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Harun Z, Shahar S, You YX, Abdul Manaf Z, Abdul Majid H, Chin CY, Haron H, Michael V, Mohamad H, Mohd Yazid SFZ, Abdul Manan M, Wan Ibadullah WZ, Brown MK, He FJ, MacGregor GA. Salt reduction policy for out of home sectors: a supplementary document for the salt reduction strategy to prevent and control non-communicable diseases (NCDS) in Malaysia 2021-2025. Health Res Policy Syst 2024; 22:49. [PMID: 38637888 PMCID: PMC11025221 DOI: 10.1186/s12961-024-01124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/17/2024] [Indexed: 04/20/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the major cause of death among Malaysians. Reduction of salt intake in populations is one of the most cost-effective strategies in the prevention of CVDs. It is very feasible as it requires low cost for implementation and yet could produce a positive impact on health. Thus, salt reduction initiatives have been initiated since 2010, and two series of strategies have been launched. However, there are issues on its delivery and outreach to the target audience. Further, strategies targeting out of home sectors are yet to be emphasized. Our recent findings on the perceptions, barriers and enablers towards salt reduction among various stakeholders including policy-makers, food industries, food operators, consumers and schools showed that eating outside of the home contributed to high salt intake. Foods sold outside the home generally contain a high amount of salt. Thus, this supplementary document is being proposed to strengthen the Salt Reduction Strategy to Prevent and Control Non-communicable Diseases (NCDs) for Malaysia 2021-2025 by focussing on the strategy for the out-of-home sectors. In this supplementary document, the Monitoring, Awareness and Product (M-A-P) strategies being used by the Ministry of Health (MOH) are adopted with a defined outline of the plan of action and indicators to ensure that targets could be achieved. The strategies will involve inter-sectoral and multi-disciplinary approaches, including monitoring of salt intake and educating consumers, strengthening the current enforcement of legislation on salt/sodium labelling and promoting research on reformulation. Other strategies included in this supplementary document included reformulation through proposing maximum salt targets for 14 food categories. It is hoped that this supplementary document could strengthen the current the Salt Reduction Strategy to Prevent and Control NCDs for Malaysia 2021-2025 particularly, for the out-of-home sector, to achieve a reduction in mean salt intake of the population to 6.0 g per day by 2025.
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Affiliation(s)
- Zaliha Harun
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
- Lincoln University College-Medical Campus, 2, Jalan Stadium SS 7/15, Ss 7, 47301, Petaling Jaya, Selangor, Malaysia
| | - Suzana Shahar
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Yee Xing You
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- School of Health and Rehabilitation Sciences, AECC University College, Bournemouth, BH5 2DF, United Kingdom
| | - Chia Yook Chin
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 47500, Subang Jaya, Selangor Darul Ehsan, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Viola Michael
- Ministry of Health (MOH), Block A, Chancery Place, Precinct 15, 62050, Putrajaya, Malaysia
| | - Hamdan Mohamad
- Ministry of Health (MOH), Block E3, Complex E, Federal Government Administrative Centre, 62590, Putrajaya, Malaysia
| | | | - Musaalbakri Abdul Manan
- Food Science and Technology Research Centre, Malaysia Agricultural Research and Development Institute, Serdang, Selangor, Malaysia
| | | | - Mhairi K Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
| | - Graham A MacGregor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
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McKenzie BL, Mustapha FI, Battumur BE, Batsaikhan E, Chandran A, Michael V, Webster J, Trieu K. Strengthening national salt reduction strategies using multiple methods process evaluations: case studies from Malaysia and Mongolia. Public Health Nutr 2024; 27:e89. [PMID: 38343162 DOI: 10.1017/s1368980023002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To understand the extent to which national salt reduction strategies in Malaysia and Mongolia were implemented and achieving their intended outcomes. DESIGN Multiple methods process evaluations conducted at the mid-point of strategy implementation, guided by theoretical frameworks. SETTING Malaysia (2018-2019) and Mongolia (2020-2021). PARTICIPANTS Desk-based reviews of related documents, interviews with key stakeholders (n 12 Malaysia, n 10 Mongolia), focus group discussions with health professionals in Malaysia (n 43) and health provider surveys in Mongolia (n 12). RESULTS Both countries generated high-quality local evidence about salt intake and levels in foods and culturally specific education resources. In Malaysia, education and reformulation activities were delivered with moderate dose (quantity) but reach among the population was low. Within 5 years, Mongolia implemented education among schools, health professionals and food producers on salt reduction with high reach, but with moderate dose (quantity) and reach among the general population. Both countries faced challenges in implementing legislative interventions (mandatory salt labelling and salt limits in packaged foods) and both could improve the scaling up of their reformulation and education activities. CONCLUSIONS In the first half of Malaysia's and Mongolia's strategies, both countries generated necessary evidence and education materials, mobilised health professionals to deliver salt reduction education and achieved small-scale reformulation in foods. Both subsequently should focus on implementing regulatory policies and achieving population-wide reach and impact. Process evaluations of existing salt reduction strategies can help strengthen intervention delivery, aiding achievement of WHO's 30 % reduction in salt intake by 2025 target.
