Alcohol consumption and risky drinking patterns in Malaysia: findings from NHMS 2011

Knowledge, attitude and practice (KAP) on food-drug interaction (FDI) among pharmacists working in government health facilities in Sabah, Malaysia

BACKGROUND

Food-drug interaction (FDI) is prevalent in our day-to-day life. Widely recognised as drug expert, pharmacists are responsible to provide patient education, including on FDI, to ensure optimum safety and efficacy of treatment. Most pharmacists have knowledge and experience regarding FDI to certain extent. However, the level of knowledge, attitude and practice (KAP) towards FDI among pharmacists were yet to elucidated for many countries, including for Malaysia.

OBJECTIVE

This study aims to assess pharmacists' KAP on FDI, their inter-association, as well as association with sociodemographic characteristics in Sabah, Malaysia.

METHODS & MATERIALS

A cross-sectional study was conducted from 1 to 31 May 2023, using online, self-administered Google Form questionnaire, involving 24 government hospitals and 113 government health clinics in Sabah.

RESULTS

A total of 273 (or 35.5%) out of 768 pharmacists responded. Over two-third were female and serving government hospitals (79.6%). Mean score of KAP were 72.5 ± 14.3%, 93.2 ± 8.3% and 56.0 ± 16.7%, respectively, reflected good attitude but moderate knowledge and practice. Knowledge gaps identified include common medications such as paracetamol and metformin.Additionally, 28.2% respondents reported lack of FDI coverage during undergraduate, while merely 17.2% have received formal training on FDI after started working. Although 89.0% respondents agree that informing patients about possible FDIs is their responsibility, only 35.9% of the respondents usually or always practiced this. Such discrepancy maybe attributed to insufficient pharmacists' knowledge on FDI, where pharmacists with good level of knowledge have almost 2 times higher odd for good level of practice, compared to those with poor/moderate knowledge (odds ratio, OR: 1.92; 95% CI 1.02-3.61; p = 0.040) in this study.

CONCLUSION

There are significant training gaps to be filled in. Pharmacist possessing good knowledge is a prerequisite for better pharmacy practice. Adequate education strategies covering FDI should be emphasised for all pharmacy undergraduates and practising pharmacists.

Research protocol of the efficacy of probiotics for the treatment of alcohol use disorder among adult males: A comparison with placebo and acceptance and commitment therapy in a randomized controlled trial

BACKGROUND AND AIM

Primarily, this study compares the efficacy of probiotic and acceptance and commitment therapy (ACT) in alleviating the severity of alcohol craving and alcohol use disorder (AUD) among patients who had undergo two weeks of in-patient detoxification. Secondarily, this study compares the efficacy of probiotic and ACT in mitigating the severity of comorbid depression and anxiety symptoms; decreasing serum level of pro-inflammatory cytokines, such as interleukin 1β (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α); changing the event-related potential in electroencephalogram (EEG) and restoring microbiota flora in the gut of AUD patients.

METHODS AND ANALYSIS

Initially, during Phase I of the study, the serum level of IL-1β, IL-6 and TNF-α; ERP changes in the EEG and fecal microbiota content will be compared between 120 AUD patients and 120 healthy controls. Subsequently in Phase II of the study, 120 AUD patients will be randomized by stratified permuted block randomization into the probiotic, ACT and placebo groups in a 1:1:1 ratio. Participants in the probiotic and placebo groups will be administered one sachet per day of Lactobacillus spp. probiotic and placebo, respectively for 12 weeks. While those in the ACT group will receive one session per week of ACT for 8 weeks. Outcome measures will be administered at four timepoints, such as t0 = baseline assessment prior to intervention, t1 = 8 weeks after intervention began, t2 = 12 weeks after intervention and t3 = 24 weeks after intervention. Primary outcomes are the degrees of alcohol craving, alcohol withdrawal during abstinence and AUD. Secondary outcomes to be assessed are the severity of co-morbid depression and anxiety symptoms; the serum levels of IL-1β, IL-6 and TNF-α; changes in ERP and fecal microbiota content.

TRIAL REGISTRATION NUMBER

NCT05830708 (ClinicalTrials.gov). Registered on April 25, 2023.

