Nutritional and Non-Communicable Disease (NCD) Status Association with Fall among Older Persons in Malaysia: Findings from National Health and Morbidity Survey (NHMS) Malaysia 2018

ntroduction Fall is a health problem for older persons. This study investigates the potential factors of concern: the nutritional status of the elderly and non-communicable disease association with incidents of falls. Methods and Materials This study used data from NHMS 2018, a cross-sectional design, applied two-stage stratified cluster sampling. Descriptive statistics such as the percentage of each variable were done. Factors associated with falls were determined at both univariate and multivariable levels using simple logistic regression and multiple logistic regression. The data were presented as standard values for each analysis and adjusted odds ratios with 95% CI with p values (<0.05). Results A total of 3,867 from 3,977 elderly (mean age 68.2+ 6.85) were recruited with the response rate of 97.2%. Factors associated with fall were 70 years old and above (AOR= 1.34, 95% CI: 1.09, 1.64), obesity (AOR=1.55, 95% CI: 1.21, 1.98), undernutrition (AOR=1.59, 95% CI: 1.30, 1.94), persons with 2 NCDs (AOR=1.49, 95% CI: 1.15, 1.92) and persons with 3 NCDs (AOR=1.63, 95% CI: 1.23, 2.16). Discussion and Conclusion Advanced age, malnutrition, obesity, and having two or more NCD are associated with falls in the NHMS 2018 study. In conclusion, falls are prevalent among older persons. There is an urgent need for public health strategies to decrease the incidence and early identification of those at risk. Implementation of fall preventive programs can also significantly reduce falls among the elderly.

Effectiveness of Phone Reminders to Improve Adherence to Anti-Retroviral Therapy: A Meta-Analysis

Introduction: Adherence to anti-retroviral therapy (ART) regimens remains a difficult issue. Thus, it was hoped that the use of phone reminders would improve adherence. Methodology: The Cochrane database was searched using selected keywords for this meta-analysis. We included randomised, controlled trials (RCTs) that utilised interventions with phone reminder and reported adherence outcomes, as the proportion of prescribed pills taken, the scores on an adherence questionnaire, or the follow-up rate. Two independent authors screened titles of article for inclusion, extracted the relevant data, and assessed articles for risk of bias. Results: Seven RCTs published between 2010 and 2017 were selected for inclusion in this review. The sample size ranged from 76 to 631 participants. Most RCTs used short message service (SMS) and phone call reminders as interventions. The rate of adherence was 1.17-fold greater among those who received phone reminders than those who did not, which was statistically significant (Z = 2.86, p = 0.004). Those who received phone reminders showed a 17% higher likelihood for adherence compared with those who did not receive any phone reminder interventions. Conclusion: Phone reminders remain significantly effective means for improving adherence.

Prevalence of ‘Researcher’s defined’ and ‘Self-rated’ Successful Aging among Pre-Retirement Public Servants

Introduction The socioeconomic impact of aging population can be reduced if majority of people achieve successful aging. This study aimed to determine the prevalence of researcher’s defined successful aging (RDSA) and self-rated successful aging (SRSA) among pre-retirement public servants and their predictors. Methodology The sample included 1,064 pre-retirement public servants (50 to 60 years old) from nine government agencies. Data was analyzed using Multiple Logistic Regression to test for the association between the studied factors and SA. Results The prevalence of RDSA and SRSA was 37.5% and 98.7%, respectively. Results showed four (4) significant factors with higher odds of having RDSA were not obese, good social support, being physically active and younger age. Meanwhile, five (5) factors highly selected by respondents as predictors for SRSA were having good spiritual or religious practice, happy family, good psycho cognitive function, social support and good physical function. Conclusion The prevalence of SRSA was higher despite the presence of self-reported chronic diseases and physical limitation identified among respondents. The discrepancy in both prevalence of SA reflects the differences that exist between the criteria for SA perceived by respondents and researchers. Misperception among respondents of their aging process as ‘successful’ despite having diseases or disability may worsen their health status because they continue practicing unhealthy lifestyles without action to improve it. Promotional activities on SA, regular health screening since young and healthy working environment should be implemented by various agencies. Keywords Successful aging - pre-retirement - public servants - predictors

Characterization of Diabetic Nephropathy and Its Correlates in a Selected Outdoor-Based Diabetic Clinic in Rangpur, Bangladesh

