revealed moderate to good correlations (ICC = 0.54-0.92; P < .001) on items categorized by intensities and domains and a κ of 0.73 for total activity. Validity results from the PA-Log were statistically significant (P < .001) across intensities and domains (� = 0.67-0.98). The IPAQ-M demonstrated good reliability and validity for the evaluation of physical activity among this Malay population.

Abstract: The common variants in the fat mass- and obesity-associated (FTO) gene have been previously found to be associated with obesity in various adult populations. The objective of the present study was to investigate whether the single nucleotide polymorphisms (SNPs) and linkage disequilibrium (LD) blocks in various regions of the FTO gene are associated with predisposition to obesity in Malaysian Malays. Thirty-one FTO SNPs were genotyped in 587 (158 obese and 429 non-obese) Malaysian Malay subjects. Obesity traits and lipid profiles were measured and single-marker association testing, LD testing, and haplotype association analysis were performed. LD analysis of the FTO SNPs revealed the presence of 57 regions with complete LD (D� = 1.0). In addition, we detected the association of rs17817288 with low-density lipoprotein cholesterol. The FTO gene may therefore be involved in lipid metabolism in Malaysian Malays. Two haplotype blocks were present in this region of the FTO gene, but no particular haplotype was found to be significantly associated with an increased risk of obesity in Malaysian Malays

Abstract: Background: Job stressors may reduce the likelihood of quitting smoking. Aims: To assess the association between job strain, smoking behaviour and smoking cessation among Malaysian male employees involved in a smoking cessation programme. Methods: The study was conducted among employees in two major public universities in Malaysia. All staff from both universities received an invitation to participate in this study. At the start of treatment, participants completed a questionnaire on sociodemographic variables, smoking habits and the Malay version of the Job Content Questionnaire (JCQ). The JCQ consists of scales of job control, job demand, supervisor support, co-worker support, job insecurity, job decision latitude and job skill discretion. Behaviour therapy with free nicotine replacement therapy (NRT) was given as treatment for two months. Participants were contacted at 1 week, 3 months and 6 months to determine their smoking status. Results: One hundred and eighty five staff from both universities responded and voluntarily showed interest in quitting. At three months (OR = 8.96; 95% CI: 1.14-70.76) and six months (OR = 8.9; 95% CI: 1.15-68.65), men with higher co-workers' support demonstrated a higher likelihood of quitting. Smokers in a 'passive job' also demonstrated higher likelihood of quitting compared with those working in the 'low strain' category at six months (OR = 9.92; 95% CI: 1.20-82.68). No meaningful associations were found between other psychosocial job variables and smoking cessation. Conclusions: A positive relationship with and support from co-workers are important factors for workplace smoking cessation. © The Author 2012. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved.

Abstract: Hypertension is a major public health problem in Malaysia. The National Health and Morbidity Survey 2006 showed the prevalence of hypertension among adults 30 years and above was 43%. Therefore we attempted to examine the association of known modifiable and non-modifiable risk factors of hypertension. A survey was initiated among the rural population of Northern Perak. A total of 2025 respondents aged 30 years and above were recruited using a multi-stage sampling among five districts in Northern Perak. Hypertension was defined as self-reported hypertension and/or average of two blood pressure readings at single occasion with SBP � 140mmHg or DBP � 90 mmHg. Body mass index (BMI) was defined using the Asian criteria and IPAQ was used to evaluate physical activity. Body weight, height and blood pressure were obtained using standard procedures. In total, 1076 (54.9%) respondents were found to be hypertensive. Significant associations (p <0.001) with hypertension were noted for increasing age, low physical activity, high BMI, no education background and positive family history of hypertension. The association between hypertension and each risk factor was investigated after adjusting for age, sex, ethnicity, education background, family history, BMI, physical activity, smoking and diet using Multiple Logistic Regression. Respondents who were obese had the odds of 3.69 (95% CI: 2.22-6.14) of having hypertension while those with positive family history had the odds of 1.96 (1.59-2.42) times for hypertension. A significant increase (p <0.001) in risk for hypertension was noted for age. Those with moderate physical activities were 1.40 (1.04-1.78) times more of having hypertension than those active. Poor diet score and smoking were not significantly associated with increased risk for hypertension. In conclusion, modifiable risk factors such as BMI and physical activity are important risk factors to target in reducing the risk for hypertension.

Abstract: Background: Disease-related malnutrition is highly prevalent in hospital patients and varies from 25-40%. Early nutritional screening of patients at admission helps to improve recognition of malnourished patients to allow early interventions and enhance clinical outcomes. Method: A total of 104 reoperative surgical patients with oesophageal (34), stomach (17) or pancreatic cancer xD;(53) were recruited in our study. The risk of malnutrition was examined using the quick-and-easy Malnutrition Universal Screening Tool (MUST). Anthropometric data and information on percent weight change over the past six months, unintentional weight loss, dietician referrals, and history of nutritional intervention were collected. Results: A total of 75% of our participants were at high malnutrition risk with a mean (±SD) percentage weight loss of 5.18 (±6.23)%, despite a mean BMI of 26.09 (±5.73) kgm-2. Participants with a significantly higher percent weight loss, unintentional weight loss, dietician xD;referral and nutritional intervention had a higher risk of malnutrition (p<0.05). Presence of unintentional weight loss was the only significant predictor (OR 3.22; 95% CI 1.23, 8.40) associated with risk of malnutrition after adjusted for all confounders. Conclusion: In conclusion, our findings highlight the importance of routine screening of malnutrition in oncology patients. Medical personnel must be aware that unintentional weight loss is an important predictor xD;of malnutrition risks even if the patient�s BMI is not suggestive of malnutrition.

