Cohort study on clustering of lifestyle risk factors and understanding its association with stress on health and wellbeing among school teachers in Malaysia (CLUSTer)--a study protocol

Assessing the effect of cardiovascular disease on work productivity and financial loss among school teachers in Peninsular Malaysia: a nested case-control study

Background

School teachers may have an increased risk of cardiovascular disease (CVD), potentially affecting their work productivity. However, limited data exists on the impact of CVD on teachers' productivity in Malaysia. Our objectives were to assess work productivity loss (absenteeism and presenteeism) as well as to determine the associated annual monetary loss among school teachers who experienced incident CVD in Peninsular Malaysia.

Methods

We adopted a nested case-control design within a cohort of school teachers. Working teachers from six states of Peninsular Malaysia, and had experienced incident CVD before a right-censored date (31st December 2021) were defined as cases. Incident CVD was operationally defined as the development of non-fatal acute coronary syndrome (ACS), stroke, congestive cardiac failure, deep vein thrombosis or peripheral arterial disease before the censored date. Controls were working teachers who did not acquire an incident CVD before the similar right-censored date. All controls were randomly selected, with a ratio of one case to four controls, from among the working teachers in one of the states in Peninsular Malaysia. We used a shortened version of the Malay-validated World Health Organization-Health and Work Performance Questionnaire (WHO-HPQ) to estimate the workplace productivity effect among teachers with incident CVD (cases). The same questionnaire was distributed to teachers in a single state of Peninsular Malaysia who did not experience incident CVD (controls). Absenteeism, presenteeism and annual monetary loss were computed based on the scoring rules in the WHO-HPQ. Analysis of covariance was performed with covariate adjustment using propensity scores. The bootstrapping method was applied to obtain better estimates of marginal mean differences, along with standard errors (SE) and appropriate effect sizes.

Results

We recruited 48 cases (baseline mean age = 42.4 years old, 54.2% females) and 192 randomly selected controls (baseline mean age = 36.2 years old, 99.0% females). The majority of the cases had ACS (73.9%). No significant difference was observed in absenteeism between cases and controls. The mean self-rated job performance score was lower for cases (7.63, SE = 0.21) compared to controls (8.60, SE = 0.10). Marginal mean scores of absolute presenteeism among cases (76.30) were lower (p < 0.05, eta squared = 0.075) than controls (85.97). The marginal mean annual cost of presenteeism was higher in cases (MYR 21,237.52) compared to controls (MYR 12,089.74) (p < 0.05, eta squared = 0.082).

Conclusion

Absolute presenteeism was lower among school teachers who experienced incident CVD and the annual cost of presenteeism was substantial. Implementing supportive work strategies in school settings is recommended to increase absolute presenteeism, which can lead to a reduction in the annual cost of presenteeism among teachers experiencing incident CVD.

Prevalence of type 2 diabetes mellitus and impaired fasting glucose, and their associated lifestyle factors among teachers in the CLUSTer cohort

Background

Teachers are responsible for educating future generations and therefore play an important role in a country's education system. Teachers constitute about 2.6% of all employees in Malaysia, making it one of the largest workforces in the country. While health and well-being are crucial to ensuring teachers' work performance, reports on non-communicable diseases such as type 2 diabetes mellitus (T2DM) among Malaysian teachers are scarce. Hence, this study focused on the prevalence of T2DM, undiagnosed diabetes mellitus (DM), impaired fasting glucose (IFG), and underlying lifestyle factors associated with these outcomes among Malaysian teachers.

Methods

This is a cross-sectional study from the CLUSTer cohort. There were 14144 teachers from the Peninsular Malaysia included in this study. The teachers' sociodemographic and lifestyle characteristics were described using a weighted complex analysis. A matched age group comparison was carried out between teachers and the Malaysian general population on T2DM, undiagnosed DM, and IFG status. Next, the researchers examined the association of lifestyle factors with T2DM and IFG using multivariable logistic regression.

Results

The prevalence of T2DM, undiagnosed DM, and IFG among the Malaysian teachers were 4.1%, 5.1%, and 5.6%, respectively. The proportions of teachers with T2DM (both diagnosed and undiagnosed) and the IFG increased linearly with age. Teachers had a lower weighted prevalence of T2DM (known and undiagnosed) than the general population. However, teachers were more inclined to have IFG than the general population, particularly those aged 45 years and older. Among all lifestyle indicators, only waist circumference (aOR: 1.14, 95% CI: 1.08, 1.20) was found to be associated with T2DM, whereas waist circumference (aOR: 1.10, 95% CI: 1.05, 1.15) and physical activity [moderately active = (aOR: 0.71, 95% CI: 0.52, 0.98); highly active = (aOR: 0.56, 95% CI: 0.40, 0.80)] were associated with IFG.

