Background HIV/AIDS remain a major public health concern in Nigeria. People living with HIV/AIDS ... more Background HIV/AIDS remain a major public health concern in Nigeria. People living with HIV/AIDS (PLWHA) face not only personal medical problems but also social problems associated with the disease such as stigma and discriminatory attitudes. This study provides an insight into HIV/AIDS related stigma and discrimination against PLWHA in Nigeria. Methods The data for this study was extracted from the 2013 Nigeria Demographic and Health Survey conducted by the National Population Commission. All men and women aged 15-49 years, permanent residents and visitors of the households were eligible for the interview. Several questionnaires were used in the survey, some covering questions on HIV/AIDS. Results A total of 56 307 men and women aged 15-49 years participated in this national survey. About half of the population in Nigeria have HIV stigma. Younger persons, men, those without formal education and those within poor wealth index are more likely to have stigma towards PLWHA. In addition, married people are more likely to have stigma on PLWHA and are more likely to blame PLWHA for bringing the disease to the community. Also about half of the population discriminates against PLWHA. However, those with higher levels of education and those from higher wealth index seem to be more compassionate towards PLWHA. About 70% in the population are willing to care for relative with AIDS, even more so among those with higher level of education.
Predicting gestational diabetes by clinical scoring is meant to improve the efficiency of screeni... more Predicting gestational diabetes by clinical scoring is meant to improve the efficiency of screening. The aim of this study was to determine the usefulness of clinical scoring in a Malaysian population. Using a retrospective cohort of 1997 women, a predictive model was developed and validated on a separate set of 1,000 patients. The efficiency of screening with risk scores was then compared with universal screening. The model derived was well calibrated (p 0 0.80) with an AUC 0.74 (95 % CI 0.71-0.76). Different combinations of thresholds for the risk score produced a screening reduction between 26 % and 29 % (Sensitivity-86 % compared to 97 % from universal screening) in Strategy 1. Strategy 2 had no screening reduction but had a higher sensitivity of 95 %. The performance of the risk score was moderate and the screening reduction minimal. Therefore the usefulness of clinical scoring in our population is of limited value.
International Journal of Environmental Research and Public Health
Sarcopenia is a condition that is highly prevalent among older adults. This condition is linked t... more Sarcopenia is a condition that is highly prevalent among older adults. This condition is linked to numerous adverse health outcomes, including cognitive impairment that impairs healthy ageing. While sarcopenia and cognitive impairment may share a common pathway, limited longitudinal studies exist to show the relationship between these two conditions. Therefore, this study aimed to examine the longitudinal association between sarcopenia and cognitive impairment. This is a cohort study among older adults residing in Kuala Pilah District, Negeri Sembilan, Malaysia. There were 2404 respondents at the baseline and 1946 respondents at one-year follow-up. Cognitive impairment was determined using Mini-mental State Examination scores. Sarcopenia was identified using the Asian Working Group for Sarcopenia 2019 criteria, gait speed was measured using a 4-meter gait test, handgrip strength was assessed using Jamar handheld dynamometer, and appendicular skeletal muscle mass was measured using b...
To determine prevalence and prevalence ratio of functional limitation amongst older people with c... more To determine prevalence and prevalence ratio of functional limitation amongst older people with combined chronic diseases and co-morbid depressive symptoms compared with older people with either chronic disease or depressive symptoms alone.