Abstract: Introduction: We report about the direct short-term effects of a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module on the knowledge, attitude, and behavior of students in the University Medical Center Utrecht (UMCU), Universitas Indonesia (UI), and University of Malaya (UM). xD;Methods: We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP). The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's α to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. xD;Results: In total, 526 students (224 UI, 202 UM, and 100 UMCU) completed the questionnaires. In the three medical schools, Cronbach's α for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD) score as the following: knowledge 5.04 (0.4) vs. 4.73 (0.69) and 4.24 (0.74), p<0.001; attitude 4.52 (0.64) vs. 3.85 (0.68) and 3.55 (0.63), p<0.001; behavior 2.62 (0.55) vs. 2.35 (0.71) and 2.39 (0.92), p=0.016; and future use of EBP 4.32 (0.59) vs. 4.08 (0.62) and 3.7 (0.71), p<0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.04±0.4 to 5.35±0.51; p<0.001) and UM students (from average 4.24±0.74 to 4.53±0.72; p<0.001) but not UI. The post-module scores for attitude did not change in the three medical schools. xD;Conclusion: EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in pre-module scores are most likely related to differences in the system and infrastructure of both medical schools and their curriculum.

Abstract: BACKGROUND: Many smokers attempt to quit smoking, but very few succeed. OBJECTIVE: To identify the timing and risk factors involved in smoking relapse. METHODS: We conducted a prospective cohort study among staff in two public universities in Malaysia. Behavioural therapy with free nicotine replacement therapy was given as treatment. Participants were followed up for 6 months. Relapse was defined as returning to smoking after having quit for at least 24 h. RESULTS: Of 185 smokers who volunteered to participate, 120 achieved at least 24-h abstinence, and 80% of these relapsed within 2 months. Compared to participants who attended a single smoking cessation session, participants who attended three sessions had a lower likelihood of relapse within 6 months of quitting. In contrast, smokers with a much longer exposure to cigarette smoking in the workplace (>3 h per week) had a greater chance of relapse compared to those with no exposure. CONCLUSIONS: Frequent attendance at clinic sessions and less exposure to other people smoking in the workplace can potentially reduce the likelihood of relapse among smokers who have recently quit. © 2012 The Union.

Abstract: Clinical epidemiology (CE) and evidence-based medicine (EBM) have become an important part of medical school curricula. This report describes the implementation and some preliminary outcomes of an integrated CE and EBM module in the Faculty of Medicine Universitas Indonesia (UI), Jakarta and in the University of Malaya (UM) in Kuala Lumpur. A CE and EBM module, originally developed at the University Medical Center Utrecht (UMCU), was adapted for implementation in Jakarta and Kuala Lumpur. Before the start of the module, UI and UM staff followed a training of teachers (TOT). Student competencies were assessed through pre and post multiple-choice knowledge tests, an oral and written structured evidence summary (evidence-based case report, EBCR) as well as a written exam. All students also filled in a module evaluation questionnaire. The TOT was well received by staff in Jakarta and Kuala Lumpur and after adaptation the CE and EBM modules were integrated in both medical schools. The pre-test results of UI and UM were significantly lower than those of UMCU students (p < 0.001). The post test results of UMCU students were comparable (p = 0.48) with UI, but significantly different (p < 0.001) from UM. Common problems for the modules in both UI and UM were limited access to literature and variability of the tutors� skills. Adoption and integration of an existing Western CE-EBM teaching module into Asian medical curricula is feasible while learning outcomes obtained are quite similar.

Abstract: Vitamin D status is influenced by sun exposure, geographic latitude, daily outdoor activities, body surface exposed to sunlight and dietary intakes. Malaysia, is sunny all year round. However, the vitamin D status of this population especially among the healthy and free living adults is not known. Therefore a study of vitamin D status and associated factors was initiated among an existing Malay cohort in Kuala Lumpur. A total of 380 subjects were sampled to have their vitamin D status assessed using 25-hydroxyvitamin D (25(OH)D). A short questionnaire enquiring socio-demographic characteristics, exposure to sunlight and clothing style was administered. Their mean age was 48.5 ± 5.2 years and the mean 25(OH)D for males and females were 56.2 ± 18.9 nmol/L and 36.2 ± 13.4 nmol/L respectively. There were significant positive correlation for sun exposure score (r = 0.27, p < 0.001) and negative correlation for sun protection score (r = -0.41, p < 0.001) with 25(OH)D levels. In the logistic regression model, females (OR = 2.93; 95% CI: 1.17, 7.31), BMI (1.1; 1.03, 1.20) and sun exposure score (0.998; 0.996, 0.999) were significantly associated with vitamin D status as represented by 25(OH)D levels. Our findings show that obesity, lifestyle behaviours and clothing style are directly associated with our participants especially females' low vitamin D status. © 2011 Elsevier B.V. All rights reserved.

