Malay Ethnicity Research Articles

A longitudinal study of physical activity among Malaysian breast cancer survivors.

Regular physical activity (PA) after a breast cancer diagnosis is associated with reduced mortality and better quality of life. In this prospective cohort study, we aimed to explore the trends of PA among breast cancer survivors over three years and identify factors associated with low PA. Interviews on 133 breast cancer patients were conducted at baseline, one and three years after the diagnosis of breast cancer at University Malaya Medical Centre in Kuala Lumpur. Physical activity was measured by using the Global Physical Activity Questionnaire. PA was categorised as active (≥ 600 MET-min/week) and inactive (<600 MET-min/week). We used the generalised estimating equation method to examine PA levels and factors affecting PA longitudinally. The survivors' mean age was 56.89 (±10.56) years; half were Chinese (50.4%), and 70.7% were married. At baseline, 48.1% of the patients were active, but the proportion of active patients declined to 39.8% at one year and 35.3% in the third year. The mean total PA decreased significantly from 3503±6838.3 MET-min/week to 1494.0±2679.8 MET-min/week (one year) and 792.5±1364 MET-min/week (three years) (p<0.001). Three years after diagnosis (adjusted odds ratio [AOR]: 1.74, p = 0.021); Malay ethnicity (AOR: 1.86, p = 0.042) and being underweight (AOR: 3.43, p = 0.004) were significantly associated with inactivity. We demonstrated that breast cancer survivors in Malaysia had inadequate PA levels at diagnosis, which decreased over time. Thus, it is vital to communicate about the benefits of PA on cancer outcomes and continue to encourage breast cancer survivors to be physically active throughout the extended survivorship period, especially in the Malay ethnic group and underweight patients.

The Invisible Struggles: A Qualitative Study in Understanding Mothers’ Perceptions and Experiences in Nurturing Small for Gestational Age Infants

Introduction: Small for gestational age (SGA) infants have been linked to poor growth trends and nutritional status. SGA infants that do not reach their full growth potential must be supervised by a multidisciplinary medical team. Parents devote more time, energy, and money for raising of the SGA infants. The objective of this present study is to explore the perceptions and the experiences of the mother in nurturing the small for gestational age infants in their first year of life. Method: A qualitative exploratory descriptive study via in-depth interview was conducted in the primary health clinics in urban areas in Malaysia to explore the mothers’ perceptions and experiences in SGA infant’s care. 13 SGA infant’s mothers participated in the study after the children achieved the age of one year old. Thematic analysis was conducted using software ATLAS.ti version 8. Results: The average mothers’ age in this study were 33 years old, majority was Malay ethnicity. Only one mother was a housewife and others were working mother. Four out of 13 SGA infants were born prematurely. This study found that homogenous experiences throughout the pregnancy and baby nurturing phase, perceptions on husband involvement and external supports in infant care, infant health status and health services provided, were highlighted as important contributor to infant survival. Conclusion: The importance of monitoring SGA infant growth and nutritional status have been highlighted. Maternal psychological support needs to be enhanced to ease the burden in SGA infant care. Targeted program intervention for family and community social support during postnatal and empowering mothers in nurturing their infants are crucial.

Choroidal Melanoma: A Case Series From Malaysia.

Choroidal melanoma is one of the subtypes of uveal melanoma and a relatively rare ophthalmic malignancy worldwide. However, it is scarce in Asian countries like Malaysia. We present eight cases of patients with choroidal melanoma referred to Hospital Serdang, a tertiary centre for oculoplastic issues, from 2021 to 2022. A retrospective case series of patients diagnosed with choroidal melanoma and referred to the Oculoplastic Clinic, Department of Ophthalmology, Hospital Serdang, was undertaken. A total of eight cases of choroidal melanoma were identified, with a median age of 65 years. Six of them were female, and two were male. There were five of Malay ethnicity, and three were Chinese. Progressive reduced vision (n = 6), noticeable ocular mass (n = 3), and visual field defect (n = 2) were the most common presenting symptoms. The mean tumour thickness was 21.25 mm (range = 10-56 mm), and the largest basal diameter ranged from 10 mm to 53 mm (mean = 22.5 mm). Most were large tumours (n = 7) and above the T3a stage. The level of lactate dehydrogenase (LDH) was elevated in three cases. Histopathologically, five of the tumours were epithelioid, while the other three were mixed types. All patients underwent enucleation (n = 5) and exenteration (n = 3) with one recurrence. One patient had liver metastasis on the diagnosis of choroidal melanoma. In Malaysia, there is an increasing number of cases of choroidal melanoma. Clinical evaluation remained the mainstay of diagnosis. Treatment should be based on multifactorial prognostication in addition to tumour size. The LDH level may be necessary for providing inexpensive but valuable prognostication and monitoring markers.

