Tag: statistics

Med J Malaysia. 2026 Jul;81(4):540-547.

ABSTRACT

INTRODUCTION: Young adulthood is a critical period for establishing lifelong health behaviours, yet oral health is often neglected. This study investigated factors associated with oral health-related quality of life (OHRQoL) among Malaysian university students.

MATERIALS AND METHODS: A cross-sectional survey was conducted among 395 undergraduate students aged 18 to 25 years. Data were collected using a structured questionnaire assessing sociodemographic characteristics, perceived oral health status, oral healthcare seeking behaviour, and OHRQoL via the short Malay version of the Oral Health Impact Profile (S-OHIP(M)). Multiple linear regression was used to identify predictors of OHRQoL.

RESULTS: The prevalence of OHRQoL impact was 41.0%, with a mean S-OHIP(M) score of 9.15 (SD=6.39). Significant predictors of poorer OHRQoL included having at least one oral health problem, dissatisfaction with oral health status, and visiting the dentist due to an oral health issue. Dental and medical students reported significantly better OHRQoL compared to health sciences students. Oral health care seeking behaviour, although generally favourable, was not significantly associated with OHRQoL.

CONCLUSION: OHRQoL among young adults is influenced by both subjective perceptions and behavioural patterns. Promoting routine dental visits and enhancing oral health awareness may improve quality of life outcomes. These findings inform strategies for preventive care and service delivery targeting young adult populations.

PMID:42584444

Med J Malaysia. 2026 Jul;81(4):513-520.

ABSTRACT

INTRODUCTION: Endometrial cancer is the most common gynecologic malignancy in developed countries, with rising incidence worldwide. While early stage disease generally carries a favorable prognosis, recurrence remains a significant clinical concern. Among the histopathological features, lymphovascular space invasion (LVSI) has emerged as a critical prognostic factor, reflecting tumor aggressiveness and potential for metastatic spread. LVSI is associated with increased risk of recurrence, distant metastasis, and reduced survival, even in patients with otherwise low risk disease. Understanding the role of LVSI in endometrial cancer is essential for refining risk stratification, guiding adjuvant therapy decisions, and improving patient outcomes. Our study to evaluate the impact of lymphovascular space invasion (LVSI) on treatment outcomes, recurrence, and survival in patients with stage I endometrioid endometrial cancer.

MATERIALS AND METHODS: A retrospective cohort study was conducted at the Hospital Canselor Tuanku Muhriz (HCTM) Gynecologic Oncology Clinic, with ethical approval from Universiti Kebangsaan Malaysia. Patients with stage I endometrial carcinoma, classified according to the International Federation of Gynecology and Obstetrics (FIGO) 2018, and confirmed on hysterectomy specimens were included. Demographic clinicopathological, and treatment data were collected. LVSI was defined as the presence of tumor cells within endothelial lined spaces. Overall survival (OS) was the primary endpoint. Statistical analyses were performed using SPSS version 26, employing chi square, t tests, and Kaplan-Meier estimates, with significance set at p < 0.05.

RESULTS: Of 180 patients, 163 had endometrioid carcinoma; 114 were included in the final analysis (mean age 58 years; 79.8% postmenopausal). LVSI was present in 14.2% of cases and was associated with higher grade and deeper myometrial invasion. Recurrence occurred in 8.5% overall, with 18.8% in LVSI positive and 4.1% in LVSI negative patients. The 2 year disease free survival (DFS) rate was 93.4% (80.8% LVSI positive vs 99% LVSI negative). The 5 year DFS rate was 91.1% (73.4% LVSI positive vs 94% LVSI negative). The OS rate was 97.3% (87.5% LVSI positive vs 99% LVSI negative). Distant metastasis predicted 2 year DFS, whereas LVSI positivity independently predicted reduced 5 year OS. At 5 years, the DFS rate was 91.1% (SE = 0.031), while the OS rate was 97.3% (SE = 0.013). The similarity between DFS and OS reflects the low number of recurrence and death events, indicating favorable prognosis and effective disease control. Median survival was not reached.

CONCLUSION: LVSI was associated with higher recurrence and poorer survival in patients with Stage I endometrioid endometrial carcinoma, independently predicting 5-year survival, supporting its role in risk stratification and treatment planning.

PMID:42584440

Med J Malaysia. 2026 Jul;81(4):504-512.

ABSTRACT

INTRODUCTION: Tuberculosis (TB) contact screening is a key strategy for early case detection and prevention of transmission. However, non-attendance at initial TB screening among contacts remains a persistent challenge, particularly in high-burden settings such as Sabah, Malaysia. This study aimed to determine factors associated with non-attendance at initial TB screening among contacts in Kudat, Sabah.

