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Aim To determine the proportion of non-compliance to iron chelation therapy (ICT) and its associated factors amongst patients with transfusion-dependent thalassaemia (TDT) in Malaysia. Methods A cross-sectional study was conducted amongst patients with TDT aged 9 years old and above, who were on iron chelation treatment, attending three tertiary hospitals in Kelantan and Terengganu. The socio-demographic, clinical and chelator history of patients were obtained. The compliance of patients to chelators was assessed using the Medication Compliance Questionnaire (MCQ). Social support was assessed using the Medical Outcome Study–Social Support Survey (MOS). Data was analysed using simple and multiple logistic regression. Results The proportion of non-compliance to ICT was 24.7%. Age, activity restriction and latest serum ferritin level of ≥1000 μg/L were significantly associated with non-compliance to ICT. Conclusion The non-compliance to ICT amongst patients with TDT in Kelantan and Terengganu is 24.7%. Providing motivational interview, enhanced self-empowerment of patients and psychological support are recommended to improve the non-compliance aspect amongst patients on ICT.

We conducted this study to estimate the prevalence of complementary and alternative medicines (CAM) usage among allergic rhinitis (AR) patients in Malaysia and understand the practice of CAM usage among them. We also included a literature review on the commonly used CAM for AR. A cross-sectional study which included a questionnaire-based study and information of allergic rhinitis from patient’s clinic records. Patients with AR who attended the ORL-HNS department in Hospital Universiti Sains Malaysia and Hospital Sultanah Aminah, Malaysia were enrolled after consented, on a first-come first-serve basis as convenience sampling from July 2020 until February 2021. A pre-tested self-administered, 16-item questionnaire in Malay language was distributed to the participants. The questionnaire consists of a set of 16 questions with subsets to enquire about the sociodemographic data and pattern of usage of CAM and its effectiveness. 372 patients were enrolled in this study consisting of 217 (58.3%) female and 155 (41.7%) male patients. 231 (62.1%) participants had used CAM for AR in the past 10 years. A higher proportion of females (p = 0.015) and those with higher income (p = 0.004) had used CAM. Among the users, 87.9% found CAM to be effective. No differences were found in terms of age (p = 0.888) and education level (p = 0.057) for CAM usage. CAM is widely used in Malaysia to alleviate AR symptoms, with a large proportion of users think it is effective. Therefore, more researches should be conducted to provide evidence and guidance to integrate CAM into AR management.

Background: In end-stage renal disease (ESRD), troponin T concentrations can be elevated even without cardiac ischaemia, which hampers the diagnosis of acute myocardial infarction (AMI). The objectives of our study were to determine the proportion of dialysisdependent ESRD patients without acute coronary syndrome (ACS) but with highly sensitive cardiac troponin T (hs-cTnT) levels above the 99th percentile upper reference limit and to evaluate the range of hs-cTnT among this population. Methods: A cross-sectional study was conducted at the haemodialysis (HD) unit of a tertiary hospital in Malaysia from January 2018 to February 2019. Dialysis-dependent ESRD patients were included and those with a recent history of ACS (within 30 days) were excluded. Pre-dialysed serum hs-cTnT levels were measured using Cobas e411. The upper limit of the 99th percentile value for troponin T was 14 ng/L. Results: A total of 150 patients were recruited as study participants. The majority were female (62%) and of Malay ethnicity (94%), and the mean (SD) age was 45.19 (16.36) years old. The hs-cTnT range (min, max) was 11.39–738.30 ng/L and the median (interquartile range [IQR]) of hs-cTnT was 59.20 (83.41) ng/L. Elevated hs-cTnT levels were observed in 149/150 (99%) of the study participants (54/55 [98.2%] of the patients were on HD, and 95/95 [100.0%] of the patients were on continuous ambulatory peritoneal dialysis). Conclusion: This study supports prior research showing that even without ACS, most ESRD patients have elevated concentrations of cardiac troponin. Furthermore, our study illustrates the need to revisit the use of absolute troponin values when making a diagnosis of ACS in ESRD patients.

Background: This study aims to compare the effect of infusions of two agents, dexmedetomidine and esmolol, with the control group in attenuating the haemodynamic stress response and neuroendocrine modulation surrogated by capillary blood glucose (BG) during the procedures. Methods: Sixty patients aged 18–70 years old who underwent elective surgeries involving endotracheal intubation were randomised into three groups of equal size: i) control; ii) dexmedetomidine and iii) esmolol. Heart rate (HR) was measured at baseline (T0), after drug administration (T1), after induction of anaesthesia (T2), immediately after intubation (T3), and 3 min, 5 min and 10 min after intubation (T4, T5 and T6). BG was measured pre-operatively and 30 min post-intubation. Results: Two-way repeated-measures analysis of variance showed significant time [within- group changes, F(3.2, 182.5) = 30.39, P < 0.001], treatment [between-group differences regardless of time, F(2, 57) = 50.24, P < 0.001] and interaction [between-group differences based on time, F(6.4, 182.5) = 37.65, P < 0.001] effects on HR. A significantly higher HR was observed in the control group compared to the dexmedetomidine and esmolol groups from T2 to T6. BG exhibited a significant time effect [F(1, 57) = 41.97, P < 0.001] with no significant treatment and interaction effects. All three groups showed a significant increase in BG from baseline. Conclusion: Both dexmedetomidine and esmolol are equally effective in attenuating haemodynamic responses to laryngoscopy and intubation. However, both do not significantly modulate neuroendocrine stress.