Five-year LDL-cholesterol trend and its predictors among type 2 diabetes patients in an upper-middle-income country: a retrospective open cohort study.

BackgroundPatients with diabetes have increased risks of cardiovascular diseases (CVD), and their LDL-cholesterol (LDL-C) has to be treated to target to prevent complications. We aim to determine the LDL-C trend and its predictors among patients with type 2 diabetes (T2D) in Malaysia.MethodsThis was a retrospective open cohort study from 2013 to 2017 among T2D patients in public primary health care clinics in Negeri Sembilan state, Malaysia. Linear mixed-effects modelling was conducted to determine the LDL-C trend and its predictors. The LDL-C target for patients without CVD was <2.6 mmol/L, whereas <1.8 mmol/L was targeted for those with CVD.ResultsAmong 18,312 patients, there were more females (55.9%), adults ≥60 years (49.4%), Malays (64.7%), non-smokers (93.6%), and 45.3% had diabetes for <5 years. The overall LDL-C trend reduced by 6.8% from 2.96 to 2.76 mmol/L. In 2017, 16.8% (95% CI: 13.2–21.0) of patients without CVD and 45.8% (95% CI: 44.8–46.8) of patients with CVD achieved their respective LDL-C targets. The predictors for a higher LDL-C trend were younger adults, Malay and Indian ethnicities, females, dyslipidemia, and diabetes treatment with lifestyle modification and insulin. Longer diabetes duration, obesity, hypertension, retinopathy, statin therapy, achievement of HbA1c target and achievement of BP target were independent predictors for a lower LDL-C trend.ConclusionsThe LDL-C trend has improved, but there are still gaps between actual results and clinical targets. Interventions should be planned and targeted at the high-risk populations to control their LDL-C.

Conditions of Work Motivation and Teacher Performance at Madrasah Tsanawiyah in North Sumatra

This study aims to describe the conditions of work motivation and teacher performance in terms of culture in North Sumatra. This research is a quantitative descriptive research on educators in North Sumatra. The sample in this study amounted to 81 teachers (male = 29.6%; female = 70.4%) consisting of various cultures, namely: Javanese = 32.1%; Malay = 13.6%; Batak = 38.3%; Sundanese = 11.1%; and Betawi = 4.9%. Data were collected through two instruments, including the work motivation instrument, which consisted of 12 items and the employee performance instrument (the employee here is a teacher) which consisted of 12 items. Data were analyzed using JASP software analysis with descriptive techniques. The results show that Sundanese ethnicity is the highest in showing good performance compared to other ethnic groups. While the highest work motivation comes from ethnic Malay and Sundanese, meaning that teachers from ethnic Malay and Sundanese have higher work motivation than Javanese, Batak, and Betawi.

Perceived Risk for Dengue Infection Mediates the Relationship between Attitude and Practice for Dengue Prevention: A Study in Seremban, Malaysia.