Abstract:

Abstract: Background: Cardiovascular diseases are the major cause of death in Malaysia. Evidence shows that dietary fat intake is one of the important risk factors for cardiovascular disease. However, studies assessing the association of fatty acids and risk of cardiovascular diseases in Malaysia are scarce. Therefore, this study aimed to develop and validate a food frequency questionnaire (FFQ) assessing total fat and different types of fat among Malay adults in Malaysia. Methods: A 100 food item FFQ focused on dietary cholesterol, total fat, saturated fat, monounsaturated fat and polyunsaturated fat intake for the past one month was developed and validated against 3-day dietary record (DR) among 151 Malay participants. Validity was assessed through the reliability and agreement of two methods. Intra-class correlation (ICC) coefficients were used to assess reliability; while regression analysis and classification into categories were used to assess agreement of the two methods. Results: The mean nutrient intakes tended to be higher in FFQ compared to DR. The developed FFQ showed excellent reliability with ICC coefficients ranging from 0.92-0.98. Regression analysis demonstrated an acceptable agreement between FFQ and DR for total fat and different types of fat intakes. There were a relatively high proportion of subjects being correctly classified (into same or adjacent category) and only a small number of grossly misclassification for total energy, fat, dietary cholesterol, saturated fat and unsaturated fat occurred. Conclusion: This FFQ is valid in assessing absolute total energy, total fat and types of fat intakes among Malay adults.

Abstract: Background: Vitamin D status, as indicated by 25-hydroxyvitamin D is inversely associated with adiposity, glucose homeostasis, lipid profiles, and blood pressure along with its classic role in calcium homeostasis and bone metabolism. It is also shown to be inversely associated with metabolic syndrome and cardiovascular diseases in western populations. However, evidence from the Asian population is limited. Therefore, we aim to study the prevalence of vitamin D insufficiency (< 50 nmol/L) and the association of 25-hydroxyvitamin D with metabolic risk factors among an existing Malay cohort in Kuala Lumpur. Methods. This is an analytical cross sectional study. A total of 380 subjects were sampled and their vitamins D status (25-hydroxyvitamin D), fasting blood glucose, full lipid profile were assessed using venous blood. Systolic and diastolic blood pressure, weight, height and waist circumference were measured following standard protocols. Socio-demographic data such as sex, age, smoking status etc were also collected. Data was analysed using t-test, chi-square test, General Linear Model and multiple logistic regression. Results: Females made up 58% of the sample. The mean age of respondents was 48.5 (SD 5.2) years. Females had significantly lower mean Vitamin D levels (36.2; 95% CI: 34.5, 38.0 nmol/L) compared to males (56.2; 95% CI: 53.2, 59.2 nmol/L). Approximately 41% and 87% of males and females respectively had insufficient (< 50 nmol/L) levels of 25-hydroxyvitamin D (p < 0.001). The prevalence of Metabolic Syndrome for the whole sample was 38.4 (95% CI: 33.5, 43.3)%. In the multivariate model (adjusted for age, sex, abdominal obesity, HDL-cholesterol, diastolic blood pressure), insufficient Vitamin D status was significantly associated with 1-year age increments (OR: 0.93; 95% CI: 0.88, 0.98), being female (OR: 8.68; 95% CI: 5.08, 14.83) and abdominal obesity (OR: 2.57; 95% CI: 1.51, 4.39). Respondents with insufficient vitamin D were found to have higher odds of having Metabolic Syndrome (OR: 1.73; 95% CI: 1.02, 2.92) after adjusting for age and sex. Conclusions: Our results highlight the high prevalence of vitamin D insufficiency among Malay adults in Kuala Lumpur. Vitamin D insufficiency is independently associated with younger age, female sex and greater abdominal obesity. Vitamin D insufficiency is also associated with Metabolic Syndrome. © 2011 Moy and Bulgiba; licensee BioMed Central Ltd.

Abstract: Recent findings have shown that the rs1042714 (Gln27Glu) single-nucleotide polymorphism (SNP) on the �²2-adrenoceptor gene may predispose to obesity. The findings from other studies carried on different populations, however, have been inconsistent. The authors investigated the association between the rs1042714 SNP with obesity-related parameters. DNA of 672 Malaysian Malays was analyzed using real-time polymerase chain reaction. Univariate and multivariate linear regression analyses revealed significant associations between rs1042714 and diastolic blood pressure in the pooled Malaysian Malay subjects under additive and recessive models. After gender stratification, however, a significant association was found between the rs1042714 and triglyceride and the rs1042714 and log-transformed high-density lipoprotein cholesterol levels in Malaysian Malay men. No significant association was found between the SNP and log-transformed body mass index. This polymorphism may have an important role in the development of obesity-related traits in Malaysian Malays. Gender is an effect modifier for the effect of the rs1042714 polymorphism on obesity-related traits in Malaysian Malays.