Background: Some multiple myeloma (MM) patients still relapse/progress despite novel agent therapy and relapse/progression in MM is therefore a vital area of ongoing research in the novel treatment era. This retrospective cohort study aimed to evaluate the time to relapse/ progression (TTP) among MM patients who received novel agents and to determine the associated prognostic factors. Methods: This study included 89 MM patients treated at Hospital Universiti Sains Malaysia. We analysed the TTP and the type of relapse/progression (biochemical versus clinical), and a Cox proportional hazard model was used to identify the significant prognostic factors. Results: Sixty-four percent of patients had biochemical relapse/progression. The overall median TTP among MM patients who received the novel agent(s) was 29.33 months (95% CI: 21.36–37.29). The type of paraprotein at diagnosis (P = 0.026, P = 0.228), International Staging System (ISS) score (P = 0.036, P = 0.067) and autologous stem cell transplant (ASCT) (P = 0.002) were prognostic factors for relapse/progression by simple Cox regression, but ASCT was the only significant predictor detected by multiple Cox regression (P = 0.003). Conclusion: Our study reflects the importance of paraprotein monitoring to detect early features of relapse/progression. ASCT is the most prognostic factor that may lengthen the TTP.

Objective. We aimed to study the median time to gain weight from baseline and factors that were associated with rate of weight gain among obese children attending pediatric endocrine clinic Hospital USM. Methodology. We recruited 70 participants with the mean age of 10.1 + 2.94 years with exogenous or simple form of obesity from June 2019 until September 2020. We analyzed their demography (age, gender, ethnicity, family background), measured their anthropometry (weight, height, BMI) and monitored monthly weight increment and finally analyzed their HOMA-IR at baseline and after 6 months of follow up. Results. The mean time to gain 5 kg from baseline was 16 weeks (95% CI): (15.2, 16.7). Multivariate analysis showed only HOMA-IR after 6 months was a significant predictor affecting time to gain 5 kg; Adjusted HR: (95%CI) 1.617(1.232, 2.123), (p=0.001). Conclusion. The time to gain 5 kg from baseline weight was increased 1.6 times in the presence of insulin resistance at 6 months follow up in patients with obesity. More intensive education and closed follow-up are recommended for children with obesity.

Background Death resulting from the acquired immunodeficiency syndrome (AIDS) is a worldwide concern. This study is aimed at determining the overall median survival time, and the prognostic factors of mortality among AIDS-infected patients in North-East Peninsular Malaysia. Methods In 2018, a retrospective cohort study stretching from January to April was conducted. This study involved a review of data obtained from the National AIDS Registry. A total of 1,073 AIDS cases diagnosed from 1 January 2010 to 31 December 2014 were selected, and follow-up procedures were conducted until 31 March 2015 (a 3-month follow-up). The Kaplan-Meier plot and Cox’s proportional hazard regression were used for data analyses. Results 564 (52.5%) patients died due to AIDS, while the remaining 509 (47.4%) were censored. The overall median survival time was 11 months. The probability of survival in 1-year, 2-year, 3-year, 4-year and 5-year periods were 49.1%, 47.8%, 47.3%, 47.0% and 46.7%, respectively. Multiple Cox regression revealed that the significant prognostic factors were age 30–49 years [adjusted hazard ratio (Adj. HR) 1.57; 95% CI: 1.14, 2.16; P = 0.006], male (Adj. HR 1.39; 95% CI: 1.07, 1.79; P = 0.012), unemployed (Adj. HR 1.40; 95% CI: 1.12, 1.75; P = 0.003) and HIV-TB co-infection (Adj. HR 1.78; 95% CI: 1.37, 2.31; P < 0.001). Conclusion The overall median survival time among AIDS patients in North-East Peninsular Malaysia was revealed to be short, in comparison to the other studies. The chances for survival can be improved with more emphasis on early detection (to ensure early treatment) and social support, particularly for HIV-TB co-infected patients, as well as for younger and unemployed patients.

Background As an early recognition of neonatal sepsis is important for triggering the initiation of treatment, this study was thus designed to assess the diagnostic performance and discrimination value of procalcitonin (PCT) in neonatal sepsis cases. Methods This cross-sectional study, which was carried out at the Paediatric Intensive Care Unit of Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia, had involved 60 neonates admitted for suspected sepsis. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and the area under receiver operating characteristics curve (AUC) for PCT were determined at initial presentation (0 h) as well as 12 h and 24 h after presentation in comparison to blood culture as the gold standard. Results The study consisted of 27 (45.0%) male and 33 (55.0%) female neonates with a mean (SD) age of 76.8 (48.25) h. At cut-off PCT value of > 2 ng/mL, the sensitivity, specificity, PPV and NPV were 66.7%, 66.7%, 33.3% and 88.9% at 0 h. The respective parameters were 83.3%. 56.3%, 32.3% and 93.1% at 12 h and 83.3%, 52.1%, 30.3% and 92.6% at 24 h. AUC was 71.6%, 76.6% and 71.7% at 0 h, 12 h and 24 h. Conclusions Diagnostic performance and discrimination values of PCT for diagnosis of neonatal sepsis varied with time of obtaining the blood samples. The PCT result at 12 h demonstrates the most optimal diagnostic performance and discrimination values.

Social media is emerging as a new avenue for hospitals and patients to solicit input on the quality of care. However, social media data is unstructured and enormous in volume. Moreover, no empirical research on the use of social media data and perceived hospital quality of care based on patient online reviews has been performed in Malaysia. The purpose of this study was to investigate the determinants of positive sentiment expressed in hospital Facebook reviews in Malaysia, as well as the association between hospital accreditation and sentiments expressed in Facebook reviews. From 2017 to 2019, we retrieved comments from 48 official public hospitals’ Facebook pages. We used machine learning to build a sentiment analyzer and service quality (SERVQUAL) classifier that automatically classifies the sentiment and SERVQUAL dimensions. We utilized logistic regression analysis to determine our goals. We evaluated a total of 1852 reviews and our machine learning sentiment analyzer detected 72.1% of positive reviews and 27.9% of negative reviews. We classified 240 reviews as tangible, 1257 reviews as trustworthy, 125 reviews as responsive, 356 reviews as assurance, and 1174 reviews as empathy using our machine learning SERVQUAL classifier. After adjusting for hospital characteristics, all SERVQUAL dimensions except Tangible were associated with positive sentiment. However, no significant relationship between hospital accreditation and online sentiment was discovered. Facebook reviews powered by machine learning algorithms provide valuable, real-time data that may be missed by traditional hospital quality assessments. Additionally, online patient reviews offer a hitherto untapped indication of quality that may benefit all healthcare stakeholders. Our results confirm prior studies and support the use of Facebook reviews as an adjunct method for assessing the quality of hospital services in Malaysia.

