The knowledge and beliefs on the presence of fluoride in drinking water, its purpose and the associated health risks aids in equate water fluoridation and effective prevention programs. Water fluoridation is a safe, effective, and necessary method where adequate doses of fluoride is added into drinking water supplies with the target of assisting in tooth restoration and preventing tooth decay and dental caries. Therefore, this study identifies the level of knowledge and perception of fluoride in drinking water among residents living in Precinct 9, Putrajaya Methods: A cross-sectional, self-administered online questionnaire was used to examine knowledge and perception of fluoride in drinking water of 240 Precinct 9 residents. Descriptive analysis was applied for socio-demographic data and Chi-square was used to compare discrete data. All data obtained were further analyzed using SPSS Version 23.0. Results: The highest frequency (percentage) of residents were 213 (88.8%), aged 18-64 years old, 141 (58.8%) female, 214 (89.2%) with tertiary education background and 125 (51.1%) of them lived in Precinct 9 for more than 10 years. Of all participants, 137 (57.1%) and 83 (34.6%) have poor knowledge and medium perception regarding fluoride in drinking water respectively. There was a significant association between those with higher education level with knowledge (p=0.02) and perception (p=0.005) where they were more likely to know about overall fluoride in drinking water. Conclusion: Most participants had limited knowledge and negative perception of fluoride beyond a general sense it was beneficial. It appears that in moving forward to receive the water fluoridation support will need to attend to the challenge of anti-fluoride sentiment influence.

Introduction: Elevated body fat percentage among elderly has resulted in a significant number of morbidity and mortality. Thus, this study aimed to determine the body fat percentage and its associated factors among hospitalized elderly in Klang Valley hospitals. Methods: A total of 57 subjects aged ≥ 60 years were recruited from the geriatric wards of three Klang Valley hospitals (Hospital Sungai Buloh, Hospital Tengku Ampuan Rahimah and Hospital Kuala Lumpur) using purposive and convenience sampling. A face-to-face interview and physical examination were conducted to obtain the data on socio-demographic characteristics, medical background, anthropometric measurements, total cholesterol levels, hand-grip strength, perception towards oral health, dietary assessment and malnutrition risk. The body fat percentage was assessed using a handheld bio-electrical impedance OMRON HBF-302 and compared with Gallagher’s classification of body fat percentage. A simple descriptive statistic and correlation analysis were used to analyze the body fat percentage and its associated factors. Results: Majority of hospitalized elderly (49%) had elevated body fat percentages. Weight (p≤0.0005), BMI (p≤0.0005), and malnutrition risk (p≤0.0005) were significantly associated with the body fat percentage. Meanwhile, other variables were not significantly associated with body fat percentage in hospitalized elderly. Conclusion: Weight, BMI, and malnutrition risk were found to be significantly associated with the body fat percentage. Other variables were not significantly associated. Thus, a better understanding of factors associated with body fat percentage is necessary in managing elevated body fat percentage to reduce the risk of morbidity and mortality among hospitalized elderly.

Introduction: Cardiovascular disease (CVD) remains the leading cause of death in Malaysia. Identification of asymptomatic at-risk individuals is often achieved by means of a risk prediction algorithm. Traditional CVD risk factors and their associated algorithms are, however, limited by residual CVD risk. High sensitivity C-reactive protein (hsCRP) has emerged as a novel CVD risk factor. This study aimed to evaluate hsCRP as an adjunct CVD risk marker among the adult Malaysian population by determining its correlation with the Framingham Risk Score (FRS). Comparison analyses were done according to sociodemographic, clinical and laboratory factors and between subjects with and without Metabolic Syndrome (MetS). Method: This cross-sectional study involved eighty-three (n=83) adults attending a health screening program at Universiti Putra Malaysia (UPM). Demographic data, anthropometric measurements and blood samples for fasting blood glucose (FBG), fasting lipid profile (FSL), glycated haemoglobin (HbA1c) and hsCRP were taken. Respondents were grouped according toFRSand the Joint Interim Statementinto 10-year CVD risk categories (low, intermediate and high) and MetS, respectively. Results: hsCRP was significantly increased in patients with high body mass index (BMI) (p=0.001), at-risk waist circumference (WC) (p=0.001) and MetS (p=0.009). Spearman’s correlation coefficient showed a significant positive correlation between hsCRP level and total FRS score (r=0.26, p<0.05) and HDL-C score (r=0.22, p<0.05). Conclusion: The significant difference of hsCRP levels across obesity levels and MetS with its modest correlation with FRS scores supported the adjunctive role of hsCRP in CVD risk prediction, most likely capturing the inflammatory pathological aspect and thus partly accounting for the residual CVD risk.