Dengue remains a public health concern due to limited curative treatment and safe vaccine availability. Prevention by individual is utmost necessary but its practice is still lacking. Perceived risk to disease has been reported to exert a good effect on health behaviour change. However, limited evidence showed its relationship towards attitude and practice for dengue prevention. Hence, we aim to measure the mediating effect of dengue risk perception in the relationship between dengue attitude and dengue prevention practice. A cross-sectional study was conducted from April 2021 to November 2021 in a district of Seremban using a pre-validated questionnaire. Informed consent was obtained from the respondents prior to inclusion in the study. The study was approved by the ethical research committee. A total of 347 respondents took part in the survey, but only 341 data points were included in the final analysis. The majority of the respondents were female (63.0%), of Malay ethnicity (86.8%), married (55.4%), and currently employed (71.0%). The pooled confirmatory factor analysis result demonstrated an RMSEA value of 0.038 (<0.08), CFI value of 0.969 (>0.90), TLI value of 0.9565 (>0.90), and ChiSq/df = 1.479 (<3.0). All the hypotheses for direct effect yielded a significant and positive relationship. Bootstrapping analysis to test for mediation revealed a partial mediation effect as both indirect and direct effects are significant. Risk perception is a mediator variable between attitude and dengue prevention practice. Therefore, our recommendation is to increase health awareness activity that helps to improve individual’s risk perception through active health promotion and a health educational campaign that inculcates dengue risk messages. Ultimately, this effort can enhance good health prevention behaviour.

Comparison of Central Corneal Thickness and Lamina Cribrosa Thickness in Ethnic Indians and Ethnic Malays as Predictors of Glaucomatous Optic Neuropathy

Background: Glaucoma poses a public health problem because it is the second leading cause of blindness after cataracts. A thinner central corneal thickness (CCT) is also a contributor to the development of primary open-angle glaucoma (POAG). Lamina cribrosa (LC) is a structure of the optic nerve head (ONH). LC structural changes such as thinning, posterior displacement, and connective tissue deficiency are associated with the mechanism of retinal nerve fiber layer (RNFL) thickness damage, leading to glaucomatous optic neuropathy.&#x0D; Methods: Cross-sectional analytic observational study. A total of 36 eyes from 36 research subjects participated in this study. Data analysis was carried out using SPSS version 25. Then, univariate and bivariate analyzes were carried out to see the difference in CCT and LC thicknesses.&#x0D; Results: The average CCT in ethnic Indians is 514.33 ± 14,142 μm and in ethnic Malays, 542.06 ± 17,234 μm. In this study, there were differences in the average CCT in Indian ethnicity and Malay ethnicity, which was statistically meaningful with a p-value = 0.000.&#x0D; Conclusion: There are differences in the average central corneal thickness and lamina cribrosa thickness in ethnic Indians compared to ethnic Malays, where the central corneal thickness and lamina cribrosa thickness in ethnic Indians are thinner than ethnic Malays.

Exploring the Relationships of Financial Literacy and Financial Behaviour with Health-Related Quality of Life (HRQOL) among the Low-Income Working Population in Malaysia during the COVID-19 Pandemic.

This cross-sectional study examined the relationships of financial literacy (FL) and financial behaviour (FB) with health-related quality of life (HRQOL) during the COVID-19 pandemic among low-income working population (20–60 years old) in Malaysia. A self-administered questionnaire survey was used with HRQOL data were gathered using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) tool. A generalised linear model was employed to examine the hypothesised relationships between the constructs. From 1186 respondents, the majority were employed (73.9%), had a monthly household income of less than RM 2500 (74.5%), and did not have any chronic medical conditions (74.5%). The mean (SD) values of FL, FB, and EQ-5D-5L were 5.95 (1.48), 22.08 (4.79), and 0.96 (0.10), respectively. The results of the adjusted model revealed lower age group, Malay ethnicity, Indian ethnicity, and increased FB score as significant determinants of higher EQ-5D-5L scores. With the addition of the chronic medical condition factor into the saturated model, the lower age group, ethnicity, and no chronic medical condition were significant determinants of higher HRQOL. The effects of FB on QOL were confounded by chronic diseases, implying that interventions that focus on improving FB for those with chronic medical condition may help to improve the QOL among the low-income working population.

Molecular, Biochemical, and Clinical Characterization of Thirteen Patients with Glycogen Storage Disease 1a in Malaysia.