MATERIALS AND METHODS: A case-control study was conducted using primary and secondary data from the National Tuberculosis Registry involving 468 TB contacts registered between June and December 2023. Cases were contacts who failed to attend initial screening within one month, while controls attended screening within the same period. Data were analysed using descriptive statistics and multiple logistic regression.

RESULTS: Multivariable logistic regression analysis revealed that factors associated with lower odds of non-attendance included contacts of male TB index patients (OR: 0.30, 95% CI: 0.194-0.470), contacts of extrapulmonary TB index patients (OR: 0.09, 95% CI: 0.050-0.179), and higher attitude scores (OR: 0.88, 95% CI: 0.818-0.952). In contrast, contacts with secondary education had higher odds of nonattendance compared to those with no formal education (OR: 1.86, 95% CI: 1.080-3.209).

CONCLUSION: Non-attendance at initial TB screening among contacts was associated with index case sex and TB form, contact education level, and attitudes towards TB. Targeted interventions addressing behavioural and structural barriers are essential to improve TB contact screening uptake in high-burden settings.

PMID:42584439

Med J Malaysia. 2026 Jul;81(4):489-496.

ABSTRACT

INTRODUCTION: In recent years, there has been an exponential rise in students inbound to Malaysia to pursue their postgraduate studies. In particular, Chinese international postgraduate students (CIPS) represent a rapidly growing student population in this country, which is postulated to lead to substantial psychological distress resulting from academic, cultural, and financial adjustments that are required of the students immersing themselves in a new environment. Nevertheless, quantitative evidence regarding depression, anxiety, and stress among CIPS in Malaysian public universities remains limited.

MATERIALS AND METHODS: A cross-sectional study was conducted among 347 Chinese international postgraduate students at Universiti Putra Malaysia (UPM) using mixedmode convenience sampling. Data were collected using a structured questionnaire that included sociodemographic variables, stressors, stress-relieving activities, and the Depression Anxiety Stress Scales-21 (DASS-21). For the statistical analysis, we performed descriptive statistics, group comparisons, Pearson correlations, and hierarchical regression analyses.

RESULTS: The prevalence of mild-to-extremely severe symptoms was 61.1% for depression, 67.1% for anxiety, and 56.2% for stress. Psychological distress was significantly associated with perceived discrimination, financial concerns, poorer self-rated health, and depression history. In the final hierarchical regression model, perceived discrimination emerged as the strongest predictor of distress (β = .270, p < .001). Furthermore, financial concerns, poorer self-rated health, and participation in artistic activities such as calligraphy classes were also positively associated with increasing DASS-21 scores, whereas positive future outlook scores showed a negative association. The final model explained 53.1% of the variance in psychological distress.

CONCLUSION: Psychological distress among CIPS at UPM was substantial and appeared to be strongly related to acculturative stress and resource-related pressures. A proposed model to overcome this should include universitydriven, culturally responsive mental health services, antidiscrimination support, and financial and academic assistance to ensure the successful onboarding and orientation of international postgraduate students.

PMID:42584437

Med J Malaysia. 2026 Jul;81(4):483-488.

ABSTRACT

INTRODUCTION: Palliative care is a human right and key to universal health coverage, yet remains inaccessible for many cancer patients. By 2030, Malaysia is expected to experience a 240% surge in demand for palliative care, with Sarawak, its largest state, projected to bear the greatest burden of unmet need. A novel statewide domiciliary palliative care (DPC) program was implemented to meet this growing demand across a culturally diverse and geographically dispersed region. This study characterizes the patterns of DPC service use during the inaugural year of this novel statewide program to inform future planning.

MATERIALS AND METHODS: This retrospective cohort study included adults with advanced illnesses referred to DPC services at eight health clinics across Malaysia’s largest state of Sarawak from July 1, 2023, to June 30, 2024. Descriptive analysis was utilized.

RESULTS: A total of 113 patients with terminal illness were seen, the majority (89%; n=101) of whom had advanced cancer. The commonest cancer types were gastrointestinal (25%; n=28) and thoracic (17%; n=19). Median time from referral to first DPC encounter was 4 days (IQR 2-7). Median time to death was 28 days (IQR 11-53). Most patients (72%; n=82) received care in urbanized locations.

CONCLUSION: This study demonstrates the wide reaching implementation of DPC across a geographically and culturally diverse region, particularly to cancer patients. Opportunities for strategic growth include expanding rural outreach, strengthening engagement with indigenous populations, and community engagement to enable more timely, inclusive, and equitable access to palliative care.

PMID:42584436

Med J Malaysia. 2026 Jul;81(4):477-482.

ABSTRACT

INTRODUCTION: Otomycosis is a common fungal infection of the external auditory canal, particularly in tropical regions. Aspergillus and Candida are the main causative agents, yet their clinical differentiation remains challenging due to overlapping manifestations. This study aimed to identify the distribution of fungal etiologies, and to compare clinical manifestations and predisposing factors between Aspergillus and Candida infections in a tertiary hospital in Central Java, Indonesia.