Background: The World Health Organization guidelines did not make a recommendation on use of remdesivir based on disease severity. Little is known regarding effectiveness of remdesivir in critically ill coronavirus disease 2019 (COVID-19) patients. This has led to a state of dilemma for doctors leaving them skeptical of whether they should continue to recommend the drug or not. Materials and Methods: A systematic search adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted from inception until February 20, 2020. Electronic bibliographic databases (PubMed, Cochrane database, Scopus, Embase) were included. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel Haenszel (M-H) using random-effects model. The primary outcome of interest was all-cause mortality in ventilated and nonventilated patients. Results: The Remdesivir arm was associated with similar rates of 28-day all-cause mortality (OR: 0.93, 95% confidence interval [CI]: 0.80 - 1.08; P = 0.33). Remdesivir was not found to be favorable for ventilated patients. Non ventilated COVID-19 patients showed a significant lower in-hospital mortality rate as compared with patients requiring mechanical ventilatory support (OR: 6.86, 95% CI: 5.39 - 268.74;P<0.0001). Conclusion Non-ventilated patients were associated with significant lower all-cause mortality rates. Prudent use of remdesivir is recommended in critically ill COVID-19 patients.

Background: The World Health Organization guidelines did not make a recommendation on use of remdesivir based on disease severity. Little is known regarding effectiveness of remdesivir in critically ill coronavirus disease 2019 (COVID-19) patients. This has led to a state of dilemma for doctors leaving them skeptical of whether they should continue to recommend the drug or not. Materials and Methods: A systematic search adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted from inception until February 20, 2020. Electronic bibliographic databases (PubMed, Cochrane database, Scopus, Embase) were included. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel Haenszel (M-H) using random-effects model. The primary outcome of interest was all-cause mortality in ventilated and nonventilated patients. Results: The Remdesivir arm was associated with similar rates of 28-day all-cause mortality (OR: 0.93, 95% confidence interval [CI]: 0.80 - 1.08; P = 0.33). Remdesivir was not found to be favorable for ventilated patients. Non ventilated COVID-19 patients showed a significant lower in-hospital mortality rate as compared with patients requiring mechanical ventilatory support (OR: 6.86, 95% CI: 5.39 - 268.74;P<0.0001). Conclusion Non-ventilated patients were associated with significant lower all-cause mortality rates. Prudent use of remdesivir is recommended in critically ill COVID-19 patients.

Introduction: Indonesia is one of the countries whose inhabitants use well water for drinking and cooking purposes. In East Java, 48.90% of the population uses well water for their daily needs. Well water contained heavy metals had bad effects on health such as cancer, damage of liver, kidneys, and others. The objective of this study was to evaluate the concentration of heavy metals in well water and relate them to a potential health outcomes. Methods: The method used in this study was analytical descriptive. Data used was secondary from East Java Environmental Office. A total of 101 samples were collected from 33 locations. There were 5 heavy metals analyzed, namely cadmium, chromium, lead, manganese, and zinc. Equipment using ICPMS and AAS. Data analyzed with descriptive statistics by SPSS. Data obtained were compared to the WHO Standard for Drinking Water Quality. Results: Concentration for cadmium was 0.002 mg/l, followed by manganese at 1.80 mg/l and zinc at 0.020 mg/l. Besides, all water samples had levels of chromium and lead below the detection limit. Conclusion: All heavy metals had concentrations below the maximum allowable standard, except for five water samples from three locations with levels of manganese which was above the maximum standard. Long term effects of manganese include neurological problems, intelligence, and low birth weight. Further studies need to be done to determine the source of manganese contamination. It is recommended that bottled water is used for drinking purposes in an area where heavy metal concentration is above the allowable limit.

Type 2 diabetes mellitus (DM) is becoming major health threat worldwide and it is extremely common in clinical setting. Malaysia is one of the highest diabetic populations among Asian countries and the new cases are increasing day to day. Early detection of people with high risk of Type 2 DM by using simple, easy and cost-effective assessment tool is the better way to identify and prevent the community from this non-communicable disease. The objectives of the study were to identify those are high risk to become type 2DM among Malaysians by using risk scoring form and to educate them how to prevent it. Total 591 subjects were recruited from the health screening programs carried out by the collaboration of Petaling Jaya Development Council (MBPJ) and Lincoln University College, Malaysia. Modified form of Finnish Type 2 Diabetes Risk Assessment Tool was used to identify people at risk of becoming type 2 DM. Descriptive analysis was performed for all included variables in this study by using SPSS version 21. The study found out that almost half of the participants were found to have family history of DM, 60% of them were overweight and obese and 47% were having above normal waist circumference. We observed that nearly 60 % of participants in the study were having moderate to high risk of becoming type 2 DM in next 10 years. To conclude, the result of our study would be helpful in implementation of cost-effective, convenient Type 2 DM risk assessment tool which has yet to be implemented in Malaysia.
Type 2 diabetes mellitus ; assessment tool ; health screening ; prevention

