Social norms, though an important contributing factor of adolescent smoking in developed countries, has not been extensively studied in Malaysia. The objective of this study was to determine the association between certain perceived norms regarding smoking with smoking status among Malaysian secondary school students in Kota Tinggi, Johor. Data were collected from 2311 respondents consisting of 1379 male and 923 female secondary school students in Kota Tinggi district via a self administered questionnaire. Five perceived norms regarding smoking were assessed, namely: perceived peer smoking prevalence, perceived parental reaction towards adolescent smoking, perceived public perception of adolescent smoking, ever noticed peers smoking inside and outside school and perceived enforcement of anti-smoking policy in school and their association with smoking status. Multiple logistic regressions controlling for gender, peer smoking and family smoking was performed. Of the five perceived norms, four were associated with smoking status, (perceived peer smoking prevalence (p<0.001value), ever seen friends smoking inside or outside school (p <0.001), perceived parental reaction towards adolescent smoking (p<0.001 value) and perceived public disapproval (p <0.001)). Higher odds for smoking was observed for adolescents who: perceived a few (aOR 3.22), many (aOR 3.01) or a lot (aOR 3.52) of their peers smoke; had ever observed friends smoking in or outside of school (aOR 1.79); perceived their parents will react badly to smoking (aOR 0.84) or perceived the public disapprove of smoking (aOR 0.93). These results suggest that perception of social norms influence adolescents’ decision to smoke, thus measures to curb smoking incidence amongst adolescents should address these perceptions of social norms.
Smoking ; Students ; Adolescent ; Social Behavior ; Life Style

Iodine deficiency disorders (IDD), is one of the most important micronutrient deficiencies which has multiple adverse effects on growth and development. The aim of this study was to determine the prevalence of IDD among school children and to elucidate the distribution of iodized salt at household level in Sarawak, East Malaysia. This cross-sectional study was conducted among school children aged 8 to 10 years in 2008. A multi-stage probability proportionate to population size (PPS) cluster sampling method was used to obtain a representative state sample of 1200 school children. Spot urine samples were collected for the determination of urinary iodine concentration while the iodine content in salt was determined using field rapid test kits. The thyroid status was determined by palpation. Response rate was 92.0% (n=1104/1200). The prevalence of goitre among school children in Sarawak was 2.9% (5.2% in urban, 0.7% in rural). The median urinary iodine concentration (UIC) among the school children was 102.1 µg/L (IQR, 62.3-146.5 µg/L). Urban children had significantly higher median UIC of 109.3 µg/L (IQR, 72.4-159.0 µg/L) than their rural counterparts [91.9 µg/L (IQR, 55.7-140.2 µg/L)]. The salt samples tested by rapid test kit (RTK) showed only 46.0% of household salt contained iodine. The present study revealed that the population in Sarawak were of borderline iodine sufficient with mild IDD seen in rural areas. Hence, the state IDD control programmes need to encourage and advocate the consumption of iodized salt in order to eliminate IDD-related health problems in Sarawak.
Congenital Hypothyroidism ; Goiter ; Schools ; Child ; Malaysia

