Development and Evaluation of a Booklet on Nutrition Education for Falls Prevention among Older Adults (Pembentukan dan Penilaian Buku Kecil Panduan Pemakanan bagi Pencegahan Pencegahan Jatuh dalam Kalangan Warga Emas) / Jurnal Sains Kesihatan Malaysia

@#The incidence of falls among older adults can be caused by nutritional, health status, physical and environmental factors. The objective of this study was to develop and evaluate the contents in a booklet on nutrition and falls prevention among older adults as a nutritional education material for falls prevention. In Phase I, market survey in bookstore, website search and need assessment among 30 respondents using a questionnaire was conducted. Results from Phase I were used to form a 32-page A5 size booklet that includes information on nutrients related to bone health, recommendations of high protein and calcium menus, ideal exercise and tips to avoid falls in older adults. The content validity of the booklet was conducted among six health professionals to assess the suitability and understanding in Phase II. The content of the booklet (Phase III) was then evaluated among 24 respondents aged 60 years and above. From the need assessment in Phase I, majority of respondents chose 7 to 9 for the score of each questions which indicates the need for all information to be included in the booklet. For Phase II, criteria with highest average score were composition and typography with a score of 60%. For Phase III, most respondents chose “good” for all the criteria stated except for pictures (satisfactory), while 62.5% of respondents stated that they were satisfied with the information contents in the booklet. In conclusion, this booklet can be used as one of the strategies for nutrition education in the prevention of falls among older adults.

Association between Isoflavones Consumption and Cognitive Function and Comorbidities among Older Adults Residing in the State of Johor, Malaysia

Introduction: This two-phase longitudinal study sought to determine the association between isoflavones intake on cognitive function and comorbidities among older adults from the state of Johor, Malaysia. Methods: Phase I involved baseline data collection to examine the association between isoflavones intake and cognitive function among 400 respondents aged 60-years and above, recruited through multistage random sampling. Phase 2 determined the association between isoflavones intake at the baseline and comorbidities at an 18-month follow-up. The baseline data collected included information on socio-demographics, health status, andunpometric measurements, and dietary intake using a dietary history questionnaire (DHQ). Each participant's cognitive function was evaluated using a mini mental state examination (MMSE), digit span, digit symbol, and geriatric depression scale (GDS). Results: The daily intake of total isoflavones, daidzein, and genistein were 19.1±19.7,11.7±12.3 and 7.6+8.1 mg/day, respectively. There was no significant association between isoflavones intake, and specific cognitive function including global, memory, executive functions, and depression. However, there was a significant association (p 0.05). Conclusion: This study found an association between isoflavones intake and memory function, but not with global cognitive, executive functions, depression, and comorbidities. There is a need to promote adequate isoflavones intake in view of its association with memory function.

Perspectives of Healthcare Professionals and Patients on Management of Gestational Diabetes Mellitus: A Qualitative Study in Negeri Sembilan, Malaysia

Introduction: Understanding the perceptions of healthcare professionals and patients regarding gestational diabetes mellitus (GDM) is important for optimal pregnancy outcomes. This study aimed to identify the problems faced by healthcare professionals in the management of GDM and the patients' perspectives as well. Methods: Two focus groups consisting of thirteen pregnant women diagnosed with GDM at 20-28 weeks of gestation and sixteen healthcare professionals were interviewed using a semi-structured questionnaire. The subjects were recruited purposively from a public health clinic in Negeri Sembilan, Malaysia. Audio recordings were made of the interview sessions and transcribed verbatim before being assessed independently by two researchers. The NVivo 10.0 programme was used to extract key themes. Results: Five emergent themes consisting of views from both groups of subjects were identified. They were: (1) perceived patients' non-adherence to medical advice versus patients' own negligence; (2) poor appetite control versus patients' poor temptation control; (3) patients' lack of knowledge versus confusing information provided by healthcare staff; (4) patients 'giving up' versus being in a non-supportive environment; and (5) patients being in denial versus the disappointment when required to control diet. Conclusion: This study revealed conflicting perspectives between pregnant mothers with GDM and the healthcare staff in managing these patients. There is a need to promote positive communication between healthcare staff and patients for a better understanding of the needs of GDM patients.