Introduction: The Patient Activation Measure (PAM) is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation levels in self-management. This study aimed to determine the validity and reliability of the PAM-13 Malay version among patients with Metabolic Syndrome (MetS) attending a primary care clinic.Methods: This work is a cross-sectional validation study among patients with MetS attending a university primary care clinic in Selangor. The PAM-13 Malay version underwent a validation process and field testing. Psychometric properties were examined using principal component analysis (PCA) with varimax rotation, scree plot, Monte Carlo simulation, internal consistency, and test-retest reliability analyses. Results: The content of the PAM-13 Malay version and the original version were conceptually equivalent. The questionnaire was refined after face validation by 10 patients with MetS. The refined version was then field-tested among 130 participants (response rate 89.7%). The Kaiser–Meyer– Olkin test was 0.767, and Bartlett’s test of sphericity was ≤0.001, indicating sampling adequacy. Two factors were identified and labeled as (1) Passive and Building Knowledge, and (2) Taking Action and Maintaining Behavior. These labels were chosen as they were conceptually consistent with the items representing the levels of activation in PAM-13. The validated PAM-13 Malay version consisted of 13 items, framed into two domains. The overall Cronbach’s α was 0.79, and the intraclass correlation coefficient was 0.45. Conclusions: The PAM-13 Malay version is valid, reliable, and fairly stable over time. This questionnaire can be used to evaluate the levels of activation among patients with MetS in primary care in Malaysia.

Introduction: Total calcium concentration is widely used to assess body calcium status although limited by many confounding factors. Thus, this study aimed to derive and internally validate an albumin-adjusted calcium equation for a selected Malaysian population. Method: This cross-sectional study involved 1011 adults at an emergency department of a tertiary hospital. Patients who had total calcium, ionised calcium and albumin measurements taken simultaneously were included. Derivation of the albumin-adjusted calcium equation was based on the adjustment equation obtained from the Association for Clinical Biochemistry and Laboratory Medicine 2015 position paper. Additionally, the equation was internally validated and compared with ionised calcium (gold standard) and the conventional Payne’s equation. Results: The newly derived equation = total calcium + 0.017 (41.35 – albumin). Internal validation exhibited the amount of shrinkage of 0.049. It tends to overestimate the adjusted calcium by a mean difference of 0.029 mmol/L compared to Payne’s equation. The comparison between Payne’s equation and the new equation with ionised calcium reclassified 402 and 486 patients, respectively into different calcium status. When both equations were compared, calcium status classification significantly differed in all and hypoalbuminaemic subjects by 90 and 16 patients, respectively. Conclusion: Locally derived albumin-adjusted calcium equation differed statistically in calcium status classification when compared to the Payne’s equation. However, to confirm this significance, the result must be compared to ionised calcium under strict, controlled preanalytical conditions. In terms of clinical significance, there was no difference in classification of calcium status between Payne’s and the new equation at medical decision limits.

Introduction: Prevention of osteoporotic fracture requires identification of individuals at high risk. Bone mineral density(BMD) is commonly used to estimate fracture probability despite inadequate predictive discrimination ability. Sphingosine-1-phosphate(S1P), a new marker of bone metabolism and bone turnover markers(BTM) such as procollagen-type-1 amino-terminal propeptide(P1NP) and C-terminal telopeptide of type I collagen(CTX) may complement current assessment. The study determined P1NP, CTX and S1P levels and their correlation with BMD, 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone(PTH) in selected subjects. Method: A cross-sectional study involving Malaysian Chinese men and women aged 50-90 years old from Puchong and Kajang, Selangor. Each subject had BMD determined by dual-energy x-ray absorptiometry and blood samples taken for 25(OH)D, PTH, P1NP, CTX and S1P. Results: A total of 131 subjects [45(34.4%) males and 86(65.6%) post-menopausal women] with median age of 65(IQR=17) were recruited. P1NP and CTX were significantly higher in post-menopausal women (P1NP=61.71 ng/ml, CTX=0.489 ng/ml) compared to men (P1NP=46.94 ng/ml, CTX=0.381 ng/ml). P1NP and CTX differed significantly according to BMD categories with values highest in osteoporosis. S1P between men (2.12±0.75 µmol/L) and post-menopausal women (1.96±0.68 µmol/L) did not differ significantly and did not differ according to BMD categories. S1P did not correlate with BMD, P1NP, CTX and 25(OH)D. P1NP and CTX negatively correlated with BMD at all measured sites but not 25(OH)D. Conclusion: CTX and P1NP, but not S1P negatively correlated with BMD. CTX and P1NP were highest in those with osteoporosis. In this group of Malaysian Chinese subjects, CTX and P1NP rather than S1P reflects bone health.