Background:The rising burden of diabetic complication associated with the diabetes mellitus (DM) pandemic. DM is a global public health problem. Diabetic nephropathy (DN) is one of the life-threatening and irreversible microvascular complications of DM. Methods:A cross-sectional study was conducted from November 2017 to April 2018 to characterize and associate of possible DN among people living with diabetes where 40 T1DM, 200 T2DM as cases group and 50 non diabetic as a control groupwere selected conveniently. Data were collected using structured questionnaire and analyzed by SPSS-22. Stages of DN were classified according ‘Revised Classification of DN’ given by the ‘Joint Committee on Diabetic Nephropathy’, Japan, 2014. Results:The mean FBS was 6.81±0.87 mmol/L in T1DM, 7.98±3.25mmol/Lin T2DM and 4.55±0.58 mmol/L in controls. The prevalence of pre-nephropathy (PN), incipient nephropathy (IN) and overt nephropathy (ON) was 10%, 82.5% and 7.5% respectively in T1DM. Similarly, in T2DM the prevalence of PN, IN, ON and chronic kidney failure (CKF) was 5.5% 81%, 10%, and 3.5% respectively. One way ANOVA followed by post hoc-LSD suggested, in T1DM the mean FBS was significantly lower in PN group than IN (p=0.017) and ON (p=0.048) group. Further in T1DM and T2DM, the mean estimated Glomerular Filtration Rate was significantly (p=0.032) lower in IN group than PN and significantly (p=0.026, 0.006) lower in ON than PN and IN respectively. Irrespective of diabetic group, according to multivariate analysis, older age (adjusted OR =1.05, CI: 1.01-1.08; adjusted OR: 2.33, CI: 2.01-2.99), sCreatinine (adjusted OR: 7.73, CI: 2.26-22.47) and female sex (adjusted OR = 0.39, CI: 0.19-0.77) were independently associated with DN adjusting BMI, SBP, DBP and FBS level. Conclusion:This study showed the prevalence rate of DN was high among diabetic and mostly in type 2 diabetics with severe stage.

Internet Addiction and Its Associated Factors among School-going Adolescents in Malaysia

Introduction: Internet usage has changed the way adolescents socialize. This study aims to determine the determinants of internet addiction among school-going adolescents in Malaysia. Methodology: This study was a cross-sectional study involving 27,455 school-going adolescents from 212 selected schools in Malaysia, as part of the 2017 National Health and Morbidity Survey that implemented a two-stage stratified cluster sampling design. Data collection via a self-administered questionnaire was conducted from March till May 2017. Results: Overall, 8,049 (29.0%) school-going adolescents had internet addiction. Internet addiction was positively associated with male (odds ratio, OR [95% confidence interval, CI] = 1.20 [1.08,1.34]) compared to female, Chinese ethnicity (1.67 [1.12,2.48]) compared to other ethnicity, feeling loneliness (1.37 [1.20,1.57]) compared to never feel lonely, unable to sleep due to worrying of something (1.40 [1.17,1.67]) compared to able to sleep, insufficient parental supervision (1.30 [1.14,1.48]) compared to sufficient parental supervision, depression (1.67 [1.48,1.89]) compared to no depression, anxiety (2.12 [1.95,2.30]) compared to no anxiety and stress (2.26 [1.96,2.61]) compared to no stress. The odds of having internet addiction increase from Form 2 (1.51 [1.28,1.78]), Form 3 (2.37 [2.01,2.80]), Form 4 (2.60 [1.76,3.85]) to Form 5 adolescents (2.96 [1.98,4.41]) compared to Form 1 adolescents. Conclusion: Our results suggest that being a male, of Chinese ethnicity, higher form level, feeling loneliness, unable to sleep due to worrying of something, insufficient parental supervision, depression, anxiety and stress were positively associated with internet addiction among school-going adolescents. Keywords: Internet addiction – public health – adolescents – NHMS - Malaysia

Alcohol Consumption Practices Among Nepali Migrant Workers in Shah Alam, Selangor

Malaysia has been considered an industrialized country and there is a demand for manpower in low-skilled jobs which usually filled by migrant workers. Therefore, this study focused to identify the level of alcohol consumption and its associated factors particularly among Nepali migrant workers in Shah Alam, Selangor. A cross-sectional study using a convenient sampling method was conducted among 233 Nepali migrant workers in Shah Alam, Selangor using a self-administered questionnaire. A validated scoring system by DASS 21 and The Alcohol Use Disorder Identification Test was employed. The results show that 60.09% of Nepali workers consumed alcohol with most of them are in low (31.43%) and medium (29.28%) risk level for alcohol consumption. The empirical findings reveal a significant association between income, education level, and peer pressure (p value<.001 respectively) with alcohol consumption. However, the study found no association between age, marital status, years of working, and body mass index (p value= 0.44, 0.19, 0.42, 0.40 respectively) with alcohol consumption. In a conclusion, most Nepali migrant workers consume alcohol but in low and medium risk severity for alcohol consumption. The results highlight sociodemographic factors such as income and education as well as peer pressure among important factors affecting alcohol consumption.

