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Shamsul Azhar Shah,1 Nazarudin Safian,1 Zulkefley Mohammad,1 Siti Rohani Nurumal,1 Wan Abdul Hannan Wan Ibadullah,1 Juliana Mansor,1 Saharuddin Ahmad,2 Mohd Rohaizat Hassan,1 Yugo Shobugawa3 1Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia; 2Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia; 3Department of Active Aging, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8510, JapanCorrespondence: Shamsul Azhar Shah, Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia, Tel +60 3-9145 8787, Fax +60 3-91456670, Email drsham@ppukm.ukm.edu.myPurpose: Handgrip strength (HGS) is indicative of overall physical health among older adults. A decrease in HGS may be associated with an increased risk of disease. The aim of this study is to determine the factors associated with HGS among older adults in Malaysia.Patients and Methods: One thousand two hundred four (1204) participants from urban and rural areas in Selangor state, Malaysia, were recruited. Sociodemographic and health-related conditions were gathered through a comprehensive face-to-face interview, followed by HGS assessments by a handgrip dynamometer. Subsequently, multiple linear regression was used to test the main association with the HGS.Results: A total of 691 participants (57.4%) were male, and 513 (42.6%) were female. Males had a mean HGS of 30.0 (SD 7.53) kg, and females had a mean HGS of 19.4 (SD 5.28) kg. Males’ handgrip strength was significantly reduced with increasing age, physically inactive, and diabetes (all at the level p< 0.001) after adjusting for social-demographic characteristics and health-related variables. Meanwhile, for females, the HGS was significantly decreased with age (p< 0.001), physically inactive (p< 0.001) and hypertension (p=0.03)

Introduction: Immunisations are one of the most effective public health interventions, reducing or eliminating the burden of many infectious diseases. This study aims to establish the construct validity of a newly developed adult immunisation perceptions questionnaire among Malaysians. Methods: The Adult Immunisation Perceptions-Questionnaire (AIP-Q) was created following literature reviews on The Health Belief Model. Primarily, 64 questions were pooled, followed by face validity by experts, pretested via 20 healthcare personnel and later translate into the Malay language. A total of 305 respondents were selected for the construct validation process. Varimax rotation method used in the analysis for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) done using AMOS software. Results: Ten constructs were produced as predicted in EFA: health believes, experience, knowledge, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, and 2 cues for action. Thirteen items with low factor loading and unrelated to the recovered domains were removed from being included in CFA. In path analysis, the scale fitted ?2/df=1.943 (n=305) =p<0.001, CFI=0.908, IFI=0.909, TLI=0.901 and RMSEA=0.056. Strong factor loading was found across the final items, ranged from 0.53 to 0.94 with a good reliability test (Cronbach Alpha, AVE and CR values) for all constructs. Conclusion: The final AIP-Q consists of 10 domains with 45 items that give a promising psychometric property. This questionnaire can measure the perceptions of adult immunisation among the Malaysian population and can be utilized for the nationwide study.

Introduction: Tobacco is the only legal product that kills a large proportion of its consumers when used as intended by its manufacturer. The effect of nicotine as a driving substance on smoking has been established for decades. Still, very little is known on how the biopsychosocial determinants relationship affects levels of nicotine addiction in smokers, especially in the urban low-income population. The study aimed to validate measurement scales related to biopsychosocial factors that will be used in the future study to evaluate biopsychosocial components that influence nicotine addiction among urban poor smokers. Methods: Exploratory factor analysis (EFA) using the principal component analysis with varimax rotation and Kaiser normalization was used to assess the factor structure. Then, the confirmatory factor analysis (CFA) was conducted to assess the unidimensionality, validity, and reliability of the latent construct. Results: EFA showed extraction of factors according to their original scales with all factor loading and communality's values were above 0.5. During CFA, factor loading less than 0.6 was deleted. Convergent validity verified by computing the Average Variance Extracted (AVE) for every construct range between 0.528 – 0.801. The Fitness Indexes achieved the required level (RMSEA=0.05, CFI=0.937, Chisq/df=1.7). Meanwhile, the Discriminant Validity Index range between 0.75-0.89, which is higher than the correlation coefficient value. Internal consistency assessed from Composite Reliability range between 0.714-0.965. Conclusion: The measurement scales are valid and reliable to assess the intended constructs among low-income male smokers in the urban area.