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Affiliation(s)
- Briar L McKenzie
- The George Institute for Global Health, UNSW, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, NSW2000, Australia
| | | | | | - Enkhtungalag Batsaikhan
- Department of Nutrition Research of the National Center for Public Health, Ulaanbaatar, Mongolia
| | - Arunah Chandran
- Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
| | - Viola Michael
- Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
| | - Jacqui Webster
- The George Institute for Global Health, UNSW, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, NSW2000, Australia
| | - Kathy Trieu
- The George Institute for Global Health, UNSW, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, NSW2000, Australia
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Zainal Arifen ZN, Haron H, Shahar S, Harun Z, Michael V, You YX, Manaf ZA, Majid HA, Chia YC, He FJ, Brown MK, MacGregor GA. Perceptions, barriers and enablers on salt reduction in the out-of-home sectors in Malaysia (MySaltOH) from the perspective of street food vendors, caterers and consumers. Public Health Nutr 2023; 27:e12. [PMID: 38098442 PMCID: PMC10828668 DOI: 10.1017/s136898002300277x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 10/04/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers. DESIGN A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data. SETTING Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online. PARTICIPANTS Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually. RESULTS Consumers and food operators perceived a high-salt intake within Malaysia's out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality. CONCLUSIONS These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia's out-of-home sectors.
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Affiliation(s)
- Zainorain Natasha Zainal Arifen
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur50300, Malaysia
| | - Hasnah Haron
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur50300, Malaysia
| | - Suzana Shahar
- Dietetic Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur50300, Malaysia
| | - Zaliha Harun
- Dietetic Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur50300, Malaysia
| | - Viola Michael
- Dietetic Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur50300, Malaysia
| | - Yee Xing You
- Dietetic Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur50300, Malaysia
| | - Zahara Abdul Manaf
- Dietetic Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur50300, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
| | - Yook Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor Darul Ehsan 47500, Malaysia
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, LondonEC1M 6BQ, UK
| | - Mhairi Karen Brown
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, LondonEC1M 6BQ, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, LondonEC1M 6BQ, UK
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Zainal Arifen ZN, Shahril MR, Shahar S, Mohamad H, Mohd Yazid SFZ, Michael V, Taketo T, Trieu K, Harith S, Ibrahim NH, Abdul Razak S, Mat Jusoh H, Hun Pin C, Lee JS, Mohamed Ismail R, Lai Kuan L, Haron H. Fatty Acid Composition of Selected Street Foods Commonly Available in Malaysia. Foods 2023; 12:foods12061234. [PMID: 36981160 PMCID: PMC10048182 DOI: 10.3390/foods12061234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Despite growing evidence of increased saturated and trans fat contents in street foods, little is known about their fatty acid (FA) compositions. This study aimed to analyse the saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and trans fatty acids (TFAs) content of 70 selected and most commonly available street foods in Malaysia. The street foods were categorised into main meals, snacks, and desserts. TFAs were not detected in any of the street foods. Descriptively, all three categories mainly contained SFAs, followed by MUFAs, and PUFAs. However, the one-way ANOVA testing showed that the differences between each category were insignificant (p > 0.05), and each FA was not significantly different (p > 0.05) from one to another. Nearly half of the deep-fried street foods contained medium to high SFAs content (1.7 g/100 g–24.3 g/100 g), while the MUFAs were also high (32.0–44.4%). The Chi-square test of association showed that the type of preparation methods (low or high fat) used was significantly associated (p < 0.05) with the number of SFAs. These findings provide valuable information about fat composition in local street foods for the Malaysian Food Composition Database and highlight the urgency to improve nutritional composition.
