Prevalence and characteristics of e-cigarette users among Malaysian current and ex-smokers.

INTRODUCTION: Electronic cigarettes (ECs) are new devices that have been accepted widely by both smokers and non-smokers. However, the evidence on EC used in Malaysia is scarce. The objective of this study was to determine the prevalence of EC use and the socio-demographic and smoking characteristics associated with current EC use among Malaysian current and ex-smokers. METHODS: This was a sub-analysis of data from a cross-sectional, national-population- based EC study conducted from May to June in 2016 in Malaysia. A detailed description of the sampling methods can be found in the National E-cigarette Survey (NECS) 2016 report. Briefly, data were obtained from 1396 individuals who had ever been smokers, i.e., 957 (68.6%) current smokers and 439 (31.4%) ex-smokers. RESULTS: Current EC use was found predominantly among current smokers (8.0%) as compared with ex-smokers (4.3%). Among current smokers, the main reasons given for smoking ECs were wanting to try it (44.7%), followed by intention to quit tobacco smoking (15.8%) and to reduce tobacco smoking (10.5%). Using multiple logistic regression analysis, we found that among current smokers, current EC users were more likely to be younger, i.e., 18-44 years (aOR= 4.83, 95% CI= 1.97-11.86, p=0.001), urban residents (aOR= 1.89, 95% CI= 1.15-3.11, p=0.012), single/ divorced/ widowed (aOR= 2.11, 95% CI= 1.24-3.61, p=0.006) and students (aOR= 2.25, 95% CI= 1.01-5.01, p=0.048). Among exsmokers, only younger respondents (18-44 years old) was reported as being more likely to be current EC users (aOR= 3.81, 95% CI= 1.14-12.76, p=0.030). CONCLUSION: This study showed that currently using and ever having used ECs were more prevalent among current smokers. The reasons given for initiating EC use among current smokers were mainly wanting to try it, followed by intention to quit and to reduce tobacco smoking. Current EC use appears to be common among current smokers who are younger, urban residents, single/divorced/widowed and students. Therefore, EC cessation intervention strategies and policies should target these high-prevalence groups.

Prolonged dengue outbreak at a high-rise apartment in Petaling Jaya, Selangor, Malaysia: A case study.

There was an increasing trend in dengue infection in Malaysia with many outbreaks that occurred in Petaling District, Selangor in 2013 - 2014. A high rise apartment in Petaling Jaya reported ten episodes of dengue outbreaks from June 2013 to June 2014. We studied the prolonged dengue hotspot at this residential complex in Petaling Jaya, Selangor and made recommendations to prevent future prolonged dengue outbreaks. This was a retrospective exploratory study by analysing secondary data on dengue outbreaks from years 2013 to 2014. Small group discussions, interview sessions with staff and site visits were carried out to obtain necessary information. Two hundred and ninety-one cases were notified during the dengue outbreaks from Epid week (EW) 25 in 2013 to EW 26 in 2014 with no mortality reported. Information entered into dengue databases might be incomplete or mixed up. Active case detection and environmental risks assessment based on cases were not carry out due to the massive outbreak. Basic information on the population in the outbreak locality was unavailable. Various control activities were carried out with varying outcomes. Community participation was poor with little cooperation from residents during health education and community-based mosquito breeding prevention activities. To ensure better management of dengue outbreaks and to prevent prolonged dengue outbreaks in the future, integrated case findings, effective control activities, extensive environmental assessment on the outbreak locality and adopting innovative community outreach initiative with sufficient staff are required to curb dengue vector.

