SUMMARY Introduction: This study aims for construct validation using two approaches, i.e., exploratory factor analysis and Rasch Model. Methods: A cross sectional of 313 male workers from multiple worksites had completed self-administered Malay translated version of Three-Factor Eating QuestionnaireR21. Data quality was assessed by misfit person criteria, dimensionality, summary statistic, item measure and rating (partial credit) scale followed by exploratory factor analysis and internal consistency reliability assessment. Results: The dual approaches of construct validation analysis were complement to each other. Rasch analysis supported the theoretical constructs of three eating behaviour dimensions among respondents. In contrary to exploratory factor analysis, it did show presence of a newfound factor (α=0.04) came up from the separation of the cognitive restrain and uncontrolled eating however, the correlation between the two respective sub-factors were fair (r=0.39) and weak (r= -0.08). Both analyses had detected three problematic items but those items were psychometrically fit for used for current study setting. The data had adequate psychometric properties. Cronbach’s alpha for cognitive restraint, uncontrolled eating and emotional eating were 0.66, 0.79 and 0.87 respectively. Rating scale quality was conformed to standard criteria. Conclusion: Malay version TFEQ-R21 with promising psychometric properties and valid measures for eating behaviour dimensions among male workers aged between 20 to 60 years old is now available. Further development should focus on the items in relation to Malaysian cultural adaptation before its use for daily practice in future setting.
Psychometrics

Introduction: Cardiovascular disease (CVD) caused significant burden to Malaysia as it accounted for 36% of total deaths. This study aims to evaluate the burden of cardiovascular risk factors among Malaysian adult and assess the difference between urban and rural population in the selected communities. Methods: This study is part of the ongoing Prospective Urban Rural Epidemiology (PURE) database, whereby the baseline data were collected since June 2008. CVD risk was measured using INTERHEART risk score which comprised of eleven risk factors i.e. age and gender, family history of heart attack, smoking status, exposure to second hand smoke, diabetes mellitus, hypertension status, waist-hip ratio, self-reported stress, depression, dietary habits and physical activity status. Results: Majority of the studied participants had low cardiovascular risk (57%). Participants from rural area were generally older, had lower educational status, higher prevalence of smokers, obesity, hypertension, diabetes, and more likely to be depressed. In comparison, urbanites had lower physical activities and more likely to be stressful. Mean INTERHEART score among rural participants were higher, especially for male, in comparison to urbanite (11.5±5.83 vs. 10.01±5.74, p<0.001). Conclusion: Contradict to common beliefs, participants in rural areas generally have higher cardiovascular risk factors compared to their urban counterparts. The rural population should be targeted for focused preventive interventions, taking account the socioeconomic and cultural context.

Background: Drug resistant tuberculosis (DR-TB) remains a public health issue that is of major concern on a global scale. The characterisation of clinical isolates may provide key information regarding the underlying mechanisms of drug resistance, and helps to augment therapeutic options. This study aims to evaluate the frequency of gene mutations associated with Rifampicin (RIF) and Isoniazid (INH) resistance among nine clinical isolates. Methods: A total of nine drug resistant Mycobacterium tuberculosis clinical isolates were screened for genetic mutations in rpoB and katG using polymerase chain reaction (PCR) amplification and DNA sequencing. Genotypic analysis was performed to detect the mutations in the sequence of the target genes. Results: Our findings reveal that 80% of the isolates possess mutations at codon 119 (His119Tyr) and 135 (Arg135Trp and Ser135Leu) within the rpoB gene; and 70% possess mutations in the katG gene at codon 238 with amino acid change (Leu238Arg). Conclusion: Findings from this study provide an overview of the current situation of RIF and INH resistance in a hospital Universiti Sains Malaysia (HUSM) located in Kelantan, Malaysia, which could facilitate molecular-based detection methods of drug-resistant strains. Further information regarding the molecular mechanisms involved in resistance in RR-/MDR-TB should be addressed in the near future.
Mycobacterium tuberculosis