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Affiliation(s)
- Zainorain Natasha Zainal Arifen
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Z.N.Z.A.)
| | - Mohd Razif Shahril
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Z.N.Z.A.)
| | - Suzana Shahar
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Hamdan Mohamad
- Non-Communicable Disease Section, Disease Control Division, Ministry of Health, Putrajaya 62590, Malaysia
| | | | - Viola Michael
- Enforcement Section, Allied Health Sciences Division, Ministry of Health, Putrajaya 62050, Malaysia
| | - Tanaka Taketo
- Representative Office for Malaysia, Brunei Darussalam, and Singapore, World Health Organization, Cyberjaya 63000, Malaysia
| | - Kathy Trieu
- The George Institute for Global Health Level 5, 1 King St, Newtown, NSW 2042, Australia
| | - Sakinah Harith
- Nutrition & Dietetic Programme, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Nerus 21300, Malaysia
| | - Nor Hayati Ibrahim
- Faculty of Fisheries and Food Science, Universiti Malaysia Terengganu, Kuala Nerus 21030, Malaysia
| | - Shariza Abdul Razak
- Nutrition Programme, School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Hanapi Mat Jusoh
- Department of Nutrition Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan 25200, Malaysia
| | - Chua Hun Pin
- Food Science and Technology Research Centre, Malaysia Agricultural Research and Development Institute, Kuching 93050, Malaysia
| | - Jau-Shya Lee
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | | | - Lee Lai Kuan
- Food Technology Programme, School of Industrial Technology, Universiti Sains Malaysia, Gelugor 11800, Malaysia
| | - Hasnah Haron
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Z.N.Z.A.)
- Correspondence: ; Tel.: +60-3-9289-7457
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Harun Z, Shahar S, You YX, Manaf ZA, Majid HA, Chia YC, Haron H, Michael V, Sukiman NS, Taib AFM, He FJ, Brown MK. Perceptions, barriers and enablers of salt reduction in Malaysian out-of-home sectors (MySaltOH): from the point of view of policy-makers and food industries. Health Res Policy Syst 2023; 21:17. [PMID: 36759869 PMCID: PMC9910255 DOI: 10.1186/s12961-023-00965-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND High salt intake is a major cause of hypertension and cardiovascular diseases. The out-of-home sectors have been identified as one of the contributors of high salt intake in the population. The National Salt Reduction Policy of Malaysia was initiated in 2015; however, out-of-home sectors are yet to be emphasized and perception by policy-makers and the food industries towards salt reduction are yet unknown. This study aimed to determine the perceptions, barriers and enablers towards salt reduction in the out-of-home sector in Malaysia, as well as among policy-makers and the food industries. METHODS This is a qualitative study via semi-structured in-depth interviews (IDI) and focus group discussions (FGD) involving several stakeholders consisting of policy-makers from five ministries, five nongovernment organizations (NGOs) and food science/food technology researchers from five regions (West, North, East, and South Peninsular and East Malaysia/Borneo), as well as the food industries. The IDI and FGD sessions were recorded, transcribed verbatim and analysed thematically using Nvivo software version 12. RESULTS All participants agreed that salt intake in Malaysia is high and leads to hypertension and cardiovascular diseases. Lack of awareness, poor eating culture and behaviour and frequent eating out were among the causes of high salt intake. Awareness campaigns and education, sodium content labelling and product reformulation were strategies that have been implemented by the government; whilst for the food industries, some of them have tried to reduce salt and labelled the sodium content on their food products. However, there were several barriers including perceived poor consumer acceptance, lack of knowledge and resources, and challenges in reformulation, as well as unavailability of guidelines and salt targets. Hence, several enablers have been suggested, which include prioritizing the salt reduction strategy, creating more awareness, collaboration and engagement, research and technology particularly for reformulation and shelf-life stability, incentives and salt tax. CONCLUSIONS Salt reduction efforts of the out-of-home sector in Malaysia could be achieved through several measures or enablers that can overcome the barriers currently faced by stakeholders, especially policy-makers, food industries and the consumers themselves. This study will benefit the policy-makers to improve the salt reduction policy of out-of-home sectors and highlight the concerns among the food industries on the policy.