Introduction The effect of dialysis modality on the survival of end-stage renal disease (ESRD) patients is a public health interest. Methods In this retrospective cohort study, all adult ESRD patients receiving dialysis treatment in Sabah between January 1, 2007 and December 31, 2017 as identified from the Malaysian Dialysis and Transplant Registry (MDTR) were evaluated and followed up through December 31, 2018. The endpoint was all-cause mortality. The observation time was defined as the time from the date of dialysis initiation after the onset of ESRD to whichever of the following that came first: date of death, date of transplantation, date of last follow-up, date of recovered kidney function, or December 31, 2018. Weighted Cox regression (WCR) was used to estimate the effect of dialysis modality. Analyses were restricted to patients with complete data on all variables. Results A total of 2,143 patients began haemodialysis (HD) and 303 patients started with peritoneal dialysis (PD), yielding 7,549.41 (median 5.48 years/person) and 1140.11 (median 5.08 years/person) person-years of observation. Seventy-two patients (2.9%) were lost to follow-up. The median survival time was 4.55 years (95% confidence interval (CI): 4.18, 4.85) among patients who started on HD and 5.23 years (95% CI: 4.31, 6.00) among those who started on PD. The effect of dialysis modality was not significant after controlling for age, sex, diabetes mellitus (DM), and cardiovascular diseases (CVD). The average hazard ratio (AHR) was 0.91 (95% CI: 0.77, 1.08) with HD as a reference. Conclusion There was no evidence of a difference in mortality between HD and PD. [This poster was submitted to the 14th National Conference for Clinical Research (NCCR) in August 18-20, 2021. https://nccrconference.com.my/: Abstract text might vary slightly from what is displayed in the e-poster], This poster was submitted to the 14th National Conference for Clinical Research (NCCR) in August 18-20, 2021. https://nccrconference.com.my/

Background: Bladder cancer ranked ninth of principal male cancer in Malaysia. This study aimed to evaluate the clinical characteristics and survival of bladder cancer patients in Malaysia. Methods: A retrospective cohort study was conducted by obtaining records in the Malaysian National Cancer Registry. Patients aged 15 years old and above with diagnosis date between 2007 and 2011 were included. Death was updated until 31 December 2016. Five-year observed survival and median survival time were determined by the life table method and Kaplan–Meier estimate method. Results: Among 1828 cases, the mean (SD) age of diagnosis was 64.9 (12.5) years. The patients were predominantly men (78.7%), Malay ethnicity (49.4%) and transitional cell carcinoma (78.2%). Only 14.8% of patients were at stage I. The overall five-year observed survival and median survival time was 36.9% (95% CI: 34.6, 39.1) and 27.3 months (95% CI: 23.6, 31.0). The highest five-year observed survival recorded at stage I (67.6%, 95% CI: 62.0, 73.3) and markedly worsen at stage II (34.3%, 95% CI: 27.9, 40.8), III (25.7%, 95% CI: 18.7, 32.6) and IV (12.2%, 95% CI: 8.1, 16.3). Conclusions: Survival of bladder cancer patients in Malaysia was lower with advancing stage. The cancer control programme should be enhanced to improve survival.

Caffeine is the most commonly used methyl xanthine for the prevention of apnoea in prematurity, but the ideal dose was uncertain, until now. This study compared two doses of caffeine for the prevention of apnoea in prematurity. A clinical trial was conducted on 78 preterm infants ≤32 weeks in Neonatal Intensive Care Unit. They were randomly allocated to receive the intervention (loading 40 mg/kg/day and maintenance of 20 mg/kg/day) or the control (loading 20 mg/kg/day and maintenance of 10 mg/kg/day) dose of caffeine. The primary outcome of the study was the frequency and total days of apnoea per duration of treatment for both groups. The frequency of apnoea ranged from zero to fourteen in the intervention group and zero to twelve in the control group. There was no statistically significant difference between the groups, with a p-value of 0.839. The number of days of apnoea was also similar between both groups, with a p-value of 0.928. There was also no significant difference in adverse events between both regimens. This study did not support the use of higher doses of caffeine as a prevention for apnoea in prematurity.

Background People with type 2 diabetes mellitus (T2DM) are best managed by a chronic care model that is associated with enhanced quality of care and improved patient outcome. Assessing patients’ perceived quality of care is crucial in improving the healthcare delivery system. Hence, this study determined the perceived quality of care among people with T2DM and explored its associations with (i) sociodemographic and clinical characteristics and (ii) types of healthcare clinics to guide future planning. Methods A cross-sectional study involving 20 primary healthcare clinics in the North East Region of Peninsular Malaysia and people with T2DM as the sampling unit was conducted from February to May 2019. The pro forma checklist, interview-guided Skala Kepuasan Interaksi Perubatan-11, and Patient Assessment of Chronic Illness Care (Malay version; PACIC-M) questionnaire were used for data collection. Univariate analysis and linear regression were used to determine the status of perceived quality of care and the factors associated with the perceived quality of care, respectively. Results Overall, data from 772 participants were analyzed. The majority was from the Malay ethnic group (95.6%) with a mean (standard deviation [SD]) glycated hemoglobin A1c (HbA1c) level of 8.91% (2.30). The median (interquartile range [IQR]) of the number of medical officers available at each clinic was 6 (7), with Family Doctor Concept (FDC) clinics having a higher number of medical officers than non-FDC clinics (p = 0.001). The overall mean (SD) PACIC-M score was 2.65 (0.54) with no significant difference between scores of patients treated in the two clinic types (p = 0.806). Higher perceived quality of care was associated with lower number of medical officers (adjusted regression coefficient [Adj.β], − 0.021; p-value [p], 0.001), and greater doctor–patient interaction in all domains: distress relief (Adj.β, 0.033; p, p, p, 0.003). Conclusion Although there was no significant difference found between clinic type, this study reflects that patients are comfortable when managed by the same doctor, which may support a better doctor-patient interaction. A larger specialized primary care workforce could improve diabetes care in Malaysia.

Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate serum vitamin D, calcium, and phosphate and bone marker levels and bone mineral density (BMD) among patients with different thyroid diseases. This cross-sectional study included patients with underlying thyroid diseases (n = 64, hyperthyroid, n = 53 euthyroid, n = 18, hypothyroid) and healthy controls (n = 64). BMD was assessed using z-score and left hip and lumbar bone density (g/cm2). The results showed that the mean serum vitamin D Levels of all groups was low (&lt, 50 nmol/L). Thyroid patients had higher serum vitamin D levels than healthy controls. All groups had normal serum calcium and phosphate levels. The carboxy terminal collagen crosslink and procollagen type I N-terminal propeptide levels were high in hyperthyroid patients and low in hypothyroid patients. The z-score for hip and spine did not significantly differ between thyroid patients and control groups. The hip bone density was remarkably low in the hyperthyroid group. In conclusion, this study showed no correlation between serum 25(OH)D levels and thyroid diseases. The bone markers showed a difference between thyroid groups with no significant difference in BMD.

Hyperprolactinemia (hPRL) often poses a diagnostic dilemma due to the presence of macroprolactin. Understanding the prevalence of macroprolactinemia (mPRL) has an important implication in managing patients with hPRL. The primary aim of this study was to determine the prevalence of mPRL globally and to explore selected factors influencing the prevalence estimate. Studies with original data related to the prevalence of mPRL among patients with hPRL from inception to March 2020 were identified, and a random effects meta-analysis was performed. Of the 3770 records identified, 67 eligible studies from 27 countries were included. The overall global prevalence estimate was 18.9% (95% CI: 15.8%, 22.1%) with a substantial statistical heterogeneity (I2 = 95.7%). The highest random effects pooled prevalence was observed in the African region (30.3%), followed by Region of the Americas (29.1%), European (17.5%), Eastern Mediterranean (13.9%), South-East Asian (12.7%), and Western Pacific Region (12.6%). Lower prevalence was observed in studies involving both sexes as compared to studies involving only female participants (17.1% vs. 25.4%) and in more recent studies (16.4%, 20.4%, and 26.5% in studies conducted after 2009, between 2000 and 2009, and before 2000, respectively). The prevalence estimate does not vary according to the age group of study participants, sample size, and types of polyethylene glycol (PEG) used for detection of macroprolactin (PEG 6000 or PEG 8000). With macroprolactin causing nearly one-fifth of hPRL cases, screening for mPRL should be made a routine before an investigation of other causes of hPRL.

The prevalence of low back pain (LBP) among nurses is high. The main aim of this study was to evaluate the effectiveness of an interactive LBP module based on the Back School Program in improving Oswestry Disability Scores (ODSs) among nurses in government hospitals in Penang, Malaysia. A cluster-randomized experimental study was conducted within four public hospitals. These hospitals were randomized to intervention and control groups. A total of 284 nurses from the selected hospitals were randomly selected (142 in each group). An interactive LBP intervention module based on the Back School Program was designed and prescribed. Both the intervention and control groups were assessed using the Oswestry Disability Questionnaire at baseline and at the end of the third and sixth weeks. Out of 284 participants, 281 completed this study. A between-group comparison revealed that ODSs were significantly lower in the intervention group than in the control group at the ends of the third (p = 0.006) and sixth weeks (p &lt, 0.001). Within-group changes revealed a significant reduction in ODSs within the intervention group from baseline to the third (p &lt, 0.001) and sixth weeks (p &lt, 0.001) of the intervention. This simple interactive LBP module was effective in reducing symptoms of LBP among nurses as early as three weeks, and this effect was sustained until the sixth week of the intervention.

Objectives: Acute appendicitis is one of the most common surgical emergencies. Perforated appendicitis can result in increased morbidity and mortality. Thus, early identification of perforation can reduce the impact on patient and improve outcome. Apart from total white cell count (TWCC), serum total bilirubin (SB) has been shown to indicate perforation in appendicitis. The aim of this study was to assess the usefulness of serum total bilirubin (SB) as the preoperative indicator for perforated appendicitis. Materials and Methods: This was a retrospective study of all appendicectomies cases done in Hospital Universiti Sains Malaysia (HUSM) over a one-year period in 2014. Only patients with histopathologically confirmed appendicitis with available liver function tests and total white blood cell count preoperatively were included in the study. These appendicitis cases were further divided into perforated and non-perforated based on histopathological reports obtained. Results: A total of 245 patients had appendicectomy done in 2014 between January to December 2014. Out of 110 from these 245 patients met the inclusion and exclusion criteria. SB was significantly higher (p

Background Pre-hospital delay is currently a major factor limiting early reperfusion among ST-elevation myocardial infarction (STEMI) patients worldwide. This study aims to determine pre-hospital factors affecting symptom-to-door time among STEMI patients in Malaysia. Methods This cross-sectional study included 222 STEMI patients admitted to two tertiary hospitals in Malaysia. By determining symptom-to-door time, the study population was categorised into two definitive treatment seeking groups: early (≤ 3 h) and delayed (> 3 h). Data was collected focusing on socio-demographical data, risk factors and comorbidities, clinical presentation, situational factors and action taken by patients. Results The mean age of our patients was 58.0 (SD = 11.9) years old, and the population consisted of 186 (83.8%) males and 36 (16.2%) females. Our study found that the median symptom-to-door time was 130.5 (IQR 240) min, with 64% of subjects arriving early and 36% arriving late. Pre-hospital delays were found to be significant among females (adj OR = 2.42; 95% CI: 1.02, 5.76; P = 0.046), patients with recurrence of similar clinical presentations (adj OR = 2.74; 95% CI: 1.37, 5.46; P = 0.004), patients experiencing atypical symptoms (adj OR = 2.64; 95% CI: 1.11, 6.31; P = 0.029) and patients who chose to have their first medical contact (FMC) for their symptoms with a general practitioner (adj OR = 2.80; 95% CI: 1.20, 6.56; P = 0.018). However, patients with hyperlipidaemia (adj OR = 0.46; 95% CI: 0.23, 0.93; P = 0.030), self-perceived cardiac symptoms (adj OR = 0.36; 95% CI: 0.17, 0.73; P = 0.005) and symptoms that began in public places (adj OR = 0.21; 95% CI: 0.06, 0.69; P = 0.010) tended to seek treatment earlier. Conclusion The symptom-to-door time among the Malaysian population is shorter in comparison to other developing countries. Nevertheless, identified, modifiable pre-hospital factors can be addressed to further shorten symptom-to-door time among STEMI patients.