Prolonged dengue outbreak at a high-rise apartment in Petaling Jaya, Selangor, Malaysia: A case study

@#There was an increasing trend in dengue infection in Malaysia with many outbreaks that occurred in Petaling District, Selangor in 2013 – 2014. A high rise apartment in Petaling Jaya reported ten episodes of dengue outbreaks from June 2013 to June 2014. We studied the prolonged dengue hotspot at this residential complex in Petaling Jaya, Selangor and made recommendations to prevent future prolonged dengue outbreaks. This was a retrospective exploratory study by analysing secondary data on dengue outbreaks from years 2013 to 2014. Small group discussions, interview sessions with staff and site visits were carried out to obtain necessary information. Two hundred and ninety-one cases were notified during the dengue outbreaks from Epid week (EW) 25 in 2013 to EW 26 in 2014 with no mortality reported. Information entered into dengue databases might be incomplete or mixed up. Active case detection and environmental risks assessment based on cases were not carry out due to the massive outbreak. Basic information on the population in the outbreak locality was unavailable. Various control activities were carried out with varying outcomes. Community participation was poor with little cooperation from residents during health education and community-based mosquito breeding prevention activities. To ensure better management of dengue outbreaks and to prevent prolonged dengue outbreaks in the future, integrated case findings, effective control activities, extensive environmental assessment on the outbreak locality and adopting innovative community outreach initiative with sufficient staff are required to curb dengue vector.

Smoking behaviours and attitudes toward tobacco control among assistant environmental health officer trainees.

Assistant environmental health officers (AEHO) are health care providers (HCPs) who act as enforcers, educators and trusted role models for the public. This is the first study to explore smoking behaviour and attitudes toward tobacco control among future HCPs. Almost 30% of AEHO trainees did not know the role of AEHOs in counselling smokers to stop smoking, but 91% agreed they should not smoke before advising others not to do so. The majority agreed that tobacco control regulations may be used as a means of reducing the prevalence of smoking. Future AEHOs had positive attitudes toward tobacco regulations but lacked understanding of their responsibility in tobacco control measures.

Prevalence and predictors of recent illness and injury among the Malaysian population.

The World Health Organization (WHO) estimates that injury will be the second leading cause of morbidity of disease burden worldwide by the year 2020. We conducted a community-based survey to determine the prevalence of recent illness and injury, in Malaysia. The survey was a cross sectional population-based household survey conducted using face to face interviews. The information was on self-reported recent illness and injury (SRRII) over the previous 2 weeks. This study was conducted during April - August 2006 and as a part of the third National Health and Morbidity Survey of Malaysia. A total of 56,710 respondents were interviewed with a response rate of 98.2% (55,660/56,710). The overall prevalence of combined SRRII was 23.6%; for injuries the prevalence was 3.1%. The groups with the highest SRRII were children 0-5 years old (31.2%), males (24.3%), Indians (26.9%), those with secondary education level (22.9%), those earning RM 1,000/ month (25.0%) and rural dwellers (25.5%). Age, sex, ethnicity, and locality were significantly associated with SRRII while monthly household income and educational level were marginally associated. On multivariate analysis, age, gender, race, ethnicity, education, income and locality were significantly associated with SRRII. The most common reported recent illness was related to the respiratory system (42.0%). The information obtained from this survey is useful to policy makers in the Ministry of Health to review and strengthen existing health programs.

Attitudes towards smoking and tobacco control among pre-clinical medical students in Malaysia.

Physicians should play a leading role in combatting smoking; information on attitudes of future physicians towards tobacco control measures in a middle-income developing country is limited. Of 310 future physicians surveyed in a medical school in Malaysia, 50% disagreed that it was a doctor's duty to advise smokers to stop smoking; 76.8% agreed that physicians should not smoke before advising others not to smoke; and 75% agreed to the ideas of restricting the sale of cigarettes to minors, making all public places smoke-free and banning advertising of tobacco-related merchandise. Future physicians had positive attitudes towards tobacco regulations but had not grasped their responsibilities in tobacco control measures.

Health seeking behavior among Malaysians with acute diarrheal disease.