Caffeine had been shown to have an ergogenic effect on trained individuals; however, studies investigating the physiological effects of caffeine on the sedentary population are limited. The aim of this study was to examine the effect of caffeine on oxygen consumption and rating of perceived exertion during moderate intensity exercise among sedentary young adult females. Subjects comprised 16 female undergraduates aged between 22 to 24 years studying at Universiti Kebangsaan Malaysia. Eligibility criteria were based on low physical activity level and daily caffeine intake of less than 50 mg a day, which was screened using the International Physical Activity Questionnaire (short version) and caffeine consumption questionnaire, respectively. The design of this study is single-blind, crossover, placebo-controlled with all subjects serving as their own controls. Subjects were required to report to the physical activity laboratory for two experimental sessions after either ingesting placebo or caffeine capsule with an interval of 3 days between these two experimental sessions. Sixty minutes after ingesting placebo capsule (Glucolin, glucose) or 100 mg caffeine (Pro-plus, United Kingdom), subjects were required to run on a treadmill for 30 minutes at a standardized power output equivalent to 60% of maximal heart rate. Oxygen consumption, heart rate, and rating of perceived exertion were recorded at 20th, 25th and 30th minutes, while blood pressure was recorded immediately after subjects completed their 30 minutes run. Mean body fat percentage was 28.4 ± 5.4. Differences were recorded after every subject completed both the placebo and caffeine experiments. Paired t-tests showed no significant difference between placebo vs caffeine trials for oxygen consumption (13.99 ± 2.47 vs 14.49 ± 1.73, p = 0.440), rating of perceived exertion (12.3 ± 2.5 vs 12.3 ± 2.1, p = 1.000), systolic blood pressure (113 ± 10 vs 117 ± 11, p = 0.129), diastolic blood pressure (67 ± 8 vs 69 ± 10, p = 0.408) and heart rate (127.3 ± 11.0 vs 127.1 ± 11.6, p = 0.912). There was strong significant negative correlation between body fat percentage and oxygen consumption (r = –0.568, p < 0.05) and strong significant positive correlation between body fat percentage and rating of perceived exertion (r = 0.515, p < 0.05). The non-significance in the results obtained could be due to the small effect size of the study (d = 0.24). Hence, future studies with a larger number of participants should be carried out to examine the effects of caffeine during exercise in a sedentary population

Prevalence of obesity in Malaysia has been steadily rising over the last two decades. Therefore, the efforts towards curbing this problem is becoming increasingly necessary. The main objective of this cross-sectional study was to evaluate the effectiveness of obesity projects conducted by the NGOs funded by the Malaysian Health Promotion Board (MHPB). In this study, the secondary data from the final reports of 22 obesity projects were analyzed to evaluate its effectiveness. All the information in the final report was transferred into the formative evaluation forms prepared by MHPB. The effectiveness of obesity projects was determined through the level of achievement of health literacy by using 21 indicators validated data extraction tool based on the RE-AIM Model. Projects which achieved 15 to 21 marks are considered to be of high quality, 8 to 14 marks are considered to be of moderate quality and 0 to 7 marks are categorized as low quality. Using the Cohen’s Kappa test to assess the inter-rater reliability towards 21 indicators validated data extraction tool based on the RE-AIM Model, it was found that there was very high level of inter-rater agreement (K = 0.868). From the 22 obesity projects studied, none was considered to be of high quality, 21 projects were found to have a moderate quality and 1 project was found to be of low quality. There was no significant difference on the percentage achievement of health literacy between different duration of project undertaken (p > 0.05). Based on the health screening of 1982 project participants, 333 (16.8%) are overweight and 354 (17.9%) are obese. In conclusion, although majority of the projects were successfully carried out by the NGOs. A follow-up study is needed to monitor lifestyles change which may eventually lead to reduction in the prevalence of obesity in the community where the projects were executed