Introduction: Immunisations are one of the most effective public health interventions, reducing or eliminating the burden of many infectious diseases. This study aims to establish the construct validity of a newly developed adult immunisation perceptions questionnaire among Malaysians. Methods: The Adult Immunisation Perceptions-Questionnaire (AIP-Q) was created following literature reviews on The Health Belief Model. Primarily, 64 questions were pooled, followed by face validity by experts, pretested via 20 healthcare personnel and later translate into the Malay language. A total of 305 respondents were selected for the construct validation process. Varimax rotation method used in the analysis for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) done using AMOS software. Results: Ten constructs were produced as predicted in EFA: health believes, experience, knowledge, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, and 2 cues for action. Thirteen items with low factor loading and unrelated to the recovered domains were removed from being included in CFA. In path analysis, the scale fitted ?2/df=1.943 (n=305) =p<0.001, CFI=0.908, IFI=0.909, TLI=0.901 and RMSEA=0.056. Strong factor loading was found across the final items, ranged from 0.53 to 0.94 with a good reliability test (Cronbach Alpha, AVE and CR values) for all constructs. Conclusion: The final AIP-Q consists of 10 domains with 45 items that give a promising psychometric property. This questionnaire can measure the perceptions of adult immunisation among the Malaysian population and can be utilized for the nationwide study.

Introduction: Tobacco is the only legal product that kills a large proportion of its consumers when used as intended by its manufacturer. The effect of nicotine as a driving substance on smoking has been established for decades. Still, very little is known on how the biopsychosocial determinants relationship affects levels of nicotine addiction in smokers, especially in the urban low-income population. The study aimed to validate measurement scales related to biopsychosocial factors that will be used in the future study to evaluate biopsychosocial components that influence nicotine addiction among urban poor smokers. Methods: Exploratory factor analysis (EFA) using the principal component analysis with varimax rotation and Kaiser normalization was used to assess the factor structure. Then, the confirmatory factor analysis (CFA) was conducted to assess the unidimensionality, validity, and reliability of the latent construct. Results: EFA showed extraction of factors according to their original scales with all factor loading and communality's values were above 0.5. During CFA, factor loading less than 0.6 was deleted. Convergent validity verified by computing the Average Variance Extracted (AVE) for every construct range between 0.528 – 0.801. The Fitness Indexes achieved the required level (RMSEA=0.05, CFI=0.937, Chisq/df=1.7). Meanwhile, the Discriminant Validity Index range between 0.75-0.89, which is higher than the correlation coefficient value. Internal consistency assessed from Composite Reliability range between 0.714-0.965. Conclusion: The measurement scales are valid and reliable to assess the intended constructs among low-income male smokers in the urban area.

Introduction: Tobacco is the only legal product that kills a large proportion of its consumers when used as intended by its manufacturer. The effect of nicotine as a driving substance on smoking has been established for decades. Still, very little is known on how the biopsychosocial determinants relationship affects levels of nicotine addiction in smokers, especially in the urban low-income population. The study aimed to validate measurement scales related to biopsychosocial factors that will be used in the future study to evaluate biopsychosocial components that influence nicotine addiction among urban poor smokers. Methods: Exploratory factor analysis (EFA) using the principal component analysis with varimax rotation and Kaiser normalization was used to assess the factor structure. Then, the confirmatory factor analysis (CFA) was conducted to assess the unidimensionality, validity, and reliability of the latent construct. Results: EFA showed extraction of factors according to their original scales with all factor loading and communality's values were above 0.5. During CFA, factor loading less than 0.6 was deleted. Convergent validity verified by computing the Average Variance Extracted (AVE) for every construct range between 0.528 – 0.801. The Fitness Indexes achieved the required level (RMSEA=0.05, CFI=0.937, Chisq/df=1.7). Meanwhile, the Discriminant Validity Index range between 0.75-0.89, which is higher than the correlation coefficient value. Internal consistency assessed from Composite Reliability range between 0.714-0.965. Conclusion: The measurement scales are valid and reliable to assess the intended constructs among low-income male smokers in the urban area.