The efficacy of virtual reality exposure therapy for the treatment of alcohol use disorder among adult males: a randomized controlled trial comparing with acceptance and commitment therapy and treatment as usual

Background

This multicenter, three-armed, parallel, single-blind randomized controlled trial (RCT) primarily aims to compare the efficacy of virtual reality exposure therapy (VRET) with that of acceptance and commitment therapy (ACT) and treatment as usual (TAU) to depreciate the degree of alcohol craving among alcohol use disorder patients who have undergone in-patient detoxification across four timelines (t0 = baseline prior to intervention, t1 = 4 weeks after baseline, t2 = 12 weeks after baseline, and t3 = 24 weeks after baseline). The secondary aims of this RCT are to compare the efficacy of VRET with that of ACT and TAU to alleviate the severity of alcohol use disorder, dissipate comorbid depressive and anxiety symptoms, and normalize event-related potential (ERP) in electroencephalogram (EEG) monitoring across the four timelines.

Methods

Initially, after 2 weeks of in-patient detoxification, 120 patients with alcohol use disorder will be randomized into three groups (VRET, ACT, and TAU control groups) via stratified permuted block randomization in a 1:1:1 ratio. Baseline assessment (t0) commences, whereby all the participants will be administered with sociodemographic, clinical, and alcohol use characteristics questionnaire, such as Alcohol Use Disorder Identification Test (AUDIT), Penn Alcohol Craving Scale (PACS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D), while event-related potential (ERP) detection in electroencephalogram (EEG) will also be carried out. Then, 4 weeks of VRET, ACT, and non-therapeutic supportive activities will be conducted in the three respective groups. For the subsequent three assessment timelines (t1, t2, and t3), the alcohol use characteristic questionnaire, such as AUDIT, PACS, HAM-D, HAM-A, and ERP monitoring, will be re-administered to all participants.

Discussion

As data on the effects of non-pharmacological interventions, such as VRET and ACT, on the treatment of alcohol craving and preventing relapse in alcohol use disorder are lacking, this RCT fills the research gap by providing these important data to treating clinicians. If proven efficacious, the efficacy of VRET and ACT for the treatment of other substance use disorders should also be investigated in future.

Clinical trial registration

NCT05841823 (ClinicalTrials.gov).

Findings from a Nationwide Study on Alcohol Consumption Patterns in an Upper Middle-Income Country

Alcohol consumption is a risk factor for various diseases, especially non-communicable diseases (NCDs) and injuries. The reduction of the harmful use of alcohol is mentioned in Target 3.5 of the Sustainable Developmental Goals (SDG). This study aimed to determine factors associated with current alcohol drinking among Malaysians aged 15 years and above. Data from the National Health and Morbidity Survey (NHMS) 2019, a cross-sectional nationwide survey using a two-stage stratified random sampling design, was used. Current alcohol drinking was defined as having consumed any alcoholic beverage in the past 12 months. Descriptive statistics and multiple logistic regression analysis were employed. The prevalence of current drinkers was 11.5%; 95% CI: 9.8, 13.5. The majority (65%) consumed alcoholic beverages in Category 2, which is mainly beer. Current drinkers consumed alcohol mostly once a month (59.0%), one or two drinks (71.1%), on a typical day. Most respondents had six or more drinks less than once a month (27.6%). Sex, age, ethnicity, education, employment, and smoking were found to be significantly associated with current alcohol drinking. Marital status, locality of residence, and household income were not significantly associated. Alcohol drinking is a problem among certain vulnerable groups and should be tackled appropriately.

Current e-cigarette use among in-school adolescents in West Malaysia: Examining the interactions between sociodemographic characteristics and lifestyle risk behaviours

Background

Adolescent e-cigarette use has increased dramatically. Most e-cigarette liquids contain nicotine, which can harm the developing adolescent brain. Local studies examining the risk factors of adolescent e-cigarette use and interactions between its risk factors are limited. This study was aimed at determining the prevalence of current e-cigarette use and its associated factors among in-school adolescents in West Malaysia. We also examined the possible sociodemographic characteristic, lifestyle risk behaviour and parental factor interactions that affect the probability of current e-cigarette use.