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Affiliation(s)
- Zaliha Harun
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Yee Xing You
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- School of Chiropractor, AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, Dorset, BH5 2DF, United Kingdom
| | - Yook Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Viola Michael
- Allied Health Sciences Division, Ministry of Health Malaysia, Level 2, Block A, Chancery Place Main Building, Jalan Diplomatik 2, Precinct Diplomatik, Precinct 15, 62050, Putrajaya, Malaysia
| | - Noor Shahida Sukiman
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Aida Farzana Mohamad Taib
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
| | - Mhairi K Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
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Michael V, Warraich S, Lock K, Lewington P. P255 Transitioning to adult services for children with cystic fibrosis (CF): what matters to all stakeholders? J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Brown MK, Shahar S, You YX, Michael V, Majid HA, Manaf ZA, Haron H, Sukiman NS, Chia YC, He FJ, MacGregor GA. Developing a policy to reduce the salt content of food consumed outside the home in Malaysia: protocol of a qualitative study. BMJ Open 2021; 11:e044628. [PMID: 34301647 PMCID: PMC8311303 DOI: 10.1136/bmjopen-2020-044628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Current salt intake in Malaysia is high. The existing national salt reduction policy has faced slow progress and does not yet include measures to address the out of home sector. Dishes consumed in the out of home sector are a known leading contributor to daily salt intake. This study aims to develop a salt reduction strategy, tailored to the out of home sector in Malaysia. METHODS AND ANALYSIS This study is a qualitative analysis of stakeholder views towards salt reduction. Participants will be recruited from five zones of Malaysia (Western, Northern, Eastern and Southern regions and East Malaysia), including policy-makers, non-governmental organisations, food industries, school canteen operators, street food vendors and consumers, to participate in focus group discussions or in-depth interviews. Interviews will be transcribed and analysed using thematic analysis. Barriers will be identified and used to develop a tailored salt reduction strategy. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Universiti Kebangsaan Malaysia Medical Research Ethics Committee (UKM PPI/1118/JEP-2020-524), the Malaysian National Medical Research Ethics Committee (NMRR-20-1387-55481 (IIR)) and Queen Mary University of London Research Ethics Committee (QMERC2020/37) . Results will be presented orally and in report form and made available to the relevant ministries for example, Ministry of Health, Ministry of Education and Ministry of Trade to encourage adoption of strategy as policy. The findings of this study will be disseminated through conference presentations, peer-reviewed publications and webinars.
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Affiliation(s)
- Mhairi Karen Brown
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Suzana Shahar
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yee Xing You
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Viola Michael
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health (CePH) and Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noor Shahida Sukiman
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yook Chin Chia
- Department of Medical Science, Sunway University, Bandar Sunway, Malaysia
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Ismail M, Regu T, Jimponey MJ, Michael V, Mohamed FN, Hussin R, Mat Ludin AF. Knowledge, attitude and practice towards salt intake and health among non-academic staff of Universiti Kebangsaan Malaysia: A pilot study. LSMB 2021. [DOI: 10.28916/lsmb.5.10.2021.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Over the years, global salt intake has increased and has resulted in the escalation of cardiovascular diseases and hypertension. The lack of knowledge, as well as poor attitude and practice, are the main reasons that have led to high salt intake. Therefore, this study aims to evaluate the knowledge, attitude and practice (KAP) towards salt intake and health among non-academic staff of the Faculty of Health Sciences (FSK), Universiti Kebangsaan Malaysia (UKM). Methodology: This cross-sectional study was conducted among the non-academic staff of the Faculty of Health Sciences (FSK), Universiti Kebangsaan Malaysia (UKM). The respondents were recruited using stratified random sampling technique with an informed consent. A validated questionnaire to test the knowledge, attitude and practice (KAP) towards salt intake and health by the Ministry of Health Malaysia was converted into a Google form and the link was emailed to 118 participants. A total of 33 responses were obtained for evaluation. The significant values were set as P < 0.05. Results: It was observed that female participants had better attitudes towards salt intake and health compared to males (p = 0.044). Also, individuals with higher education levels had better attitudes towards salt intake and health, compared to those with lower education levels (p=0.009). However, knowledge and practice of salt intake and health bore no significant results when considering gender, education level and age. Discussion and Conclusion: Overall, this study has identified sociodemographic characteristics as contributing factors towards individuals’ attitude on salt intake and health. This may provide a crucial foundation in the development of cost-effective healthcare programs to widen knowledge, create awareness and promote a healthy lifestyle by reducing salt intake and further reduce the prevalence of non-communicable diseases.