About 1.8 million people die annually from acute diarrheal disease globally. A nationwide cross-sectional survey was conducted via face-to-face interview with eligible subjects to determine the incidence and health seeking behavior of Malaysians with acute diarrheal disease (ADD). An acute diarrheal episode was defined as having three or more loose stools in any 24 hour period during the four weeks period prior to the interview. The exclusion criteria included pre-existing chronic diarrhea, such as with cancer of the bowel, ulcerative colitis or Chrohn's disease. Forty three point three percent of those with ADD (95% CI 41.3-45.4) sought treatment for the illness. Younger age groups (0-4 years, 67.7%; 95% CI 61.5-73.4; 5-9 years, 56.5%; 95% CI 48.6-64.1) were more likely to seek care for ADD. Seventy-one point eight percent of those seeking treatment, (95% CI 69.0-74.4) did so within 12 hours of the onset of symptoms. Most people with ADD sought treatment at private clinics. The main reasons given for not seeking treatment were the illness was mild and did not warrant treatment and the practice of self-medication (22.4%; 95% CI 20.0-24.9). These findings show self-medication is a major health seeking behavior among Malaysians with ADD. Self-medication of ADD deserves more in-depth study to ensure it is safe.

Incidence and determinants of acute diarrhoea in Malaysia: a population-based study.

Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly under-notified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea while improving surveillance and notification of the disease.

Prevalence of Chronic Illness and Health Seeking Behaviour in Malaysian Population: Results from the Third National Health Morbidity Survey (NHMS III) 2006.

The third National Health Morbidity Survey was conducted in 2006 on a nationally representative sample of population in Malaysia in order to obtain community-based data and information on the prevalence of chronic illness. Of 57,500 eligible respondents 56710 (98.6%) participated in the study. Estimated overall prevalence of chronic illness in the Malaysian population within a recall period of one year was 15.5% (95% CI 15.1% - 15.9%). Chronic illness was reported significantly higher among the females, 16.8% (16.3 - 17.3). The most common chronic illness was hypertension (7.9%, 7.6 - 8.2), followed by diabetes mellitus (4.0%, 3.8 - 4.2) and highest reported by the Indians (19.7%, 18.4 - 21.0). Among the respondents who had sought treatment for chronic illness from government health facilities, Malays (65.8%) and those with monthly household income of less than RM400 (76.6%) were the highest. Chinese (44.5%) and those with household income of RM5000 and above (54.3%) were the highest groups who sought treatment from the private health facilities. Most of the respondents reported mild illness was the main reason for not seeking treatment for their chronic illness. It is hoped that the results of this survey will help the Ministry of Health Malaysia to enhance health programmes and planning resource allocation in order to improve health status of the population.

Prevalence of diabetes in the Malaysian National Health Morbidity Survey III 2006.

The Malaysian National Health Morbidity Survey III (NHMS III), conducted in 2006, was a cross-sectional household survey of the prevalence of chronic diseases, involving 34,539 respondents of age > or =18 years old, in all states of Malaysia. Data collection was by face-to-face interview. Those who self-professed not to be diabetics underwent finger-prick glucose test following at least 8 hours of fasting. The overall prevalence of diabetes mellitus (known and newly diagnosed) was 11.6%. The Indians had the highest prevalence of 19.9% followed by Malays 11.9% and Chinese 11.4%. The prevalence of people with known diabetes and newly diagnosed diabetes was 7.0% and 4.5% respectively. Impaired Fasting Glycaemia was found to be 4.2%. Majority (73.5%) of the patients used government healthcare facilities for their diabetic care. Usage of insulin alone or in combination was low at 7.2% of patients. Only 45.05% of known diabetics have ever had their eye examined. Amputees formed 4.3% of the patients with known diabetes while 3.4% had suffered a stroke event and 1.6% was on some form of renal replacement therapy.

Evaluation of the accuracy of the Omron HEM-907 blood pressure device.