Methods

We conducted a cross-sectional study using data from the National Health and Morbidity Survey 2017. Respondents aged 13–18 years were included in the study. The data were analysed using STATA (v.15).

Results

The prevalence of current e-cigarette use was 9.1%. Male gender, older age, Malay ethnicity, schooling in urban area, current smoking, current alcohol use, current drug use, having parents that are not married and living together and parental tobacco product use were significantly associated with current e-cigarette use. There were significant interactions between: i) gender with age, ethnicity, current smoking, current alcohol use and current drug use, ii) ethnicity with current smoking and current alcohol use, iii) locality with ethnicity, current smoking and current alcohol use, iv) current drug use with age, ethnicity, current smoking and current alcohol use, v) parental marital status with gender, age and ethnicity, and vi) parental tobacco use with ethnicity and current smoking.

Conclusion

Our findings identify significant associations between sociodemographic characteristics, lifestyle risk behaviours and parental factors with current e-cigarette use. They also provide new insight into the interactions between these factors that affect the probability of current e-cigarette use among West Malaysian adolescents. Efforts to tackle e-cigarette use in Malaysian adolescents should target sociodemographic characteristics, lifestyle risk behaviours and parental factors such as smoking cessation intervention for parents.

Influence of cultural practices on breast cancer risks, stage at presentation and outcome in a multi-ethnic developing country

Malaysia is a developing country made up of three main ethnicities: Malay, Chinese and Indian. There are significant ethnic differences with regard to the type of daily food and cooking methods, contraception, breast-feeding preferences, confinement period and care, postmenopausal intake and influence of the traditional healer. Breast cancer is the most common cancer among Malaysian women across all three ethnicities. However, the National Cancer Registry and local medical centres have documented ethnic differences in breast cancer risk (Chinese, 40.7 per 100,000; Indian, 38.1 per 100,000; Malay, 31.5 per 100,000), peak age (youngest in the Malays), stage at presentation (largest percentage at advanced stage among the Malays) and survival (poorest survival rate among the Malays). The Malays have several practices that are protective against breast cancer compared with the Chinese. However, the Malays have strong beliefs in the traditional healer, which contribute to the delay in getting treatment, causing a poor outcome and a low survival rate. The highest BRCA1 and 2 genetic mutation incidence is amongst the Chinese, but the Malays have the largest triple-negative breast cancer rates. These factors may also contribute to the statistical breast cancer data.

Longitudinal predictors of problematic alcohol use in adolescence: A 2-year follow-up study

Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.

Prevalence of nocturia among community-dwelling adults: a population-based study in Malaysia

BACKGROUND

Nocturia is widely prevalent condition with detrimental effects on quality of life and general health. In Malaysia, there is a lack of up-to-date prevalence study on nocturia. This study aimed to investigate the prevalence of nocturia and awareness pertaining to nocturia among Malaysian adults.

METHODS

A cross-sectional population-based study was conducted among Malaysian adults aged ≥ 18 years old. The data was collected by mixed mode self-administered questionnaire from May 2019 to September 2019. Nocturia was defined as one or more voids at night.

RESULTS

There were a total of 4616 respondents with 74.5% of response rate. The overall prevalence of nocturia among Malaysian adults was found to be 57.3%. In multivariate analysis, respondents aged 31-40 (1.91 [1.52-2.40]) or > 60 years old (2.03 [1.48-2.71]), and those who presented with hypertension (2.84 [2.28-3.53]), diabetes mellitus (1.78 [1.42-2.25]), renal disease (3.58 [1.93-6.63]) or overactive bladder (1.61 [1.10-2.35]) were associated with higher prevalence of nocturia. A significantly lower disease prevalence (p < 0.05) was noted among those aged 41-50 (0.73 [0.59-0.91]), male (0.78 [0.69-0.88]) and Chinese (0.47 [0.30-0.74]) or Indian (0.34 [0.21-0.54]) ethnicities. A total of 37.3% of respondents with nocturia reported that they faced sleeping difficulty about half the time or more after waking up in the middle of night. Those who had ≥ 2 voids per night experienced significantly higher mean bother score than those who had 1 void per night (p < 0.001). Approximately half (56.7%) of all respondents were not aware that night time urination is a medical condition. Only 25.2% of respondents with nocturia had sought medical attention for their nocturia.