Association of Fruit and Vegetable Consumption with Mild Cognitive Impairment Among Older Persons Living in Low-Cost Residential Areas in Kuala Lumpur

Introduction: The benefits of sufficient fruits and vegetables consumption for health are well known. This study investigated the adequacy of fruit and vegetable intake among older persons and its association with mild cognitive impairment (MCI). The study also identified motivation and barrier factors affecting fruit and vegetables consumption. Methods: A total of 114 respondents aged 60-years and above (25 and 89 respomdents with and without MCI, respectively) from low cost housing areas in Kuala Lumpur participated in the study. Participants were interviewed using a standardised questionnaire with neurocognitive testing scales to determine their cognition level. Results: Of the non-MCI participants, 15.7% met World Health Organisation's (WHO) (2003) recommendations for fruit and vegetable consumption of 400 g/ day compared to 12.0% of the subjects with MCI (p<0.05). Participants without MCI also had a significantly higher intake of fruit and vegetables (281.6 ± 77.2 g/ day) compared to those with MCI (250.4 ± 51.3 g/ day). Total daily intake of vegetables and fruits was significantly correlated with the digit span score of the participants (r=0.214, p<0.02). Total daily intake of leafy green vegetables was correlated with the verbal memory domain score of the total digit span (r=0.254, p<0.01). The main motivating factor for taking fruits, vegetables, and 'ulam' (salad) was their belief in its health benefits. The main barriers to their consumption were dental problems, and a dislike of their taste. Conclusion: Generally, the intake of fruits and vegetables among older persons was inadequate and was associated with poorer cognitive functions. Improvement of oral health status and the provision of more choices of fruits and vegetables for older persons may increase their daily intake.

Sensitivity, Specificity, Predictive Value and Inter-Rater Reliability of Malnutrition Screening Tools in Hospitalised Adult Patients

Nutrition screening is recommended as a first step of nutrition care to allow early identification and intervention of malnourished patients. The present study determined the validities and reliabilities of two malnutrition screening tools namely, the Malnutrition Universal Screening Tool (MUST) and Malnutrition Screening Tool (MST) among adult patients at the Hospital Kuala Lumpur. Methods: The sensitivity, specificity and predictive value of MUST and MST were conducted against the Subjective Global Assessment (SGA), anthropometric parameters including body mass index (BMI), calf circumference (CC),mid-upper arm circumference (MUAC) and energy intake. Inter-rater reliability was evaluated using kappa value (κ) to determine the level of agreement between raters. Results: A total of 151 subjects with mean age of 45.2 ± 13.7 years participated in this study. Prevalence of malnutrition according to MUST, MST and SGA was 34.4%, 33.8% and 19.9%, respectively. As compared to SGA, MUST and MST had a sensitivity of 96.6% and 93.3% respectively, whereas the specificity was 80.9% for both tools. The sensitivity and specificity of MUST against the anthropometric parameters (BMI, CC and MUAC) were between 53.8% to 88.8% and 67.4% to 69.9%, respectively. The sensitivity values for MST were between 46.1% to 63.6% and specificity values were between 64.4% to 67.6%. The inter-rater reliability of MUST was higher (substantial, mean (κ) = 0.78) than for MST (moderate, mean (κ) = 0.52). Conclusions: In conclusion, MUST was found to have similar validity levels but higher reliability result than MST. Based on our result, MUST is recommended for use in identifying adult patients who are at high risk of malnutrition. It can be used as a malnutrition screening tool but there is a need to evaluate the cost effectiveness of its implementation.

Evaluation of the reagent test strips and microscopic examination of urine in the diagnosis of urinary tract infection in sows / Precisão da tira reagente e do exame microscópico da urina no diagnóstico de infecções do trato urinário em porcas