Conclusions

Modifiable lifestyle factors such as abdominal obesity and physical activity were associated with T2DM and IFG. Intervention programs targeting these factors could help reduce future treatment costs and increase productivity.

Prevalence of stress and its relevance on psychological well-being of the teaching profession: A scoping review

Background

Well-being among teachers contributes toward quality work and better student support. Teachers' well-being persists to be a concern in school settings; there is a lacuna in understanding the concept of well-being among them. This scoping review identifies the stress factors and map their association with the psychological well-being of teachers employed in schools. Additionally, to identify the methodology and the interventions used in reducing teachers' stress and their relevance on their psychological well-being.

Methods

First, Pubmed, Web of Science, and Scopus databases were searched for eligible studies with MeSH terms for stress factors, well-being, and teachers from 2010 to 2022. Identified studies were screened thoroughly and excluded or included based on prior established criteria. Data from the included studies were extracted and summarized according to the study protocol.

Results

Among the 60 studies that met our inclusion criteria, the majority were quantitative, with cross-sectional studies. Several studies focused on emotional exhaustion, depersonalization, and diminished personal accomplishment aspect among teachers. Almost half of the included studies focused on organizational and social pressures such as administration workload, classroom management issues, lack of supervisor and team support, students' behaviour, and pressure from parents. The most used interventions to overcome stress were coping strategies and mindfulness training intervention tools.

Conclusions

The findings from the current scoping review will reveal the different stressors which impact psychological well-being. Focus on the most used interventions to overcome stress among schoolteachers. This will also provide recommendations to regulators and management to identify the factors causing stress among teachers and their relevance to their psychological well-being, overcome employee turnover and absenteeism issues. Also, different alternatives available to reduce the stress may benefit the stakeholders and policymakers to confirm a suitable intervention that will benefit the teaching profession.

Is the Prevalence of Low Physical Activity among Teachers Associated with Depression, Anxiety, and Stress?

The aim of this study was to analyze the levels of stress, depression, and anxiety among Polish secondary school teachers and their association with selected psychosocial, sociodemographic, and lifestyle factors. A cross-sectional study was conducted among 116 Polish teachers in 2019, using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Depression and Anxiety Stress Scale (DASS-21), and author questionnaire including psychosocial factors specific to the respondents' work environment. The prevalence of moderately to extremely severe levels of depression, anxiety, and symptoms of stress in teachers was 18.1%, 22.4%, and 51.7%, respectively. Among respondents with moderate or high physical activity level (PAL), normal or mild levels of depression (OR = 3.62; CI [1.31-10.03]), anxiety (OR = 2.61; CI [1.01-6.73]), and stress (OR = 2.79; CI [1.16-6.69]) were more common. The level of individual symptoms of mental disorders was higher than indicated by previous Polish reports. Given that teachers' low PAL is significantly related to their moderately to extremely severe levels of stress, depression, and anxiety, we suggest running leisure-time physical activity (LTPA) enhancement programs and supporting the leadership of school management and the higher-education system in this regard.

Psychosocial Work Environment and Teachers' Psychological Well-Being: The Moderating Role of Job Control and Social Support

Nowadays, the issue of teachers’ psychological well-being causes serious concern, especially in Malaysia. Many studies related to psychological well-being have focused on students rather than on the health and well-being of teachers. Thus, the current study investigated the determinants of psychological well-being (depression, anxiety and stress) from the psychosocial work environment (job control, job demands and social support), and examined the moderating role of job control and social support in the relationship between job demands and psychological well-being among teachers. The design of this study was quantitative research through a survey questionnaire. The sample consisted of 335 high school teachers (23.3%—male; 76.7%—female) who responded to measuring scales of job demands, job control, social support, depression, anxiety and stress, and socio-demographic profile. The data were analyzed using two statistical methods, namely descriptive and inferential statistics. The hierarchical linear regression model was used to analyze the data by assisting the statistical software, i.e., SPSS-23. The results showed that job demands, job control and social support significantly predicted teachers’ psychological well-being. Furthermore, the effect of job demands on teachers’ depression and anxiety was partially moderated by job control and social support. In conclusion, this study has successfully identified the significant predictors of teachers’ psychological well-being and the role of job control and social support as a moderating variable to teachers’ psychological well-being in Malaysia. The result provides insights and contributes to the literature of teachers’ psychological well-being determinants and involves Malaysian respondents with a collectivistic eastern culture.