CONCLUSIONS

The prevalence of nocturia among Malaysian adults is high and strongly influenced by age, sex, race and comorbidities. However, the general awareness pertaining to nocturia being a health issue remains low among Malaysians. The findings also highlighted the impact of nocturia on sleep and the need for nocturia education to better address this disease.

Prevalence and risk factors associated with alcohol consumption among indigenous people in Sabah Borneo Island

OBJECTIVES

In this study, we aimed to determine the prevalence and risk factors of alcohol use among a cohort of population in Sabah.

DESIGN

This is a prospective, cohort study involving rural community residents.

SETTING

Rural community resident at Bingkor, Keningau, Sabah.

PARTICIPANTS

363 individuals aged 13 years old and above.

INTERVENTION

Community-based participatory research to determine the prevalence and risk factors associated with alcohol use.

MAIN OUTCOME MEASURES

Measurement of alcohol use using Alcohol Use Disorders Identification Test (AUDIT) and assessment of psychiatric morbidity using Mini International Neuropsychiatric Interview (MINI) questionnaires.

RESULTS

Most alcohol drinkers aged between 36-45 years old, followed by 26-35 years old and 46-55 years old. Interestingly, there are almost similar female to male ratio. Most were Kadazan-Dusun ethnic, non-Muslims, and married. Although only less than a third of the participants received tertiary education, the majority were working. Based on the findings, being a male, non-Muslim and having an obsessive-compulsive disorder (OCD) (current) posed a significantly higher risk of alcohol consumption.

CONCLUSION

A worryingly high prevalence of hazardous alcohol consumption among the locals is reported. There is a need for population-wide intervention towards preventive measures based on the identified risk factors for hazardous alcohol use.

Hypertension in a multi-ethnic Asian population of Singapore

The prevalence of hypertension varies by country and region, but it remains a leading yet modifiable risk factor of cardiovascular disease. There are many factors that contribute to the burden of hypertension in Asia, a region with diverse ethnicity. It has been shown that sociodemographic variability is related to ethnic differences, thereby emphasizing the importance of hypertension screening and educating at-risk or vulnerable groups. In this review, we describe the ethnic differences in genetic variants, dietary choice, and lifestyle habits, as well as its association with sociodemographic differences, hypertension awareness, and treatment control.

Prevalence of Severe Mental Illness Dual Diagnosis Among Inpatients in a Psychiatric Hospital in Malaysia

The aim of this study was to determine the prevalence of alcohol or non-alcohol substance use dual diagnosis among inpatients with severe mental illness in a psychiatric institution in Malaysia. In addition, this study aimed to determine adverse outcomes between dual diagnosis versus single diagnosis. Methods: This was a cross-sectional study conducted in the inpatient ward using the Mini-International Neuropsychiatric Interview (MINI) to establish the diagnosis of severe mental illness and to screen for alcohol or non-alcohol substance use disorder comorbidity. Outcomes and severity of different domains among severe mental illness patients were assessed using the Addiction Severity Index (ASI). Results: Out of 152 patients who participated in this study, 51.3% (n = 78) had comorbid alcohol use disorder, and 29.6% (n = 45) had non-alcohol substance use disorder. Males with Kadazan ethnicity with severe mental illness and alcohol use disorder had a higher risk of having comorbid non-alcohol substance use disorder. Similarly, male Kadazan patients with severe mental illness and non-alcohol substance use disorder had a higher risk of having a comorbid alcohol use disorder. Dual diagnosis patients with alcohol and non-alcohol substance use disorder had higher rates of hospitalizations (p < .001 and p = .001). Family and social relationships were affected among the alcohol use disorder group as shown by the higher composite score for family status (FCOMP; p < .001). This group also showed more severe psychiatric status, as the composite score for psychiatric status (PCOMP) was high (p = .004). Suicidality was higher among patients with alcohol use disorder and severe mental illness (p < .001). Conclusions: The prevalence of severe mental illness dual diagnosis was high in this study with poorer outcomes, higher rates of admissions, and risk of suicidality. This highlights the importance of provisions for a more holistic treatment approach among patients with dual diagnosis.