Safety Culture in Handling Radioactive Materials for Radiation Practitioners: A Review

This paper reviews the safety culture in handling radioactive sources. Safety culture refers to how safety is addressed and communicated in the workplace. It encompasses the attitudes, beliefs, perceptions, and values of all employees in an organization in relation to safety. A good safety culture can be promoted by management through commitment to safety, realistic practices for handling hazards, continuous organizational learning and concern for hazards shared across the workforce. The radioactive substances used should comply with the following characteristics where radiotoxicity must be as low as possible, short-living isotopes are preferred than long-living ones and the amounts used must be kept to a minimum. Therefore, the ‘As Low As Reasonably Achievable’ (ALARA) principle was applied that based on the minimization of radiation doses and limiting the release of radioactive materials into the environment by employing all reasonable methods. Besides that, the ALARA principle is an integral part of all activities that involve the use of radiation or radioactive materials and can help prevent unnecessary exposure as well as overexposure. The three major ALARA principles to assist with maintaining doses are time, distance and shielding. It takes a whole team effort to successfully implement the ALARA in safety culture while doing routine element of working in handling radioactive materials.

Coping Strategies in Children of Parents Deceased from Cancer and Children of Parents Healed from Cancer

This study aimed to compare coping strategies in children of parents deceased from cancer and children of parents healed from cancer in the city of Shiraz, Iran. One-hundred and fifteen people [58 children of parents healed from cancer and 57 children of parents deceased from cancer] were recruited in this study via a convenience sampling method. Coping Inventory for Stressful Situations was used to measure different types of coping strategies [task-oriented coping strategy, emotion-oriented coping strategy, and avoidance coping strategy]. The results showed that the children of parents healed from cancer used task-oriented coping strategy significantly more than children of parents deceased from cancer. Moreover, the results showed that the use of emotion-oriented coping strategy in children of parents deceased from cancer was significantly more than children of parents healed from cancer. No significant difference was observed between the two groups in the use of avoidance coping. This study highlights the importance of coping strategies in families with a cancer parent which demand the importance of teaching appropriate coping strategies in order to reduce the adverse consequence of cancer in the family.

Training is an Important Factor for Community Health Workers in Performing KOSPEN Health Screening Activities in Malaysia: Community Health Workers (KOSPEN) 2016

Introduction: Community health workers (CHW) or volunteers are health workers who are trained but do not possess a professional certificate. They are community members who live and work in that particular community. The Ministry of Health Malaysia had initiated a community-based intervention programme, Healthy Community Empowers the Nation or ‘Komuniti Sihat Pembina Negara’ (KOSPEN) in October 2013. In this programme, CHWs main task is to conduct non-communicable diseases (NCD) risk factor screening. Methods: Data from the “Evaluation of the implementation of KOSPEN programme in Malaysia 2016” was used. It is a cross-sectional study which was carried out in randomly selected KOSPEN localities throughout Malaysia. Logistic regression analysis was applied to determine factors associated with not performing KOSPEN screening activities by the volunteers. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results: A total of 700 volunteers were included in this study. Most of the volunteers were female (65.7%) and were aged 50-59 years (30.9%), followed by those aged 40-49 (27.1%). Majority had secondary education (65.3%), employed (55.7%.) and were married (80.4%). Multivariate logistic regression showed that volunteers who never attended training (aOR 2.79; 95% CI:1.66, 4.67) and who felt the content of the training module was inadequate (aOR 2.693; 95% CI: 1.46, 4.98) were more likely to not perform screening activities in the community. Conclusion: Attendance of the training should be a pre-requisite to qualify as a volunteer. Improvement to the training module should done to increase comprehensibility of the modules among the volunteers. Keywords: KOSPEN-community health workers-NCD screening-community-based intervention

Homeless Management During Movement Control Order Due To COVID-19 Pandemic: Experience from Federal Territory Kuala Lumpur, Malaysia

Malaysia has been hit by COVID-19 pandemic since 2020 and this problem also affects countries around the world. This COVID-19 infection does not distinguish age, gender, educational and financial status. Homeless people are also not exempt from being infected with COVID-19, especially when the government implements the Movement Control Order, particularly these people who have no permanent home. This article describes the activities carried out by the government agencies, especially from the Ministry of Health Malaysia, Department of Social Welfare, National Anti-Drugs Agency, Immigration Department of Malaysia, as well as other non-governmental agencies in the Federal Territory of Kuala Lumpur on homeless people during movement control orders. It is hoped that this shared experience can be a guide to government agencies, non-governmental organizations, private sectors and individuals in other states to manage this underprivileged group, especially during the ongoing COVID-19 pandemic