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Ismail M, Regu T, Jimponey MJ, Michael V, Mohamed FN, Hussin R, Mat Ludin AF. Knowledge, attitude and practice towards salt intake and health among non-academic staff of Universiti Kebangsaan Malaysia: A pilot study. LSMB 2021. [DOI: 10.28916/lsmb.5.1.2021.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Over the years, global salt intake has increased and has resulted in the escalation of cardiovascular diseases and hypertension. The lack of knowledge, as well as poor attitude and practice, are the main reasons that have led to high salt intake. Therefore, this study aims to evaluate the knowledge, attitude and practice (KAP) towards salt intake and health among non-academic staff of the Faculty of Health Sciences (FSK), Universiti Kebangsaan Malaysia (UKM). Methodology: This cross-sectional study was conducted among the non-academic staff of the Faculty of Health Sciences (FSK), Universiti Kebangsaan Malaysia (UKM). The respondents were recruited using stratified random sampling technique with an informed consent. A validated questionnaire to test the knowledge, attitude and practice (KAP) towards salt intake and health by the Ministry of Health Malaysia was converted into a Google form and the link was emailed to 118 participants. A total of 33 responses were obtained for evaluation. The significant values were set as P < 0.05. Results: It was observed that female participants had better attitudes towards salt intake and health compared to males (p = 0.044). Also, individuals with higher education levels had better attitudes towards salt intake and health, compared to those with lower education levels (p=0.009). However, knowledge and practice of salt intake and health bore no significant results when considering gender, education level and age. Discussion and Conclusion: Overall, this study has identified sociodemographic characteristics as contributing factors towards individuals’ attitude on salt intake and health. This may provide a crucial foundation in the development of cost-effective healthcare programs to widen knowledge, create awareness and promote a healthy lifestyle by reducing salt intake and further reduce the prevalence of non-communicable diseases.
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Ambak R, He FJ, Othman F, Michael V, Mohd Yusoff MF, Aris T. Salt intake was higher among males and those with high BMI and waist circumference: introduction to the Malaysian Community Salt Survey (MyCoSS), a population-based salt intake survey in Malaysia. J Health Popul Nutr 2021; 40:23. [PMID: 34059145 PMCID: PMC8165995 DOI: 10.1186/s41043-021-00229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recognising that excessive dietary salt intake is associated with high blood pressure and adverse cardiovascular health, the Ministry of Health Malaysia conducted the Malaysian Community Salt Survey (MyCoSS) among Malaysian adults. This paper introduced MyCoSS projects and presented findings on the salt intake of the Malaysian adult population. METHODS MyCoSS was a nationally representative survey, designed to provide valuable data on dietary salt intake, sources of salt in the diet, and knowledge, perception, and practice about salt among Malaysian adults. It was a cross-sectional household survey, covering Malaysian citizens of 18 years old and above. Multi-stage-stratified sampling was used to warrant national representativeness. Sample size was calculated on all objectives studied, and the biggest sample size was derived from the knowledge on the effect of high salt on health (1300 participants). Salt intake was estimated using a single 24-h urine collection and its sources from a food frequency questionnaire. Knowledge, attitude, and practice were determined from a pre-tested questionnaire. All questionnaires were fully administered by trained interviewers using mobile devices. Anthropometric indices (weight, height, and waist circumference) and blood pressure were measured using a standardised protocol. Ethical approvals were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia, and Queen Mary University of London prior to conducting the survey. RESULTS Findings showed that the average sodium intake of Malaysian adults (3167 mg/day) was higher than the WHO recommendation of 2000 mg/day. Daily intake was significantly higher among males and individuals with higher BMI and higher waist circumference. CONCLUSION Salt intake in the Malaysian population was higher than the WHO recommendation. MyCoSS's findings will be used for the development and implementation of national salt reduction policy. A successful implementation of a national salt reduction programme in Malaysia will benefit the whole population.