Forecasting mortality rates using hybrid Lee–Carter model, artificial neural network and random forest

Inaccurate prediction would cause the insurance company encounter catastrophic losses and may lead to overpriced premiums where low-earning consumers cannot afford to insure themselves. The ability to forecast mortality rates accurately can allow the insurance company to take preventive measures to introduce new policies with reasonable prices. In this paper, several Lee–Carter (LC) based models are used to forecast the mortality rates in a case study of the Malaysian population. The LC-ARIMA model and also a combination of the LC model with two machine learning (ML) methods, namely the random forest (RF) and artificial neural network (ANN) methods are utilized on the prediction of mortality rates for males and females in Malaysia, whereby the LC-Random Forest (LC-RF) hybrid model is a new model that is introduced in this paper. Seventeen years of mortality data in Malaysia are selected as the dataset for this research. To analyze how the forecasting models perform for other countries, we have determined the model that has the best fit and produced the best forecasted mortality rates for all the other countries that are studied. This research has showed that LC-ANN and LC-ARIMA are the best model in predicting the mortality rates of males and females in Malaysia, respectively. This study has also found that the LC-ARIMA model is the best performing model in forecasting the mortality rates in countries that have longer life expectancy and a good healthcare system such as Sweden, Ireland, Japan, Hong Kong, Norway, Switzerland and Czechia. In contrast, the LC-ANN model is the best performing model in forecasting the mortality rates in countries that have a less efficiency, less accessibility healthcare system, and bad personal behavior such as Malaysia, Canada and Latvia.

Rahman MH, Mohammed Z, You YX. Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study

(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.

Problematic alcohol use and depression in secondary school students in Miri, Malaysia

BACKGROUND

Alcohol consumption in the under-aged is one of the main concerns regarding Malaysian adolescents. There is no previous study on problematic alcohol use (PAU) in adolescents in Sarawak. The aim of this study was to determine the prevalence of PAU, its associated variables and its relationship with depression.

METHODS

This was a cross-sectional study. A total of 327 secondary school students completed the Alcohol Use Disorder Identification Test and Children's Depression Inventory, and a sociodemographic questionnaire. Binary and multivariable logistic regression were used to examine the relationship between the different variables.

RESULTS

A total of 42.2% of adolescents had PAU. Urban adolescents had a higher prevalence compared with rural adolescents (OR, 1.612; 95% CI: 1.036-2.508 P = 0.034). Female adolescents (56.8%) and Bumiputera Sarawak adolescents (76.8%) comprised a large proportion of the respondents with PAU. Cultural norm (78.3%) and curiosity (68.1%) were the two main reasons for PAU. Only family history of alcohol use (OR, 2.273; 95% CI: 1.013-5.107; P = 0.047), ever consumed alcohol (OR, 57.585; 95% CI: 21.885-151.525; P < 0.001) and ever consumed beer (OR, 2.564; 95% CI: 1.032-6.372; P = 0.043) were significantly associated with PAU. The prevalence of depression was 21.4%. A significant relationship between PAU and depression was seen (OR, 2.557; 95% CI: 1.479-4.420; P = 0.001).

CONCLUSION

There is a high prevalence of PAU in adolescents in Miri, Malaysia. More effort is needed to implement policies for this vulnerable group, with collaboration between agencies to ensure their mental and physical wellbeing and prevent a negative impact later. Clinicians should be more vigilant in detecting depression in adolescents with PAU to enable early intervention.

