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Purpose: To compare the effects of a high-calcium vitamin D-fortified milk with added FOS-inulin versus regular milk on serum parathyroid hormone, and bone turnover markers in premenopausal (Pre-M) and postmenopausal (PM) women over 12 weeks. Methods: Premenopausal women ( n = 136, mean age 41 (±5) years) and postmenopausal women [ n = 121, mean age 59 (±4) years] were recruited, and each age group randomised into two groups to take two glasses per day of control = regular milk (500 mg calcium per day) or intervention (Int) = fortified milk (1000 mg calcium for pre-M women and 1200 mg calcium for PM women, 96 mg magnesium, 2.4 mg zinc, 15 µg vitamin D, 4 g FOS-inulin per day). At baseline, week 4 and week 12 serum minerals and bone biochemical markers were measured and bone density was measured at baseline. Results: Mean 25-hydroxyvitamin D [25(OH) vitamin D] levels among groups were between 49 and 65 nmol/L at baseline, and over the 12 weeks of supplementation, the fortified milk improved vitamin D status in both Int groups. CTx-1 and PINP reduced significantly in both Pre-M and PM groups over the 12 weeks, with the changes in CTx-1 being significantly different ( P < 0.035) between PM control and PM Int groups at week 12. Parathyroid hormone levels were significantly reduced in all groups over time, except for control PM group where levels increased at 12 weeks. Conclusion: The overall pattern of responses indicates that while both regular milk and fortified milk reduce bone resorption in young and older women, fortified milk is measurably more effective. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate parental perception of neighbourhood environments and safety in association with children's physical activity among primary school children in Klang, Selangor, Malaysia. Methods A total of 250 children (9-12 years of age) and their parents participated in this cross-sectional study. Physical Activity Questionnaire for Older Children and Neighbourhood Environmental Walkability Scale as well as questions on constrained behaviours (avoidance and defensive behaviours) were used to assess the children's physical activity and parental perception of neighbourhood environment and safety, respectively. Results More than one-third (36.0%) of the children were physically inactive compared with only a small percentage (4.8%) who were physically active, with boys achieving higher physical activity levels than girls ( t = 2.564, P = 0.011). For the environmental scale, parents' perception of land-use mix (access) ( r = 0.173, P = 0.006), traffic hazards ( r = −0.152, P = 0.016) and defensive behaviour ( r = −0.024, P = 0.143) correlated significantly with children's physical activity. In multiple linear regression analysis, child's gender ( β = −0.226; P = 0.003), parent's education ( β = 0.140; P = 0.001), household income ( β = 0.151; P = 0.024), land-use mix (access) ( β = 0.134; P = 0.011) and defensive behaviour ( β = −0.017; P = 0.038) were significantly associated with physical activity in children ( R = 0.349, F = 6.760; P < 0.001), contributing 12.2% of the variances in physical activity of the children. Conclusion Results highlight the links between parental perception of neighbourhood environments, safety and constrained behaviours with their children's participation in active play. Interventions aimed to increase actual and perceived safety and reduce perceptions of risk by parents in safe neighbourhoods can be targeted to increase children's physical activity in their local neighbourhoods. [ABSTRACT FROM AUTHOR]

Background: Double-burden of malnutrition (DBM) is an emerging public health concern among the Orang Asli (indigenous peoples) of Peninsular Malaysia. This study aimed to identify the presence of DBM at the community and household levels in Orang Asli population and its associated demographic and socio-economic factors. Methods: This cross-sectional study was conducted in 11 Orang Asli villages surrounding the Krau Wildlife Reserve, Peninsular of Malaysia from October 2011 to January 2012. Of 438 households, a total of 981 adults and 304 children who met the study criteria agreed to participate. About 160 households were further selected with pairs of children aged 3-59 months and non-pregnant mothers aged 15-55 years. Demographic and socio-economic data were obtained using interviewer-administered questionnaire while weight and height were measured using standard procedures. Double-burden of malnutrition was defined as overweight/obese mother-underweight child (OWOBM/UWC), overweight/obese mother-stunted child (OWOBM/STC) or overweight/obese mother-underweight or/and stunted child (OWOBM/UWSTC). Binary logistic regression identified the demographic and socio-economic factors associated with double-burden households. Results: About 26 % of overweight and obese adults coexisting with high proportions of underweight (49 %) and stunted (64 %) children in these Orang Asli villages. There was a higher prevalence of households with OWOBM/ UWSTC (20 %) and OWOBM/STC (19.4 %) than households with OWOBM/UWC (12.5 %). Boys (P < 0.05), older age mothers (P < 0.05), mothers with higher education (P < 0.05) and households with income per capita less than USD 29.01 (RM 97.00) (P < 0.01) were associated with higher odds of OWOBM/STC. Jah Hut (P < 0.05) and higher number of children (P < 0.05) were significantly associated with lower odds of OWOBM/UWC. Conclusions: The occurrence of double-burden of malnutrition in Orang Asli population deserves attention. Poverty reduction, access to quality diet and improved health and nutrition literacy are among strategies that could address the coexistence of DBM in this population. [ABSTRACT FROM AUTHOR]