Introduction: Immunisations are one of the most effective public health interventions, reducing or eliminating the burden of many infectious diseases. This study aims to establish the construct validity of a newly developed adult immunisation perceptions questionnaire among Malaysians. Methods: The Adult Immunisation Perceptions-Questionnaire (AIP-Q) was created following literature reviews on The Health Belief Model. Primarily, 64 questions were pooled, followed by face validity by experts, pretested via 20 healthcare personnel and later translate into the Malay language. A total of 305 respondents were selected for the construct validation process. Varimax rotation method used in the analysis for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) done using AMOS software. Results: Ten constructs were produced as predicted in EFA: health believes, experience, knowledge, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, and 2 cues for action. Thirteen items with low factor loading and unrelated to the recovered domains were removed from being included in CFA. In path analysis, the scale fitted ?2/df=1.943 (n=305) =p<0.001, CFI=0.908, IFI=0.909, TLI=0.901 and RMSEA=0.056. Strong factor loading was found across the final items, ranged from 0.53 to 0.94 with a good reliability test (Cronbach Alpha, AVE and CR values) for all constructs. Conclusion: The final AIP-Q consists of 10 domains with 45 items that give a promising psychometric property. This questionnaire can measure the perceptions of adult immunisation among the Malaysian population and can be utilized for the nationwide study.

Shamsul Azhar Shah, 1 Nazarudin Safian, 1 Saharuddin Ahmad, 2 Siti Rohani Nurumal, 1 Zulkefley Mohammad, 1 Juliana Mansor, 1 Wan Abdul Hannan Wan Ibadullah, 1 Yugo Shobugawa, 3 Megumi Rosenberg 4 1Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia; 2Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia; 3Department of Active Aging, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; 4Centre for Health Development, World Health Organization, Kobe, JapanCorrespondence: Shamsul Azhar ShahDepartment of Community Health, Faculty of Medicine, National University of Malaysia, Cheras, Kuala Lumpur, 56000, MalaysiaTel +60 3-9145 8787Fax +60 3-91456670Email drsham@ppukm.ukm.edu.myPurpose: Older people often have chronic diseases which require a continuity of care over the long term. Countries undergoing population aging need to ensure that older people are receiving the care they need. This study assesses the prevalence of, reasons for, and factors associated with unmet healthcare needs among older people individuals in Malaysia.Patients and Methods: This cross-sectional study used data collected during 2018– 2020 from 1204 older adults aged 60 and older selected from Selangor state, Malaysia. A comprehensive face-to-face interview based on the Bahasa Malaysia version of the Japan Gerontological Evaluation Study (JAGES-BM) questionnaire was administered to gain information on unmet healthcare needs, socioeconomic factors, health-related factors, and measures of function (activities of daily living, depression, visual impairment, hearing impairment, memory impairment, and walking impairment). Multivariate logistic regression was used to analyze factors associated with their unmet healthcare needs.Results: Overall, the percentage of older people respondents with unmet healthcare needs is 6.6%. The most reported reasons for forg

Shah SA, Safian N, Ahmad S, et al. J Multidiscip Healthc. 2021;14:2931–2940. The authors have advised there was misuse of the word “elderly” in the title and some sentences within the main text. Additionally, the Ethics Approval and Funding sections have also been updated. The paper title should read from “Unmet Healthcare Needs Among Elderly Malaysians” to “Unmet Healthcare Needs Among Older Malaysians”. On page 2935, second paragraph from the right column, the first sentence should read from “This study found that overweight and obese elderly more likely to have unmet healthcare needs than the non-obese elderly.” to “This study found that overweight and obese older people are more likely to have unmet healthcare needs than the non-obese older people.” On page 2935, second paragraph from the right column, the last sentence should read from “Regardless, cautious interpretation of BMI in the elderly is necessary because lean body mass, fat mass, or fluid retention are not determinants of BMI,22,26 and aging is associated with progressive loss of muscle strength, mass, and increased fat mass.19,27” to “Regardless, cautious interpretation of BMI in older people is necessary because lean body mass, fat mass, or fluid retention are not determinants of BMI,22,26 and aging is associated with progressive loss of muscle strength, mass, and increased fat mass.19,27” On page 2937, last sentence on the left column should read from “The inability of the elderly to travel alone therefore needs attention in collaboration with the community or nearby nongovernmental agencies to provide these older people with transportation assistance to reach nearby health facilities.” to “The inability of older people to travel alone therefore needs attention in collaboration with the community or nearby nongovernmental