Background Glycogen storage disease type 1a (GSD1a) is a rare autosomal recessive metabolic disorder characterized by hypoglycaemia, growth retardation, lactic acidosis, hepatomegaly, hyperlipidemia, and nephromegaly. GSD1a is caused by a mutation in the G6PC gene encoding glucose-6-phosphatase (G6Pase); an enzyme that catalyses the hydrolysis of glucose-6-phosphate (G6P) to phosphate and glucose. Objective To elaborate on the clinical findings, biochemical data, molecular genetic analysis, and short-term prognosis of 13 GSD1a patients in Malaysia. Methods The information about 13 clinically classified GSD1a patients was retrospectively studied. The G6PC mutation analysis was performed by PCR-DNA sequencing. Results Patients were presented with hepatomegaly (92%), hypoglycaemia (38%), poor weight gain (23%), and short stature (15%). Mutation analysis revealed nine heterozygous mutations; eight previously reported mutations (c.155 A > T, c.209 G > A, c.226 A > T, c.248 G > A, c.648 G > T, c.706 T > A, c.1022 T > A, c.262delG) and a novel mutation (c.325 T > C). The most common mutation found in Malaysian patients was c.648 G > T in ten patients (77%) of mostly Malay ethnicity, followed by c.248 G > A in 4 patients of Chinese ethnicity (30%). A novel missense mutation (c.325 T > C) was predicted to be disease-causing by various in silico software. Conclusions The establishment of G6PC molecular genetic testing will enable the detection of presymptomatic patients, assisting in genetic counselling while avoiding the invasive methods of liver biopsy.

Longitudinal characterization of determinants associated with obesogenic growth patterns in early childhood.

Longitudinal assessment of the determinants of obesogenic growth trajectories in childhood can suggest appropriate developmental windows for intervention. Latent class growth mixture modelling was used to identify body mass index (BMI) z-score trajectories from birth to age 6 years in 994 children from a prospective mother-offspring cohort (Chinese, Indian and Malay ethnicities) based in Singapore. We evaluated the early-life determinants of the trajectories as well as their associations with cardiometabolic risk markers at age 6 years. Five BMI z-score trajectory patterns were identified, three within the healthy weight range, alongside early-acceleration and late-acceleration obesogenic trajectories. The early-acceleration pattern was characterized by elevated fetal abdominal circumference growth velocity, BMI acceleration immediately after birth and crossing of the obesity threshold by age 2 years. The late-acceleration pattern had normal fetal growth and BMI acceleration after infancy, and approached the obesity threshold by age 6 years. Abdominal fat, liver fat, insulin resistance and odds of pre-hypertension/hypertension were elevated in both groups. Indian ethnicity, high pre-pregnancy BMI, high polygenic risk scores for obesity and shorter breastfeeding duration were common risk factors for both groups. Malay ethnicity and low maternal educational attainment were uniquely associated with early BMI acceleration, whereas nulliparity and obesogenic eating behaviours in early childhood were uniquely associated with late BMI acceleration. BMI acceleration starting immediately after birth or after infancy were both linked to early cardiometabolic alterations. The determinants of these trajectories may be useful for developing early risk stratification and intervention approaches to counteract metabolic adversities linked to childhood obesity.

Fasting and stimulated glucagon-like peptide-1 exhibit a compensatory adaptive response in diabetes and pre-diabetes states: A multi-ethnic comparative study.