Abstract: Background: Reduced handgrip strength is an aging process that significantly influences the living activities of elderly. It is linked to premature mortality, disability and other health complications among elderly. Therefore, we aim to determine the associated predictors with handgrip strength among the free living elderly in Malaysia. Methods: This was a cross sectional study conducted in a rural state in Malaysia. A total of 434 elderly individuals performed handgrip assessment. Socio-demographic characteristics, medical conditions, occupational history, functional ability (ADL) and depression (GDS) were enquired. Anthropometric measurements (weight and height) were also obtained. Results: Majority of the respondents were Malays with mean age of 67.9 ± 6.3 years. Maximum handgrip strength of males and females were 28.8±9.2 kg and 18.9±6.9 kg respectively (P<0.05). The aborigines had significantly lower handgrip strength (P<0.05) compared to Malays, Chinese and Indians. Handgrip strength was positively correlated (P<0.05) with weight, height and ADL, while negatively associated (P<0.05) with GDS for both gender. In the multivariate linear regression analysis; weight, height and race significantly predicted handgrip strength among both male and female elderly after adjustment for all potential confounders. However, GDS and ADL were only found to significantly predict handgrip strength among the male elderly; while age was only significant among the females. Conclusion: Our sample population has significantly lower handgrip strength than the Western counterpart. Weight, height and race significantly predict handgrip strength among both male and female elderly. GDS, ADL are only found to be significant in males while age was only significant among the females.

Abstract: Background: There is an unclear relationship between smoker's early motivation and success rates. Here we aimed to explore the correlates of motivation and smoking abstinence and relapse in worksite smoking cessation programmes. Methods: This prospective cohort study involved employees from two major public universities in Malaysia. Participants were actively recruited into a smoking cessation programme. At the start of treatment, participants were administered a questionnaire on sociodemographic variables, smoking habits and 'stage of change'. Behaviour therapy with free nicotine replacement therapy (NRT) was given as treatment for two months. A similar stage of change questionnaire was given at six months, and their smoking status was determined. Results: There were 185 smokers from both Universities, who joined the programme. At six months, 24 smokers reported sustained abstinence while the others had relapsed. Prior to the programme, the majority of smokers were seriously planning on quitting (59.5%- preparation stage), but over a third had no plans to quit (35.5%- contemplation stage). There was no significant difference noted in changes of motivation stage among the relapsers and the non quitters. In addition, logistic regression showed that sustained abstinence was not predicted by pre-session motivation stage, but this did predict higher relapse for the participants, compared to those in the preparation stage. Conclusion: It is possible to help smokers in the lower motivation groups to quit, provided extra caution is taken to prevent relapse. Healthcare providers' recruitment strategies for cessation programmes should thus encompass smokers in all motivation stages.

Abstract: Objective: The authors examined the effects that change in perception about the advantages and disadvantages of smoking and quitting had on quitting outcome among smokers enrolled in a program for smoking cessation. Methods: A total of 185 smokers from 2 public universities who were interested in quitting received smoking cessation counseling on understanding the risks and benefits of quitting (or smoking) in addition to a course of free nicotine replacement therapy (NRT). A decisional balance questionnaire (DBQ) was administered at baseline and at 2 months postcounseling to determine and assess changes in smoking perception. Results: After counseling, 72.3% of smokers had reduced their perceptions about the advantages of smoking, and 66.4% had increased perceptions of disadvantages of smoking. At the eighth week, 51 participants (27%) had quit. Smokers who had reduced perceptions of the advantages of smoking had significantly higher quit rates compared with those with no improvement in perception (82.6% vs 17.4%; odds ratio = 2.47; 95% confidence interval = 1.00-6.10). Conclusion: After counseling, smokers did change their perception of the advantages and disadvantages of smoking during the quitting process. These changes are associated with a higher likelihood of smoking cessation.

Abstract: Smoking cessation studies are often performed in clinic based settings. The present example aimed to find predictors of success among staff in worksite smoking cessation programmes in two major public universities in Klang Valley, Malaysia. All staff from both universities received an open invitation via staff e-mail and letters to participate. At the start of treatment, participants were administered the Rhode Island Stress and Coping Questionnaire and Family Support Redding's Questionnaire. Behaviour therapy with free nicotine replacement therapy (NRT) were given as treatment. After two months, they were contacted to determine their smoking status. 185 staff from University A (n=138) and University B (n=47), responded and voluntarily showed interest to quit. There was no significant difference in respondents with respect to socio demographic characteristics and smoking history. After two months of treatment, quit rates were 24% in University A vs. 38 % in University B (p>0.05). Univariate predictors of cessation were adherence to NRT (p<0.001), smoking fewer cigarettes per day (p<0.05) and the number of behaviour therapy sessions attended (p<0.001). Logistic regression identified 3 significant predictors of smoking cessation. Participants attending more than one session (OR= 27.00; 95% CI : 6.50; 111.6), and having higher pre-treatment general stress (OR= 2.15; 95% CI: 1.14; 4.05) were more likely to quit, while a higher number of cigarettes smoked (OR= 0.19: 95% CI: 0.06; 0.59) reduced the likelihood of quitting. Increasing age, ability to cope with stress and family support were not significant predictors. We conclude that factors such as the number of counseling sessions, the amount of cigarettes smoked at baseline, adherence to NRT and pretreatment stress are important considerations for success in a worksite smoking cessation programme.