Dose-Response Relationship between Western Diet and Being Overweight among Teachers in Malaysia

The rising prevalence of overweight and obesity is partly due to nutrition transition. The reported association between dietary patterns and overweight/obesity has been controversial because of inconsistent results and weak observed associations. Although it has been hypothesized that an unhealthy diet can increase obesity risk, none of the previous studies have examined the dose-response association using nonlinear dose-response analyses. This study aimed to examine the dose-response association between major dietary patterns and overweight/obesity. This was a cross-sectional study involving teachers selected through stratified multistage sampling from public schools in three Malaysian states. Dietary intake was assessed using a food frequency questionnaire, and two major dietary patterns (Western and Prudent diet) were extracted using factor analysis. Logistic regression followed by trend analysis was used to test the difference in odds of overweight and obesity in each quintile of diet score. A further analysis using restricted cubic spline models was performed to examine the dose-response associations of dietary patterns with odds of overweight/obesity. The logistic regression analysis showed that participants with the highest quintile of Western diet score were 1.4 times more likely to be overweight/obese compared to those in the lowest quintile (95% CI: 1.11, 1.83, p-trend < 0.001). The odds of overweight/obesity showed a significant increasing trend across quintiles of Western diet among both men and women (p-trend < 0.001). In the dose-response analysis, a positive linear association (P_nonlinearity = 0.6139) was observed where overweight/obesity was more likely to occur among participants with a Western diet score greater than a mean score of zero. There was an inverse trend of odds of overweight/obesity across quintiles of Prudent diet score, significant only for men (p for trend < 0.001). Linear association was found between Prudent diet score and odds of overweight/obesity among both men (P_nonlinearity = 0.6685) and women (P_nonlinearity = 0.3684) in the dose-response analysis. No threshold at the level of adherence to Prudent diet was linked to odds of overweight/obesity. Dose-response analysis indicated that women with a Western diet score greater than zero were more likely to be overweight or obese among women. In men, higher adherence to Western diet was associated with increased odds of overweight/obesity, while greater adherence to Prudent diet decreased the odds of overweight/obesity. Promoting and enhancing the consumption of Prudent diet and limit in Western diet may be used to guide the development of evidence-based diet interventions to curb overweight and obesity.

Perspective: Whole and Refined Grains and Health-Evidence Supporting "Make Half Your Grains Whole"

Research-based dietary guidelines suggest that consumers "make half their grains whole." Yet some advocate ingesting only whole-grain foods (WGFs) and avoiding all refined-grain foods (RGFs). Some even recommend avoiding all grain-based foods (GBFs). This article will provide arguments to counter negative deductions about GBFs and RGFs, especially staple ones, and to support dietary guidance recommending a balance of GBFs-achieved through the right mix, type, and quantity of WGFs and RGFs. Studies looking at early mortality, body weight, and glucose tolerance and diabetes will be used as examples to characterize the literature about GBFs. The following issues are highlighted: 1) inconsistent findings between epidemiological and interventional studies and impacts of GBFs on health outcomes, and the underreporting of findings showing RGFs neither raise nor lower health risks; 2) multiple confounding and potential interactions make adequate statistical adjustment difficult; 3) nonuniform WGF definitions among studies make comparison of results challenging, especially because some WGFs may contain 49-74% refined grain (RG); 4) binary categorization of GBFs creates bias because nearly all categories of WGFs are recommended, but nearly half the RGF categories are not; 5) ingestion of >5 (30-g) servings RGFs/d and <1 serving WFGs/d creates dietary imbalance; 6) pattern names (e.g., "white bread") may impugn RGFs, when names such as "unbalanced" or "few fruits and vegetables" may more fairly characterize the dietary imbalance; 7) avoidance of all enriched RGs may not only impair status of folate and other B vitamins and certain minerals such as iron and zinc but also decrease acceptability of WGFs; 8) extrapolation beyond median documented intakes in high-WGF consumers (∼48 g whole grain/d) in most cohorts is speculative; 9) recommended dietary patterns such as the Mediterranean diet demonstrate that the right mix of WGFs and RGFs contributes to positive health outcomes.