BackgroundImpaired secretion of glucagon-like peptide-1 (GLP-1) among Caucasians contributes to reduced incretin effect in type 2 diabetes mellitus (T2DM) patients. However, studies emanating from East Asia suggested preserved GLP-1 levels in pre-diabetes (pre-DM) and T2DM. We aimed to resolve these conflicting findings by investigating GLP-1 levels during oral glucose tolerance test (OGTT) among Malay, Chinese, and Indian ethnicities with normal glucose tolerance (NGT), pre-DM, and T2DM. The association between total GLP-1 levels, insulin resistance, and insulin sensitivity, and GLP-1 predictors were also analyzed.MethodsA total of 174 subjects were divided into NGT (n=58), pre-DM (n=54), and T2DM (n=62). Plasma total GLP-1 concentrations were measured at 0, 30, and 120 min during a 75-g OGTT. Homeostasis model assessment of insulin resistance (HOMA-IR), HOMA of insulin sensitivity (HOMA-IS), and triglyceride–glucose index (TyG) were calculated.ResultsTotal GLP-1 levels at fasting and 30 min were significantly higher in T2DM compared with pre-DM and NGT (27.18 ± 11.56 pmol/L vs. 21.99 ± 10.16 pmol/L vs. 16.24 ± 7.79 pmol/L, p=0.001; and 50.22 ± 18.03 pmol/L vs. 41.05 ± 17.68 pmol/L vs. 31.44 ± 22.59 pmol/L, p<0.001; respectively). Ethnicity was a significant determinant of AUCGLP-1, with the Indians exhibiting higher GLP-1 responses than Chinese and Malays. Indians were the most insulin resistant, whereas Chinese were the most insulin sensitive. The GLP-1 levels were positively correlated with HOMA-IR and TyG but negatively correlated with HOMA-IS. This relationship was evident among Indians who exhibited augmented GLP-1 responses proportionately to their high insulin-resistant states.ConclusionThis is the first study that showed GLP-1 responses are augmented as IR states increase. Fasting and post-OGTT GLP-1 levels are raised in T2DM and pre-DM compared to that in NGT. This raises a possibility of an adaptive compensatory response that has not been reported before. Among the three ethnic groups, the Indians has the highest IR and GLP-1 levels supporting the notion of an adaptive compensatory secretion of GLP-1.

The Role of Angiotensinogen rs699 in Diabetic Nephropathy Among Type 2 Diabetes Mellitus Patients with Uncontrolled Postprandial Glucose Levels

Diabetic Nephropathy (DN) is the most common complication of Type 2 Diabetes Mellitus (T2DM), leading to the highest mortality rate of DM complications. However, its etiology is still questionable. Hyperglycemia, hypertension, and particular genetic susceptibility are associated with DN. Not all patients with uncontrolled hyperglycemia suffer DN. Thus, genetic susceptibility may be a risk factor for DN. The genetic variant of angiotensinogen rs699 is known to be associated with the risk of DN with inconsistent results between ethnicities. This study aims to reveal the correlation between the AGT rs699 with the incidence of diabetic nephropathy among type-2 diabetes mellitus patients with uncontrolled postprandial glucose levels in the Jambi Malay ethnicity. This study was observational analytic research with a cross-sectional design. It used 48 DNA samples from type-2 diabetes mellitus patients with uncontrolled postprandial glucose levels. The authors took 24 DNA samples from patients with DN and 24 without DN (as a control group). The genotyping method used ARMS-PCR specific for AGT rs699. Subjects with the CT genotype had a lower risk for diabetic nephropathy than the CC genotype, but it was not statistically significant (p=0.247; OR=0.508; 95%CI=0.160-1.607). In addition, subjects with the T allele (p=0.331; OR=0.621; 95%CI-0.237-1.630) had a lower risk for diabetic nephropathy than the C allele, but it was not statistically significant. In conclusion, Angiotensinogen rs699 is not a risk factor for diabetic nephropathy among type-2 diabetes mellitus patients with uncontrolled postprandial glucose levels in the Jambi Malay ethnicity.

Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns

The burden of frequent attenders (FAs) of emergency departments (EDs) on healthcare resources is underestimated when single-centre analyses do not account for utilisation of multiple EDs by FAs. We aimed to quantify the extent of multiple ED use by FAs and to characterise FAs. We reviewed nationwide ED attendance in Singapore data from 1 January 2006 to 31 December 2018 (13 years). FAs were defined as patients with ≥4 ED visits in any calendar year. Single ED FAs and multiple ED FAs were patients who attended a single ED exclusively and ≥2 distinct EDs within the year, respectively. Mixed ED FAs were patients who attended a mix of a single ED and multiple EDs in different calendar years. We compared the characteristics of FAs using multivariable logistic regression. We identified 200,130 (6.3%) FAs who contributed to1,865,704 visits (19.6%) and 2,959,935 (93.7%) non-FAs who contributed to 7,671,097 visits (80.4%). After missing data were excluded, the study population consisted of 199,283 unique FAs. Nationwide-linked data identified an additional 15.5% FAs and 29.7% FA visits, in addition to data from single centres. Multiple ED FAs and mixed ED FAs were associated with male sex, younger age, Malay or Indian ethnicity, multiple comorbidities, median triage class of higher severity, and a higher frequency of ED use. A nationwide approach is needed to quantify the national FA burden. The multiple comorbidities and higher frequency of ED use associated with FAs who visited multiple EDs and mixed EDs, compared to those who visited a single ED, suggested a higher level of ED burden in these subgroups of patients. The distinct characteristics and needs of each FA subgroup should be considered in future healthcare interventions to reduce FA burden.