A study was undertaken to assess the accuracy of the Omron HEM-907 blood pressure measuring device for use in community studies. A modified version of the British Hypertension Society (BHS) and American Association for the Advancement Medical Instrumentation (AAMI) protocol for measuring the accuracy of a blood pressure measuring device was used. A total of 104 subjects were recruited from two clinics. Observer-observer agreement for readings within the 5 mmHg was good; 80.8% and 84.6% of systolic blood pressure (SBP) and diastolic blood pressure (DBP) agreement respectively. Of the two, the better observer-device agreement readings within the 5 mmHg were 66.4% and 50.0% for SBP and DBP respectively, giving an overall grade B. The mean differences and standard deviation of the differences were within < or =5 mmHg with a standard deviation (SD) of < or =8 mmHg. The Omron HEM-907 satisfied both the AAMI and BHS protocols for accuracy for a non-invasive blood pressure monitoring device using single observer readings.

Changing habits and attitudes towards smoking among future physicians.

This study was conducted to asses the future physicians' habits, knowledge and attitude towards smoking. These factors influence the credibility of future Malaysian physicians as advocators and treatment providers. A cross sectional study was carried out among medical students at the Medical Faculty, University Malaya. Knowledge on smoking was evaluated on the total scores for knowledge questions, with one point and zero for each correct and incorrect answer respectively, to a maximum of six potential points. Attitude towards smoking was measured by summation of scores on attitude items; each item was scored from five points for "against smoking" and one point for "favourable to smoking". The possible score ranged from 10 to 50. The response rate was 79.4%. Prevalence of overall smokers was 4.4%. The mean knowledge score among smokers (4.30 +/- 2.17) was significantly lower than nonsmokers (5.19 +/- 1.28). The mean attitude score was higher among non-smokers (44.30 +/- 6.54) than smokers (39.86 +/- 10.93). The result from this study showed that smoking prevalence was lower compared to previous studies done in Malaysia.

Comparison of techniques for detecting antigens of Giardia lamblia and Cryptosporidium parvum in faeces.

AIM: To compare the use of commercial monoclonal antibody test systems--the Giardia CEL IF test and the Crypto CEL IF test--for the detection of Giardia lamblia and Cryptosporidium parvum antigens in faeces with conventional techniques. METHODS: Sensitivity and specificity were evaluated using preparations of cysts of G lamblia and purified oocysts of C parvum. Evaluation of 59 random faecal samples passing through the Department of Clinical Parasitology, Hospital for Tropical Diseases, London, was carried out for both organisms. RESULTS: The fluorescence staining techniques proved more sensitive than other tests routinely used for diagnosis.

Staphylococci in swimming pool water.

During a period of five years 1192 water samples from swimming pools were examined for staphylococci and 338 for coliform organisms only. Eighty-nine different pools were sampled.Numbers of staphylococci, estimated by the membrane filtration technique did not bear any significant relation to either bathing load or concentration of free chlorine.Wide variation in the staphylococcal count was observed when different parts of a pool were sampled on the same occasion.The only practicable standard for pool samples in relation to staphylococci would appear to be that these organisms should be absent from 100 ml. water when the pool has been out of use during at least ten hours before sampling if filtration and chlorination are adequate.

Salmonellas on pig farms and in abattoirs.

Salmonella infection on two pig farms and its relation to infection in pigs at slaughter was studied. On the first farm feed ingredients were mixed on the farm, and these included fish meal which was found to be contaminated with salmonellas. The feed was pumped to pigs in liquid form. There was a high salmonella isolation rate at slaughter when the contaminated fish meal was fed in liquid feed, but it was significantly lower when no fish meal was fed to the pigs examined at slaughter. In some instances the same serotypes were found in fish meal and pig excreta on the farm and in caecal contents of the pigs at slaughter. No serotype was repeatedly isolated from any source and it appeared that the serotypes were not able to establish themselves in the pigs. It is concluded that infection found at slaughter originated on the farm where fish meal introduced and maintained infection. There was an opportunity for salmonellas to have multiplied in the liquid feed for several hours each day.On a second farm environmental conditions were similar, but feed was given in the form of ready-made pellets and nuts. Salmonellas were not isolated from the feed. At slaughter there was a significantly lower isolation rate than on the first farm.