Risk Factors for Recurrent Perceived Voice Disorders in Elementary School Teachers-A Longitudinal Study

OBJECTIVE

To identify the progression of voice disorders and their risk factors in teachers.

DESIGN

Longitudinal quantitative study conducted in municipal schools.

METHOD

Of the 575 teachers who participated in the baseline study, 469 were re-evaluated after 3 years of the initial study. Out of these, 152 reported having a voice disorder at baseline and participated in the re-evaluation. Voice disorders were diagnosed with the Voice Handicap Index (VHI) and teachers were considered positive for voice disorders when the total score was above 19. Symptoms of common mental disorder were measured with the SRQ-20 scale (Self-Reporting Questionnaire, 20 items), with a cut-off value of 8 points. A bivariate analysis was performed using Poisson regression to verify the differences in the proportion of teachers who continued presenting a voice disorder among the different categories of the independent variables in the study.

RESULTS

A total of 69.1% of the teachers reported having a voice disorder after 3 years. High prevalence of acute common mental disorder symptoms was a predictor for a recurring perceived voice disorder. The risk of having a voice disorder was 30% higher for teachers who presented a common mental disorder 3 years after.

CONCLUSIONS

Teachers who had both a voice disorder and symptoms of common mental disorder were more likely to maintain the voice disorder.

Prospective Study on the Association Between Adherence to Healthy Lifestyles and Depressive Symptoms Among Japanese Employees: The Furukawa Nutrition and Health Study

Background

While a growing body of research suggests a protective role of healthy lifestyle against depression, evidence from prospective studies is scarce. We constructed a healthy lifestyle index (HLI) and examined its prospective association with depressive symptoms in a Japanese working population.

Methods

Participants were 917 employees (19–68 years old) who were free from depressive symptoms at baseline in 2012–2013 and attended the 3-year follow-up survey. The HLI (range: 0–7 points) was constructed by assigning 1 point to each healthy lifestyle factor, namely, (1) normal body mass index (18.5–24.9 kg/m²), (2) non-smoking, (3) no or moderate alcohol intake (≤23 g ethanol/day), (4) adequate physical activity (≥7.5 metabolic equivalent-hours/week), (5) high vegetable intake (≥350 g/day), (6) high fruit intake (≥200 g/day), and (7) adequate sleep duration (6–8.9 hours/day), which was categorized into three groups (low: 0–2 points; middle: 3–4 points; and high: 5–7 points). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale.

Results

A total of 155 incident cases (17.0%) of depressive symptoms were identified at the follow-up survey. Compared with the low HLI group, multivariable-adjusted odds ratios of depressive symptoms were 0.74 (95% confidence interval, 0.48–1.15) and 0.55 (95% confidence interval, 0.31–0.99) for the middle and high HLI groups, respectively (P-trend = 0.041).

Conclusion

The present study suggests the importance of adherence to multiple healthy lifestyle factors in prevention of depressive symptoms.

Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country

This study aimed to determine the prevalence and factors associated with poor sleep quality among secondary school teachers in the state of Selangor, Malaysia. This was a cross sectional study, conducted in two phases. Phase I tested the reliability of the Pittsburgh Sleep Quality Index in the Malay language (M-PSQI), whereas Phase II determined the prevalence and factors associated with poor sleep quality where a total of 1,871 secondary school teachers were studied. Participants were recruited using multistage sampling. Self-administered questionnaire was used to collect data on socio-demographic and teaching characteristics, comorbidities and characteristics of sleep. The M-PSQI was used to measure sleep quality. The Depression Anxiety Stress Scale-21 was used to measure mental health status. Results showed that the M-PSQI had a good internal consistency and moderate reliability. The prevalence of poor sleep quality was 61 (95% CI: 54-67)%. Total teaching hours/day, depression and stress were significantly associated with poor sleep quality in the univariate analysis, while only stress (OR 1.04; 95% CI 1.02-1.05%) remained significant in the multivariate analyses. In conclusion, stress level of the secondary school teachers should be reduced to improve sleep quality.