Trends in Alcohol Intake and the Association between Socio-Demographic Factors and Volume of Alcohol Intake amongst Adult Male Drinkers in China

Background: The volume of alcohol intake and type of alcohol affect Chinese men’s health. This study investigated changes of alcohol type between 2004 and 2011, explored the trend of change in alcohol type with age and determined the social demographic factors influencing the alcohol intake of Chinese men. Methods: Research data originated from the public database, China Health and Nutrition Survey (CHNS). Three chi-square tests were used to determine the prevalence of different alcohol types (beer, wine and liqueur) and the trend with age among male drinkers from 2004 to 2011. An ordered logistic regression model was established with alcohol intake as the dependent variable and social demography as the independent variable to analyze the influence of these factors on male alcohol intake. Results: This study confirmed that from 2004 to 2011, 70.1% of Chinese men consumed alcohol less than 168 g/w. The popularity of beer was on the rise, while the liqueur alcohol consumption decreased from 2004 to 2011 and the consumption of wine began to rise rapidly after 2006 (p < 0.05 for all). The prevalence of liqueur drinking increased with age and the prevalence of beer drinking decreased with age among Chinese male drinkers (p < 0.05 for all). From 2004 to 2011, a positive correlation appeared between age and male alcohol intake (p < 0.05 for all). In 2004 (OR = 1.22, 95% CI: 1.03–1.44), 2006 (OR = 1.21, 95% CI: 1.02–1.42) and 2011 (OR = 1.51, 95% CI: 1.31–1.75), Chinese men living in rural areas had a high volume of alcohol intake. From 2004 to 2011, the participants had married consumed more alcohol (p < 0.05 for all). In 2004 (OR = 0.61, 95% CI: 0.43–0.88) and 2011 (OR = 0.80, 95% CI: 0.68–0.94), higher education levels were negatively correlated with male alcohol intake. In 2006 (OR = 1.29, 95% CI: 1.07–1.56), 2009 (OR = 1.76, 95% CI: 1.45–2.14) and 2011 (OR = 1.35, 95% CI: 1.13–1.61), male drinkers who were working consumed more alcohol. From 2004 to 2011, a significant positive correlation appeared between tobacco consumption and alcohol intake (p < 0.05 for all). Conclusion: Consumption of three types of alcohol (beer, wine and liqueur) varies with the year. Beer consumption decreases with age, whereas liqueur consumption increases with age. Social demographic factors, such as residence, age, highest education level, working status and tobacco consumption, are related to alcohol intake. Our study affirms the effect of age on the choice of different types of alcohol.

Private troubles to public issue: empowering communities to reduce alcohol-related harm in Sabah, Malaysia

Summary

Alcohol is the number three contributor to the burden of disease worldwide so must remain a priority health promotion issue internationally. Malaysia is a Muslim country and alcohol-related harm was not seen as a priority until recently, because it only affects a minority of the population. Sabah has more than 30 different ethnic groups, and alcohol has a traditional role in the cultural practices of many of these groups. In 2009, the Intervention Group for Alcohol Misuse (IGAM) was formed, under the umbrella of Mercy Malaysia by a group of healthcare workers, academics, members of the Clergy and people who were previously alcohol-dependent concerned about the harmful effects of excessive alcohol consumption. IGAM in collaboration with other bodies have organized public seminars, visited villages and schools, encouraged the formation of a support group and trained healthcare professionals in health promotion intervention. The focus later changed to empowering communities to find solutions to alcohol-related harm in their community in a way which is sensitive to their culture. A standard tool-kit was developed using WHO materials as a guide. Village committees were formed and adapted the toolkit according to their needs. This strategy has been shown to be effective, in that 90% of the 20 committees formed are actively and successfully involved in health promotion to reduce alcohol-related harm in their communities.

Prevalence and predictors of erectile dysfunction in adult male outpatient clinic attendees in Johor, Malaysia

INTRODUCTION

Erectile dysfunction (ED) is a serious global burden that affects men as well as their partners. This study aimed to determine the prevalence and predictors of ED among male outpatient clinic attendees in Johor, Malaysia.

METHODS

We conducted a cross-sectional study of Malaysian men aged ≥ 18 years attending two major outpatient clinics in Johor Bahru and Segamat in Johor, Malaysia, between 1 January 2016 and 31 March 2016. Subjects were chosen via simple random sampling and 400 patients were recruited. The study instrument was a survey form that consisted of three sections: sociodemographic and comorbid profile, validated English and Malay versions of the 15-item International Index of Erectile Function, and the 21-item Depression Anxiety Stress Scale.