Abstract: Background. Metabolic Syndrome is associated with increased risk for type 2 diabetes and cardiovascular diseases. However, different diagnostic criteria have been recommended by different expert groups. In Malaysia, there is a lack of research comparing these different diagnostic criteria. Therefore, it is our aim to study the concordance between the IDF and the modified NCEP ATP III definitions of Metabolic Syndrome among a Malay cohort in Kuala Lumpur; and to demonstrate if all participants have the same cardiometabolic risks. Methods. This was an analytical cross sectional study. Ethics approval was obtained and informed consent was given by all participants. Anthropometric measurements, blood pressure, fasting blood glucose and lipid profile were taken following standard protocols. Results. Metabolic Syndrome was diagnosed in 41.4% and 38.2% participants using the modified NCEP and IDF criteria respectively. Among those diagnosed with Metabolic Syndrome by modified NCEP, 7.6% were missed by the IDF criteria. Participants diagnosed by the modified NCEP criteria had lower BMI and waist circumference but had higher cardiometabolic risks than those diagnosed with both criteria. Their blood pressure, glucose, total cholesterol and triglyceride were more adverse than the IDF group. This demonstrated that central obesity may not be a prerequisite for the development of increased cardiometabolic risks within this Malay cohort. Conclusion. Metabolic syndrome is common in this Malay cohort regardless of the criterion used. The modified NCEP ATP III criteria may be more suitable in diagnosis of metabolic syndrome for this Malay cohort. © 2010 Moy and Bulgiba; licensee BioMed Central Ltd.

Abstract: Night work and rotating shift work are found to be detrimental to the health of workers. A cross sectional analytical study was conducted among the employees of a public medical centre in Kuala Lumpur. A total of 380 employees participated in the health screening and questionnaire survey. The majority of the respondents were Malays, females, and with mean age of 49 years old. The shift workers persistently had higher but non-significant proportions of being overweight/obesity and unhealthy clinical indicators such as systolic and diastolic blood pressure, fasting blood glucose and lipid profile except waist circumferences and HDL-cholesterol. There were also slightly more shift workers diagnosed with diabetes mellitus, hypertension or coronary heart disease (p>0.05). Although the present study could not provide established evidence for a relationship between shift work and cardiovascular risks, this could serve as a pilot study for future studies in this area.

Abstract: This was a cross-sectional study to determine the prevalence and characteristics of mother-infant bed-sharing practice in Klang district, Malaysia. Data was collected by face-to-face interview using a structured questionnaire for a four month period in 2006. A total of 682 mother-infant pairs attending government health clinics were included in the study. Data regarding socio-demographic characteristics of the mothers, information on the infants, bed-sharing and breastfeeding practices were collected. The mean maternal age was 28.4 ± 5.1 years while the mean infant gestational age was 38.8 ± 1.8 weeks. The study showed the prevalence of bed-sharing was 73.5% (95% CI: 70.0, 76.7). In multivariate analysis; area of interview, maternal occupation, family income, breastfeeding and infant birth weight were associated with bed-sharing after adjusted for maternal ethnicity, age, marital status, educational level, parity, infant gender and infant gestational age. In conclusion, bed-sharing is a common practice in Klang district, Malaysia, not specific to ethnicity, but strongly associated with low family income and breastfeeding.

Abstract: An analytical cross-sectional study was conducted in a public university in Kuala Lumpur among a random sample of 2665 undergraduates. The objective was to study the prevalence of breakfast skipping and its associated factors. Data collection was conducted via a self-administered pre-tested questionnaire. There were 43.5% male respondents, with Malays being the majority (58.3%). The prevalence of breakfast skipping was 29.2 (95% CI: 27.3 - 30.3) %. The factors significantly associated with breakfast skipping (p<0.05) were age, race, accommodation, faculty and skipping dinner. As the respondents' age increased, their risk of breakfast skipping was lower (OR: 0.95; 0.89 - 0.99). Malays (OR: 1.94; 1.48 - 2.54), Indians (OR: 1.70; 1.08 - 2.66), and students from the Sabah and Sarawak indigenous communities (OR: 2.13; 1.37 - 3.33) were more likely to skip breakfast compared to their Chinese counterparts. Respondents who stayed in their own houses were also less likely to skip breakfast compared to those staying in hostel with meals catered (OR: 2.32; 1.39 - 3.84), hostel with cafeteria (OR: 2.92; 1.74 - 4.91) or in rented houses (OR: 2.08; 1.25 - 3.46). Respondents majoring in Arts & Economics had 1.40 (1.07 - 1.82) times risk of breakfast skipping compared to those majoring in Life Sciences. Those who skipped dinner too had twice the odds (1.47 - 2.77) of breakfast skipping. In conclusion the prevalence of breakfast skipping among the undergraduates of this university was moderately high. Health awareness campaigns or introduction of healthy eating guidelines should be initiated for the undergraduates as well as food caterers in campus. The policy and pricing of catered food in campus should also be reviewed.