MATERIALS AND METHODS: A cross-sectional study was conducted at a tertiary hospital, including patients aged 17 years and above with clinically and microbiologically confirmed otomycosis. Demographic data, symptoms, physical findings, and predisposing factors were collected. Fungal identification was performed using culture and microscopy. Comparative analyses were conducted using chi-square or Fisher’s exact test.

RESULTS: A total of 41 patients (56 fungal isolates) were included. Aspergillus spp. accounted for 58.9% of isolates, while Candida spp. comprised 41.1%, with mixed infections observed in 16.1%. Itching, hearing loss, and ear fullness were the most common symptoms in both groups. No statistically significant differences were found in clinical manifestations or physical examination findings between Aspergillus and Candida infections (all p>0.05). Although whitish debris was more frequent in Candida and brownish debris in Aspergillus, these patterns were not discriminatory. Ear drop use and cotton bud manipulation were significantly associated with Aspergillus infections (p<0.05).

CONCLUSION: Substantial clinical overlap exists between Aspergillus and Candida otomycosis, underscoring the importance of microbiological confirmation for accurate diagnosis.

PMID:42584435

Med J Malaysia. 2026 Jul;81(4):466-472.

ABSTRACT

INTRODUCTION: Inadequate medication adherence is a significant problem globally, affecting up to 50% of chronic illness patients. The complications can also be significant, with increased rates of disease complications and hospitalisations due to lack of adherence. This research study seeks to find the medication adherence rate across select suburban areas in Johor, Malaysia, and to identify the relationship between medication adherence and treatment concordance.

MATERIALS AND METHODS: A community-based cross-sectional study was conducted among patients with chronic diseases across various locations in Johor. A validated questionnaire, the Malaysia Medication Adherence Assessment Tool (MyMAAT) and a Modified Concordance Scale were used to explore the study objectives.

RESULTS: Medication adherence is defined as a MyMAAT score of ≥54. A total of 82 chronic illness patients participated in this study, with males (48.8%) and females (51.2%). The mean age of the participants is 57.5 years old. The study reported 41.5% adherence (MyMAAT ≥54). Female vs male OR was calculated via logistic regression adjusting for confounding factors, with adherence (MyMAAT≥54) as a binary factor (OR=4.23; 95% CI 1.38-12.91; p=0.011). A statistically significant weak correlation was found between the MyMAAT score and the Modified Concordance Scale score (SR ρ=0.286, p=0.009).

CONCLUSION: In conclusion, the study shows a potential relationship between medication concordance and improved patient adherence in the Malaysian setting. More research should be conducted to further verify these findings.

PMID:42584433

Med J Malaysia. 2026 Jul;81(4):461-465.

ABSTRACT

INTRODUCTION: Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality, with cervical insufficiency being a major contributor. While transvaginal ultrasound is the gold standard, concerns over invasiveness, resource requirements, and acceptability limit its universal use. Transabdominal cervical length measurement may offer a pragmatic alternative, particularly in conservative populations. We aim to compare transabdominal versus transvaginal cervical length measurement for screening of short cervix during the mid-trimester, and to determine the feasibility and clinical utility of using transabdominal ultrasound as a primary screening tool, especially in populations with reservations about undergoing transvaginal scans.

MATERIALS AND METHODS: This was a prospective observational cohort diagnostic accuracy study involving pregnant women undergoing routine mid-trimester anomaly scans. Cervical length was measured using transabdominal and transvaginal ultrasound by experienced sonographers.

STATISTICAL ANALYSIS: correlation assessed with Spearman’s coefficient. Agreement evaluated with intraclass correlation and Bland-Altman plots. Diagnostic accuracy metrics (sensitivity, specificity, PPV and NPV) were calculated for transabdominal thresholds. Confounding factors, including bladder filling, maternal body mass index (BMI), and prior caesarean delivery on visualisation, were also evaluated.

RESULTS: Of the 266 women eligible to participate in the study, 6.0% were excluded as they declined a transvaginal scan. Postvoid transabdominal (TA) measurements demonstrated better agreement with transvaginal (TV) values but were associated with higher rate of nonvisualization (10.0%). Bland-Altman plots showed good agreement without systematic bias. The mean prevoid TA cervical length and postvoid TA cervical length were 35.7 mm and 35.6 mm respectively, compared to 39.3 mm on TV measurement. Non-visualization occurred more often postvoid (10%) than prevoid (6.4%), while postvoid TA measurements showed stronger agreement with TV (ICC=0.818). Agreement of measurements was higher among Maternal-Fetal Medicine (MFM) consultants than among MFM fellows. Body mass index (BMI) and prior caesarean section scars did not significantly affected visualization or measurement accuracy.

