Effect of Physical Activity Intervention on Physical Activity, Body Mass Index, Blood Pressure, Blood Lipid and Fasting Blood Sugar Among Overweight and Obese Military Personnel

Abstract@#Introduction: About 18% of Malaysian Armed Forces (MAF) personnel are diagnosed with either hypertension, diabetes or coronary artery disease, while another 8% are obese. The rising prevalence necessitates intervention. Methods: This is a single blinded randomized controlled trial among overweight and obese MAF personnel attending medical checkup in MAF hospital in Kuala Lumpur. An intervention module was developed to increase their physical activity level. Short version of International Physical Activity Questionnaire was used to assess physical activity in metabolic equivalent of task score (METs score), while blood pressure, body mass index (BMI), blood lipid profile and fasting blood sugar measurements were also obtained. These parameters were measured at baseline and again at 6 months. Generalized estimating equations (GEE) statistical test were applied to evaluate the effect of the intervention. Results: Response rate was 100%. Most of participants were aged above 40 years, male, from Malay ethnic group, completed secondary education and had monthly income above RM 4000. Most of the respondents were obese and had moderate level of physical activity at baseline. All variables compared between groups at baseline showed no significant difference. At six months, after controlling for covariates, the significant difference was only in METs score. The odds of having high METs score in the intervention group after receiving intervention was nearly 3 times higher than those in the control group, after adjusting for interaction between time and group as well as other covariates (AOR = 2.908, 95% CI 1.323 – 6.391, P=0.008). Conclusion: Intervention was effective in increasing physical activity among overweight and obese military personnel.

Biochemical Effects of Statins on Lipid Parameters among Newly Diagnosed Dyslipidaemia Subjects in Primary Care

@#Introduction: Statins have several pleiotropic effects including its primary effect of lipid lowering that is important to prevent cardiovascular disease (CVD). Subjects often have heterogeneous responses to statin. This study aims to determine the biochemical effects of statins on lipid parameters among newly diagnosed dyslipidaemia subjects. Methods: This was a prospective observational study involving 118 newly diagnosed adults with dyslipidaemia from three government health clinics in Selangor, Malaysia. Biochemical analyses including fasting lipid profile [triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and apolipoproteins (apoA1, apoB) were taken at baseline and follow-up after a month on statin. Results: Majority of subjects (61.9%) were prescribed with lovastatin, with the rest on simvastatin. At baseline, the median values for all lipid profile parameters (TC, LDL-C, HDL-C) and non-conventional lipid parameters (LDL-C:HDL-C ratio, non-HDL-C, TC:HDL-C ratio, apoB:apoA1 ratio) were deranged except for TG and apoA1. On follow up, all parameters showed median values within the reference range except for HDL-C, non-HDL-C and TC:HDL-C ratio. There was significant difference in the effect of statins on lipid parameters including predictors of cardiovascular risk, simvastatin having better effects. Conclusions: Different statinshave varying effects on lipid parameters. Simvastatin showed significantly better effects compared to lovastatin. Non-HDL value should be included in the standard lipid profile report given its ease of use and implementation as it’s both a marker of coronary artery disease (CAD) risk stratification as well as an established determinant of goal attainment during therapy.

Growth patterns of Palestinian children from birth to 24 months

Background: Growth faltering in early life can adversely affect health in later childhood and adulthood. Growth monitoring of children can provide evidence to help formulate effective strategies to address growth problems but such information on Palestinian children is lacking.

Objectives: This study aimed to determine the growth patterns of children under 2 years in Gaza, Palestine.

Methods: This retrospective cohort study was conducted in 2014 in 10 randomly selected primary health care clinics in 5 governorates of Gaza. Weight and length data were obtained from the health cards of children born in 2012, and z-scores were calculated and compared with the WHO Growth Standard [2006].

Results: A total of 2 632 children's cards were included at the beginning of the study. Weight-for-age and weight-forlength decreased from birth to 6 months to about –0.40 SD but increased afterwards to –0.11 SD and 0.34 SD at 24 months respectively. Length-for-age declined after 6 months, reaching –0.85 SD at 24 months. At 6 months, the prevalence of underweight and stunting were 5% and 9% but at 24 months, the prevalence was 4% and 20% respectively. Wasting was highest at 6 months [10%] but decreased to 3% at 24 months. Significantly more girls were stunted at 9, 12 and 18 months [P < 0.001], underweight at 24 months [P < 0.05] and wasted at 12 months [P < 0.05]. Early life faltering in length was more pronounced than weight, with stunting occurring in one fifth of boys and girls by 2 years of age.