The joint effects of major lifestyle factors on colorectal cancer risk among Chinese men: A prospective cohort study

Previous studies have suggested individual healthy lifestyle factors are related to lower risk of colorectal cancer. Their joint effects, however, have rarely been investigated. We aimed to assess the combined lifestyle impact on colorectal cancer risk and to estimate the population attributable risks of these lifestyle factors. Using data from the Shanghai Men's Health Study (2002-2013), we constructed healthy lifestyle index composing the following lifestyle factors: smoking, alcohol consumption, diet, waist-hip ratio and exercise participation. Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Over a median of 9.28 years' follow-up, 671 colorectal cancer cases occurred (400 colon cancer and 274 rectal cancer) among 59,503 men. Each increment of healthy lifestyle index was associated with a 17% lower risk of colorectal cancer (HR = 0.83, 95% CI: 0.78, 0.89), 10% of colon cancer (HR = 0.90, 95% CI: 0.83, 0.99) and 27% of rectal cancer (HR = 0.73, 95% CI: 0.66, 0.82). If all men in the cohort followed a lifestyle as defined by these five factors, 21% colorectal cancer cases would have been prevented (PAR = 21%, 95% CI: 4%, 36%). In conclusion, combined lifestyle factors are significantly related to lower risk of colorectal cancer and the effects are more pronounced on rectal cancer than on colon cancer.

Combined Impact of Known Lifestyle Factors on Total and Cause-Specific Mortality among Chinese Men: A Prospective Cohort Study

Impact of combined lifestyles on risk of mortality needs to be explored quantitatively. We aimed to evaluate the associations of combined lifestyle factors with total and cause-specific mortality in Chinese men. We used data from the Shanghai Men's Health Study (2002-2013), an on-going population-based prospective cohort study of men (aged 40 to 74 years). Four traditional unfavorable lifestyle factors were included: smoking, heavy alcohol use, unhealthy diet and physical inactivity. Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Among about 61,480 men in the cohort, a total of 4,952 men died, of which 1,637 men died from cardiovascular diseases (CVD), 2,122 from cancer during a median of 9.29 years' follow-up. The HRs of men with four risk practices comparing to those with zero were 2.92 (95%CI: 2.53, 3.38) for all-cause mortality, 3.15 (95%CI: 2.44, 4.05) for CVD mortality, and 3.18 (95%CI: 2.55, 3.97) for cancer mortality. The population attributable risks (PARs) were 0.41, 0.40 and 0.38 for total, CVD and cancer mortality, accordingly. As combined unhealthy lifestyle behaviors had substantial impact on total and cause-specific mortality, promotion of healthy lifestyle should be a public health priority.

The Role of Healthy Lifestyle in the Implementation of Regressing Suboptimal Health Status among College Students in China: A Nested Case-Control Study

BACKGROUND

Suboptimal health status (SHS) is the intermediate health state between health and disease, it is medically undiagnosed and is also termed functional somatic syndrome. Although its clinical manifestations are complicated and various, SHS has not reached the disease status. Unhealthy lifestyle is associated with many chronic diseases and mortality. In accordance with the impact of lifestyle on health, it is intriguing to determine the association between unhealthy lifestyle and SHS risk.

METHODS

We conducted a nested case-control study among healthy Chinese college students from March 2012 to September 2013, which was nested in a prospective cohort of 5676 students. We performed 1:1 incidence density sampling with matched controls for birth year, sex, grade, specialty and individual character. SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0). Exposure was defined as an unhealthy lifestyle per the frequency of six behavioral dimensions from the Health-promoting Lifestyle Profile (HPLP-II).

RESULTS

We matched 543 cases of SHS (42.66%) in a cohort of 1273 students during the 1.5 years mean follow-up time with controls. A significant difference (t = 9.79, p < 0.001) and a reduction in HPLP-II total score was present at 1.5 years follow-up (135.93 ± 17.65) compared to baseline (144.48 ± 18.66). A level-response effect was recorded with an increase of the total HPLP-II (every dimension was correlated with a decreased SHS risk). Compared to respondents with the least exposure (excellent level), those reporting a general HPLP-II level were approximately 2.3 times more likely to develop SHS (odd ratio = 2.333, 95% CI = 1.471 to 3.700); and those with less HPLP-II level (good level) were approximately 1.6 times more likely (1.644, 1.119-2.414) to develop SHS (p < 0.05). Our data indicated that unhealthy lifestyle behavior with respect to behavioral dimensions significantly affected SHS likelihood. Further analyses revealed a marked increase (average increased 14.73 points) in lifestyle level among those SHS regression to health after 1.5 years, with respect to the HPLP-II behavioral dimensions, in addition to the total score (t = -15.34, p < 0.001).

CONCLUSIONS

SHS is highly attributable to unhealthy lifestyles, and the Int. J. Environ. Res. Public Health 2017, 14, 240 2 of 17 mitigation of modifiable lifestyle risk factors may lead to SHS regression. Increased efforts to modify unhealthy lifestyles are necessary to prevent SHS.