CONCLUSION: TA cervical length measurement is a reliable initial screening approach for identifying women at risk of short cervix during mid-trimester when performed by experienced operators. It serves as a pragmatic alternative in settings where TV scans are declined or not feasible, facilitating timely referral for TV confirmation and early initiation of preventive interventions such as progesterone therapy or cerclage. However, its application may be limited in untrained hands.

PMID:42584432

Med J Malaysia. 2026 Jul;81(4):455-460.

ABSTRACT

INTRODUCTION: Improper disposal of unused or expired medications poses significant public health and environmental risks. Despite Malaysia’s “Return Your Medicines Program,” improper disposal practices persist, particularly among Type 2 diabetic patients on long-term therapies. This study aimed to determine awareness and disposal practices of unused or expired medications among Type 2 diabetic patients in Ipoh and identify factors influencing improper disposal.

MATERIALS AND METHODS: A cross-sectional study was conducted at three government clinics in the Kinta District of Ipoh, Malaysia. Data were collected from 241 participants using structured questionnaires and analysed using descriptive statistics and Pearson’s chi-square tests.

RESULTS: A total of 34.4% of respondents reported having unused or expired medications, primarily due to overprescription (36.1%). Among the diabetic patients surveyed, 68% demonstrated satisfactory awareness regarding the disposal of unused prescribed medications, while 32% showed unsatisfactory awareness. In terms of disposal practices, 43.37% of participants followed proper methods, whereas 56.63% engaged in poor disposal practices. A statistically significant association was observed between the level of awareness and the disposal practices adopted by the participants(p=0.000). It is recommended that health authorities enhance public education campaigns and implement accessible, wellpublicized medication take-back programs to promote proper disposal of unused or expired medicines.

CONCLUSION: The study identifies a strong association between awareness levels and proper disposal practices of unused or expired medications, emphasizing the need for targeted educational initiatives to promote safe disposal among patients.

PMID:42584431

Med J Malaysia. 2026 Jul;81(4):421-429.

ABSTRACT

INTRODUCTION: COVID-19, caused by SARS-CoV-2 virus, is a respiratory infection that led to the 2020 pandemic. During the pandemic, mortality directly related to COVID-19 infection were classified as COVID-19 death based on case definition. However, excess mortality would be a more comprehensive method to look at the true impact of the pandemic rather than focusing only on COVID-19 deaths alone. The objective of this study was to determine the excess mortalities and top 5 causes of mortality that occurred during and after the COVID-19 pandemic in Perak.

MATERIALS AND METHODS: Total and age-specific mortality data tabulated by the Department of Statistics Malaysia (DOSM) for the years 2010-2023 for the state of Perak was obtained. Data for the years 2010-2019 was re-grouped according to clustered age groups. This was used to generate the linear prediction line for mortality in 2020-2023 using Microsoft Excel 2010. Excess mortalities were calculated for 2020-2023 by subtracting the actual deaths from the predicted deaths. The top 5 common causes of mortality and COVID-19 deaths were also re-tabulated for the years 2020-2023 for the clustered age groups. “Positive Excess Mortality” (PEM) meant that the number of actual deaths were higher than predicted and “Negative Excess Mortality” (NEM) meant that the actual deaths were lower than the predicted number. Significant PEM meant that the value of the actual mortality was above the upper limit of the 95% confidence interval of the predicted mortality.

RESULTS: All clustered age groups showed NEM for the year 2020. For the years 2021-2022, there was a PEM for all clustered age groups except those in the group “19 and below”. The highest excess mortality was in the “65 and above” group with 343.44 and 685.56 per 100,000 agespecific population for 2021 and 2022 respectively. The mortality rate returned to the predicted value in 2023. In 2021 and 2022, there was a PEM for the “20-39” and “40-64” clustered age groups, however they were lower compared to the “65 and above” groups. Significant PEM was seen for all deaths in the “65 and above” in 2021 (237 per 100,000) and in 2022, 596 per 100,000. There was also a significant PEM after the removal of COVID-19 deaths in 2022 for the “65 and above” age groups- 366 per 100,000. Significant PEM was also seen in the “20-39” age groups and “40-64” age groups in 2021- 14 per 100,000 and 36 per 100,000 respectively. The other values that passed the 95%CI were deemed to be negligible. There were a few changes in the top 5 ranking for causes of death in Perak, the only obvious inclusion was deaths due to COVID-19 infections in 2021 in all groups except the “19 and below”.

CONCLUSION: There was a PEM in all groups except “19 and below” after the year 2020, with the highest in the “65 and above” group. COVID-19 deaths were included in the top 5 causes of death and contributed only partly to the excess mortality across all groups except “19 and below”.

PMID:42584427