Following the reveal of borderline iodine sufficiency among the Sarawakians from the 2008 National Iodine Deficiency Disorders (IDDs) survey, a mandatory universal salt iodization (USI) was implemented in Sarawak thereafter. This study aimed to determine the current status of USI in Sarawak after a 3-year implementation of USI from 2008 to 2011. The IDD survey was conducted between Jun 2011 to July 2011 involving six districts in Sarawak (Sarikei, Mukah, Kapit, Sibu, Bintulu and Miri). The schools were selected via multistage proportionate-to-population size sampling technique and the children were randomly selected via systematic sampling. A total of 19 schools and 661 children were recruited into the survey. Thyroid size was determined by palpation and was and graded according to the classification of the World Health Organization (grade 0-2). The iodine excretion level in spot morning urine was measured using in-house microplate method. The urinary iodine concentration (UIC) values were compared by Kruskal-Wallis test and Chi-square tests were used to compare categorical variables. A total of 610 school children were participated in the study (92.3%). The TGR of grade 1 and 2 was found to be 0.3% (n = 2). Overall the median UIC level was 154.2 (IQR, 92.7 - 229.8) µg/L, with the highest median UIC been observed in Sarikei [178.0 (IQR, 117.6 - 308.9) µg/L], followed by Mukah [174.8 (IQR, 99.0 - 224.3) µg/L)], Miri [158.6 (IQR, 92.3 - 235.4) µg/L], Sibu [147.0 (IQR, 89.8 - 221.4) µg/L], Bintulu [142.3 (IQR, 52.8 - 245.1) µg/L] and Kapit [131.0 (IQR, 88.6 - 201.9) µg/L]. One in every ten child was of iodine deficient (UIC < 50µg/L) while a third of the child (32%) were of adequate level of UIC. The present findings indicate that the mandatory USI successfully improves the iodine level of children in Sarawak. However, regular and proper monitoring of the UIC level in the communities is needed to prevent excessive iodine intake.​

The present study examines age and education determinants of consumption of medical care using Malaysian data. The present study offers a better understanding of the effects of age and education on medical care and assists policy makers in developing more effective intervention measures to improve population health. A nationally representative data with a large sample size (n = 14838) was used for analyses. Several important findings are noteworthy. First, age and education are positively associated with consumption of medical care. Second, the impact of education on medical care varies across age. Third, there is no diminishing marginal effect of education on medical care. Findings of the present study suggest that age and education play an important role in determining consumption of medical care. When designing policies to improve population health, consideration should be given to the effects of age and education factors on consumption of medical care. It is important for policy makers to understand which age group and education level of people are more or less likely to use medical care.

Iodine deficiency is still prevalent worldwide and it is the main cause of goiter, thyroid dysfunction and mental retardation. The aim of the study was to determine the iodine status and goiter prevalence among the school children in Terengganu. The representative sample consists of 1163 primary school children aged 8-10 years old randomly selected from urban and rural schools in Terengganu using stratified systematic random sampling technique. Urinary iodine levels in spot urine were determined by in house modified micro-method while goiter assessment was carried out by palpation of thyroid gland. The status of iodine deficiency was determined by the median urinary iodine concentrations (UIC) and total goiter prevalence (TGP) in accordance with the WHO criteria. The result showed the median [inter-quartile range (IQR)] urinary iodine concentrations was 78.7µg/L (50.1µg/L -120.0µg/L) indicating the iodine intake was slightly lower than recommended range of 100 µg/L. The rural school children had a significantly lower Iodine levels (median UIC=72.4µg/L, IQR=46.7µg/L -113.0µg/L) than the urban school children (median UIC=87.7µg/L, IQR=54.5 µg/L - 127.5µg/L). The total goiter prevalence (TGP) was 5.7%. The prevalence of goiter was significantly higher in rural (TGP=6.9%) compared to urban areas (TGP=3.6%). The study revealed that school children in Terengganu showed mild iodine deficiency and the condition is more pronounced in children from rural areas. The findings emphasize the importance of intervention implementation, universal salt iodization to ensure sufficient intake of iodine among the Terengganu school children.
Congenital Hypothyroidism ; Child ; Thyroid Gland ; Goiter

Identification of the stages of smoking cessation among smokers is essential to improve the rate of smoking cessation. The aims of this study were to determine the prevalence and factors associated with stages of smoking cessation across the demographic distribution of adult smokers in Malaysia. Data were derived from a population-based study among Malaysian adults aged 18 years and above. Face-to-face interviews were carried out by trained staff using a validated questionnaire to obtain data related to smoking from 4,288 selected respondents. Of 4,288, 438 respondents are current smokers. Multivariable logistic regression analysis was used to determine factors associated with stage of smoking cessation. Approximately 60% (n=269/438) of the current smokers were in the pre-contemplation stage and 40% (n=169/438) were in the contemplation and preparation stages of smoking cessation. The proportion of pre-contemplators was higher among smokers with higher levels of nicotine addiction (71.3%), lower education attainment (71.4%), and those who were single/widowed/divorced (66.9%). Multivariable analysis showed that males, and those who reported low to high level of nicotine addiction were more likely to be in the pre-contemplation stage whilst those in the older age groups were more likely to be in the advanced stage of smoking cessation. The study revealed that the majority of current smokers in Malaysia had no intention to quit smoking within 6 months. Specific interventions targeting males, young adults and smokers with low to high nicotine addiction should be introduced to ensure the smokers proceed to the advanced stage of smoking cessation.