Association of psychological distress and work psychosocial factors with self-reported musculoskeletal pain among secondary school teachers in Malaysia

Background

Musculoskeletal pain is common among teachers. Work-related psychosocial factors are found to be associated with the development of musculoskeletal pain, however psychological distress may also play an important role.

Objectives

To assess the prevalence of self-reported low back pain (LBP), and neck and/or shoulder pain (NSP) among secondary school teachers; and to evaluate the association of LBP and NSP with psychological distress and work-related psychosocial factors.

Methods

This was a cross-sectional study conducted among teachers in the state of Penang, Malaysia. The participants were recruited via a two stage sampling method. Information on demographic, psychological distress, work-related psychosocial factors, and musculoskeletal pain (LBP and NSP) in the past 12 months was collected using a self-administered questionnaire. Poisson regression was used to estimate the prevalence ratio (PR) for the associations between psychological distress and work-related psychosocial factors with LBP and NSP.

Results

The prevalence of self-reported LBP and NSP among 1482 teachers in the past 12 months was 48.0% (95% Confidence Interval (CI) 45.2%, 50.9%) and 60.1% (95% CI 57.4%, 62.9%) respectively. From the multivariate analysis, self-reported LBP was associated with teachers who reported severe to extremely severe depression (PR: 1.71, 95% CI 1.25, 2.32), severe to extremely severe anxiety (1.46, 95% CI 1.22, 1.75), high psychological job demand (1.29, 95% CI 1.06, 1.57), low skill discretion (1.28, 95% CI 1.13, 1.47) and poorer mental health (0.98, 95% CI 0.97, 0.99). Self-reported NSP was associated with mild to moderate anxiety (1.18, 95% CI 1.06, 1.33), severe to extremely severe anxiety (1.25, 95% CI 1.09, 1.43), low supervisory support (1.13, 95% CI 1.03, 1.25) and poorer mental health (0.98, 95% CI 0.97, 0.99).

Conclusions

Self-reported LBP and NSP were common among secondary school teachers. Interventions targeting psychological distress and work-related psychosocial characteristics may reduce musculoskeletal pain among school teachers.

Metabolic syndrome among non-obese adults in the teaching profession in Melaka, Malaysia

Background

Non-obese individuals could have metabolic disorders that are typically associated with elevated body mass index (BMI), placing them at elevated risk for chronic diseases. This study aimed to describe the prevalence and distribution of metabolically obese, non-obese (MONO) individuals in Malaysia.

Methods

We conducted a cross-sectional study involving teachers recruited via multi-stage sampling from the state of Melaka, Malaysia. MONO was defined as individuals with BMI 18.5–29.9 kg/m² and metabolic syndrome. Metabolic syndrome was diagnosed based on the Harmonization criteria. Participants completed self-reported questionnaires that assessed alcohol intake, sleep duration, smoking, physical activity, and fruit and vegetable consumption.

Results

A total of 1168 teachers were included in the analysis. The prevalence of MONO was 17.7% (95% confidence interval [CI], 15.3–20.4). Prevalence of metabolic syndrome among the normal weight and overweight participants was 8.3% (95% CI, 5.8–11.8) and 29.9% (95% CI, 26.3–33.7), respectively. MONO prevalence was higher among males, Indians, and older participants and inversely associated with sleep duration. Metabolic syndrome was also more prevalent among those with central obesity, regardless of whether they were normal or overweight. The odds of metabolic syndrome increased exponentially from 1.9 (for those with BMI 23.0–24.9 kg/m²) to 11.5 (for those with BMI 27.5–29.9 kg/m²) compared to those with BMI 18.5–22.9 kg/m² after adjustment for confounders.

Conclusions

The prevalence of MONO was high, and participants with BMI ≥23.0 kg/m² had significantly higher odds of metabolic syndrome. Healthcare professionals and physicians should start to screen non-obese individuals for metabolic risk factors to facilitate early targeted intervention.

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The prevalence of metabolic syndrome among the non-obese teachers was 17.7%.

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The odds of metabolic syndrome increased exponentially from a BMI of 23.0 kg/m².

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Metabolic syndrome was more prevalent among males, Indians, and older teachers.

Risk Factors for the Incidence of Perceived Voice Disorders in Elementary and Middle School Teachers

OBJECTIVE/HYPOTHESIS

This study aimed to identify risk factors for the incidence of perceived voice disorders in teachers, specifically related to the influence of common mental disorders.

