Predictors of adherence to clinical breast examination and mammography screening among Malaysian women.

Breast cancer is the most common cancer among Malaysian women and early detection can play an important role in reducing cancer morbidity and mortality. The aim of this cross-sectional study was to determine the rates and factors related to clinical breast examination (CBE) and mammography among 425 female teachers in Selangor, Malaysia. A self-administered questionnaire that included questions on socio-demography, cancer-related knowledge practice and an adapted version of Champion's revised Health Belief Model Scale was employed. The mean age of participants was 37.2±7.16 years. Only 25% of the women ever had a CBE. Of women over the age 40 (n=138), 13.6% reported having had a mammography. The results showed higher susceptibility to breast cancer, higher benefits of doing CBE and regular visits with a physician to be significant predictors for undergoing CBE (p<0.05). In addition, higher a perceived susceptibility to breast cancer and regular undergoing CBE were significant predictors for having a mammography. The findings clearly suggest a need for improving women's awareness on breast cancer screening, its importance and recommended guidelines

Objective and subjective nutritional assessment of patients with cancer in palliative care

This study aimed to evaluate the nutritional status of patients with cancer in palliative care and to examine the interrelationship between objective and subjective nutritional assessment measures. Patients' nutritional status in a palliative care unit of a Malaysian government hospital and a hospice facility were assessed using anthropometric measurements, weight loss at 1/6 months, and the scored patient-generated subjective global assessment (PG-SGA). Moderate-to-severe malnutrition was observed in a range from 31% to 69% using both measurements. Common nutritional impact symptoms were pain, xerostomia, and anorexia. Patient-generated subjective global assessment scores were significantly correlated with anthropometric measurements (P <.050). The PG-SGA is equally informative as objective indicators and is recommended as a quickly applied tool for nutritional status assessment of patients with cancer in palliative care

Symposium 3: Young Investigators Symposium Diet-related psycho-social factors associated with fat, fruits and vegetable consumption in adults

There is consistent evidence that eating fruits and vegetables (F&V) and reducing fat intake reduce risks of major chronic diseases, including cardiovascular diseases and some cancers. The purpose of this cross-sectional study was to determine the relationship between diet-related psycho-social factors such as stages of change, self-efficacy, perceived benefits, perceived barriers and fat, fruit, and vegetable intake among 100 UPM staff. The sample comprised academic (29%) and non-academic staff (71%) with a mean age of 34 years. Data on socio-economic status, selfefficacy, and stages of change (SOC), perceived benefits and barriers to fat, fruit and vegetable intake were collected using a pre-tested interviewer-administered questionnaire. Dietary fat, fruit and vegetable servings were determined from two days of 24-hour diet recall data. The mean fat intake was 54.98±22.72 g with 63% of the subjects consuming more than 30% of total calories from fat. The mean serving size for fruit and vegetables was 1.57±1.79 and 2.04±1.91 respectively. A significantly higher intake of fruit was observed in the academic group compared to the nonacademic group (t=6.441, p<0.05) but not for fat and vegetable intake. Using the SOC algorithm, 11% and 7% of the subjects were in Stage I (Pre-Contemplation), for fat and F&V (combined) intake respectively, 6% and 1% in Stage II (Contemplation), followed by 68% and 40% in Stage III (Preparation), 1% and 34% in Stage IV and in Stage V, 14% and 18%, respectively. Fruit mean serving size increased from lowest in Stage 1 (0.8) and highest in Stage 3 (1.79). A similar trend was seen for vegetable intake. Self-efficacy for fat showed a decrease in fat intake from highest in the ‘not confident’ group (58.57±24.8 g) to lowest in the ‘very confident’ group (50.15±17.45 g). The mean number of fruit servings was similar across self efficacy levels but vegetable intake was highest in the ‘somewhat confident’ group (2.21±2.44) and lowest in the ‘not confident’ group (1.87±1.18). Frequent eating out was the highest barrier for fat reduction (42%) while the highest benefit for fat reduction was its potential to reduce the risk for chronic diseases (56%). For benefits of consuming fruits and vegetables, 60% agreed that both are good for health while 8% identified price and shelf life as the most important barriers. Persons with more perceived benefits consumed less fat and more fruits and vegetables. The perceived benefits were negatively associated with perceived barriers for fat intake (r=-0.204, p<0.05) while there was no association between perceived benefits and barriers with fruit and vegetable servings. In conclusion, psychosocial factors appear to influence fat, fruit and vegetable intake in this group of adults. Nutrition education programmes should focus on staging, increasing self-efficacy and perceived benefits while trying to reduce perceived barriers for effective change in diet related health behaviours