Conclusions: Preventive strategies are urgently needed to address early life causes of undernutrition, particularly stunting, in Palestinian children in Gaza

Prevalence and Predictors of Intestinal Worm Infections Among Semai Aboriginal Tribe School Children in Tapah, Malaysia

Introduction: Worm infection is one of the major global public health problems especially among rural communities. Objectives: to determine the prevalence of intestinal worm infection and factors associated among Semai Aboriginal children aged between 6 to 13 years in Tapah, Malaysia. Methods: A cross-sectional study design was used in this study. The estimated sample size was 508. Data was collected using a validated pretested questionnaire. Faecal samples were also examined. Data was analysed using SPSS version 22. Results: The response rate was 80.9%. The overall mean age of the 411 respondents was 10.1 years(95% CI = 9.89, 10.22). Majority (71.5%) were poor. Prevalence of intestinal worm infections was 60.8% and 57.2% had multiple infections. The multiple logistic regression analysis showed that those with poor hygiene practices were 2.18 times the odds of worm infection when compared with children with good hygiene practices (95% CI = 1.4, 3.4). Similarly, poor attitudes towards prevention of worm infection increased the odds of having worm infection by 1.62 times among Orang Asli children. Children living without toilets had 2.45 times higher odds as compared with those who had proper toilets. Absence of river near by these areas where there is no safe water supply also increases the risk of worm infection among children by 1.84 times among Orang Asli children. Conclusions: the prevalence of worm infection is still very high among rural Aboriginal community. Current control measures should be reassessed to enable introduction of effective measures to reduce the worm infection among Orang Asli children.

Erratum: Health Blief Model-based intervention to improve nutritional behavior among elderly women

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Health Blief Model-based intervention to improve nutritional behavior among elderly women

BACKGROUND/OBJECTIVES: Nutrition is a determinant factor of health in elderly people. Independent living in elderly people can be maintained or enhanced by improvement of nutritional behavior. Hence, the present study was conducted to determine the impact of Health Belief Model (HBM)-based intervention on the nutritional behavior of elderly women. SUBJECTS/METHODS: Cluster-random sampling was used to assess the sample of this clinical trial study. The participants of this study attended a 12-week nutrition education program consisting of two (2) sessions per week. There was also a follow-up for another three (3) months. Smart PLS 3.5 and SPSS 19 were used for structural equation modeling, determination of model fitness, and hypotheses testing. RESULTS: The findings indicate that intervention had a significant effect on knowledge improvement as well as the behavior of elderly women. The model explained 5 to 70% of the variance in nutritional behavior. In addition, nutritional behavior was positively affected by the HBM constructs comprised of perceived susceptibility, self-efficacy, perceived benefits, and barriers after the intervention program. CONCLUSION: The results of this study show that HBM-based educational intervention has a significant effect in improving nutritional knowledge and behavior among elderly women.

Health Blief Model-based intervention to improve nutritional behavior among elderly women

BACKGROUND/OBJECTIVES: Nutrition is a determinant factor of health in elderly people. Independent living in elderly people can be maintained or enhanced by improvement of nutritional behavior. Hence, the present study was conducted to determine the impact of Health Belief Model (HBM)-based intervention on the nutritional behavior of elderly women. SUBJECTS/METHODS: Cluster-random sampling was used to assess the sample of this clinical trial study. The participants of this study attended a 12-week nutrition education program consisting of two (2) sessions per week. There was also a follow-up for another three (3) months. Smart PLS 3.5 and SPSS 19 were used for structural equation modeling, determination of model fitness, and hypotheses testing. RESULTS: The findings indicate that intervention had a significant effect on knowledge improvement as well as the behavior of elderly women. The model explained 5 to 70% of the variance in nutritional behavior. In addition, nutritional behavior was positively affected by the HBM constructs comprised of perceived susceptibility, self-efficacy, perceived benefits, and barriers after the intervention program. CONCLUSION: The results of this study show that HBM-based educational intervention has a significant effect in improving nutritional knowledge and behavior among elderly women.

Visual Status following Contact Lens Related Microbial Keratitis

Introduction: A hospital based case control study was conducted in government hospitals on contact lens patients diagnosed with microbial keratitis. Methods: The objective of this study is to determine the visual outcomes of contact lens related microbial keratitis. The visual outcomes which comprised of visual acuity, keratometry readings, corneal topography findings and contrast sensitivity examinations was determined after three months from the first presentation at the hospitals. Results: The mean LogMAR visual acuity during presentation was 0.96 ± 0.73 or a Snellen equivalent 6/60 (n=76) and mean LogMAR visual acuity after three months was 0.10 ± 0.48 or a Snellen equivalent 6/7.5 (n=76) with a significant difference (t=11.22, df=78, p=0.001). Best fit curve for the cases had a regression coefficient, r=0.350 ± 0.063 (95% CI = 0.224, 0.447, df=78, p=0.001. The visual acuity in cases and controls was 0.10 ± 0.48 and -0.10 ± 0.14 respectively (t= -3.61, df=154 p=0.001) after three months which showed improvement. There was a reduction in the corneal uniformity index and corneal asphericity in the cases. The Corneal Uniformity Index (CU index) in cases was 63.03 ± 26.38 (n=76) and in controls, 80.13 ± 11.30 (n=77), (t= -5.22, df=151, p=0.001). There was also a reduction in the contrast sensitivity function at all spatial frequencies in the cases which was significantly different. Conclusion: Microbial keratitis reduced the vision, corneal uniformity index, asphericity and contrast sensitivity after three months in eyes of patients diagnosed with the condition.

