Noor Hassim Ismail

Non-occupational exposure of Malay women in Kuala Lumpur, Malaysia, to cadmium and lead

Abstract Peripheral blood and 24-h total food duplicate samples were obtained from 49 adult Malay women in Kuala Lumpur, Malaysia, in July, 1995. Samples of boiled and uncooked (raw) rice were also collected from the subjects. The blood samples, homogenates of each food duplicates and rice samples (both cooked and raw) were digested by heating in the presence of mineral acids, and the digests were subjected to analysis for cadmium (Cd) and lead (Pb) with a system composed of a fully automated liquid sampler, a graphiie furnace atomic absorption spectrometer and a data processor. The geometric mean metal concentrations in blood were 0.71 ng Cd per ml and 45.6 ng Pb per ml, and the dietary metal intakes were 7.31 μg Cd per day and 10.1 μg Pb per day. The metal intake via rice accounted for 53% and 13% of total dietary intake of cadmium and lead, respectively. When the absorption from the air and foods was compared, the cadmium burden came almost exclusively from foods, whereas the lead burden came both from air (44%) and foods (56%).

Do indoor environments influence asthma and asthma-related symptoms among adults in homes? A review of the literature

This review summarizes the results of epidemiological studies focusing on the detrimental effects of home environmental factors on asthma morbidity in adults. We reviewed the literature on indoor air quality (IAQ), physical and sociodemographic factors, and asthma morbidity in homes, and identified commonly reported asthma, allergic, and respiratory symptoms involving the home environment. Reported IAQ and asthma morbidity data strongly indicated positive associations between indoor air pollution and adverse health effects in most studies. Indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke. Environmental exposure may increase an adults risk of developing asthma and also may increase the risk of asthma exacerbations. Evaluation of present IAQ levels, exposure characteristics, and the role of exposure to these factors in relation to asthma morbidity is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity.

Serum selenium level and other risk factors for breast cancer among patients in a Malaysian hospital

ObjectiveThe aim of this study is to investigate the association between breast cancer and serum selenium level as well as other risk factors for breast cancer.MethodsA matched case-control study was conducted in a hospital in Malaysia from July 2000 to January 2001 and from May 2001 to June 2001. Sixty-two newly diagnosed breast cancer patients were selected as the cases. Each control, selected from the same hospital population was matched to each case according to age, ethnic group, and menopausal status.ResultsThe mean selenium concentration among the cases was significantly lower than that among the control. There was a significant association (p<0.05) between breast cancer and low selenium serum level, nulliparity (OR=5.5,95% CI=1.22 to 24.81), exposure to cigarette smoke (OR=2.2, 95% CI=1.04 to 4.65) and use of oral contraceptives (OR=3.0, 95% CI=1.09 to 8.25) as determined by the McNemar test. Multivariate analysis showed that nulliparity (OR=10.08, 95% CI=1.48 to 68.52) and use of oral contraceptives (OR=3.66, 95% CI=1.36 to 9.87) were associated with increased breast cancer risk. An increased selenium concentration contributes to a reduced risk of breast cancer (OR=0.89, 95% CI=0.84 to 0.94).ConclusionThe results suggest that use of oral contraceptive pills, being nulliparous, and a low serum selenium level are associated with breast cancer.

Metal dust exposure and lung function deterioration among steel workers: an exposure-response relationship

Background: Metallic dust is a heterogeneous substance with respiratory sensitizing properties. Its long term exposure adversely affected lung function, thus may cause acute or chronic respiratory diseases. Methods: A cross-sectional study was conducted in a steel factory in Terengganu, Malaysia to assess the metal dust exposure and its relationship to lung function values among 184 workers. Metal dust concentrations values (Co, Cr, and Ni) for each worker were collected using air personal sampling. Lung function values (FEV1, FVC, and %FEV1/FVC) were determined using spirometer. Results: Exposure to cobalt and chromium were 1–3 times higher than permissible exposure limit (PEL) while nickel was not exceeding the PEL. Cumulative of chromium was the predictor to all lung function values (FEV1, FVC, and %FEV1/FVC). Frequency of using mask was positively associated with FVC (Adj b = 0.263, P = 0.011) while past respiratory illnesses were negatively associated with %FEV1/FVC (Adj b = –1.452, P = 0.026). Only few workers (36.4%) were found to wear their masks all times during the working hours. Conclusions: There was an exposure-response relationship of cumulative metal dust exposure with the deterioration of lung function values. Improvement of control measures as well as proper and efficient use or personal protection equipment while at work could help to protect the respiratory health of workers.

360 STOKING THE FIRE- LOW SECONDARY PREVENTION MEDICATIONS AMONG HIGH RISK PATIENTS IN MALAYSIA

Background and Objective: Beta-blockers, antiplatelets, ACE inhibitors / Angiotensin Receptor Blockers (ACE-i/ARB) and statins are well established secondary prevention drugs for high risk patients, especially those with coronary heart disease (CHD) or stroke. However, often these are not widely used. The objective of this study is to determine their use in Malaysia. Methodology: The Prospective Urban Rural Epidemiology (PURE) study is a community-based world-wide research collaboration involving 154,000 adults (15,617 from Malaysia) to evaluate the impact of urbanization on cardiovascular disease. Demographic, anthropometric, blood pressure and fasting glucose and lipids were obtained using validated questionnaires and standard laboratory methods. Results: PURE involves 6891 rural and 8726 urban dwellers with a mean age 51.13+9.9 years; 55.9% are females. Hypertension, diabetes, overweight (BMI 25-30), obesity (BMI>30), and smokers make up 44.1%, 15.7%, 38.2%, 21.3% and 23.1% respectively. Beta-blockers, antiplatelets, ACE-i/ARB and statins are used in 2.9%, 1.3%, 2.5% and 2.5% respectively. Among CHD or stroke participants, their use is 11.1%, 13.6%, 10.9% and 13.9% respectively; urban dwellers using more Beta-blockers and antiplatelets (14.0% vs 13.4% and 12.9% vs 9.9% respectively) and rural dwellers using more ACEi/ARB and statins (11.5% vs 10.1% and 14.1% vs 13.5% respectively) and their use is more in males than females. Conclusion: Although the Malaysian public health system provides these drugs free, their actual use is abysmally low even among high risk individuals. Improving patient awareness, health education, professional commitment and health delivery system may alter the scenario.