RESULTS

The overall prevalence of self-reported ED was 81.5%. The prevalence of ED according to severity was as follows: mild (17.0%), mild to moderate (23.8%), moderate (11.3%) and severe (29.5%). Multivariate analysis showed that ED was associated with increasing age (odds ratio [OR] 4.023, 95% confidence interval [CI] 1.633-9.913), Indian as compared to Malay ethnicity (OR 3.252, 95% CI 1.280-8.262), secondary as compared to tertiary education (OR 2.171, 95% CI 1.203-3.919), single as compared to married status (OR 6.119, 95% CI 2.542-14.734) and stress (OR 4.259, 95% CI 1.793-10.114).

CONCLUSION

ED has significant prevalence and severity among adult male outpatient clinic attendees in Johor. Increasing age, Indian ethnicity, lower educational level, singlehood and stress were significant predictors of ED.

Measuring and preventing alcohol use and related harm among young people in Asian countries: a thematic review

Background

The paper reviews alcohol consumption patterns and alcohol-related social and health issues among 15–29-year old young people in Asian countries, and discusses strategies for preventing and controlling alcohol use and related harms.

Methods

We searched Google Scholar, PubMed, and Web of Science for reports, reviews and journal articles published in English between 1st Jan 1990 and 31st August 2016.

Results

Forty-one reports, reviews and journal papers were identified and included in the final review. The current drinking levels and prevalence among young people are markedly different between eight included Asian countries, ranging from 4.2% in Malaysia to 49.3% in China. In a majority of the selected Asian countries, over 15% of total deaths among young men and 6% among young women aged 15–29 years are attributable to alcohol use. Alcohol use among young people is associated with a number of harms, including stress, family violence, injuries, suicide, and sexual and other risky behaviours. Alcohol policies, such as controlling sales, social supply and marketing, setting up/raising a legal drinking age, adding health warning labels on alcohol containers, and developing a surveillance system to monitor drinking pattern and risky drinking behaviour, could be potential means to reduce harmful use of alcohol and related harm among young people in Asia.

Conclusions

The review reveals that drinking patterns and behaviours vary across eight selected Asian countries due to culture, policies and regional variations. The research evidence holds substantial policy implications for harm reduction on alcohol drinking among young people in Asian countries -- especially for China, which has almost no alcohol control policies at present.

Healthcare resources are inadequate to address the burden of illness among HIV-infected male prisoners in Malaysia

Purpose Criminalization of drug use in Malaysia has concentrated people who inject drugs (PWID) and people living with HIV into prisons where health services are minimal and HIV-related mortality is high. Few studies have comprehensively assessed the complex health needs of this population. The paper aims to discuss these issues. Design/methodology/approach From October 2012 through March 2013, 221 sequentially selected HIV-infected male prisoners underwent a comprehensive health assessment that included a structured history, physical examination, and clinically indicated diagnostic studies. Findings Participants were mostly PWID (83.7 percent) and diagnosed with HIV while incarcerated (66.9 percent). Prevalence of hepatitis C virus (90.4 percent), untreated syphilis (8.1 percent), active (13.1 percent), and latent (81.2 percent) tuberculosis infection was several fold higher than non-prisoner Malaysian adults, as was tobacco use (71.9 percent) and heavy drinking (30.8 percent). Most (89.5 percent) were aware of their HIV status before the current incarceration, yet few had been engaged previously in HIV care, including pre-incarceration CD4 monitoring (24.7 percent) or prescribed antiretroviral therapy (ART) (16.7 percent). Despite most (73.7 percent) meeting Malaysia's criteria for ART (CD4 <350 cells/ μL), less than half (48.4 percent) ultimately received it. Nearly one-quarter (22.8 percent) of those with AIDS (<200 cells/ μL) did not receive ART. Originality/value Drug addiction and communicable disease comorbidity, which interact negatively and synergistically with HIV and pose serious public health threats, are highly prevalent in HIV-infected prisoners. Interventions to address the critical shortage of healthcare providers and large gaps in treatment for HIV and other co-morbid conditions are urgently needed to meet the health needs of HIV-infected Malaysian prisoners, most of whom will soon transition to the community.