LEP G2548A polymorphism is associated with increased serum leptin and insulin resistance among T2DM Malaysian patients.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic syndrome that is rapidly increasing across the world, especially in Malaysia. Leptin plays a vital role in the regulation of metabolism through its effect on peripheral tissues. G2548A polymorphism in the LEP gene promoter has been associated with insulin resistance, leptin, and type 2 diabetes mellitus across different population, but has not been inclusively reported within the Malaysian population. Thus, our study aimed to investigate the impact of G2548A polymorphism on serum leptin levels and insulin resistance among Malaysian T2DM patients. This case-control study involved 150 T2DM patients and 150 non-diabetic volunteers from ethnic Malays, Chinese and Indians. Genotyping of G2548A polymorphism was carried out using PCR-RFLP. Serum leptin and insulin levels were determined via ELISA. ANOVA and Chi-square tests were used to determine the distribution of genotypes and allelic frequencies based on serum leptin and insulin levels. Frequency of AA genotype and A allele of G2548A variant were significantly (P < 0.05) higher in T2DM patients of Malay and Indian ethnicities (4%, 35%, and 36%, 57%, respectively) as compared to the control groups (0%, 22%, and 18%, 35%, respectively). Fasting serum leptin levels were significantly (P < 0.001) higher in T2DM patients compared to non-diabetic subjects (166.78 pg/ml, 101.94 pg/ml, respectively). Additionally, elevated serum leptin, insulin levels, and BMI in diabetic patients were found to be associated with the AA genotype of this variant, compared to GG, and GA genotypes (P < 0.05). Our findings suggest a significant association between G2548A polymorphism among Malaysian T2DM subjects, particularly among Malay and Indian ethnic groups. Moreover, the A allele frequency of the G2548A variant significantly increased the risk of T2DM and is significantly associated with increased serum leptin, insulin levels, and elevated BMI.

UTILIZATION AND CONSERVATION OF Nepenthes ampullaria Jack IN THE TRADITION OF KENDURI SKO COMMUNITY OF KERINCI, JAMBI

It is common for ethnic Malay in Indonesia and Malaysia to use Nepenthes ampullaria as food containers. However, the use of Nepenthes as part of a cultural tradition has been found only in Kerinci Regency, Jambi. This study explores the local wisdom in utilizing and maintaining the presence of N. ampullaria in Kerinci. Data collection through open-ended and deep interviews through participatory observation methods. Data analysis and presentation are delivered descriptively. Lemang is a compulsory item to be served in traditional ceremonies of kenduri sko. There are two types of lemang in Kerinci, lemang bamboo and lemang kancung beruk. The latter is found only during the kenduri sko tradition in Kecamatan Gunung Raya and Bukit Kerman. Therefore, the existence of lemang kancung beruk in these two sub-districts has become obligatory and has no other comparable substitute. In Gunung Raya and Bukit Kerman, the Kenduri sko is held four times a year. The need for N. ampullaria for kenduri sko in these two sub-districts is enormous. For the event, each household needs at least 500 to 2000 pitchers of N. ampullaria. The people of Kerinci harvest N. ampullaria directly from the wild to fulfill the need. The population of N. ampullaria that still survives in its natural habitat is evidence of the success of the local community in maintaining the existence of N. ampullaria in Kerinci. Method and schedule arrangements can allow the population of N. ampullaria to recover. &#x0D; &#x0D; Key words: Nepenthes, Kenduri sko, Lemang kancung beruk

Women's health beliefs and uptake of breast cancer screening in Malaysia.