Background Body self-image questionnaire-short form (BSIQ-SF) is developed to measure body image perceptions. Due to the cultural, language and environmental differences between western and eastern population, the validity and reliability need to be established. The aim of this study was to determine validity and reliability of Malay version BSIQ-SF. Methods A cross-sectional study involved web-based survey was employed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was performed using SPSS version 22 and Mplus 7.3. Results There were 688 young adults in Malaysia with mean age of 23.67 (SD = 0.188) and mean body mass index (BMI) of 23.34 (SD = 0.27) participated in the study. Exploratory factor analysis performed and the number domains reduced from nine to four, namely 'Negative Affect', 'Attractiveness Evaluation', 'Physical Functionality Awareness' and 'Height Dissatisfaction'. CFA further confirmed the structure of the model with adequate goodness-of-fit values [CFI = 0.927, TLI = 0.913, SRMR = 0.075, RMSEA = 0.053 (95% CI: 0.047, 0.060)]. Conclusion The revised 21-item of the Malay version BSIQ-SF was a valid and reliable instrument to measure body image perceptions among Malaysian young adults.

Social media sites, dubbed patient online reviews (POR), have been proposed as new methods for assessing patient satisfaction and monitoring quality of care. However, the unstructured nature of POR data derived from social media creates a number of challenges. The objectives of this research were to identify service quality (SERVQUAL) dimensions automatically from hospital Facebook reviews using a machine learning classifier, and to examine their associations with patient dissatisfaction. From January 2017 to December 2019, empirical research was conducted in which POR were gathered from the official Facebook page of Malaysian public hospitals. To find SERVQUAL dimensions in POR, a machine learning topic classification utilising supervised learning was developed, and this study’s objective was established using logistic regression analysis. It was discovered that 73.5% of patients were satisfied with the public hospital service, whereas 26.5% were dissatisfied. SERVQUAL dimensions identified were 13.2% reviews of tangible, 68.9% of reliability, 6.8% of responsiveness, 19.5% of assurance, and 64.3% of empathy. After controlling for hospital variables, all SERVQUAL dimensions except tangible and assurance were shown to be significantly related with patient dissatisfaction (reliability, p &lt, 0.001, responsiveness, p = 0.016, and empathy, p &lt, 0.001). Rural hospitals had a higher probability of patient dissatisfaction (p &lt, 0.001). Therefore, POR, assisted by machine learning technologies, provided a pragmatic and feasible way for capturing patient perceptions of care quality and supplementing conventional patient satisfaction surveys. The findings offer critical information that will assist healthcare authorities in capitalising on POR by monitoring and evaluating the quality of services in real time.

The implementation of Family Doctor Concept (FDC) to restructure the primary healthcare systems in Malaysia were expected to enhance patient&rsquo, s satisfaction on doctor-patient interaction and subsequently improved glycaemic control among Type 2 Diabetes Mellitus (T2DM) patients. Thus, this study aims to determine the difference in doctor-patient interaction satisfaction between T2DM patients attended FDC-implemented clinic vs non-FDC clinics, and to determine the association between FDC-implemented clinic and doctor-patient interaction satisfaction towards glycaemic control. A cross-sectional study was conducted throughout 10 districts in Kelantan from February until May 2019 using interview-guided Skala Kepuasan Interaksi Perubatan-11 (SKIP-11) and proforma checklist. Data were analyzed using SPSS ver.24. Chi-square statistic used to determine the difference in doctor-patient interaction satisfaction between both clinics type. Multiple logistic regression used to examine the association between FDC-implemented clinic and doctor-patient interaction satisfaction towards glycaemic control. Twenty primary health clinics involved, and 772 T2DM patients recruited. FDC clinics attendees has higher proportion of satisfaction (40.1%) compared to non-FDC attendees (33.7%) (p = 0.070). Multiple logistic regression confirmed the association of FDC-implemented health clinics (Adj. OR 1.63, p = 0.021), and doctor-patients interaction satisfaction (Adj. OR 1.77, p = 0.005) towards glycaemic control. Hence, strengthening of FDC in primary healthcare and improve the doctor-patient interaction satisfaction were essential to escalate good glycaemic control.

Background Lack of knowledge and poor attitude are barriers to colorectal cancer screening participation. Printed material, such as pamphlets and posters, have been the main approach in health education on disease prevention in Malaysia. Current information technology advancements have led to an increasing trend of the public reading from websites and mobile apps using their mobile phones. Thus, health information dissemination should also be diverted to websites and mobile apps. Increasing knowledge and awareness could increase screening participation and prevent late detection of diseases such as colorectal cancer. Objective This study aimed to assess the effectiveness of the ColorApp mobile app in improving the knowledge and attitude on colorectal cancer among users aged 50 years and older, who are the population at risk for the disease in Kedah. Methods A quasi-experimental study was conducted with 100 participants in Kedah, Malaysia. Participants from five randomly selected community empowerment programs in Kota Setar district were in the intervention group; Kuala Muda district was the control group. Participants were given a self-administered validated questionnaire on knowledge and attitudes toward colorectal cancer. A mobile app, ColorApp (Colorectal Cancer Application), was developed as a new educational tool for colorectal cancer prevention. The intervention group used the app for two weeks. The same questionnaire was redistributed to both groups after two weeks. The mean percentage scores for knowledge and attitude between groups were compared using repeated measure ANCOVA. Results There was no significant difference in age, sex, highest education level, current occupation, and diabetic status between the two groups. The number of smokers was significantly higher in the intervention group compared with the control group and was controlled for during analysis. The intervention group showed a significantly higher mean knowledge score compared with the control group with regards to time (Huynh-Feldt: F1,95=19.81, P Conclusions The ColorApp mobile app may be an adjunct approach in educating the public on colorectal cancer.