The diagnosis of the urinary tract infection (UTI) in sows is usually performed by using reagent test strips, since it is a fast and practical method, and capable of being done at the farm. The microscopic examination of the urine is rarely used at the farm since it is a more time consuming and difficult technique. However, there are no studies on the accuracy of those two techniques for the UTI diagnosis on this species. This study aims to assess the accuracy of the reagent test strip and the urine microscopic examination in the diagnosis of ITU in sows, comparing them with the bacteriological examination of urine. In order to select the sows for this study, a chemical reagent test strip was carried out previously and a total of 139 sows were selected, 66 sows of which showed positivity to nitrite in the reagent test strip and 73 without nitrituria. Then, the next day, a new sample collection for performing a complete urinalysis was carried out from those 139 sows, which included physical, chemical, microscopic and microbiological examination of these urine samples. The results revealed that the nitrite test of the reagent strip showed 100% of specificity and 93% of sensitivity. The specificity of the microscopic examination for bacteriuria was 82% and the sensitivity was 100%. The UTI diagnosis by using reagent strips and/or the urine sediment test is reliable if compared to the urine bacteriological examination, which makes possible the rapid diagnosis of UTI in sows at the farm.

O diagnóstico de infecção do trato urinário (ITU) em porcas geralmente é feito com o auxílio de tiras reagentes, por ser um método rápido, prático e passível de ser realizado na própria granja. O exame microscópico da urina raramente é utilizado em granjas por ser uma técnica mais demorada e trabalhosa. No entanto, não existem estudos sobre a precisão destas duas técnicas no diagnóstico de ITU nesta espécie. O objetivo deste estudo foi avaliar a precisão da tira reagente e do exame microscópico da urina no diagnóstico de ITU em porcas, comparando-os com o exame bacteriológico da urina. Para selecionar as porcas que iriam compor o estudo foi realizado um exame químico prévio com tira reagente, do qual foram selecionadas 139 porcas, 66 positivas para nitrito na tira reagente e 73 negativas. No dia seguinte foi realizada uma nova coleta de urina destas 139 porcas para realização da urinálise completa, que incluiu os exames físico, químico, microscópico e microbiológico destas amostras de urina. Os resultados demonstraram que a prova de nitrito da tira reagente apresentou 100% de especificidade e 93% de sensibilidade. A especificidade do exame microscópico para bacteriúria foi de 82% e a sensibilidade de 100%. O diagnóstico de ITU com o uso de tiras reagentes e/ou com exame microscópico da urina é confiável, quando comparado com o exame bacteriológico da urina, o que torna possível o diagnóstico rápido de ITU em porcas na granja.

Relationship between Appetite, Food Intake and Body Composition among Elderly Malays from an Urban Residential Area in Kuala Lumpur, Malaysia

Loss of appetite, decrease in food intake and changes in body composition appear to be inter-related factors that can influence the well-being of older individuals. Therefore, a study was conducted to determine the level of appetite, food intake and its relation to body composition and functional status among noninstitutionalised elderly Malays in Cheras, Kuala Lumpur. The Council on Nutrition Appetite Questionnaire (CNAQ), Diet History Questionnaire (DHQ), Bio-impedance Analysis (BIA) and Instrumental Activity of Daily Living (IADL) questionnaire and handgrip dynamometer were used to measure appetite, food intake, body composition and functional status respectively. A total of 112 subjects (41.1% men and 58.9% women) participated with mean age being 66.0 ± 5.0 years for men and 66.3 ± 6.2 years for women. Prevalence of poor appetite was higher in elderly women (72.3%) than in men (52.3%) (p<0.05). Pearson’s correlation test showed that CNAQ score correlated significantly with age (r=-0.255, p<0.01), energy intake (r=0.272, p<0.01), IADL score (r=0.408, p<0.01) and handgrip strength (r=0.263, p<0.05). Energy intake correlated significantly with fat free mass (r=0.424, p<0.05), muscle mass (r=0.456, p<0.05) and total body water (r=0.403, p<0.05). Multiple regression analysis showed that 27.0% of poor appetite could be explained by advanced age, low energy intake and decreased functional status. In conclusion, the study showed that poor appetite was prevalent among the subjects, especially women and this was influenced by aging, inadequate energy intake and decreased functional status.