Ecological perspectives on youth alcohol consumption in the Kuala Lumpur conurbation: a place-based study in Malaysia

Objective The objectives of this study were to investigate the patterns of alcohol consumption and ecological factors influencing those patterns in the Klang Valley. The study focuses on youth from the Chinese, Indian and Malay ethnic groups in Malaysia, resident in urban and semi-urban areas of the Klang Valley. Methods Data were collected with a combination of interviews and self-administered questionnaires available in Bahasa Malaysia and English were adapted from the Centers for Disease Control (CDC) Youth Risk Behavior Survey. The study sample consisted of 326 respondents: 103 Malays, 111 Chinese and 112 Indians. There were 171 males and 155 females, with mean age of 20.56 and 20.59 years, respectively, were identified by convenience sampling in six sites. Results A combination of at least one family member and one friend who consumed alcohol was a significant driver of alcohol use: 80% in this category had tried alcohol; 55% were current drinkers; and 35% were binge drinkers. With at least one family member, the respective figures were 72%, 48%, and 30%; and with at least one friend, but no family pattern of consumption, the figures dropped to 64%, 42% and 26%, respectively. With respect to ethnicity, 72% of Chinese youth had tried alcohol or were current drinkers (49%). The figure was lower for Indian youth (47% and 37%, respectively) and Malay youth (15% and 9%, respectively). In the binge drinking category, however, the highest figures were from the Indian youth (31%) followed by Chinese youth (23%) and significantly less in Malay youth (5%). Alcohol consumption was consistently higher among males: 54% had tried alcohol, 44% were current drinkers, and 30% were binge drinkers, compared to 36%, 18% and 9% of female youth, respectively. Conclusion Family alcohol consumption patterns were most strongly associated with consumption patterns which varied across the three ethnic groups. Family education regarding family influence on youth's alcohol consumption patterns is warranted.

Alcohol use disorders in Iran: Prevalence, symptoms, correlates, and comorbidity

BACKGROUND

For nearly four decades, alcohol production and consumption has been banned in the Islamic country of Iran. However, little is known about the extent of alcohol use and associated problems in the country. The paper aims to present findings on the 12-month prevalence, symptoms, severity, correlates, and comorbidity of alcohol use disorders in the Iranian population.

METHODS

This report is based on the 2011 Iranian household Mental Health survey (IranMHS), a nationally representative face-to-face household survey with a multi-stage, cluster sampling design. A total of 7840 individuals aged 15-64 responded to the alcohol section. We assessed 12-month alcohol use disorders according to DSM-IV and DSM-5 criteria and harmful use according to the ICD-10 criteria.

RESULTS

Weighted prevalence of using alcohol at least once in the past 12 months was 5.7%. The prevalence of 12-month alcohol use disorders was 1% according to DSM-IV criteria and 1.3% according to DSM-5. Harmful use was reported in 0.6%. Alcohol use disorders were markedly more common in men than women with an odds ratio (OR) of 13.3. It was also more prevalent in never-married versus married individuals (OR=2.5) and in those living in urban versus rural areas (OR=2.4). Among those with alcohol use disorders, 46.3% had a concurrent mood or anxiety disorder. Aggressive behaviors and injuries were more likely in those with alcohol use disorders.

CONCLUSION

Although Iran has a low level of alcohol use, its adverse consequences including use disorders, aggression, and injuries are moderately common and raise serious public health concerns.

Alcohol Use Disorder and Heavy Episodic Drinking in Rural Communities in Cambodia

Alcohol misuse is increasing in Southeast Asia. We investigated the extent of and risk factors for alcohol use disorder (AUD) and heavy episodic drinking (HED) in a rural community in Cambodia. We also attempted to explore the communities’ perception of alcohol misuse and elicited potential community-based strategies to address the alcohol problem. A mixed-methods study design was used, combining a cross-sectional questionnaire survey with qualitative interviews (focus group discussions and key informant interviews). AUD and HED were measured using the AUDs Identification Test Alcohol Consumption questionnaire. The prevalence of AUD and HED was high: 25% and 31%, respectively. Male sex, younger age, and increasing income were significant risk factors. The communities were well aware of the harmful effects of alcohol, expressed the importance of implementing community-based measures, and proposed various community-led solutions. Evidence-based strategies that are culturally appropriate, accepted, and driven by communities are urgently needed.