Background: Structured education is needed to cultivate safe sharp disposal behavior among diabetic patients. Thus, this study aimed to assess the effectiveness of the Diabetes Community Sharp Disposal Education Module in improving knowledge and sharp disposal practice among Malaysian Type 2 diabetic patients. Methods: This quasi-experimental study was conducted at primary health clinics in two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. A total of 132 Type 2 diabetic patients on insulin therapy were involved, with 68 participants in each control and intervention group. The health education intervention was based on the validated Diabetes Community Sharp Disposal Education Module. The knowledge and practices were measured using a validated questionnaire at baseline, one month, and three months after the intervention. Results: There was a significant increment in the mean knowledge score for intervention group, from baseline to one month follow up and from baseline to three months follow up [Greenhouse-Geisser, F(1.5, 199.7) = 62.38, p &lt, 0.001, effect size (&eta, 2) = 0.318]. Intervention group had significantly higher mean knowledge score as compared to control group, at one month and three months follow up [F(1, 134) = 17.38, p &lt, 2) = 0.115]. There was a statistically significant increment in the proportion of participants in the intervention group who practiced the proper community sharp disposal method over time, X2(2) = 52.061, p &lt, 0.001. Conclusions: The Diabetes Community Sharp Disposal Education Module was an effective health education tool to improve knowledge and encourage Malaysian diabetic patients to engage with proper sharp disposal practices.

Background Measurement of breast cancer burden and identification of its influencing factors help in the development of public health policy and strategy against the disease. This study aimed to examine the variability of the excess mortality of female breast cancer patients in the North East Region of Peninsular Malaysia. Methods This retrospective cohort study was conducted using breast cancer data from the Kelantan Cancer Registry between 2007 and 2011, and Kelantan general population mortality data. The breast cancer cases were followed up for 5 years until 2016. Out of 598 cases, 549 cases met the study criteria and were included in the analysis. Modelling of excess mortality was conducted using Poisson regression. Results Excess mortality of breast cancer varied according to age group (50 years old and below vs above 50 years old, Adj. EHR: 1.47; 95% CI: 1.31, 4.09; P = 0.004), ethnicity (Malay vs non-Malay, Adj. EHR: 2.31; 95% CI: 1.11, 1.96; P = 0.008), and stage (stage III and IV vs. stage I and II, Adj. EHR: 5.75; 95% CI: 4.24, 7.81; P Conclusions Public health policy and strategy aim to improve cancer survival should focus more on patients presented at age below 50 years old, Malay ethnicity, and at a later stage.

Background: Type 2 diabetic patients are major users of medical sharps in the community. Proper sharp disposal practice among them, however, was reported to be low. The current study was aimed to determine the factors contributing to sharp waste disposal at a health care facility among Type 2 diabetic patients. Methods: In this cross-sectional study, Type 2 diabetic patients who were on insulin therapy attending health clinics were randomly selected and interviewed using a validated questionnaire. Binary logistic regression analysis was applied. Results: Out of 304 respondents, only 11.5% of them brought their used sharps to be disposed at health care facilities. Previous advice on sharp disposal from health care providers, knowledge score, and duration of diabetes were significant contributing factors for sharp waste disposal at health care facilities: (Adj. OR 6.31, 95% CI: 2.63, 15.12, p &lt, 0.001), (Adj. OR 1.05, 95% CI: 1.03, 1.08, 0.001), and (Adj. OR 2.51, 95% CI: 1.06, 5.93, p = 0.036), respectively. Conclusion: Continuous education and a locally adapted safe sharp disposal option must be available to increase awareness and facilitate diabetic patients adopting proper sharp disposal behavior.

Enhanced oxidative stress is involved in the pathogenesis of endothelial dysfunction in preeclampsia (PE). Circulating oxidised LDL (oxLDL) and antibodies to oxLDL (Ab-oxLDL) have been found to be associated with atherosclerosis. The objectives of this study were to investigate the association of oxLDL and Ab-oxLDL with PE and to assess the association between oxLDL and Ab-oxLDL. The levels of oxLDL and Ab-oxLDL were measured by enzyme-linked immunoassay in 78 women with preeclampsia (PE group) and 78 women with normal pregnancy (control group). The PE group had higher oxLDL and Ab-oxLDL levels than the control group (485.1vs.145.9 ng/ml, p

(1) Background: Several studies have suggested that the vitamin D receptor (VDR) gene plays a role in type 2 diabetes mellitus (T2DM) susceptibility. Nonetheless, the association between T2DM and VDR polymorphisms remains inconclusive. We determined the genotype of VDR rs1544410 (BsmI) and rs2228570 (FokI) polymorphisms among Malaysian patients with T2DM and their association with glycemic control factors (vitamin D levels, calcium, magnesium, and phosphate). (2) Methods: A total of 189 participants comprising 126 patients with T2DM (63 with good glycemic control and 63 with poor glycemic control) and 63 healthy controls were enrolled in this case–control study. All biochemical assays were measured using spectrophotometric analysis. VDR gene FokI and BsmI polymorphisms were analyzed using polymerase chain reaction and endonuclease digestion. (3) Results: Our findings revealed no significant differences in VDR FokI and BsmI genotypes between participants with T2DM and healthy controls. Moreover, no significant association was observed between both single nucleotide polymorphisms and glycemic control factors. Participants with poor glycemic control had significantly lower serum magnesium levels and significantly higher HOMA-IR compared to the other groups. (4) Conclusions: The present study revealed that VDR gene BsmI and FokI polymorphisms were not significantly associated with T2DM.