Abstract: Lifestyle modification is effective in the prevention of cardiovascular diseases. This study aimed to promote healthy lifestyle behaviours to prevent cardiovascular disease. This study was a quasi-experimental trial with a follow up of two years. The intervention group (n = 102) received intensive individual and group counselling on diet and physical activity. The comparison group (n = 84) was given minimal education through mail and group counselling. Following the intervention, both groups reduced their total fat intake through a replacement in carbohydrate intake. The saturated fat and cholesterol intake was also reduced with a larger magnitude in the intervention group. Fruits and vegetables consumption was increased within the intervention group. The intervention group showed a statistically significant reduction in their mean total cholesterol levels with an intervention effect of -0.38 (95% C.I. = -0.63, -0.14) mmol/l. This study has achieved moderate improvement in dietary intakes as well as the total cholesterol of the participants.

Abstract: Framingham Risk Scores is an established method to predict an individual's 10-year risk for coronary heart disease (CHD). It provides a more precise delineation of risk which might lead to appropriate selection of therapy and opportunities for patient education and motivation. A Healthy Lifestyle Project was initiated to decrease the modifiable risk factors for CHD in a worksite in Kuala Lumpur. The participants were Malay men (n=186) working as security guards in a public university. Their mean age was 46.6 ± 6.6 years. The majority had secondary education and were married. The participants' 10-year risks based on the Framingham Risk Scores were 55.4%, 39.8% and 4.8% respectively for categories of low (<10%), intermediate (10 to 20%) and high (>20%) risk. Their Framingham Risk Scores were then correlated with anthropometric measurements such as the Body Mass Index (BMI), waist circumference and waist-hip-ratio (WHR). All the anthropometric measurements had weak but significant correlation with the Framingham Risk Scores (WHR: r=0.26; waist circumference: r=0.23; BMI: r=0.16). In conclusion, 44.6% of our participants had more than 10% risk in developing CHD in the coming ten years. Hence, they are suitable target candidates for the promotion of a healthy lifestyle such as smoking cessation, weight control, healthy dietary patterns and increased physical activities. Indicators of abdominal obesity like WHR or waist circumference may be used to complement the Framingham Risk Scores for the prediction of CHD risk in this population.

Abstract: The objective of this study was to determine the prevalence of sleep disturbance with work characteristics among nurses in the Melaka Hospital, Malacca, Malaysia. This was a cross sectional study conducted in Melaka Hospital. Universal sampling was conducted and a Malay version of the Pittsburgh Sleep Quality Index (PSQI) questionnaire was used in data collection. Sociodemographic characteristics such as age, marital status, number of children and work characteristics such as type of work schedule and duration were also enquired. Factors associated with poor sleep quality were compared between those nurses with good sleep quality by using logistic regression. There were 607 nurses who completed the questionnaire with a response rate of 73.1%. There was a moderate prevalence (57.8%) of poor sleep quality (PSQI > 5) in all study subjects. The prevalence of sleep disturbance was more widespread among nurses who worked shifts (62.0%) compared to non-shift working nurses (41.5%) p<0.001. A logistic regression analysis showed that age, marital status and unit group were the major associating factors of poor sleep quality. Sleep disturbance decreased with increasing age (OR = 0.42, 95% CI 0.25, 0.73) while married nurses (OR = 2.3, 95% CI 1.42, 3.82) and those in the category of intensive group (OR = 2.1, 95% CI 1.1, 4.1) were more prone to have sleep disturbances. In conclusion, this study revealed moderate prevalence of sleep disturbance among nurses working in Melaka Hospital but it was not associated with the work shifts. Age, marital status and work environment especially in the intensive group unit seemed to be factors associated with reduced global sleep quality among nurses in this study. (JUMMEC 2008; 11 (2): 66-71).

Abstract: Introduction: The objective was to evaluate the perceived risks, barriers and stages of change on smoking cessation among the Malay male security guards. Materials and Methods: In the year 2004, a cross sectional survey was conducted on a group of security guards working in the campus and the hospital of a public xD;university in Kuala Lumpur. Universal sampling (n=210) was conducted with a response rate of 88.6%. A selfadministered questionnaire was used to survey the participants on their smoking status, stages of change, perceived risks and barriers to smoking cessation. Results: There were 37% current smokers and 23.7% exsmokers. The mean year of smoking was 19.2 + 8.1 and the number of cigarettes smoked was 16.4 + 8.0 per day among the current smokers. About two-third of the smokers perceived the amount smoked currently was bad for health. However, only 23.3% and 30.9% of the smokers perceived themselves to be at higher risk for lung cancer and heart disease respectively. The three main reasons to quit smoking were health reasons, doctors� advice and cost. The main barriers were addiction (53.3%) and stress (28.3%). Most of the smokers xD;(42%) were in the pre-contemplation stage with half of them not having thoughts of quitting. Conclusion:The smokers had misperception on smoking and majority was at the pre-contemplation stage of change in smoking cessation. The findings of this survey add on to the existing literature about the perception of risks, barriers and stages of change to smoking cessation. This will provide valuable information on the planning and delivering of smoking cessation programmes in the local context.