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Affiliation(s)
- Rashidah Ambak
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Fatimah Othman
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Viola Michael
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | - Tahir Aris
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
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Baharudin A, Ambak R, Othman F, Michael V, Cheong SM, Mohd. Zaki NA, Abdul Aziz NS, Mohd. Sallehuddin S, Ganapathy SS, Palaniveloo L, He FJ. Knowledge, attitude and behaviour on salt intake and its association with hypertension in the Malaysian population: findings from MyCoSS (Malaysian Community Salt Survey). J Health Popul Nutr 2021; 40:6. [PMID: 34059158 PMCID: PMC8166009 DOI: 10.1186/s41043-021-00235-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND High blood pressure or hypertension has become one of the main health problems, worldwide. A number of studies have proven that an increased intake of salt was related to an increased prevalence of cardiovascular diseases. Of late, its relationship with high salt intake has received a lot of attention. Studies in Malaysia have shown both rising hypertension over time as well as high salt consumption. Actions to reduce salt intake are essential to reduce hypertension and its disease burden. As such, we carried out a study to determine associations between knowledge, attitude and behaviour towards salt intake and hypertension among the Malaysian population. METHODS Data obtained from the Malaysian Community Salt Survey (MyCoSS) was used partially for this study. The survey used a cross-sectional two-stage sampling design to select a nationally representative sample of Malaysian adults aged 18 years and above living in non-institutional living quarters (LQ). Face-to-face interviews were done by trained research assistants (RA) to obtain information on sociodemography, medical report, as well as knowledge, attitude and behaviour of the respondents towards salt intake and blood pressure. RESULTS Majority of the respondents have been diagnosed with hypertension (61.4%) as well as knowledge of the effects of high salt intake on blood pressure (58.8%). More than half of the respondents (53.3%) said they controlled their salt intake on a regular basis. Those who knew that a high salt diet could contribute to a serious health problem (OR=0.23) as well as those who controlled their salt intake (OR=0.44) were significantly less likely to have hypertension. CONCLUSION Awareness of the effects of sodium on human health, as well as the behaviour of controlling salt intake, is essential towards lowering the prevalence of hypertension among Malaysians.
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Affiliation(s)
- Azli Baharudin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Rashidah Ambak
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Fatimah Othman
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Viola Michael
- Non-Communicable Disease Section, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Siew Man Cheong
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Nor Azian Mohd. Zaki
- Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak Malaysia
| | - Nur Shahida Abdul Aziz
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Syafinaz Mohd. Sallehuddin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Shubash Shander Ganapathy
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Lalitha Palaniveloo
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Feng J. He
- Wolfson Institute of Preventive Medicine, London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Haron H, Hiew I, Shahar S, Michael V, Ambak R. A Survey on Salt Content Labeling of the Processed Food Available in Malaysia. Int J Environ Res Public Health 2020; 17:E2469. [PMID: 32260382 PMCID: PMC7178129 DOI: 10.3390/ijerph17072469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 01/20/2023]
Abstract
Salt content in processed foods is high, and it is usually used as preservatives, stabilizers, and color enhancers in the products. Increased consumption of processed foods in the modern world has contributed to a high salt intake and thus increased the prevalence of hypertension among Malaysian populations. Therefore, this study aimed to identify and compare salt content in processed food products available in supermarkets and determine the percentage of processed food products exceeding the reference value stated in International Product Criteria (2016). The percentage of processed food products without salt and sodium labeling was determined in this study, in which 76.5% of unlabeled processed food products were made in Malaysia, while 23.5% were imported products. The food group with the highest average salt content was gravy and sauce (3.97 g/100 g), followed by soup (2.95 g/100 g), cheese (2.14 g/100 g), meat (1.37 g/100 g), fish (1.25 g/100 g), chicken (1.20 g/100 g), vegetables (1.18 g/100 g), butter and margarine (1.13 g/100 g), breakfast cereal (0.94 g/100 g), savory snacks (0.90 g/100 g), flatbread (0.86 g/100 g), sweet snacks (0.30 g/100 g), and potato (0.29 g/100 g). In addition, 79.5% of butter and margarine products had an average salt content above the reference value stated in the International Product Criteria, followed by gravy and sauce (79.3%), vegetables (72%), soup (50%), fish (49.2%), breakfast cereal (41%), cheese (36.6%), potato (36%), savory and sweet snacks (29.1), meat (12.5%) and chicken products (2.3%). Most processed food products available in local supermarkets were high in salt content.
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Affiliation(s)
- Hasnah Haron
- Nutritonal Sciences Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Ivy Hiew
- Nutritonal Sciences Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Suzana Shahar
- Dietetics Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (R.A.)
| | - Viola Michael
- Non-communicable Disease Division, Ministry of Health, Putrajaya 62590, Malaysia;
| | - Rashidah Ambak
- Dietetics Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (R.A.)