To determine the prevalence, distribution, severity and treatment need of enamel opacities among ... more To determine the prevalence, distribution, severity and treatment need of enamel opacities among 11-12 year-old school children in a fluoridated urban community. A cross-sectional descriptive survey of enamel opacities in 11-12 year-old schoolchildren. A questionnaire survey and a clinical examination of erupted teeth using the Modified DDE Index was conducted on schoolchildren in randomly selected schools. 957 schoolchildren from government schools in Kuala Lumpur comprising the three major ethnic groups of Malay, Chinese and Indian children. The severity of enamel opacities was assessed by the extent of buccal surface involvement. Normative treatment need was based on severity of opacities. Enamel opacities were found in 90.7% of subjects and 47.2% of teeth. Malays have the highest prevalence with Chinese the least. Although ethnic differences is statistically significant (p < 0.01), the differences in prevalence between ethnicity is small. The most common type of defect was "diffuse opacities" (88.6% of subjects). Most subjects (70%) showed bilateral distribution of diffuse opacities indicating a systemic disturbance. Posterior teeth were twice more commonly affected (p < 0.05). The majority of opacities in anterior teeth (66.7%) were minor, involving less than 1/3 of the labial surface. Only 0.6% of the whole sample required some form of aesthetic intervention. Despite the high prevalence of enamel opacities, the degree of severity is very mild with only minimal aesthetic and public health concern.
Background: The study on Clustering of Lifestyle risk factors and Understanding its association w... more Background: The study on Clustering of Lifestyle risk factors and Understanding its association with Stress on health and wellbeing among school Teachers in Malaysia (CLUSTer) is a prospective cohort study which aims to extensively study teachers in Malaysia with respect to clustering of lifestyle risk factors and stress, and subsequently, to follow-up the population for important health outcomes. Method/design: This study is being conducted in six states within Peninsular Malaysia. From each state, schools from each district are randomly selected and invited to participate in the study. Once the schools agree to participate, all teachers who fulfilled the inclusion criteria are invited to participate. Data collection includes a questionnaire survey and health assessment. Information collected in the questionnaire includes socio-demographic characteristics, participants' medical history and family history of chronic diseases, teaching characteristics and burden, questions on smoking, alcohol consumption and physical activities (IPAQ); a food frequency questionnaire, the job content questionnaire (JCQ); depression, anxiety and stress scale (DASS21); health related quality of life (SF12-V2); Voice Handicap Index 10 on voice disorder, questions on chronic pain, sleep duration and obstetric history for female participants. Following blood drawn for predefined clinical tests, additional blood and urine specimens are collected and stored for future analysis. Active follow up of exposure and health outcomes will be carried out every two years via telephone or face to face contact. Data collection started in March 2013 and as of the end of March 2014 has been completed for four states: Kuala Lumpur, Selangor, Melaka and Penang. Approximately 6580 participants have been recruited. The first round of data collection and blood sampling is expected to be completed by the end of 2014 with an expected 10,000 participants recruited. Discussion: Our study will provide a good basis for exploring the clustering of lifestyle risk factors and stress and its association with major chronic medical conditions such as obesity, hypertension, impaired glucose tolerance, diabetes mellitus, coronary heart diseases, kidney failure and cancers among teachers.
Background. The objective of this study is to look at how well patient history and examination fi... more Background. The objective of this study is to look at how well patient history and examination findings can be used in screening for angina. Methods. A total of 887 records were extracted from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. The data was cleaned; 69 possible variables were extracted, and univariate and multivariate analyses were performed. Results. From the univariate analysis, it was found that 19 variables are significantly associated with a diagnosis of angina. However, multiple logistic regression reveals that only 11 of these 19 variables are significantly related to a diagnosis of angina. Chest pain aggravated by exertion, history of diabetes mellitus, and history of heart disease (regardless of whether on treatment or not) are significant predictors of angina. Sudden onset chest pain, pain that is persistent, pain relieved by other means, pain aggravated by inspiration, and findings of rhonchi are important predictors of a diagnosis other than angina. The degree of overall accuracy is high at 71.3%. There are eight factors which are significant in the univariate analysis but are not significant in the multivariate analysis. These are marital status, pain relieved by glyceryl trinitrate (GTN), pain relieved by rest, associated nausea, pain aggravated by posture, pain aggravated by cough, history of hypertension, and history of smoking. Conclusions. These findings suggest that examination findings do not play a significant role in screening for angina.
Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important i... more Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important in an era of rising costs, patient safety concerns and evidence-based health care. CE and EBM research in the Asia Pacific region have grown significantly. However, there are three main challenges such as linking evidence to practice and policy; developing a strong collaborative network; and a need for resources and technical expertise to produce evidence. The Cochrane Collaboration is a possible solution to resolve above challenges identified, particularly the challenge of transforming evidence to practice. In addition, training can be carried out to enhance technical expertise in the region and there is also the promising potential that collaborations could extend beyond systematic reviews. To improve the adoption of evidence-based health policy, selection of the best evidence for the right audience and focusing on the relevant issues through appropriate methodology are essential. Information on effectiveness and cost effectiveness needs to be highlighted for policy makers. The way forward to strengthen research and capacity building is to establish the Asia Pacific Consortium for CE and EBM. The consortium would help to create mutually rewarding scientific research and collaborations that will augur well for advances in CE and EBM.
Methods: We used an adapted version of a 26-item validated questionnaire, including four subscale... more Methods: We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP). The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's a to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. Results: In total, 526 students (224 UI, 202 UM, and 100 UMCU) completed the questionnaires. In the three medical schools, Cronbach's a for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD) score as the following: knowledge 5.04 (0.4) vs. 4.73 (0.69) and 4.24 (0.74), p B0.001; attitude 4.52 (0.64) vs. 3.85 (0.68) and 3.55 (0.63), p B0.001; behavior 2.62 (0.55) vs. 2.35 (0.71) and 2.39 (0.92), p00.016; and future use of EBP 4.32 (0.59) vs. 4.08 (0.62) and 3.7 (0.71), p B0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.0490.4 to 5.3590.51; p B0.001) and UM students (from average 4.2490.74 to 4.5390.72; p B0.001) but not UI. The post-module scores for attitude did not change in the three medical schools. Conclusion: EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in premodule scores are most likely related to differences in the system and infrastructure of both medical schools and their curriculum.
Background: Ever-increasing numbers of opioid use disorder (OUD) in Canada has created the recent... more Background: Ever-increasing numbers of opioid use disorder (OUD) in Canada has created the recent opioid crisis. One common treatment for OUD is methadone maintenance treatment (MMT). Various factors, including being a parent which entails specific stressors, may increase susceptibility to negative treatment outcomes. This study aims to investigate differences between OUD patients with and without children in socio-demographic and clinical outcomes. Methods: Data for this study are part of a larger program. All participants are 18+ years old with OUD, provided consent, and receiving MMT. We performed a multivariable logistic regression to examine the differences between participants' parental status, sociodemographic variables, and clinical parameters including MMT outcomes. We performed subgroup analyses on individuals with children younger than 18. Results: A total of 1099 participants were included, with 64% having children. Participants with children were older (OR 1.06, 95% CI 1.04, 1.08), more likely to be female (OR 2.39, 95% CI 1.75, 3.27), living with a partner (OR 1.75, 95% CI 1.27, 2.41), first exposed to opioids through a prescription (OR 1.517, 95% CI 1.13, 2.04) and had lower levels of education (OR 1.86, 95% CI 1.20, 2.87). There was no significant difference in illicit opioid use patterns between groups. Same results held true in the subgroup analyses based on the age of the children except for participant age. Conclusion: Our results demonstrate social and demographic differences between parents and non-parents receiving MMT. These differences highlight the need to understand necessary additional support for parents such as child support and other necessary therapies.
Background: Poor adherence is a significant nursing and public health concern because it affects ... more Background: Poor adherence is a significant nursing and public health concern because it affects patients' quality of life and it compounds disease burden of the growing coronary heart disease population. Promoting optimal patient adherence to cardiac-health enhancing recommendations by healthcare providers can reduce mortality and morbidity risk after ACS. Aim: This paper sought to examine rates and predictors of patient adherence to health recommendations after acute coronary syndrome (ACS). Methods: A cross sectional survey of 210 Malaysian patients using consecutive sampling was conducted in early 2009 at a tertiary teaching hospital. The Medical Outcome Study Specific Adherence Scale (MOSSAS) questionnaire was adapted to measure the extent of patient adherence to recalled health recommendations. Logistic regression modelling was applied to determine odds ratio and factors of suboptimal adherence.
Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important i... more Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important in an era of rising costs, patient safety concerns and evidence-based health care. CE and EBM research in the Asia Pacific region have grown significantly. However, there are three main challenges such as linking evidence to practice and policy; developing a strong collaborative network; and a need for resources and technical expertise to produce evidence. The Cochrane Collaboration is a possible solution to resolve above challenges identified, particularly the challenge of transforming evidence to practice. In addition, training can be carried out to enhance technical expertise in the region and there is also the promising potential that collaborations could extend beyond systematic reviews. To improve the adoption of evidence-based health policy, selection of the best evidence for the right audience and focusing on the relevant issues through appropriate methodology are essential. Information on effectiveness and cost effectiveness needs to be highlighted for policy makers. The way forward to strengthen research and capacity building is to establish the Asia Pacific Consortium for CE and EBM. The consortium would help to create mutually rewarding scientific research and collaborations that will augur well for advances in CE and EBM.
Physical Activity Scale for the Elderly (PASE) is among the frequently used self-reported physica... more Physical Activity Scale for the Elderly (PASE) is among the frequently used self-reported physical activity assessment for older adults. This study aims to assess the validity and reliability of a Malay version of this scale (PASE-M). A total of 408 community-dwelling older adults were enrolled. Concurrent validity was evaluated by Spearman’s rank correlation coefficients between PASE with physical and psychosocial measures. Test-retest reliability was determined by the intraclass correlation coefficient (ICC). The mean PASE-M scores at baseline and follow-up were 94.96 (SD 62.82) and 92.19 (SD 64.02). Fair to moderate correlation were found between PASE-M and physical function scale, IADL ( rs = 0.429, P < .001), walking speed ( rs = 0.270, P < .001), grip strength ( rs = 0.313-0.339, P < .001), and perceived health status ( rs = −0.124, P = .016). Test-retest reliability was adequate (ICC = 0.493). The Malay version of PASE was shown to have acceptable validity and reliab...
Background: The study on Clustering of Lifestyle risk factors and Understanding its association w... more Background: The study on Clustering of Lifestyle risk factors and Understanding its association with Stress on health and wellbeing among school Teachers in Malaysia (CLUSTer) is a prospective cohort study which aims to extensively study teachers in Malaysia with respect to clustering of lifestyle risk factors and stress, and subsequently, to follow-up the population for important health outcomes. Method/design: This study is being conducted in six states within Peninsular Malaysia. From each state, schools from each district are randomly selected and invited to participate in the study. Once the schools agree to participate, all teachers who fulfilled the inclusion criteria are invited to participate. Data collection includes a questionnaire survey and health assessment. Information collected in the questionnaire includes socio-demographic characteristics, participants' medical history and family history of chronic diseases, teaching characteristics and burden, questions on smoking, alcohol consumption and physical activities (IPAQ); a food frequency questionnaire, the job content questionnaire (JCQ); depression, anxiety and stress scale (DASS21); health related quality of life (SF12-V2); Voice Handicap Index 10 on voice disorder, questions on chronic pain, sleep duration and obstetric history for female participants. Following blood drawn for predefined clinical tests, additional blood and urine specimens are collected and stored for future analysis. Active follow up of exposure and health outcomes will be carried out every two years via telephone or face to face contact. Data collection started in March 2013 and as of the end of March 2014 has been completed for four states: Kuala Lumpur, Selangor, Melaka and Penang. Approximately 6580 participants have been recruited. The first round of data collection and blood sampling is expected to be completed by the end of 2014 with an expected 10,000 participants recruited.