Introduction: The number of patients with poor glycaemic control who refuse insulin therapy is alarming. Factors that contribute to insulin refusal are important to study to identify high risk groups so that appropriate measures can be taken to prevent progression of uncontrolled diabetes. The objective of this study is to determine the risk factors of insulin refusal among type 2 diabetes mellitus patients with poor glycaemic control at Tanglin Health Clinic, Kuala Lumpur, Malaysia. Methods: A case control study was conducted among 216 cases and 230 controls using stratified sampling method. Cases were defined as patients with HbA1C more than 7.5% but not on insulin therapy despite being offered by the doctor whereas controls consist of patients with HbA1C of more than 7.5% but already on insulin therapy. Data was collected from April until May 2018, using a self-administered questionnaire. Analysis was done via IBM SPSS version 23.0. Results: Response rate for cases was 93.9% and response rate for controls was 100%. Risk factors of insulin refusal among poor glycaemic control includes age above 60 years old, tertiary level education, duration of diabetes less than 10 years, poor level of knowledge on insulin, fear on injection pain and fear to bruising due to injections. Conclusion: Hence, efforts must be taken to tackle the modifiable factors such as knowledge on insulin and diabetes, and fear on injections and bruises.

Introduction: The number of patients with poor glycaemic control who refuse insulin therapy is alarming. Factors that contribute to insulin refusal are important to study to identify high risk groups so that appropriate measures can be taken to prevent progression of uncontrolled diabetes. The objective of this study is to determine the risk factors of insulin refusal among type 2 diabetes mellitus patients with poor glycaemic control at Tanglin Health Clinic, Kuala Lumpur, Malaysia. Methods: A case control study was conducted among 216 cases and 230 controls using stratified sampling method. Cases were defined as patients with HbA1C more than 7.5% but not on insulin therapy despite being offered by the doctor whereas controls consist of patients with HbA1C of more than 7.5% but already on insulin therapy. Data was collected from April until May 2018, using a self-administered questionnaire. Analysis was done via IBM SPSS version 23.0. Results: Response rate for cases was 93.9% and response rate for controls was 100%. Risk factors of insulin refusal among poor glycaemic control includes age above 60 years old, tertiary level education, duration of diabetes less than 10 years, poor level of knowledge on insulin, fear on injection pain and fear to bruising due to injections. Conclusion: Hence, efforts must be taken to tackle the modifiable factors such as knowledge on insulin and diabetes, and fear on injections and bruises.

Background: Limited comparative data are available on the symptom severity and burden of dialyzed versus nondialyzed end-stage renal disease (ESRD) patients and their association with negative emotional states. Objective: To investigate the prevalence of symptom burden and severity of ESRD patients and correlate the findings with their psychological status. Methods: This was a cross-sectional study of dialyzed (N = 87) and nondialyzed (N = 100) patients. The symptom burden and severity were determined using the Dialysis Symptom Index (DSI) and the psychological assessment using Depression Anxiety Stress Scale 21 (DASS-21). Results: Symptom severity evaluated using the DSI was comparable in both groups with fatigue as the most common symptom (n = 141, 75.4%), followed by sleep-related, sexual dysfunction, and dry skin problems. The symptom burden for worrying, dry skin and mouth, decreased appetite, numbness, and leg swelling were significant in not dialyzed group (p < 0.05).The DASS-21 scores revealed that 11% of patients were depressed, 21.8% were stressed, and 15.6% were anxious (p < 0.030). The prevalence of psychological disturbances was associated with high symptom burden regardless of their treatment options (p < 0.005). Dialyzed patients showed a positive psychological status trend on DASS-21 assessment. The not dialyzed group consisted of 34% from comprehensive conservative group, 26% of choice-restricted conservative care, and 40% with no definitive future plan. Conclusions: There was no difference in the prevalence of symptom burden and severity, irrespective of the type of treatment. Psychological disturbances were associated with higher symptom burden and severity and, therefore, should be screened thoroughly to achieve optimal ESRD management.