- Institute of Public Health, Jalan Bangsar, Federal Hill, Wilayah Persekutuan Kuala Lumpur, Kuala Lumpur 50590, Malaysia
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Abstract
OBJECTIVE To investigate the sodium content in sauces sold in Malaysian supermarkets. METHODS A cross-sectional market survey was conducted in 2017 of 233 sauces sold in Malaysian supermarkets. Information on the sodium content was collected from the product packaging and nutrient information panels of the sauces sold in the seven top supermarkets in the capital of Malaysia. RESULTS Of the 233 sauces surveyed, 116 did not include sodium content information on the nutrient information panel (49.8%). Soy sauce (particularly sweet soy sauce) and ketchup (particularly chilli sauce) were found to be the highest number of products surveyed in the analysis (N=54 and N=48, respectively). The highest sodium content information was displayed by fish/prawn sauce (budu/cencalok) (5192±3228 mg/100 g) which was followed by the light/thin soy sauce (5116±2084 mg/100 g), and followed by salty soy sauce (4780±988 mg/100 g). The sodium content information of the imported sauces was higher compared with local products produced in Malaysia. However, for sweet soy sauce, the sodium content information of the local products was higher compared with the imported products. Of the 116 sauces which displayed information regarding their sodium content, only 18.2% of the salty soy sauce and 25% of the light/thin soy sauce were found to be below the 2017 Malaysian sodium guidelines. Furthermore, only 21.7% of chilli ketchup and no tomato ketchup were below the 2017 UK salt guidelines. CONCLUSIONS Almost half of the sauces surveyed did not include sodium content information on the nutrient information panel. It is recommended that sodium content information is provided on all sauces sold in Malaysia. Also, manufacturers should be urged to reduce the sodium content level of their sauces to a minimum of 5%.
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Affiliation(s)
- Suzana Shahar
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yee Xing You
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Viola Michael
- Disease Control Division, Ministry of Health, Malaysia, Putrajaya, Malaysia
| | - Rashidah Ambak
- Centre for Nutrition Epidemiology Research, Institute for Public Health, Ministry of Health, Setia Alam, Selangor, Malaysia
| | - Hasnah Haron
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Feng J He
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Kittel J, Lee J, Woody N, Amy Z, Murphy E, Barnett G, Michael V, Stevens G, Suh J, Chao S. Adjuvant Radiation May Not Be Necessary Following Gross Total Resection of an Atypical Meningioma. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- J J Richmond
- Department of Physiology, University of Illinois, Chicago Colleges
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van den Berghe J, Fesser J, Wanda H, Michael V. A comparison of molecular prognostic tests in multiple myeloma. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Spyropoulos C, Konidaris D, Papanicolaou A, Stephanidis A, Michael V, Androulakakis PA. Posterior urethral polyp in a boy, diagnosed by colour Doppler ultrasonography. BJU Int 1999; 84:881-2. [PMID: 10532995 DOI: 10.1046/j.1464-410x.1999.00336.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C Spyropoulos
- Department of Paediatric Urology, Aghia Sophia Children's Hospital, Athens, Greece
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Abstract
OBJECTIVES To assess the treatment and long-term survival of children under 14 years old operated upon for renal cell carcinoma (RCC). PATIENTS AND METHODS The records of five patients (aged 2, 4, 6, 9 and 13 years) who had been treated for RCC between 1982 and 1993 were reviewed. All had undergone nephrectomy with (two) or without (three) regional lymphadenectomy. After surgery four patients received chemotherapy (vincristine with actinomycin-D, three, vinblastine, one), and two with advanced-stage disease received other agents (interferon alpha, interleukin-2). They were followed for 5 to 15 years. RESULTS Three patients with stage I-II RCC were well at 13, 15 and 15 years after treatment. Of the two patients with regional lymph node involvement (stage III), one was well 5 years after surgery while the other developed hepatic, lung and bone metastases, and died 2 years after presentation. CONCLUSION The prognosis and long-term survival of children under 14 years old with RCC is very good for those with low-stage tumours. Nephrectomy with complete tumour extirpation is the main mode of treatment. For advanced-stage tumours, the role of adjuvant chemotherapy and/or biological agents must be defined more clearly.