Background HIV/AIDS remain a major public health concern in Nigeria. People living with HIV/AIDS ... more Background HIV/AIDS remain a major public health concern in Nigeria. People living with HIV/AIDS (PLWHA) face not only personal medical problems but also social problems associated with the disease such as stigma and discriminatory attitudes. This study provides an insight into HIV/AIDS related stigma and discrimination against PLWHA in Nigeria. Methods The data for this study was extracted from the 2013 Nigeria Demographic and Health Survey conducted by the National Population Commission. All men and women aged 15-49 years, permanent residents and visitors of the households were eligible for the interview. Several questionnaires were used in the survey, some covering questions on HIV/AIDS. Results A total of 56 307 men and women aged 15-49 years participated in this national survey. About half of the population in Nigeria have HIV stigma. Younger persons, men, those without formal education and those within poor wealth index are more likely to have stigma towards PLWHA. In addition, married people are more likely to have stigma on PLWHA and are more likely to blame PLWHA for bringing the disease to the community. Also about half of the population discriminates against PLWHA. However, those with higher levels of education and those from higher wealth index seem to be more compassionate towards PLWHA. About 70% in the population are willing to care for relative with AIDS, even more so among those with higher level of education.
Predicting gestational diabetes by clinical scoring is meant to improve the efficiency of screeni... more Predicting gestational diabetes by clinical scoring is meant to improve the efficiency of screening. The aim of this study was to determine the usefulness of clinical scoring in a Malaysian population. Using a retrospective cohort of 1997 women, a predictive model was developed and validated on a separate set of 1,000 patients. The efficiency of screening with risk scores was then compared with universal screening. The model derived was well calibrated (p 0 0.80) with an AUC 0.74 (95 % CI 0.71-0.76). Different combinations of thresholds for the risk score produced a screening reduction between 26 % and 29 % (Sensitivity-86 % compared to 97 % from universal screening) in Strategy 1. Strategy 2 had no screening reduction but had a higher sensitivity of 95 %. The performance of the risk score was moderate and the screening reduction minimal. Therefore the usefulness of clinical scoring in our population is of limited value.
International Journal of Environmental Research and Public Health
Sarcopenia is a condition that is highly prevalent among older adults. This condition is linked t... more Sarcopenia is a condition that is highly prevalent among older adults. This condition is linked to numerous adverse health outcomes, including cognitive impairment that impairs healthy ageing. While sarcopenia and cognitive impairment may share a common pathway, limited longitudinal studies exist to show the relationship between these two conditions. Therefore, this study aimed to examine the longitudinal association between sarcopenia and cognitive impairment. This is a cohort study among older adults residing in Kuala Pilah District, Negeri Sembilan, Malaysia. There were 2404 respondents at the baseline and 1946 respondents at one-year follow-up. Cognitive impairment was determined using Mini-mental State Examination scores. Sarcopenia was identified using the Asian Working Group for Sarcopenia 2019 criteria, gait speed was measured using a 4-meter gait test, handgrip strength was assessed using Jamar handheld dynamometer, and appendicular skeletal muscle mass was measured using b...
To determine prevalence and prevalence ratio of functional limitation amongst older people with c... more To determine prevalence and prevalence ratio of functional limitation amongst older people with combined chronic diseases and co-morbid depressive symptoms compared with older people with either chronic disease or depressive symptoms alone.