Risk Factors Associated with Contact Lens Related Microbial Keratitis

Introduction: Microbial keratitis is one of the most challenging complications of contact lens (CL) wear. Proper CL practice plays an important role to reduce the risk for contact lens related microbial keratitis (CLRMK). Methods: This multi-centre case-control study was conducted from January 2008 until June 2009 to determine the risk factors associated with CLRMK. Cases were defined as respondents who were treated for CLRMK, whilst controls were respondents who were contact lens wearers without microbial keratitis. Ninety four cases were compared to 94 controls to determine the risk factors for CLRMK. Results: The predictors for CLRMK were: Not washing hands with soap before handling CL (aOR 2.979, CI 1.020, 8.701 p=0.046), not performing rubbing technique whilst cleaning the CL (aOR 3.006, CI 1.198, 7.538 p=0.019) and, not cleaning the lens case with multipurpose solution daily (aOR 3.242 CI 1.463, 7.186 p=0.004). Sleeping overnight with the CL in the eye (aOR 2.864, CI 0.978, 8.386 p=0.049) and overall non-compliance with lens care procedures (aOR 2.590, CI 1.003, 6.689 p=0.049) contributed significantly to CLRMK. Conclusion: Health education and promotion in contact lens care are important and should be conducted by eye care practitioners to reduce the occurrence of CLRMK.

Current Clinical Status and Vascular Complications among Patients with Type 2 Diabetes Mellitus at Tertiary Hospitals in Malaysia.

Objective: To assess the prevalence of diabetic vascular complications and cardiovascular risk factors control in type 2 diabetic patients at tertiary settings. Methods: This cross-sectional study was conducted among 313 patients diagnosed with type 2 diabetes mellitus (T2DM) at two tertiary referral hospitals in Malaysia. Data regarding socio-demographics, macro- and microvascular complications, family health history, blood pressure, anthropometric indices, glycaemic control, and lipid profile were obtained from medical records, face-to-face interview and physical examination. Results: The mean age of patients was 55.7±9.2 years, mean diabetes duration was 10.1±8.1 years, and 52.1% were females. Approximately 36.1% patients had cardiovascular disease (CVD). There were high prevalence of established coronary artery disease (30.7%), cerebrovascular disease (10.2%), and peripheral vascular disease (5.1%). Peripheral neuropathy, diabetic nephropathy and retinopathy were present in 41.5%, 17.6% and 15.0% patients respectively. Only 14.1% of the patients reached optimal HbA1c level and 21.1% patients achieved target fasting plasma glucose. The overall prevalence of dyslipidemia was 89.1%, hypertension was 80.2%, and obesity was 35.9% (BMI) and 86.5% (waist-to-hip ratio). Conclusions: Diabetic vascular complications were highly prevalent among the type 2 diabetic patients. Cardiovascular risk factors control was suboptimal. Both awareness and application of recommended guidelines need to be reinforced.

Perceived Norms and Smoking Status among Secondary School Students in Kota Tinggi, Johor, Malaysia

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.

Leisure Time Physical Activities among Adult Attendees at a Primary Health Care Clinic

Objectives: This cross-sectional study was undertaken to determine the leisure-time physical activities of adult attendees in a rural health clinic in July 2002. Methods: Simple random sampling method of the clinic register was used. Data was collected via a face-to-face interview using a pre-tested questionnaire. Results: A majority (73%) of these attendees performed leisure-time physical activity. The majority were between 20 to 29 years (p0.05), Kadazan, Iban and Orang Asli (p>0.05), had attained tertiary education (p0.05). They were also fee from chronic illnesses. The most common activities were walking, aerobic dancing and gardening. Physical and mental wellness, advice from doctor and support from family and friends were the reasons for performing these activities. The reasons for not performing leisure physical activity were (i) being too busy, (ii) already active at workplace, and (iii) being unwell. Conclusions: Sustained community interventions in the community couldd prove useful to encourage individuals to carry out leisure-time physical activities.