DESIGN

This is a longitudinal quantitative study conducted in municipal schools.

METHOD

We performed a data analysis of 469 teachers, reassessed 3 years after an initial study. The Voice Handicap Index was used to measure the impact of a probable voice problem with a cutoff value of 19 points. Mental disorder symptomatology was measured by the Self-Reporting Questionnaire (20 items), with a cutoff value of eight points. Bivariate analysis was conducted through Poisson regression to verify proportion differences in the occurrence of perceived voice disorders among the study's different categories of independent variables. The same technique of Poisson regression was used to assess risk factors for perceived voice disorder incidence in a specific hierarchic model.

RESULTS

The incidence of a perceived voice disorder was 17.1%. Teachers who lectured in fourth grade and below presented a risk of 20% less than those who lectured from the fifth grade up (P = 0.046). Teachers who reported taking a leave of absence because of their voice had a 32% more chance of a probable perceived voice disorder (P = 0.024). Teachers who presented a common mental disorder had twice the risk of perceived voice disorder (P > 0.001).

CONCLUSIONS

This study concluded that teachers presented a higher risk of developing a perceived voice disorder when they have the following features: lectured from fifth grade up, have gone on leave because of their voice, and showed behavior indicative of common mental disorder.

Vitamin D deficiency and depression among women from an urban community in a tropical country

Objective

To determine the association of vitamin D status with depression and health-related quality of life among women.

Design

This was a cross-sectional study conducted among women in Kuala Lumpur, Malaysia. Sociodemographic characteristics, physical activity status, perceived depression and health-related quality of life were assessed via a self-administered questionnaire. Fasting blood samples were taken for the analysis of 25-hydroxyvitamin D, parathyroid hormone, fasting blood glucose and full lipid profile. Complex samples multiple logistic regression analysis was performed.

Setting

Public secondary schools in Kuala Lumpur, Malaysia.

Subjects

Seven hundred and seventy female teachers were included.

Results

The mean age of participants was 41·15 (95 % CI 40·51, 41·78) years and the majority were ethnic Malays. Over 70 % of them had vitamin D deficiency (<20 ng/ml or <50 nmol/l) and two-thirds were at risk for depression. In the multivariate analysis, ethnic Malays (adjusted OR (aOR)=14·72; 95 % CI 2·12, 102·21) and Indians (aOR=14·02; 95 % CI 2·27, 86·59), those at risk for depression (aOR=1·88, 95 % CI 1·27, 2·79) and those with higher parathyroid hormone level (aOR=1·13; 95 % CI 1·01, 1·26) were associated with vitamin D deficiency, while vitamin D deficiency was negatively associated with mental health-related quality of life (Mental Component Summary) scores (aOR=0·98; 95 % CI 0·97, 0·99).

Conclusions

Vitamin D deficiency is significantly associated with depression and mental health-related quality of life among women in Kuala Lumpur, Malaysia.

Vitamin D level and its association with adiposity among multi-ethnic adults in Kuala Lumpur, Malaysia: a cross sectional study

Background

Vitamin D deficiency is highly prevalent in both temperate as well as tropical countries. Obesity is one of the factors contributing to vitamin D deficiency. As our country has a high prevalence of overweight and obesity, we aimed to study serum 25-hydroxyvitamin D (25(OH)D) level and its association with adiposity using various adiposity indicators; and to study other risk factors that affect serum 25(OH)D level among multi-ethnic adults in Kuala Lumpur, Malaysia.

Methods

This was a cross sectional study conducted with a multistage sampling. All permanent teachers working in government secondary schools in Kuala Lumpur were invited for the study. The data collection included serum 25(OH)D, Parathyroid Hormone (PTH), body fat percentage, waist circumference, body mass index (BMI) and blood pressure. Demographic characteristics, sun avoidance, sun exposure and physical activity were enquired from the participants using a self-administered questionnaire. The data was analyzed using a complex sample analysis.

Results

A total of 858 participants were recruited. Majority of them were Malays, females and had tertiary education. The overall prevalence of vitamin D deficiency (<20 ng/ml) was 67.4 %. Indian participants (80.9 %) had the highest proportion of vitamin D deficiency, followed by Malays (75.6 %), others (44.9 %) and Chinese (25.1 %). There was a significant negative association between serum 25(OH)D level with BMI (β = −0.23) and body fat percentage (β = −0.14). In the multivariate linear regression analysis, Malays, Indians and females (p < 0.001); higher BMI and larger waist circumference (p < 0.05) were significantly associated with lower serum 25(OH)D level. The full model explained 32.8 % of the variation between participants in the serum 25(OH)D level. The two most influential factors affecting serum 25(OH)D level were ethnicity and gender.