Factors associated with breast self-examination among Malaysian women teachers

The purpose of this study was to examine factors related to breast self-examination (BSE) among teachers in Selangor, Malaysia. A cross-sectional study was conducted among 425 female teachers in 20 randomly selected secondary schools. A self-administered questionnaire based on the health belief model was randomly selected secondary schools. A self-administered questionnaire based on the health belief model was used, including sociodemographic background and knowledge, beliefs and practices about breast cancer and BSE. Only 19% of the women performed BSE on a regular basis. Higher knowledge about breast cancer, greater confidence in performing BSE and regular visits to a physician were significant predictors for practising BSE. To promote BSE practice among Malaysian women, tailored health education and health promotion programmes should be developed based on a specific understanding of women's health beliefs

A workplace email-linked website intervention for modifying cancer-related dietary and lifestyle risk factors: rationale, design and baseline findings

INTRODUCTION:The use of email and website as channels for workplace health information delivery is not fully explored. This study aims to describe the rationale, design, and baseline findings of an email-linked website intervention to improve modifiable cancer risk factors. METHODS:Employees of a Malaysian public university were recruited by systematic random sampling and randomised into an intervention (n = 174) or control group (n = 165). A website was developed for the intervention and educational modules were uploaded onto the website. The intervention group received ten consecutive weekly emails with hypertext links to the website for downloading the modules and two individual phone calls as motivational support whilst the control group received none. Diet, lifestyle, anthropometric measurements, psychosocial factors and stages of change related to dietary fat, fruit and vegetable intake, and physical activity were assessed. RESULTS:Participants were predominantly female and in non-academic positions. Obesity was prevalent in 15% and 37% were at risk of co-morbidities. Mean intake of fats was 31%, fruit was -1 serving/day and vegetable was < 1 serving/day. Less than 20% smoked and drank alcohol and about 40% were physically inactive. The majority of the participants fell into the Preparation stage for decreasing fat intake, eating more fruit and vegetables, and increasing physical activity. Self-efficacy and perceived benefits were lowest among participants in the Precontemplation/Contemplation stage compared to the Preparation and Action/Maintenance stages. CONCLUSION:Baseline data show that dietary and lifestyle practices among the employees did not meet the international guidelines for cancer prevention. Hence the findings warrant the intervention planned

Dietary risk factors for colorectal adenomatous polyps: a mini review

At least 6 million deaths occurred worldwide are due to cancer and this figure is expected to rise to 15 millions by the year 2020. Colorectal cancer is among the most commonly occurring cancers both globally and in Malaysia. Numerous studies have shown significant relationships between various dietary components and the risks for colorectal cancer. Meanwhile, several theories have been suggested as etiological explanations, one of which is the influence of dietary factors on the cell proliferation rate. A higher cell proliferation rate is statistically associated with increased risk of colorectal cancer. However, evidence of a significant relationship between diet and colorectal adenomas, a potential precursor for colorectal cancer, remains insufficient. Colorectal adenomas or polyps are vital in their relationship with colorectal cancers as almost 70% of all colorectal cancers are developed from these polyps. Studying the modifiable risk factors related to polyps will provide an opportunity for the prevention of colorectal cancer even before it develops. This paper reviews the available evidence linking dietary factors with the risk for colorectal adenomas. As the numbers of published studies are limited, of which most are concentrated in Western countries, there is a need for epidemiological studies in Malaysia to strengthen the evidence of a relationship between diet and colorectal adenomas

Assessing the children’s views on foods and consumption of selected food groups : outcome from focus group approach

The food choices in childhood have high a probability of being carried through into their adulthood life, which then contributes to the risk of many non-communicable diseases. Therefore, there is a need to gather some information about children’s views on foods which may influence their food choices for planning a related dietary intervention or programme. This paper aimed to explore the views of children on foods and the types of foods which are usually consumed by children under four food groups (snacks, fast foods, cereals and cereal products; and milk and dairy products) by using focus group discussions. A total of 33 school children aged 7-9 years old from Selangor and Kuala Lumpur participated in the focus groups. Focus groups were audio-taped, transcribed and analyzed according to the listed themes. The outcomes show that the children usually consumed snacks such as white bread with spread or as a sandwich, local cakes, fruits such as papaya, mango and watermelon, biscuits or cookies, tea, chocolate drink and instant noodles. Their choices of fast foods included pizza, burgers, French fries and fried chicken. For cereal products, they usually consumed rice, bread and ready-to-eat cereals. Finally, their choices of dairy products included milk, cheese and yogurt. The reasons for the food liking were taste, nutritional value and the characteristics of food. The outcome of this study may provide additional information on the food choices among Malaysian children, especially in urban areas with regard to the food groups which have shown to have a relationship with the risk of childhood obesity

Lifestyle change using the health belief model to improve cardiovascular risk factors among postmenopausal women.