Malnutrition can be associated as one of the factors which affect health status. The term is used to describe imbalance of nutrients either over- or under-nourished, resulting in measurable adverse effects on body composition, function and clinical outcome. The National Health And Morbidity Survey (NHMS) 2011 assessed 4304 individuals aged 10-17 years old through a household survey of Malaysian population. Thinness and obesity are the malnutrition indicators based on Centre for Disease Control (CDC) 2000 classification as recommended by WHO (2007). The findings of the survey showed that the national prevalence of thinness (BMI for age <-2SD), was 9.7% (95% Confidence Interval: 8.4-11.2). The state of Sabah/Labuan had the highest thinness of prevalence, 17.0% (11.1-25.2) and lowest in Penang at 5.3% (2.7-10.0). The prevalence of thinness was higher in urban areas than in rural areas at 10.3% (8.5-12.3). Meanwhile; national prevalence of obesity (BMI for age ≥+2SD) was only 5.7% (4.9-6.7). The state of Perak had the highest obesity prevalence 10.0% (6.2-15.8) and lowest in Sabah/Labuan at 2.4% (1.4-4.1). The obesity prevalence was higher among adolescents in urban areas at 6.3% (5.2-7.6) than in rural areas. Thinness as a form of malnutrition is more prevalent than obesity. Even though the prevalence of obesity is low, the impact affects not only the adolescents, but also the family, the society and the nation in the future. The increasing prevalence of obesity will have significant public health implication related to non-communicable diseases.
Obesity ; Thinness ; Adolescent ; Malaysia ; Malnutrition

​Overweight and obesity is a major public health problem in Malaysia. This study aims to determine the prevalence of overweight and obesity among the Malaysian adult population and their association with socio-demographic characteristics (gender, ethnic, and age groups). A total of 17,257 adults aged 18 years and older (8,252 men, 9,005 women) were assessed for BMI status, with a response rate of 97.8%, through a household survey from the National Health and Morbidity Survey (NHMS), conducted in all states of Malaysia in 2011. All socio-demographic factors were consistently associated with higher chance of being overweight (except gender and location) and obesity (except location and household income). The identified risk of overweight were Indian (aOR: 1.8, 95% CI: 1.2-2.8), aged 50-59 years (aOR: 2.8, 95% CI: 2.0-3.9), widower (aOR: 1.6, 95% CI: 1.3-2.0), subject with secondary education (aOR: 1.2, 95% CI: 1.0-1.4), Homemaker/unpaid worker (aOR: 1.3, 95% CI: 1.1-1.4), and with high household income group (aOR: 1.3, 95% CI: 1.2-1.6). The identified risk of obesity were women (aOR: 1.4, 95% CI: 1.2-1.6), Indian (aOR: 1.7, 95% CI: 0.9-3.2), aged 30-39 years (aOR: 3.6, 95% CI: 2.4-5.5), widower (aOR: 1.2, 95% CI: 0.9-1.6), subjects with primary education (aOR: 1.2, 95% CI: 0.9-1.6), Homemaker/unpaid worker (aOR: 1.3, 95% CI: 1.1-1.6), and with middle household income group (aOR: 1.3, 95% CI: 1.2-1.6). Our data indicate a high prevalence of overweight and obesity in the population. Several sociodemographic characteristics are associated with both overweight and obesity. This study highlights the serious problem of overweight and obesity among Malaysia adults. Documentation of these problems may lead to research and policy agendas that will contribute both to our understanding and to the reduction of these problems.