To determine the prevalence, distribution, severity and treatment need of enamel opacities among ... more To determine the prevalence, distribution, severity and treatment need of enamel opacities among 11-12 year-old school children in a fluoridated urban community. A cross-sectional descriptive survey of enamel opacities in 11-12 year-old schoolchildren. A questionnaire survey and a clinical examination of erupted teeth using the Modified DDE Index was conducted on schoolchildren in randomly selected schools. 957 schoolchildren from government schools in Kuala Lumpur comprising the three major ethnic groups of Malay, Chinese and Indian children. The severity of enamel opacities was assessed by the extent of buccal surface involvement. Normative treatment need was based on severity of opacities. Enamel opacities were found in 90.7% of subjects and 47.2% of teeth. Malays have the highest prevalence with Chinese the least. Although ethnic differences is statistically significant (p &amp;amp;amp;amp;amp;amp;lt; 0.01), the differences in prevalence between ethnicity is small. The most common type of defect was &amp;amp;amp;amp;amp;amp;quot;diffuse opacities&amp;amp;amp;amp;amp;amp;quot; (88.6% of subjects). Most subjects (70%) showed bilateral distribution of diffuse opacities indicating a systemic disturbance. Posterior teeth were twice more commonly affected (p &amp;amp;amp;amp;amp;amp;lt; 0.05). The majority of opacities in anterior teeth (66.7%) were minor, involving less than 1/3 of the labial surface. Only 0.6% of the whole sample required some form of aesthetic intervention. Despite the high prevalence of enamel opacities, the degree of severity is very mild with only minimal aesthetic and public health concern.
Background: The study on Clustering of Lifestyle risk factors and Understanding its association w... more Background: The study on Clustering of Lifestyle risk factors and Understanding its association with Stress on health and wellbeing among school Teachers in Malaysia (CLUSTer) is a prospective cohort study which aims to extensively study teachers in Malaysia with respect to clustering of lifestyle risk factors and stress, and subsequently, to follow-up the population for important health outcomes. Method/design: This study is being conducted in six states within Peninsular Malaysia. From each state, schools from each district are randomly selected and invited to participate in the study. Once the schools agree to participate, all teachers who fulfilled the inclusion criteria are invited to participate. Data collection includes a questionnaire survey and health assessment. Information collected in the questionnaire includes socio-demographic characteristics, participants' medical history and family history of chronic diseases, teaching characteristics and burden, questions on smoking, alcohol consumption and physical activities (IPAQ); a food frequency questionnaire, the job content questionnaire (JCQ); depression, anxiety and stress scale (DASS21); health related quality of life (SF12-V2); Voice Handicap Index 10 on voice disorder, questions on chronic pain, sleep duration and obstetric history for female participants. Following blood drawn for predefined clinical tests, additional blood and urine specimens are collected and stored for future analysis. Active follow up of exposure and health outcomes will be carried out every two years via telephone or face to face contact. Data collection started in March 2013 and as of the end of March 2014 has been completed for four states: Kuala Lumpur, Selangor, Melaka and Penang. Approximately 6580 participants have been recruited. The first round of data collection and blood sampling is expected to be completed by the end of 2014 with an expected 10,000 participants recruited. Discussion: Our study will provide a good basis for exploring the clustering of lifestyle risk factors and stress and its association with major chronic medical conditions such as obesity, hypertension, impaired glucose tolerance, diabetes mellitus, coronary heart diseases, kidney failure and cancers among teachers.
Background. The objective of this study is to look at how well patient history and examination fi... more Background. The objective of this study is to look at how well patient history and examination findings can be used in screening for angina. Methods. A total of 887 records were extracted from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. The data was cleaned; 69 possible variables were extracted, and univariate and multivariate analyses were performed. Results. From the univariate analysis, it was found that 19 variables are significantly associated with a diagnosis of angina. However, multiple logistic regression reveals that only 11 of these 19 variables are significantly related to a diagnosis of angina. Chest pain aggravated by exertion, history of diabetes mellitus, and history of heart disease (regardless of whether on treatment or not) are significant predictors of angina. Sudden onset chest pain, pain that is persistent, pain relieved by other means, pain aggravated by inspiration, and findings of rhonchi are important predictors of a diagnosis other than angina. The degree of overall accuracy is high at 71.3%. There are eight factors which are significant in the univariate analysis but are not significant in the multivariate analysis. These are marital status, pain relieved by glyceryl trinitrate (GTN), pain relieved by rest, associated nausea, pain aggravated by posture, pain aggravated by cough, history of hypertension, and history of smoking. Conclusions. These findings suggest that examination findings do not play a significant role in screening for angina.
Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important i... more Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important in an era of rising costs, patient safety concerns and evidence-based health care. CE and EBM research in the Asia Pacific region have grown significantly. However, there are three main challenges such as linking evidence to practice and policy; developing a strong collaborative network; and a need for resources and technical expertise to produce evidence. The Cochrane Collaboration is a possible solution to resolve above challenges identified, particularly the challenge of transforming evidence to practice. In addition, training can be carried out to enhance technical expertise in the region and there is also the promising potential that collaborations could extend beyond systematic reviews. To improve the adoption of evidence-based health policy, selection of the best evidence for the right audience and focusing on the relevant issues through appropriate methodology are essential. Information on effectiveness and cost effectiveness needs to be highlighted for policy makers. The way forward to strengthen research and capacity building is to establish the Asia Pacific Consortium for CE and EBM. The consortium would help to create mutually rewarding scientific research and collaborations that will augur well for advances in CE and EBM.
Methods: We used an adapted version of a 26-item validated questionnaire, including four subscale... more Methods: We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP). The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's a to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. Results: In total, 526 students (224 UI, 202 UM, and 100 UMCU) completed the questionnaires. In the three medical schools, Cronbach's a for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD) score as the following: knowledge 5.04 (0.4) vs. 4.73 (0.69) and 4.24 (0.74), p B0.001; attitude 4.52 (0.64) vs. 3.85 (0.68) and 3.55 (0.63), p B0.001; behavior 2.62 (0.55) vs. 2.35 (0.71) and 2.39 (0.92), p00.016; and future use of EBP 4.32 (0.59) vs. 4.08 (0.62) and 3.7 (0.71), p B0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.0490.4 to 5.3590.51; p B0.001) and UM students (from average 4.2490.74 to 4.5390.72; p B0.001) but not UI. The post-module scores for attitude did not change in the three medical schools. Conclusion: EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in premodule scores are most likely related to differences in the system and infrastructure of both medical schools and their curriculum.
Background: Ever-increasing numbers of opioid use disorder (OUD) in Canada has created the recent... more Background: Ever-increasing numbers of opioid use disorder (OUD) in Canada has created the recent opioid crisis. One common treatment for OUD is methadone maintenance treatment (MMT). Various factors, including being a parent which entails specific stressors, may increase susceptibility to negative treatment outcomes. This study aims to investigate differences between OUD patients with and without children in socio-demographic and clinical outcomes. Methods: Data for this study are part of a larger program. All participants are 18+ years old with OUD, provided consent, and receiving MMT. We performed a multivariable logistic regression to examine the differences between participants' parental status, sociodemographic variables, and clinical parameters including MMT outcomes. We performed subgroup analyses on individuals with children younger than 18. Results: A total of 1099 participants were included, with 64% having children. Participants with children were older (OR 1.06, 95% CI 1.04, 1.08), more likely to be female (OR 2.39, 95% CI 1.75, 3.27), living with a partner (OR 1.75, 95% CI 1.27, 2.41), first exposed to opioids through a prescription (OR 1.517, 95% CI 1.13, 2.04) and had lower levels of education (OR 1.86, 95% CI 1.20, 2.87). There was no significant difference in illicit opioid use patterns between groups. Same results held true in the subgroup analyses based on the age of the children except for participant age. Conclusion: Our results demonstrate social and demographic differences between parents and non-parents receiving MMT. These differences highlight the need to understand necessary additional support for parents such as child support and other necessary therapies.
Background: Poor adherence is a significant nursing and public health concern because it affects ... more Background: Poor adherence is a significant nursing and public health concern because it affects patients' quality of life and it compounds disease burden of the growing coronary heart disease population. Promoting optimal patient adherence to cardiac-health enhancing recommendations by healthcare providers can reduce mortality and morbidity risk after ACS. Aim: This paper sought to examine rates and predictors of patient adherence to health recommendations after acute coronary syndrome (ACS). Methods: A cross sectional survey of 210 Malaysian patients using consecutive sampling was conducted in early 2009 at a tertiary teaching hospital. The Medical Outcome Study Specific Adherence Scale (MOSSAS) questionnaire was adapted to measure the extent of patient adherence to recalled health recommendations. Logistic regression modelling was applied to determine odds ratio and factors of suboptimal adherence.
Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important i... more Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important in an era of rising costs, patient safety concerns and evidence-based health care. CE and EBM research in the Asia Pacific region have grown significantly. However, there are three main challenges such as linking evidence to practice and policy; developing a strong collaborative network; and a need for resources and technical expertise to produce evidence. The Cochrane Collaboration is a possible solution to resolve above challenges identified, particularly the challenge of transforming evidence to practice. In addition, training can be carried out to enhance technical expertise in the region and there is also the promising potential that collaborations could extend beyond systematic reviews. To improve the adoption of evidence-based health policy, selection of the best evidence for the right audience and focusing on the relevant issues through appropriate methodology are essential. Information on effectiveness and cost effectiveness needs to be highlighted for policy makers. The way forward to strengthen research and capacity building is to establish the Asia Pacific Consortium for CE and EBM. The consortium would help to create mutually rewarding scientific research and collaborations that will augur well for advances in CE and EBM.
Physical Activity Scale for the Elderly (PASE) is among the frequently used self-reported physica... more Physical Activity Scale for the Elderly (PASE) is among the frequently used self-reported physical activity assessment for older adults. This study aims to assess the validity and reliability of a Malay version of this scale (PASE-M). A total of 408 community-dwelling older adults were enrolled. Concurrent validity was evaluated by Spearman’s rank correlation coefficients between PASE with physical and psychosocial measures. Test-retest reliability was determined by the intraclass correlation coefficient (ICC). The mean PASE-M scores at baseline and follow-up were 94.96 (SD 62.82) and 92.19 (SD 64.02). Fair to moderate correlation were found between PASE-M and physical function scale, IADL ( rs = 0.429, P < .001), walking speed ( rs = 0.270, P < .001), grip strength ( rs = 0.313-0.339, P < .001), and perceived health status ( rs = −0.124, P = .016). Test-retest reliability was adequate (ICC = 0.493). The Malay version of PASE was shown to have acceptable validity and reliab...
Background: The study on Clustering of Lifestyle risk factors and Understanding its association w... more Background: The study on Clustering of Lifestyle risk factors and Understanding its association with Stress on health and wellbeing among school Teachers in Malaysia (CLUSTer) is a prospective cohort study which aims to extensively study teachers in Malaysia with respect to clustering of lifestyle risk factors and stress, and subsequently, to follow-up the population for important health outcomes. Method/design: This study is being conducted in six states within Peninsular Malaysia. From each state, schools from each district are randomly selected and invited to participate in the study. Once the schools agree to participate, all teachers who fulfilled the inclusion criteria are invited to participate. Data collection includes a questionnaire survey and health assessment. Information collected in the questionnaire includes socio-demographic characteristics, participants' medical history and family history of chronic diseases, teaching characteristics and burden, questions on smoking, alcohol consumption and physical activities (IPAQ); a food frequency questionnaire, the job content questionnaire (JCQ); depression, anxiety and stress scale (DASS21); health related quality of life (SF12-V2); Voice Handicap Index 10 on voice disorder, questions on chronic pain, sleep duration and obstetric history for female participants. Following blood drawn for predefined clinical tests, additional blood and urine specimens are collected and stored for future analysis. Active follow up of exposure and health outcomes will be carried out every two years via telephone or face to face contact. Data collection started in March 2013 and as of the end of March 2014 has been completed for four states: Kuala Lumpur, Selangor, Melaka and Penang. Approximately 6580 participants have been recruited. The first round of data collection and blood sampling is expected to be completed by the end of 2014 with an expected 10,000 participants recruited.
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Papers by A. Bulgiba