Objective: Depression is the single largest contributor to the global burden of disease. Depression was found as a common disorder among children lower than 18 years old. The aim of this study is to determine the prevalence and factors associated with depression severity among adolescents in Malaysia. Study design: A cross-sectional study Methods: In order to achieve the objective of this study, secondary data analysis from Malaysian National School Based Health Survey 2012 was carried out, involving a total of number of 21,764 eligible school adolescents between the ages of 12 to 18 years old. Additionally, complex sample ordinal logistic regression was also employed for analysing and quantifying the odds ratio, in which 95% confidence interval was achieved. Results and Discussion: This study discovered that the prevalence of mild, moderate and severe depression was 16.6%, 12.8% and 3.8% respectively. The result of the multivariable analysis showed that females have 32% more risk in having more severe depression as compared to males. Indians ethnics have 73% higher odds in developing more severe depression as compared to Malays. Those who were smoker and drink alcohol have 30% higher risk in having more severe depression as compared to non-smoker and who do not drink alcohol. Adolescent who ever used drug had 81% higher chance in having more severe depression as compared to those who never used drug. Adolescent who ever had suicidal ideation had 3-time greater chance in having more severe depression as compared to whom don’t. Adolescent who involved in truancy activity had 31% higher chance in having more severe depression as compared to those who didn’t. Adolescent who ever being bullied had 84% higher chance in having more severe depression as compared to those who never been bullied. Adolescent who have parent or guardian never or rarely know what they were doing had 33% greater risk in having more severe depression as compared to who have parent or guardian know what they do. Lastly, adolescent who have parent or guardian never or rarely understand what their problems and worries had 29% greater risk in having more severe depression as compared to who have parent or guardian understand their problems and worries. Conclusion: The submission of this study is that there is need for prevention and intervention programs, which must be designed and targeted towards adolescents who are exposed to various risks identified in this study.

High blood pressure is a worldwide problem and major global health burden. Whether alone or combined with other metabolic diseases, high blood pressure increases the risk of cardiovascular disease. This study is a secondary data analysis from the National Health and Morbidity Survey 2015, a population-based study that was conducted nationwide in Malaysia using a multi-stage stratified cluster sampling design. A total of 15,738 adults ≥18-years-old were recruited into the study, which reports the prevalence of hypertension stages among adults in Malaysia using the JNC7 criteria and determinants of its severity. The overall prevalence of raised blood pressure was 66.8%, with 45.8% having prehypertension, 15.1% having Stage 1 hypertension, and 5.9% having Stage 2 hypertension. In the multivariate analysis, a higher likelihood of having prehypertension was observed among respondents with advancing age, males (OR = 2.74, 95% CI: 2.41-3.12), Malay ethnicity (OR = 1.21, 95% CI: 1.02-1.44), lower socioeconomic status, and excessive weight. The factors associated with clinical hypertension (Stages 1 and 2) were older age, rural residency (Stage 1 OR = 1.22, Stage 2 OR = 1.28), Malay ethnicity (Stage 2 OR = 1.64), diabetes (Stage 2 OR = 1.47), hypercholesterolemia (Stage 1 OR = 1.34, Stage 2 OR = 1.82), being overweight (Stage 1 OR = 2.86, Stage 2 OR = 3.44), obesity (Stage 1 OR = 9.01, Stage 2 OR = 13.72), and lower socioeconomic status. Almost 70% of Malaysian adults are at a risk of elevated blood pressure. The highest prevalence was in the prehypertension group, which clearly predicts a future incurable burden of the disease. Public health awareness, campaigns through mass and social media, and intervention in the work place should be a priority to control this epidemic.

© Penerbit Universiti Sains Malaysia, 2019. Background: Understanding the individual aspirations of exercise participation is important for promoting physical activity. However, there is a lack of evidence to validate a measurement instrument for exercise-based goal content among Malaysian populations. The purpose of this study was to determine the validity and reliability of the Malay version of the Goal Content in Exercise Questionnaire (GCEQ) for a sample of Malaysian undergraduates. Methods: The original English version of the GCEQ underwent forward and backward translation into the Malay language. A cross-sectional study was conducted. The finalised Malay version was administered to 674 undergraduate students at the Health Campus of the Universiti Sains Malaysia (USM) with a mean age of 20.27 years (SD = 1.35 years). Confirmatory factor analysis (CFA) was conducted for the psychometric evaluation. Results: The measurement model consisted of 20 observed items and five latent factors. CFA demonstrated adequate fit to the data: comparative fit index = 0.929; standardised root mean square residual = 0.052; root mean square error of approximation = 0.061 (90% CI = 0.056, 0.067). The composite reliability coefficients for the five latent factors ranged from 0.777 to 0.851. All the correlations between the factors were less than 0.85, so discriminant validity was achieved. Conclusion: The findings suggested that the Malay version of the GCEQ is valid and reliable for assessing goal content in the exercise context of undergraduates at the Health Campus, USM. This present study was supported by the Research University’s Individual Grant (USMRUI) from Universiti Sains Malaysia [1001/ PPSP/812149].