Assessment of Physical Activity Level among Individuals with Type 2 Diabetes Mellitus at Cheras Health Clinic, Kuala Lumpur

A cross-sectional study was carried out to assess the physical activity levels among patients with type 2 diabetes mellitus (DM) at Cheras Health Clinic in Kuala Lumpur. A total of 132 subjects (62 men and 70 women) aged 30 years and above participated in this study. Data was collected using an interview based questionnaire to obtain socio-demographic and health profile information. Physical activity was assessed using a shortened version of the International Physical Activity Questionnaire (IPAQ). Anthropometric measurements and body fat were also taken. Glycaemic status, that is, HbA1c, fasting blood sugar (FBS) and 2 hours post-prandial (2-HPP) were obtained from medical records. Results showed that the mean age of the patients was 51.9 + 5.8 years. The majority of patients had poor glycaemic control based on HbA1c (70.7%), FBS (71.9%) and 2HPP (85.4%). Patients who were unmarried and aged(60 years and above had a lower physical activity level (p<0.05). In the older age group, low physical activity was associated with poor glycaemic control (p<0.05). Patients in the moderate and high physical activity level were motivated to perform physical activity so as to be healthy (68.1%). Low physical activity level among patients was due to lack of time (54.5%) and lack of energy (21.2%). In conclusion, physical activity levels of the patients were unsatisfactory and associated with poor glycaemic control, especially in the elderly. There is a need to encourage diabetic patients to undertake regular physical activity in order to achieve optimal glycaemic control.

Nutritional Status of Children below Five Years in Malaysia: Anthropometric Analyses from the Third National Health and Morbidity Survey III (NHMS, 2006)

The Third National Health and Morbidity Survey (NHMS III) was conducted in 2006 on a nationally representative sample of population in Malaysia. Over 21,000 children aged 0-17.9 years were measured for body weight and stature according to the protocol of the World Health Organization. This article describes the nutritional status of children aged 0-59.9 months. Mean z score for weightfor-age (WAZ), height-for-age (HAZ) and BMI-for-age were compared with the z-scores tables of the WHO standards. The overall prevalence of underweight and stunting of the children were 12.9% and 17.2% respectively. These levels included 2.4% severe underweight and 6.0% severe stunting. In terms of z scores, the age group of 0–5.9 months showed the best nutritional status with mean WAZ of -0.33 (95%CI: -0.52, 0.15) and -0.40 (-0.57, 0.24) for boys and girls respectively, while mean HAZ was 0.64 (0.38, 0.89) for boys and 0.76 (0.54, 0.98) for girls. Mean HAZ and WAZ status was least satisfactory after about 6 months, suggesting a faltering in growth rate at an age that coincides with dependence on complementary feeding. Prevalence of overweight based on BMI-for-age for the sexes combined was 6.4%, while that based on WAZ was 3.4%. The NHMS III results indicate that Malaysian children have better nutritional status compared to children under 5 years in neighbouring countries. In order to meet the targets set in the National Plan of Nutrition (2006-2015), more effective intervention programmes are needed to accelerate the reduction of underweight and stunting, and to arrest the rise of overweight in young children.

Prevalência de cárie e fatores associados em crianças hemofílicas / Prevalence of caries and associated factors in hemophiliac children

O presente estudo teve como objetivo verificar a prevalência de cárie e alguns fatores associados em crianças portadoras de hemofilia, na faixa etária de 3 a 12 anos, de ambos os sexos, atendidas no Centro de Hemoterapia de Pernambuco (Hemope) nos anos de 2005/2006. Os dados foram coletados através de uma amostra intencional, composta por quarenta crianças. O levantamento dos dados foi feito através de uma etapa clínica e outra não-clínica. Na etapa clínica foi realizado o exame clínico intrabucal por uma examinadora calibrada. Na etapa não-clínica foram aplicados questionários aos responsáveis, com perguntas objetivas e subjetivas sobre alguns fatores comportamentais e sociais. Para determinação da prevalência de cárie foi adotado o índice ceo-d e CPO-D de acordo com os critérios da OMS. Após análise dos dados, verificou-se que o índice ceo-d foi igual a 2,00 e o do CPO-D igual a 0,67. Além disso, com relação ao grau de instrução dos responsáveis, o valor do ceo-d foi de 1,51 para as crianças cujos pais possuíam 1º grau incompleto e de 2,50 para aqueles com o 1º grau completo; o CPO-D foi de 0,78 para aquelas cujos pais tinham 1º grau incompleto e de 0,59 para os com o 1º grau completo. Foi possível concluir: a prevalência de cárie no grupo pesquisado foi baixa; verificou-se uma relação significante entre a prevalência de cárie e os indicadores de desenvolvimento socioeconômico, relacionado ao grau de instrução dos responsáveis; observou-se uma menor prevalência de cárie nas crianças cujas mães receberam orientações sobre higiene bucal e dieta.