Conclusions

The prevalence of vitamin D deficiency among our participants was high. Adiposity was associated with serum 25(OH)D level. Skin pigmentation and gender based behaviours were more dominant in contributing to serum 25(OH)D level. Health education should be targeted in weight management, gender based behaviours on sun exposure, as skin pigmentation is non-modifiable.

Determinants and Effects of Voice Disorders among Secondary School Teachers in Peninsular Malaysia Using a Validated Malay Version of VHI-10

OBJECTIVES

To establish the prevalence of voice disorder using the Malay-Voice Handicap Index 10 (Malay-VHI-10) and to study the determinants, quality of life, depression, anxiety and stress associated with voice disorder among secondary school teachers in Peninsular Malaysia.

METHODS

This study was divided into two phases. Phase I tested the reliability of the Malay-VHI-10 while Phase II was a cross-sectional study with two-stage sampling. In Phase II, a self-administered questionnaire was used to collect socio-demographic and teaching characteristics, depression, anxiety and stress scale (Malay version of DASS-21); and health-related quality of life (Malay version of SF12-v2). Complex sample analysis was conducted using multivariate Poisson regression with robust variance.

RESULTS

In Phase I, the Spearman correlation coefficient and Cronbach alpha for total VHI-10 score was 0.72 (p < 0.001) and 0.77 respectively; showing good correlation and internal consistency. The ICCs ranged from 0.65 to 0.78 showing fair to good reliability and demonstrating the subscales to be reliable and stable. A total of 6039 teachers participated in Phase II. They were primarily Malays, females, married, had completed tertiary education and aged between 30 to 50 years. A total of 10.4% (95% CI 7.1, 14.9) of the teachers had voice disorder (VHI-10 score > 11). Compared to Malays, a greater proportion of ethnic Chinese teachers reported voice disorder while ethnic Indian teachers were less likely to report this problem. There was a higher prevalence ratio (PR) of voice disorder among single or divorced/widowed teachers. Teachers with voice disorder were more likely to report higher rates of absenteeism (PR: 1.70, 95% CI 1.33, 2.19), lower quality of life with lower SF12-v2 physical (0.98, 95% CI 0.96, 0.99) and mental (0.97, 95% CI 0.96, 0.98) component summary scales; and higher anxiety levels (1.04, 95% CI 1.02, 1.06).

CONCLUSIONS

The Malay-VHI-10 is valid and reliable. Voice disorder was associated with increased absenteeism, marginally associated with reduced health-related quality of life as well as increased anxiety among teachers.

Cardiometabolic risks profile of normal weight obese and multi-ethnic women in a developing country

OBJECTIVES

To determine the prevalence of normal weight obesity among multi-ethnic women in Peninsular Malaysia and examine its associations with cardiometabolic risks and lifestyle behaviours.

METHODS

This was a cross-sectional study involving women recruited via multi-stage sampling from six states in Malaysia. Anthropometric and body composition analysis were performed. Normal weight obese (NWO) was defined as normal body mass index for Asians and the highest tertile of % body fat (BF). Biochemical measurements included fasting lipid and blood glucose levels. Metabolic syndrome was diagnosed based on the Harmonization criteria. Participants completed self-reported questionnaires that included physical activity, smoking, alcohol consumption, fruit and vegetable intake and sleep duration.

MAIN OUTCOME MEASURE

Body mass index, %BF, cardiometabolic risk factors, lifestyle behaviours.

RESULTS

A total of 6854 women were recruited and the prevalence of NWO was 19.8% (95% CI: 17.3-22.5). NWO was more prevalent among the Indians and older women. NWO women had higher odds for abdominal obesity (OR: 2.64, 95% CI: 1.73-4.04), hypertriglyceridemia (2.51, 1.47-4.29) and hypertension (1.63, 1.15-2.31) compared to women with lower % body fat after adjusted for age and ethnicity. The prevalence of metabolic syndrome among NWO women was 5.4% (95% CI: 3.0-9.8). None of the lifestyle behaviours were significantly associated with NWO.

CONCLUSIONS

Women with NWO had cardiometabolic abnormalities including abdominal obesity, dyslipidaemia and increased blood pressure. Health promotion efforts should include NWO women who may be oblivious of their deleterious health risks.