Introduction: Pneumonia continues to be as one of the top causes of hospitalisations and deaths in Malaysia despite the advancement in prevention and treatment of pneumonia. One of the possible explanations is the frequent misdiagnosis of pneumonia which had been reported elsewhere but such data is not available locally., Objectives: This is an audit project aiming to evaluate the proportion of misdiagnosis among hospitalised communityacquired pneumonia (CAP) patients in the Respiratory wards of Penang General Hospital based on their initial presentation data, and their associated outcomes., Methods: We reviewed the medical notes and initial chest radiographs of 188 CAP patients who were admitted to respiratory wards. Misdiagnosis was defined as cases which lack suggestive clinical features and/or chest radiograph changes. In-hospital mortality and length of stay (LOS) were the outcomes of interest., Results: The study found that 38.8% (n=73) of the hospitalised CAP patients were misdiagnosed. The most common alternative diagnosis was upper respiratory tract infection (32.8%, n=24). There was no statistical difference between misdiagnosis and CAP patients in the demographic and clinical variables collected. In terms of outcomes, misdiagnosed patients were discharged earlier (mean LOS= 3.5±3.28 days vs. 7.7±15.29 days, p=0.03) but the in-hospital mortality difference was not statistically significant (p=0.07)., Conclusions: One third of our CAP admissions were misdiagnosed. Although initial misdiagnosis of CAP in our study did not show any increase in mortality or morbidity, a proper diagnosis of CAP will be helpful in preventing inappropriate prescription of antibiotics and unnecessary admission.

Introduction: In most Asian countries, stroke is one of the major causes of mortality. A stroke event is life-changing for stroke survivors, which results in either mortality or disability. Therefore, this study comprehensively focuses on prevalence, risk factors, and secondary prevention for stroke recurrence identified in South, East, and Southeast Asian countries., Methods: This scoping review uses the methodological framework of Arksey and O'Malley. A comprehensive search of academic journals (English) on this topic published from 2007 to 2017 was conducted. A total of 22 studies were selected from 585 studies screened from the electronic databases., Results: First-year stroke recurrence rates are in the range of 2.2% to 25.4%. Besides that, modifiable risk factors are significantly associated with pathophysiological factors (hypertension, ankle-brachial pressure index, atherogenic dyslipidaemia, diabetes mellitus, metabolic syndrome, and atrial fibrillation) and lifestyle factors (obesity, smoking, physical inactivity, and high salt intake). Furthermore, age, previous history of cerebrovascular events, and stroke subtype are also significant influence risk factors for recurrence. A strategic secondary prevention method for recurrent stroke is health education along with managing risk factors through a combination of appropriate lifestyle intervention and pharmacological therapy., Conclusion: To prevent recurrent stroke, health intervention should be geared towards changing lifestyle to embody a healthier approach to life. This is of great importance to public health and stroke survivors' quality of life.

Introduction: It is known that dietary diversity improves diet quality and nutritional status of young children. This study aimed to determine the relationship between dietary diversity and nutritional status of Orang Asli children in Krau Wildlife Reserve., Methods: A total of 216 children from three Orang Asli sub-tribes (Jah Hut, Temuan and Che Wong) aged 1 to 6 years from 162 households in 16 villages participated in this cross-sectional study. Children and mothers were measured for body weight and height. Mothers were interviewed for household socio-demographic information and diet diversity of children in the last 7 days. Diet diversity score (DDS) was calculated based on 15 food groups., Results: There was a high prevalence of underweight (50.9%) and stunting (61.6%) in Orang Asli children. For mothers, 11.1%, 27.8% and 7.4% were underweight, overweight and obese, respectively. Mean DDS of children was 6.38 [95% CI-6.10, 6.65] of the possible 15. Higher DDS of children was significantly related to older age (p < 0.05), the non Jahut sub-tribe (p < 0.01) and longer maternal years of schooling (p < 0.05). DDS was also positively related to weight-for-age z-scores (p < 0.001) and height-for-age z-scores (p < 0.05)., Conclusion: Undernutrition remains a major nutrition problem among Orang Asli children living within the forest reserve. Efforts to promote dietary diversity should emphasise traditional and nutritious foods that could improve health and nutritional status of the Orang Asli children.