Background: Limited comparative data are available on the symptom severity and burden of dialyzed versus nondialyzed end-stage renal disease (ESRD) patients and their association with negative emotional states. Objective: To investigate the prevalence of symptom burden and severity of ESRD patients and correlate the findings with their psychological status. Methods: This was a cross-sectional study of dialyzed (N = 87) and nondialyzed (N = 100) patients. The symptom burden and severity were determined using the Dialysis Symptom Index (DSI) and the psychological assessment using Depression Anxiety Stress Scale 21 (DASS-21). Results: Symptom severity evaluated using the DSI was comparable in both groups with fatigue as the most common symptom (n = 141, 75.4%), followed by sleep-related, sexual dysfunction, and dry skin problems. The symptom burden for worrying, dry skin and mouth, decreased appetite, numbness, and leg swelling were significant in not dialyzed group (p < 0.05).The DASS-21 scores revealed that 11% of patients were depressed, 21.8% were stressed, and 15.6% were anxious (p < 0.030). The prevalence of psychological disturbances was associated with high symptom burden regardless of their treatment options (p < 0.005). Dialyzed patients showed a positive psychological status trend on DASS-21 assessment. The not dialyzed group consisted of 34% from comprehensive conservative group, 26% of choice-restricted conservative care, and 40% with no definitive future plan. Conclusions: There was no difference in the prevalence of symptom burden and severity, irrespective of the type of treatment. Psychological disturbances were associated with higher symptom burden and severity and, therefore, should be screened thoroughly to achieve optimal ESRD management.

BackgroundThe surrounding environment influences the constitution of illness perceptions. Therefore, local research is needed to examine how Libyan diabetes patients perceive diabetes and how their perceptions influence their medication adherence.MethodsA cross-sectional study was conducted at the National Centre for Diabetes and Endocrinology in Tripoli, Libya, between October and December 2013. A total of 523 patients with type 2 diabetes participated in this study. A self-administered questionnaire was used for data collection; this included the Revised Illness Perception Questionnaire and the eight-item Morisky Medication Adherence Scale.ResultsThe respondents showed moderately high personal control and treatment control perceptions and a moderate consequences perception. They reported a high perception of diabetes timeline as chronic and a moderate perception of the diabetes course as unstable. The most commonly perceived cause of diabetes was Allah's will. The prevalence of low medication adherence was 36.1%. The identified significant predictors of low medication adherence were the low treatment control perception (p=0.044), high diabetes identity perception (p=0.008), being male (p=0.026), and employed (p=0.008).ConclusionDiabetes illness perceptions of type 2 diabetic Libyans play a role in guiding the medication adherence and could be considered in the development of medication adherence promotion plans.

BackgroundThe surrounding environment influences the constitution of illness perceptions. Therefore, local research is needed to examine how Libyan diabetes patients perceive diabetes and how their perceptions influence their medication adherence.MethodsA cross-sectional study was conducted at the National Centre for Diabetes and Endocrinology in Tripoli, Libya, between October and December 2013. A total of 523 patients with type 2 diabetes participated in this study. A self-administered questionnaire was used for data collection; this included the Revised Illness Perception Questionnaire and the eight-item Morisky Medication Adherence Scale.ResultsThe respondents showed moderately high personal control and treatment control perceptions and a moderate consequences perception. They reported a high perception of diabetes timeline as chronic and a moderate perception of the diabetes course as unstable. The most commonly perceived cause of diabetes was Allah's will. The prevalence of low medication adherence was 36.1%. The identified significant predictors of low medication adherence were the low treatment control perception (p=0.044), high diabetes identity perception (p=0.008), being male (p=0.026), and employed (p=0.008).ConclusionDiabetes illness perceptions of type 2 diabetic Libyans play a role in guiding the medication adherence and could be considered in the development of medication adherence promotion plans.