Abstract: This is a retrospective case control study conducted between 1 January 2005 and 30 June 2006 at the Hospital Tuanku Jaafar, Seremban, Malaysia. The objective was to study the maternal sociodemographics and foetal characteristics associated with premature delivery. There were 387 cases selected universally and 387 controls selected by using systematic random sampling involving every 13 cases. The patients were women who had delivered their babies before 37 completed weeks, while the control were women who had term deliveries during the same period. Data were collected using structured questionnaire through secondary data. Results showed that having multiple pregnancies (OR=8.33, 95% CI: 2.91, 23.84), congenital abnormality (OR=4.6, 95% CI: 0.98, 21.84) and intrauterine growth retardation (OR=15.59, 95% CI: 3.69, 65.82) were the risk factors of premature delivery. Being an ethnic Indian also raised the odds (OR=1.67, 95% CI: 1.14, 2.43) but this was not significant in the multivariate analysis. Other sociodemographic characteristics did not contribute significantly to the risk factors for premature delivery in this sample. In conclusion, foetal characteristics were found to be significantly associated with premature delivery after adjustment for other confounding factors. (JUMMEC 2008; 11 (2): 59-65).

Abstract: The worksite is one of the key channels for the delivery of interventions to reduce chronic diseases among adult populations. It provides easy and regular access to a relatively stable population and it encourages sustained peer support. This paper reports a 2-year follow-up of the impact of a worksite health promotion programme on serum cholesterol and dietary changes among employees in a city in Malaysia. A quasi-experimental study was conducted among Malay-Muslim male security guards, with those working in a public university in Kuala Lumpur comprising the intervention group, and those working in the teaching hospital of the same university as the comparison group. They were comparable in socio-demographic characteristics. The intervention group received intensive individual and group counselling on diet, physical activity and quitting smoking. The comparison group was given minimal education on the same lifestyle changes through mail and group counselling. The intervention group showed a statistically significant reduction in their mean total cholesterol levels as compared with the comparison group, with an intervention effect of -0.38 (95% CI = -0.63, -0.14) mmol/l. The intervention group also reported a reduction in the amount of cigarettes smoked. The worksite was shown to be an effective channel for health promotion. The adoption of the new lifestyle behaviours should be supported and sustained through modification of work policies. © The Author (2006). Published by Oxford University Press. All rights reserved.

Abstract: Eating patterns such as eating frequency, skipping of breakfast, and frequency xD;of meals eaten away from home might influence school-going children's nutri- xD;tional status, which will then influence their health and academic performance. xD;This article reports the findings of a survey on the eating patterns of the school xD;children and adolescents in Kuala Lumpur. A total of 3620 school children xD;studying in Primary 5, Secondary 2 and Secondary 4 were selected using xD;multi-stage sampling. The students were surveyed using a pre-tested xD;questionnaire while their weights and heights were measured in the field. It xD;was found that 19.9% skipped at least one meal a day with the youngest group xD;having the lowest prevalence. The most frequently missed meal is breakfast xD;(12.6%) followed by lunch (6.7%) and dinner (4.4%). The school is an important xD;provider of breakfast and lunch for the students. As the students' age xD;increased, the prevalence of eating breakfast and lunch in school increased. xD;The youngest age group had the highest prevalence of snacking and taking of xD;nutritional supplements (p<0.05). Fast food and local hawker food were also xD;consumed by about 60-70% of the students. Logistic regression analysis xD;showed that skipping of breakfast is significantly associated with age, sex, BMI xD;and taking of nutritional supplements. Promotion of healthy eating should be xD;targeted at students in primary and secondary schools as they tend to depend xD;on outside food.

Abstract: The nominal groups technique (NGT) was used as part of a needs assessment of a health promotion project on healthy lifesyle behaviour. Two aspects of healthy lifestyle behaviours which were physical exercise and healthy diet were selected by the participants. Two NGT groups were carried out simultaneously by two facilitators. A Likert scale of 1-10 was used to rank the importance of ideas generated during the discussion. The level of group support was ranked by the median while the level of agreement was rankedby the mean absolute deviation from the median. The representativeness of the NGT group was assessed with the subjects who did not participate in the NGT procedure. The level of agreement was observed to be higher in the NGT group for both the physical exercise and diet groups. The reason could be due to clarification and discussion which were carried out in the NGT group. The rank order of the exercise group did not differ in the NGTand the survey groups (Mann-Whitney U test, z=1.65, p=0.2), however the diet group showed different ranking with higher ranking from the survey groups (Mann-Whitney U test z=1.33, p=0.02). This could be due to the higher ranking assigned by the subjects in the survey group. Despite the difference in the ranking order in one of the groups, the researcher felt that the NGT outcomes are still representative of the larger group and will generate more infomation in developing a questionaire in the planning and implementation of the health promotion program.