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Affiliation(s)
- P A Androulakakis
- Department of Paediatric Urology, Aghia Sophia Children's Hospital, Athens, Greece
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Androulakakis PA, Michael V, Stephanidis A. Ureterocystoplasty in patients with small-capacity, non-compliant bladders. Pediatr Nephrol 1999; 13:90-1. [PMID: 10100298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Androulakakis PA, Michael V, Stefanidis A. Endoscopic management of ureteroceles in children. Eur Urol 1998; 34:163. [PMID: 9693254 DOI: 10.1159/000019704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Michael V, Davaris P, Arhontakis A, Androulakakis PA. Effects of submucosal Teflon paste injection in vesicoureteric reflux: results with 1- and 2-year follow-up data. Eur Urol 1993; 23:379-81. [PMID: 8508893 DOI: 10.1159/000474634] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
One hundred refluxing ureters with grades II (n = 65), III (n = 27) and IV (n = 8) vesicoureteric reflux (VUR) were treated with endoscopic submucosal polytetrafluoroethylene (Teflon) paste injection. Reflux stopped in 77 ureters after a single injection and in 13 ureters following a second injection. Two ureters remained with minimal (grade I) residual reflux, whilst in another 5 improvement from grades III and IV to grade II reflux was noted. In 3 ureters reflux remained unchanged, because of lateral ectopia of the refluxing ureteric ostium, hindering the injection of Teflon into the correct position. Re-evaluation at 1 year postinjection, of 48 previously cured ureters showed recurrence of reflux in 1 (2%), but no further recurrences were noted in 19 ureters reevaluated after 2 years.
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Affiliation(s)
- V Michael
- Department of Paediatric Urology, Aghia Sophia Children's Hospital, Athens, Greece
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Abstract
A group of 44 patients, aged from 10 months to 14 years, underwent surgery for urinary calculi over a 7-year period (1982-1989). Eleven patients had bilateral or multiple calculi (total number of stones = 55, 20 of which were staghorn). Metabolic disorders (n = 25) and Proteus urinary infection (n = 15) were the 2 factors most often associated with lithiasis. Of the 55 stones, 51 were removed by open surgery. Complete stone clearance was achieved in 29 of 36 kidneys. Follow-up periods in the remaining 7 renal units (with small residual fragments) ranged from 3.5 to 7.5 years (mean 6.2) and revealed stone recurrence in only 2 patients. Evaluation of childhood urolithiasis should include thorough metabolic investigation and sound surgical judgment; effective management requires prolonged post-operative follow-up.
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Affiliation(s)
- P A Androulakakis
- Department of Paediatric Urology, Aghia Sophia Children's Hospital, Athens, Greece
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Androulakakis PA, Michael V, Aghioutantis C, Giannakis C. Ostioplasty: a simple technique for ureterovesical reconstruction following intravesical ureterocelectomy. Eur Urol 1991; 19:308-11. [PMID: 1915536 DOI: 10.1159/000473648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A simple operation for the management of simple, i.e. intravesical, ureteroceles, which we have named 'ostioplasty', is presented. After unroofing the ureterocele, the retracted, gaping ureteric ostium is advanced and fixed medially to the center of the bladder trigone with three 5-0 polyglycolic acid sutures. The exposed intravesical ureter is covered with a new mucosal layer formed from the mobilized lateral edges of the unroofed ureterocele, sutured together over the ureter with 5-0 polyglycolic acid. Ostioplasty has been used in 5 patients so far with excellent anatomic and functional results. It is a simple and valuable surgical option to standard ureterovesical reimplantation after excision of a simple ureterocele, provided that the ureterocele is of moderate size and the bladder trigone retains good muscular support.
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Affiliation(s)
- P A Androulakakis
- Department of Paediatric Urology, Aghia Sophia Children's Hospital, Athens, Greece
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Pavlidis P, Michael V, Androulakakis P. reCorrection of reflux with the ureteric crossover method. Clinical experience in 50 patients. A. Kondo and T. Otani, Br. J. Urol., 60, 36-38, 1987. BJU Int 1988. [DOI: 10.1111/j.1464-410x.1988.tb13985.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Michael V. Home team's sense of achievement. Nurs Mirror 1984; 159:14. [PMID: 6567915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Michael V. A vital link takes shape. Nurs Mirror 1984; 159:14. [PMID: 6567165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Michael V. Just another body to be processed. Nurs Mirror 1984; 159:15. [PMID: 6566324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Michael V. Having a birth right at home. Nurs Mirror 1984; 159:14. [PMID: 6566282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Michael V. Application of insights learned in disasters to institutional systems. Bull Am Protestant Hosp Assoc 1978; 43:95-7. [PMID: 10246593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Michael V. Coping choices in disasters and emerging health patterns. Bull Am Protestant Hosp Assoc 1977; 42:124-6. [PMID: 10240980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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