Globally, CVD is the number one cause of death and are projected to remain so in the future. The main cause of death in Iran is CVD which accounts for almost half (42%) of total deaths. It was a randomized controlled trial to determine the impact of a 6-month lifestyle changes using the Health Belief Model (HBM) on cardiovascular risk factors in sedentary, postmenopausal Iranian women. This study started on June 2007 and completed on May 2008. A total of 67 healthy and sedentary postmenopausal women recruited and randomly assigned to two groups namely; exercise (38), and control (29). Over the six months follow-up, the intervention group received five educational sessions (one face to face education in the first session and one in the 3rd month and three lecture discussion classes with slide demonstration) at the first month about physical activity according to the Health Belief Model. Every participant received a telephone call at the end of each month starting with the second month to remain on the exercise. Pre-intervention and post-intervention HBM components, anthropometric measurements, blood pressure (BP), blood lipids and physical activity were assessed. Data analyzed using the SPSS version 15. Descriptive, univariate and multivariate statistics were used. Results: The women in the exercise group experienced significant decrease in their LDL (-15mg/dl), FBS (-7.4mg/dl), and increased their physical activity compared to the control group (272 minutes/week, p=0.02). All components of HBM except for knowledge improved significantly in the exercise group compared to the control group (p=0.001). Lifestyle change intervention using the HBM can be an effective means of reducing cardiovascular risk in obese and sedentary postmenopausal women

Glycaemic control, lipid profile, blood pressure and body weight status among diabetics in rural Malaysia.

Diabetes is associated with a high risk of cardiovascular disease. The management of blood glucose, dyslipidaemia and other modifiable risk factor, is a key element in the multifactorial approach to prevent complications of type 2 diabetes. Materials and Methods: A cross sectional study was conducted to determine the level of glycaemic control, lipid profile, blood pressure and body weight status among type 2 diabetics in rural Malaysia. A total of 237 diabetic subjects participated in this study. Physical examination was carried out, including measurements of height, weight, waist and hip circumferences, and systolic and diastolic blood pressure. Fasting venous blood samples were collected to determine the glucose level and lipid profile. Results: About 70% of the subjects had a high body mass index (BMI), equal to or above 25 kg/ m2. More than 60% of the subjects had systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg. Mean fasting blood glucose was 9.84±4.54 mmol/L. Mean total cholesterol was 5.18±1.35 mmol/L. High density lipoprotein cholesterol (HDLC) and triglyceride (TG) and glucose levels were higher in male than in female, but not statistically significant (p>0.05). However, low density lipoprotein cholesterol (LDLC) was higher in females than males (p<0.05). Mean HDLC was below 1.0 mmol/L in all subjects. Conclusion: Glycaemic control, lipid profile, blood pressure and body weight status were not satisfactory and may increase the risk of microvascular and macrovascular complications among these subjects. Appropriate intervention programs should be implemented for better diabetes control among rural subjects

Knowledge and behavior regarding breast cancer screening among female teachers in Selangor, Malaysia.

A cross-sectional study was carried out to determine the knowledge and practices of 425 female secondary school teachers from 20 selected secondary schools in Selangor, Malaysia on breast cancer screening (BCS). A self-administered, structured questionnaire was used for data collection. This study showed moderate to low knowledge on breast cancer (BC) and BCS among teachers. Only 19%, 25% and 13.6% eligible women performed breast self-examination (BSE), clinical breast examination (CBE) and mammography respectively, on a regular basis. Level of breast cancer knowledge was significantly associated with BSE (p=0.000). Having heard/ read about BCS, and regular visit with a physician were associated with BCS behaviors (P0.05 and age, family history of breast cancer, marital status or having health insurance). Efforts are needed to increase knowledge and remove misconceptions about breast cancer and screening practices among Malaysian women