Validation of instruments is essential when assessing physical activity (PA). The aim of this study was to validate a Malay language version of the International Physical Activity Questionnaire (IPAQ-M) against Actical accelerometer and to determine its reliability and validity. A total of 90 Malay adults aged 35-65 years old participating in The Malaysian Cohort project were recruited for this study. The IPAQ-M is comprised of 12 items, covering vigorous, moderate, walking, sitting and sleeping activities, and was administered on two occasions (Day 1 and Day 9) by interviewing the participants. Participants wore the Actical accelerometer for seven consecutive days between the two interview sessions. Validity tests showed that time spent in moderate-vigorous physical activity (MVPA) (min wk-1) from IPAQ-M was significantly correlated with MVPA from accelerometer (ρ=0.32, p<0.01). Time spent in vigorous activity (ρ=0.44) and total activity (ρ=0.36) from IPAQ-M were significantly correlated (p<0.01) with that measured by accelerometer, but no correlation was observed for sedentary behaviour. Reliability tests revealed significant correlations between the two interview sessions for all intensities of PA (=ρ0.55 to 0.71, p<0.01). Bland-Altman plots showed that time spent in MVPA for IPAQ-M was significantly different from that measured by accelerometer (mean difference: 98.02 min wk-1; 95% limits of agreement: -785.33 to 1317.83 min wk-1; p<0.01). When classifying people into meeting PA recommendation, the agreement between the two instruments was fair (κ=0.22). The IPAQ-M has acceptable validity for MVPA, vigorous and total physical activity, and was reliable for assessing the physical activity of Malay adults.​

Demodex sp. is a skin ectoparasite known as follicle mite. The objectives of this study were to determine the prevalence of Demodex sp. infestation among Malaysian adults with age ranges from 20 to 29 years old in Lembah Klang and to determine the relationship between the infestation status and gender and acne problem on face. This is the first study that has been conducted in Malaysia to determine the prevalence of Demodex sp. infestation. A total of 350 people participated in this study. Samples were selected by stratified random sampling. Skin scraping was carried out on forehead, nose, cheeks and chin. All specimens were mounted in Hoyer’s medium and studied under light microscope. Questionnaires were distributed to the subjects to identify acne problem on their skin conditions. The overall prevalence of Demodex sp. infestation was 18.9% with higher prevalence in males (25.7%) compared to females (12.0%). There was no significant difference between acne problem and Demodex sp. infestation. In conclusion, infestation of Demodex sp. was detected in a fifth of the subjects, with men had more problems.

​The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide and many of these affected individuals remain unidentified. Undiagnosed T2DM may impose substantial public health implications because these individuals remain untreated and at risk for complications. The objective of this study was to determine the national prevalence of undiagnosed T2DM and to identify the associated risk factors. A nationwide cross-sectional study was conducted involving 17,783 respondents. Two-stage stratified sampling design was used to select a representative sample of the Malaysian adult population. Structured validated questionnaires with face to face interviews were used to obtain data. Respondents, who claimed that they were not having diabetes, were then asked to perform a fasting blood glucose finger-prick test by Accutrend GC machine. The prevalence of undiagnosed T2DM was 8.9% (n=1587). The highest percentage of undiagnosed T2DM was found among males (10.2%), 55-59 years old (13.4%), highest education attainers of primary school (11.1%), Indians (10.3%), married (10.3%), working (8.9%) and living in the urban areas (9.2%). Multivariate analyses showed that factors associated with undiagnosed T2DM were gender, age group, ethnicity, marital status, obesity and hypertension. This study found an increasing trend of undiagnosed T2DM in Malaysia compared to 2006. This finding is alarming as risk factors associated with undiagnosed diabetes were related to most of the socio-demographic factors studied. Therefore, early diabetic screening is crucial especially among adults aged 30 and above to prevent more serious complications of this disease.​

Diabetes in pregnancy is associated with risks to the woman and her developing fetus. Management of the condition at the primary care level includes pre-conception care, screening, diagnosis, as well as antenatal and postpartum care. A multidisciplinary approach is essential in ensuring its holistic management.

OBJECTIVEThe 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.

METHODSA 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.

RESULTSThe 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).

CONCLUSIONThe results suggest that use of oral contraceptive pills, being nulliparous, and a low serum selenium level are associated with breast cancer.