Introduction: Premature ejaculation (PE) reduces sexual satisfaction and quality of life. Both SSRI Fluoxetine and Dapoxetine have been used in the treatment of PE. Fluoxetine is used as off-label treatment meanwhile Dapoxetine is the first SSRI specifically designed for PE with short half-life and few side effects. Objectives: To compare the PE symptoms and marital satisfaction score between Fluoxetine and Dapoxetine groups. Materials and method: In this clinical trial, 44 participants aged between 18 and 64 with PEDT score of ≥9 from the Primary Care clinic of Hospital USM, Kelantan were recruited and randomized into two groups; Fluoxetine Group(FG) and Dapoxetine Group(DG). They were prescribed with either daily oral Fluoxetine 20mg or Dapoxetine 30mg on demand twice weekly for 8 weeks. PE symptoms were measured using the Premature Ejaculation Diagnostics Tool(PEDT) score and marital satisfaction score were measured using the Dyadic Satisfaction-Dyadic Adjustment Scale(DS-DAS) score. Measurements were made at baseline and at the 8thweek(post intervention). Results: In FG and DG, 22 and 21 participants completed the study, respectively. PEDT scores reduced significantly within both groups[from 11.41 to 5.45(P

Objectives: This study was done to estimate serum anti-Mullerian hormone (AMH) level in polycystic ovary syndrome (PCOS) patients and to correlate serum AMH level with insulin resistance, lipid profile, and adiponectin levels. Materials and Methods: A cross-sectional study was conducted at Hospital Universiti Sains Malaysia (Hospital USM), Health Campus, Kubang Kerian, Kelantan, Malaysia. Thirty newly diagnosed patients with PCOS attending gynecology clinic between July 2016 and April 2017 were recruited. Fasting venous blood samples were collected from the subjects. Serum AMH, insulin, adiponectin, triglycerides, high-density lipoprotein cholesterol (HDL-C), and plasma glucose levels were measured, and insulin resistance was calculated based on homeostasis model of assessment-insulin resistance (HOMA-IR). The serum AMH level was estimated, and the correlation of serum AMH level with the metabolic parameters was analyzed. Results: The median of serum AMH levels in women with PCOS was 6.8 ng/mL (interquartile range: 7.38 ng/mL). There was a significant negative correlation between serum AMH and HOMA-IR or triglyceride levels (r = −0.49, P = 0.006 and r = −0.55, P = 0.002, respectively). A significant positive correlation was observed between serum AMH and serum HDL-C or serum adiponectin levels (r = 0.56, P = 0.001 and r = 0.44, P = 0.014, respectively) in all study subjects. Conclusion: The serum AMH level is associated with HOMA-IR, triglycerides, HDL-C, and adiponectin levels, and hence it may be used as a potential cardiometabolic risk marker in women with PCOS.

Objectives: To determine the prevalence of low back pain (LBP) and its associated factors among the nurses working in the public hospitals of Penang, Malaysia. Methods: A cross-sectional study was conducted on nurses, aged 25–60 years, who had been working for at least three months at six public hospitals of Penang. A proportionate stratified random sampling method was applied to select 1292 respondents. The Malay-validated BACKS Tool questionnaire using a 5-point Likert scale was used to obtain data. Simple and multiple logistic regression analyses were performed. Results: A total of 989 (76.5%) nurses suffered from LBP at a point of time. The factors significantly associated with LBP among the nurses included working more than seven hours [adjusted odds ratio (AOR) (95% confidence interval (CI)) 1.48 (1.06, 1.98)], twisting of the body while working [AOR (95% CI) 1.60 (1.13, 2.26)], manual handling of patients in wards [AOR (95% CI) 1.44 (1.08, 2.07)], and fatigue [AOR (95% CI) 2.63 (1.94, 3.58)]. Conclusion: The prevalence of LBP among the nurses in the public hospitals of Penang was relatively high. The factors predicting LBP included working more than seven hours a day, twisting of the body while working, manual handling, and fatigue. The findings from this study may better enable policymakers to devote resources to minimize low back pain among nurses. The nurses should be encouraged to comply with safe working procedures.

Prompt investigation of food poisoning outbreak are essential, as it usually involves a short incubation period. Utilizing the advancement in mobile technology, a mobile application named MyMAFI (My Mobile Apps for Field Investigation) was developed with the aim to be an alternative and better tool for current practices of field investigation of food poisoning outbreak. A randomized cross-over trial with two arms and two treatment periods was conducted to assess the effectiveness of the newly developed mobile application as compared to the standard paper-based format approach. Thirty-six public health inspectors from all districts in Kelantan participated in this study and they were randomized into two equal sized groups. Group A started the trial as control group using the paper-format investigation form via simulated outbreaks and group B used the mobile application. After a one-month &lsquo, washout period&rsquo, the group was crossed over. The primary outcome measured was the time taken to complete the outbreak investigation. The treatment effects, the period effects and the period-by-treatment interaction were analyzed using Pkcross command in Stata software. There was a significant treatment effect with mean square 21840.5 and its corresponding F statistic 4.47 (p-value = 0.038), which indicated that the mobile application had significantly improve the reporting timeliness. The results also showed that there was a significant period effect (p-value = 0.025), however, the treatment by period interaction was not significant (p-value = 0.830). The newly developed mobile application&mdash, MyMAFI&mdash, can improve the timeliness in reporting for investigation of food poisoning outbreak.

Objectives Promoting physical activity is a global strategy to reduce the burden of cardiovascular disease. This study aimed to determine and compare the effect of light resistance training using either dumbbells or ankle-wrist weights on the anthropometric parameters and body composition of adults in Kelantan, Malaysia. Methods This randomized community trial was conducted in Kelantan, Malaysia, from March through August 2012. Adults with a body mass index (BMI) of more than 23 kg/m 2 were randomized into dumbbell (N = 69) and ankle-wrist (N = 69) weight groups. Participants in the dumbbell group performed structured group exercises three times per week using a pair of one-kilogram dumbbells. Participants in the ankle-wrist weight group were given one pair of 500 gm ankle weights and one pair of 500 gm wrist weights to be worn during the activities of daily living three days per week for at least 20 min. BMI, waist circumference (WC), waist-to-hip ratio (WHR), body fat percentage (BF%) and skeletal muscle percentage (SM%) were measured at baseline, week 6, month 3 and month 6. Results Eighty-nine participants completed this study. There were significant reductions in BMI only at week six for the dumbbell group. No significant BMI changes were observed for the ankle-wrist weight group. Significant improvements of WC, WHR, BF%, and SM% were observed in both intervention groups from baseline at week 6, month 3, and month 6. Conclusion Resistance exercise using either dumbbells or ankle-wrist weights produced significant improvements in certain components of body composition and anthropometric parameters.