The present study aimed at verifying tooth decay and some associated factors in hemophilic children of both genders with ages from 3 to 12 years old, treated in the Center of Hemoterapia of Pernambuco (Hemope) in 2005 and 2006. The data were collected from an intentional sample composed of 40 children. Data collection was achieved in two phases: clinical and non-clinical. In the clinical phase, an intrabuccal clinical examination was performed by a specialist. While in the non-clinical phase, the guardians of the children were requested to complete a questionnaire with objective and subjective questions on behavioral and social factors. To determine tooth decay, the ceo-d and CPO-D indexes were adopted as recommended by the World Health Organization. Analysis of the data showed the ceo-d index was 2.00 and the CPO-D index was 0.67. Additionally, in respect to the education of the guardians, the ceo-d index was 1.51 and 2.50 for children of parents with incomplete and complete primary school education, respectively. Similarly, the CPO-D was 0.78 and 0.59 for participants whose parents had incomplete and complete primary school education, respectively. It was possible to conclude that tooth decay in this group was low and there was a significant association between tooth decay and socioeconomic development indicators. In respect to the education of guardians, less tooth decay was observed in children whose mothers received guidance on oral hygiene and diet.

Abdominal Obesity in Malaysian Adults: National Health and Morbidity Survey III (NHMS III, 2006)

Abdominal obesity (AO) is an independent risk factor for cardiovascular disease, hypertension and diabetes mellitus in adults. There is a lack of data on the magnitude and socio-demographic profile of AO among Malaysian adults at the national level. In the Third National Health and Morbidity Survey (NHMS III) conducted in 2006, AO of adults aged 18 years and above was determined based on the waist circumference as part of the nutritional status assessment. This article reports the prevalence of AO in relation to socio-economic factors and demographic characteristics of adult subjects. Out of a total of 33,465 eligible individuals 18 years and above, waist circumference was measured in 32,900 (98.3%) individuals. The prevalence of AO was assessed using the cut-off points recommended by World Health Organization. The mean waist circumference in men and women was 84.0cm [95% confidence interval (95% CI): 83.8, 84.3] and 80.3cm (95% CI: 80.1, 80.6) respectively. The national prevalence of AO was 17.4% (95% CI: 16.9, 17.9). The identified risks of AO were women (OR: 4.2, 95% CI: 3.8, 4.6), aged 50-59 years (OR: 5.6, 95% CI: 4.0, 7.7), Indians (OR: 3.0, 95% CI:2.4, 3.8), housewives (OR: 1.4, 95% CI: 1.1, 1.7), subjects with primary education (OR: 1.3, 95% CI: 1.1, 1.5) and ever married (OR: 1.4, 95% CI: 1.2, 1.6). Being the largest population-based study on AO among Malaysians, these findings have important public health implications. There is an urgent need to revise public health policies and programmes aimed at prevention of abdominal obesity especially in the groups at risk.

Rabies laboratory diagnosis: peculiar features of samples from equine origin

Rabies laboratory diagnosis is performed by using microscopic examination for Negri bodies (MEN), fluorescent-antibody test (FAT) and mouse inoculation test (MIT). In the majority of cases, when specimens are properly collected and conserved and the laboratory worker has good experience, agreement among employed techniques is verified. Comparing the sensitivity of these three diagnosis techniques in 3,713 samples (hippocampus and brain stem) received during 1981-1994 period, being 3,010 from bovine (983 positives) and 703 from equine (111 positives) species, it was observed that in equine rabid samples, this agreement was not mantained. For the latter specie, only in few opportunities the Negri bodies could be observed. With respect to FAT, the test detected a lower porcentage of positive equine samples compared to bovie species. Statistical analysis demonstrated that the difference was significative. Mouse inoculation test proved to be more sensitive. However, a significant difference in mice incubation period was observed for samples from both species. The absence of inclusion bodies and the longer incubation period for equine samples suggest that rabies pathogenesis studies for equine species have to be intensified.