This study investigated women's health beliefs, the use of breast cancer (BC) screening services, and the factors that potentially influence uptake of screening. Face-to-face interviews were conducted with a randomly selected community sample of 992 women (>40 years old) in Selangor State, Malaysia. Approximately 35% of women received a clinical breast examination (CBE) and 27% had a mammogram within the last 1 to 2 years. The regression analyses indicated that Chinese ethnicity has higher perceived susceptibility to BC compared to Malay ethnicity (mean 7.74, SD: 2.75; 95% CI 0.09, 1.03) whilst a lower perceived susceptibility was observed in women aged ≥70 years (mean 6.67, SD: 3.01; 95% CI -1.66, -0.24) compared to women aged 40-49 years. Indian Malaysian women (mean 16.87, SD: 2.59; 95% CI 0.12, 1.01) and women who had received a CBE (mean 16.10, SD:2.35; 95% CI 0.18, 0.89) were more likely to have higher perceived benefits scoring. Indian ethnicity, secondary education and tertiary education, top 20% income group, past history of CBE and mammogram uptake were significantly associated with lower barriers scoring. There is a need to target BC screening uptake improvement programmes towards communities in which women experience disadvantages related to income, education, employment, and, in particular, to tailor programmes to take into consideration differences between ethnic groups regarding their beliefs about cancer screening.

Clinical validation of a smartphone application for automated wound measurement in patients with venous leg ulcers.

Chronic wounds are associated with significant clinical, economic and quality-of-life burden. Despite the variety of wound imaging systems available in the market for wound assessment and surveillance, few are clinically validated among patients of Asian ethnicity. We aimed to clinically validate the accuracy of a smartphone wound application (Tissue Analytics [TA], Net Health Systems Inc, Florida, USA), versus conventional wound measurements (visual approximation and paper rulers), in patients of Asian ethnicity with venous leg ulcers (VLU). A prospective cohort study of patients presenting with VLU to a specialist wound nurse clinic over a 5-week duration was conducted. Each patient received seven wound measurements: one by a trained wound nurse clinician, and three separate wound measurements using TA on each of the iOS and Android operating systems. Inter-rater and intra-rater reliability between clinical and TA-based measurements were analysed using intra-class correlation statistics, with values of <0.5, 0.5 to 0.75, 0.75 to 0.9, and >0.9 indicating poor, moderate, good and excellent reliability, respectively. 82 patients (51% males), with a mean age at 65.8 years, completed the 5-week study duration. 25 (30%) had underlying diabetes mellitus. Chinese, Malay and Indian ethnicity comprised 68%, 12% and 11%, respectively. The VLU healed in 26 (32%) of patients within the study period. In total, 358 wound episodes with 2334 wound images were analysed. Inter-rater reliability for length, width and area between wound nurse measurements and TA application measurements was good (range 0.799-0.919, P < 0.001). Separate measurements of intra-rater reliability for length, width and area within the iOS or Android systems were excellent (range 0.967-0.985 and range 0.977-0.984 respectively, P < 0.001). Inter-rater reliability between TA used on the iOS and Android systems was also excellent (0.987-0.989, P < 0.001). Tissue Analytics, a smartphone wound application, is a useful adjunct for wound assessment and surveillance in VLU patients of Asian ethnicity.

Malaysian socio-demographic characteristics, mean haemoglobin levels and BMI distribution of the monthly transfused group (MTG) and non-monthly transfused group (NMTG) thalassemia patients

Background: Thalassemia is a genetic blood disorder characterized by insufficient haemoglobin level due to mutation in the globin chains causing anaemia with iron overload and the most common genetic haemoglobinopathy in Malaysia. They are grouped as transfusion dependent and non-dependent according to their transfusion requirement. The frequency of thalassemia transfusions can be discriminated further into monthly to non-monthly transfusion group. Objective: To analyze the socio-demographic characteristic, haemoglobin levels and BMI distribution after classifying the thalassemia patients according to monthly transfused group (MTG), non-monthly transfused group (NMTG) and comparing to a healthy individual control group. Methods and Materials: This was a prospective cross-sectional study gathering data on socio-demographic characteristic, haemoglobin levels and BMI distribution of patients with MTG and NMTG thalassemia patients from a thalassemia clinic in Ampang Hospital and comparing them to healthy individuals in Faculty of Medicine and Health Sciences, Universiti Putra Malaysia. The study embarked between August to October 2020. Results: Our study clearly shows in adult thalassemia MTG are predominantly in Malay ethnicity and younger in comparison to NMTG. The mean Hb levels of MTG is lower compared to NMTG regardless of the genotype and phenotype characteristics.