PURPOSE: Graves' disease presenting concurrently with thyroid cancer is a rare condition. The clinical behaviors and the extent of surgery in this condition is still controversial. This study examined the prognostic factors influencing the long-term outcomes as well as the appropriate treatment modalities in patients with Graves' disease presenting concurrently with thyroid cancer. METHODS: Forty nine patients who underwent surgery for thyroid cancer with Graves' disease were enrolled in this study. The outcomes of various types of surgical treatments as well as the factors associated with the long-term outcome were retrospectively analyzed. RESULTS: There were 42 women and 7 men with a median age 39 years (15~70 years). The surgical procedures included a bilateral subtotal thyroidectomy (n=17), a bilateral total thyroidectomy (n=16), and a total and contralateral subtotal thyroidectomy (n=16). The mean follow-up period was 83 months (4~218 months) after surgery. Disease-free survival at 5 and 10 years were 97.6% and 88.9%, respectively. Univariate log-rank survival analyses revealed that the age at diagnosis, the size of the thyroid cancer, capsular invasion, multiplicity, lymph node involvement, and clinical cancer to be poor prognostic factors. However, the extent of the surgical treatment was not significant for survival. CONCLUSION: The prognosis is expected to be poor when thyroid cancer presenting concurrently with Graves' disease is clinically apparent or has invaded the thyroid capsule. Patients with Graves' disease should be screened with ultrasonography to detect thyroid cancer. A total thyroidectomy or completion total thyroidectomy is not necessary in patients who do not have any of the poor prognostic factors, such as incidentally detected microcarcinoma postoperatively.
Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Graves Disease* ; Humans ; Lymph Nodes ; Male ; Prognosis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Ultrasonography

PURPOSE: The aims of this study were to introduce an alternative surgical technique using a ballooning catheter and assess the outcomes of its use in patients with an upper mediastinal mass originated from the thyroid gland. METHODS: Between May 2001 and April 2004, 8 patients undewent an operation via a cervical approach using a ballooning catheter were enrolled in this study. The study group was reviewed by their clinical characteristics, diagnostic methods, postoperative results, histopathological findings and prognosis. Instead of a sternotomy, a ballooning catheter technique was used to assist in the transcervical delivery and extraction of these huge or deep mediastinal masses. The ballooning catheter was placed at the base of the mediastinal mass via a narrow plane which could not be reached by the surgeon's fingers. When the mediastinal mass was freed up by careful dissection with traction using an inflated ballooning catheter, could the mass was able to be delivered without injury to the surrounding tissues. RESULTS: There were 3, 2 and 3 cases of substernal goiters, substernal goiters combined with a papillary microcarcinoma and metastatic papillary carcinoma from thyroid cancer, respectively. The mean operation time and period of hospitalization were 121 minutes, (ranging from 70 to 195 minutes), and 6 days, (ranging from 3 to 10 days), respectively. In the 5 cases with a substernal goiter, the average size of the resected specimen was 9.9 cm, (ranging from 5.5 to 17.6 cm), with an average weight of 100.2 g, (ranging from 45 to 172.2 g). In the 3 cases of metastatic mediastinal lymph nodes, the postoperative 131I scan and serum thyroglobulin level showed no evidence of remnant metastatic tissue or cancer spillage. The median follow up duration was 24.8 months (ranging from 13 to 42 months). No major complications were documented, and no evidence of recurrence was encountered. CONCLUSION: The use of the ballooning catheter was found to be helpful in the transcervical removal of an upper mediastinal mass, and useful for substernal goiters. Furthermore, for mediastinal lymph node metastasis, this technique can be adopted as an alternative method in carefully selected cases.
Carcinoma, Papillary ; Catheters* ; Fingers ; Follow-Up Studies ; Goiter, Substernal ; Hospitalization ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Sternotomy ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms ; Traction