Identification, propagation and subgroup characterization of an equine rotavirus isolated in Säo Paulo, Brazil

Duas amostras de fezes de equinos (EQ/28 e EQ/29) foram recebidas para diagnóstico no Instituto Biológico. As amostras eram provenientes de Orlândia, Säo Paulo, de dois animais com diarréia. A identificaçäo de rotavírus foi feita através de ensaio imunoenzimático (EIARA/FIOCRUZ) e por eletroforese em gel de poliacrilamida (PAGE). As amostras foram positivas para rotavírus pelas duas técnicas, com eletroferótipo característico de rotavírus equino (segmentos 3 e 4 bem próximos) e segmentos 7, 8 e 9 separados). O rotavírus foi isolado em linhagem celular de rim fetal de macaco Rhesus (MA104), com a adiçäo de tripsina, em equipamento do tipo "roller", chegando a sexta passagem, com efeito citopítico característico. Os lisados de cada passagem em culturas celulares foram positivos para rotavírus por EIARA e PAGE, com eletroferótipo semelhante ao da amostra original, em relaçäo aos segmentos 1 a 6, e com algumas diferenças na migraçäo dos segmentos 7 a 11. As amostras originais e lisados das passagens em culturas de células foram testados para determinaçäo de subgrupo, com anticorpos monoclonais (MAb) específicos para grupo A, subgrupo I e subgrupo II, através de um teste imunoenzimático. Tanto as amostras originais quanto os lisados reagiram com o MAb específico para o grupo A e näo reagiram com os anticorpos antisubgrupos I e II, da mesma forma que a amostra H-2 e outros rotavírus equinos. Este é o primeiro isolamento de um rotavírus equino no Brasil, tornando-se importante elucidar sua prevalência em animais normais e com diarréia

A ética médica e suas infraçoes: um estudo sobre os processos éticos-profissionais do estado do Rio de Janeiro / Medical ethics and transgression

Descreve a preocupaçäo com a conduta ética na área da saúde, uma conceituaçäo genérica do termo e utilizando as palavras do Cameiro Leäo a "ética representa um conjunto de princípios chamados à orientar e a guiar as relaçoes individuais e sobretudo as relaçoes sociais." Considera os médicos como a categoria típica da área da saúde, vemos que este profissionais enfrentam atualmente severos dilemas de ordem ética. Na estrutura dos serviços, o mais sagrados direito da cidadania o direito a vida näo vem sendo respeitado

Neuropatia periférica e síndrome hipereosinofílica idiopática: revisäo bibliográfica a propósito de um caso com apresentaçäo atípica / Peripheral neuropathy and idiopathic hypereosinophilic syndrome: review of the literature apropos of a case with atypical presentation

O envolvimento do sistema nervoso na síndrome hipereosinofílica idiopática é achado comum, sendo a neuropatia periférica a manifestaçäo neurológica mais freqüente, comumente surgindo no início ou após o aparecimento da eosinofilia. Os autores descrevem o caso de paciente de 42 anos, do sexo masculino, com eosinofilia persistente (> 1500 mm3) por período superior a 6 meses, na ausência de causa conhecida para eosinofilia com acometimento de órgäos-alvo, no qual o envolvimento neurológico, que precedeu de meses a elevaçäo da contagem periférica de eosinófilos, consistiu de neuropatia periférica e acometimento näo-usual de nervo craniano. Havia severa fraqueza e atrofia distais nos 4 membros, com distúrbios sensitivos que se desenvolveram ao longo desses meses, juntamente com surdez neurossensorial à esquerda. Estudos eletrodiagnósticos demonstraram comprometimento generalizado dos nervos, do tipo axônico. A biópsia de nervo näo revelou infiltraçäo eosinofílica ou alteraçöes vasculíticas, sugerindo que produtos eosinofílicos neurotóxicos possam exercer influência na neuropatia. Houve marcada reduçäo da contagem de eosinófilos e leve reduçäo das alteraçöes sensitivas e motoras durante o curso de corticoterapia