Mammography screening is associated with more favourable breast cancer tumour characteristics and better overall survival: case-only analysis of 3739 Asian breast cancer patients

BackgroundEarly detection of breast cancer (BC) through mammography screening (MAM) is known to reduce mortality. We examined the differential effect that mammography has on BC characteristics and overall survival and the sociodemographic determinants of MAM utilization in a multi-ethnic Asian population.MethodsThis study included 3739 BC patients from the Singapore Breast Cancer Cohort (2010–2018). Self-reported sociodemographic characteristics were collected using a structured questionnaire. Clinical data were obtained through medical records. Patients were classified as screeners (last screening mammogram ≤ 2 years before diagnosis), non-screeners (aware but did not attend or last screen > 2years), and those unaware of MAM. Associations between MAM behaviour (MB) and sociodemographic factors and MB and tumour characteristics were examined using multinomial regression. Ten-year overall survival was modelled using Cox regression.ResultsPatients unaware of screening were more likely diagnosed with late stage (ORstage III vs stage I (Ref) [95% CI]: 4.94 [3.45–7.07], p < 0.001), high grade (ORpoorly vs well-differentiated (reference): 1.53 [1.06–2.20], p = 0.022), nodal-positive, large size (OR>5cm vs ≤2cm (reference): 5.06 [3.10–8.25], p < 0.001), and HER2-positive tumours (ORHER2-negative vs HER2-positive (reference): 0.72 [0.53–0.97], p = 0.028). Similar trends were observed between screeners and non-screeners with smaller effect sizes. Overall survival was significantly shorter than screeners in the both groups (HRnon-screeners: 1.89 [1.22–2.94], p = 0.005; HRunaware: 2.90 [1.69–4.98], p < 0.001).Non-screeners and those unaware were less health conscious, older, of Malay ethnicity, less highly educated, of lower socioeconomic status, more frequently ever smokers, and less physically active. Among screeners, there were more reported personal histories of benign breast surgeries or gynaecological conditions and positive family history of breast cancer.ConclusionsMammography attendance is associated with more favourable BC characteristics and overall survival. Disparities in the utility of MAM services suggest that different strategies may be needed to improve MAM uptake.

Meaning of Various Social Values and Aspects in Rituals Reject the Malay Claim, Serdang, North Sumatera.

This study examines the meaning of social values ​​and aspects in the ritual of rejecting reinforcements from the Serdang Malays, which contain many values ​​of life as well as perspectives and principles of life that are still maintained by the Serdang Malay tribal community. Values ​​are traits or things that are important and beneficial to humans, or something that perfects humans according to their nature. Values ​​can also be translated as social media or social media that are considered appropriate and useful to achieve. In the field of sociology, the existence of values ​​is very important, values ​​and aspects that influence humans in determining their choice among existing alternatives. Likewise with the values ​​and aspects contained in the ritual of rejecting reinforcements in the Malay community of Serdang, North Sumatra Province, not only as a racial tradition. ethnic Malays from the past generation, but also have very useful aspects such as social values, psychological and pedagogical values, religious values, intellectual values ​​and intelligence. This study uses descriptive qualitative methods with the techniques of observation, in-depth interviews and literacy studies. As for what makes the Malay community of Serdang still maintain the ritual of rejecting reinforcements because it is still considered to have a role and function as well as life values ​​that are still relevant and dynamic which until now continue to be continued and remain as a reference. Of course, these values ​​and aspects have advantages and disadvantages to be applied. Values ​​and aspects that have weaknesses need to find new solutions and creativity in dealing with these matters. Values ​​and aspects that have advantages need to be maintained and preserved.