Abstract: Lifestyle and disease patterns in Malaysia have changed following rapid economic development. It is important to find out how these changes have affected the nutritional status and health behaviour of the population, especially school children and adolescents. Therefore a survey on school childrens' and adolescents' health behaviours and perception in Kuala Lumpur was initiated. This paper only reports the observed body mass status of the school children. A total of 3620 school children were selected in this survey using the method of multistage sampling. The students were surveyed using pre-tested questionnaires while weight and height were measured by the research team in the field. Using the cut-off of BMI-for-age � 95th percentile and � 95th percentile for overweight and underweight respectively, there were a total of 7.3% of overweight students and 14.8% of underweight students. When analysed by gender; 7.5% of boys and 7.1% girls were overweight, while 16.2% of the boys and 13.3% of the girls were underweight. The youngest age group (11 years old) had the highest prevalence of underweight as well as overweight. With increasing age, the prevalence of underweight and overweight decreased and more children were in the normal weight range. The overall prevalence of overweight among the three ethnic groups was similar. However the prevalence of underweight was highest among the Indian students (24.9%), followed by Malays (18.9%) and Chinese (9.5%) (P &lt;0.001). The results showed that both the problems of under- and over-nutrition co-exist in the capital city of Malaysia. The promotion of healthy eating and physical activities is required to address the problems of under- and over-nutrition in order to build up a strong and healthy nation in the future.

Abstract: Malaysia has undergone rapid pace of industrialization and urbanization in recent decades and this has brought about imminent changes in the lifestyle of Malaysians. This is a cross-sectional study which attempts to examine the lifestyle practices and the prevalence of obesity of a group of security guards and their spouses of the University of Malaya, Kuala Lumpur. Data collection was conducted by both the methods of face-to-face interview and self-administered questionnaire. The respondents were surveyed on lifestyle practices such as smoking habits, exercise and eating pattern. Anthropometric measurement such as weight and height were also taken to establish the extend of obesity by using Body Mass Index (BMI). This study reveals that the community did have some unhealthy lifestyle practices such as smoking (27.7%; 95%CI 20.2%, 36.2%), low prevalence of adequate exercise (13.8%; 95%CI 8.4%, 21.0%); high prevalence of overweight and obesity (64%; 95%CI 55.1%, 72.3%); and high prevalence of co-morbidities such as diabetes mellitus and cardiovascular diseases. In conclusion, the community is considered to be a vulnerable and high-risk group for morbidity and mortality with the above predisposed risk factors. (JUMMEC 2003-2005; 8: 33-38).

Abstract: Body Mass Index (BMI) is the most established anthropometric indicator used for assessment of nutritional status. Other anthropometric indicators which are related closely to BMI are waist hip ratio (WHR) and waist circumference. In this paper, receiver operating characteristics (ROC) curves were constructed to assess the value of waist circumference and waist hip ratio as a screening measure for the need of weight management using BMI as the reference test. Sensitivity and specificity were calculated at several cut-offs. The areas under the ROC curve calculated by comparing waist circumference with BMI were high (0.70-0.86) while the areas calculated for WHR were low (0.46 -0.67). Sensitivities of 0.745 and 0.800 were observed at cut-off points of waist circumference at 90cm and 80cm for males and females respectively, while the false positive rates were 0.233 for males and 0.250 for females. These cut-off points could be considered as a fair trade-off. Therefore it is concluded that waist circumference performed better than WHR as a screening test. It is indicative that waist circumference could be used as a tool in raising awareness of weight management in this population.

Abstract: A cross sectional study on Type 2 diabetes patients seeking treatment in the Primary Health Care outpatient clinic of the University Malaya Medical Centre, Kuala Lumpur was undertaken. Two hundred and thirty-three subjects participated. They were asked questions on biodata and dietary intake using face-to-face interview techniques. Dietary intake was assessed using the 24-hour dietary recall. Anthropometric measurements including weight and height were taken and Body Mass Index (BMI) was computed to establish the extent of obesity. Of the 196 subjects, 66.8% were overweight (BMI �25 kg/m2) with 15.8% obese (BMI �30 kg/m2). The mean BMI of males and females were 25.9±4.3 kg/m2 and 27.2±4.7 kg/m2 respectively. The findings from the dietary survey showed that the mean energy intake of the subjects only achieved about 72% of the Recommended Daily Allowance (RDA) for Malaysia while protein intake of all subjects was adequate. The macronutreint contribution to the total calorie was consistent with the recommendation of the Malaysian Diabetic Association for a healthy diet for diabetes patients. The male subjects were found to meet the RDA requirements for all nutrients while the female subjects did not have sufficient intake of calcium, vitamin A and niacin. No consistent pattern in energy and nutrient intake was observed among different age groups. On the other hand, the Malay subjects seemed to have lower energy and all nutrient intake (except vitamin A and vitamin C) compared to the Chinese and Indian subjects. The Indian subjects seemed to have the highest intake of calcium compared to the others. Advice needs to be given to those who did not have adequate nutrient intake as well as those who need to reduce their weight.