Smoking among rural adolescents in Malaysia is on the rise with a significant difference seen between urban and rural youths. Therefore, this study was carried out to determine a predictive model of smoking among the rural-school adolescents population in Malacca, Malaysia. An unmatched case-control study was conducted in 2010 involving 484 cases and 444 controls of Form Two students in Malacca, Malaysia, using cluster sampling. Smoking was the dependent factor of this study while the independent factors were individual, family, school and environment. Data were obtained through a self-administered questionnaire. The response rate of the study was 100% whereas the smoking prevalence was 20.9%. Binary logistic regression was used to determine the smoking predictive model. Strong predictors of smoking behavior were: influenced by artistes who smoke (Adjusted OR=8.67, 95% CI 5.53-13.58); the male gender (Adjusted OR=6.7, 95% CI 4.14-10.83); Muslim (Adjusted OR=4.46, 95% CI 2.36-8.44); and the belief that smoking is not dangerous when the teacher is seen smoking as well (Adjusted OR=3.95, 95% CI 2.19-7.10). Other predictors were: being offered cigarettes by friends (Adjusted OR=2.81, 95% CI 1.79-4.42); the belief that smoking will relax the mind (Adjusted OR=2.45, 95% CI 1.33-4.51); having friends who smoke (Adjusted OR=2.32, 95% CI 1.29-4.81); forced by friends to smoke (Adjusted OR=2.17, 95% CI 1.15-4.12); have heard of the national No-Smoking Campaign (Adjusted OR=1.89, 95% CI 1.06-3.37); have problems with the school management (Adjusted OR=1.75, 95% CI 1.07- 2.88); parental consent to watch sexual activities, drug use or violence on television or at the cinema (Adjusted OR=1.73, 95% CI 1.06-2.83); and have lunch in school (Adjusted OR=1.58, 95% CI 1.04- 2.41). This paper ends with the recognition of the need for intervention in dismantling the predictors that can lead to the development of smoking among Malaysian adolescents in rural schools.

Smoking among rural adolescents in Malaysia is on the rise with a significant difference seen between urban and rural youths. Therefore, this study was carried out to determine a predictive model of smoking among the rural-school adolescents population in Malacca, Malaysia. An unmatched case-control study was conducted in 2010 involving 484 cases and 444 controls of Form Two students in Malacca, Malaysia, using cluster sampling. Smoking was the dependent factor of this study while the independent factors were individual, family, school and environment. Data were obtained through a self-administered questionnaire. The response rate of the study was 100% whereas the smoking prevalence was 20.9%. Binary logistic regression was used to determine the smoking predictive model. Strong predictors of smoking behavior were: influenced by artistes who smoke (Adjusted OR=8.67, 95% CI 5.53-13.58); the male gender (Adjusted OR=6.7, 95% CI 4.14-10.83); Muslim (Adjusted OR=4.46, 95% CI 2.36-8.44); and the belief that smoking is not dangerous when the teacher is seen smoking as well (Adjusted OR=3.95, 95% CI 2.19-7.10). Other predictors were: being offered cigarettes by friends (Adjusted OR=2.81, 95% CI 1.79-4.42); the belief that smoking will relax the mind (Adjusted OR=2.45, 95% CI 1.33-4.51); having friends who smoke (Adjusted OR=2.32, 95% CI 1.29-4.81); forced by friends to smoke (Adjusted OR=2.17, 95% CI 1.15-4.12); have heard of the national No-Smoking Campaign (Adjusted OR=1.89, 95% CI 1.06-3.37); have problems with the school management (Adjusted OR=1.75, 95% CI 1.07- 2.88); parental consent to watch sexual activities, drug use or violence on television or at the cinema (Adjusted OR=1.73, 95% CI 1.06-2.83); and have lunch in school (Adjusted OR=1.58, 95% CI 1.04- 2.41). This paper ends with the recognition of the need for intervention in dismantling the predictors that can lead to the development of smoking among Malaysian adolescents in rural schools.

Background: Aspirin use is known to reduce the recurrence of stroke. However, the clinical response to aspirin has been mixed. The rate of stroke recurrence whilst on aspirin treatment is still unacceptably high. A plausible explanation for this may be resistance to the effects of aspirin. The causes of aspirin resistance are manifold and multi-factorial. We conducted a study to investigate the prevalence rate of biochemical aspirin resistance in a cohort of aspirin-naïve stroke patients. We also sought to determine the inherent factors that may predispose towards the development of aspirin resistance. Method: This was a cross-sectional, observational study conducted on patients admitted to our centre with an acute stroke who were aspirin-naïve. The diagnosis of an acute stroke was confirmed by clinical history and brain imagi ng. Fifty consecutive patients were prospectively enrolled. Socio demographic data were collected and baseline blood investigations were performed. Patients were tested for biochemical aspirin resistance using Multiplate platelet analyser (Dynabyte, Munich, Germany) after 5 doses of aspirin, corresponding to a total dose of 900 mg. Results: The median age of patients was 65.5 years and 54 % of patients were female. There were 11 smokers; of these 10 were male. Twenty-six (52 %) patients were Chinese, 21 (41%) were Malay and 3 (6.0 %) were Indian. Aspirin resistance was present in 14 % of our patients.There was an inverse relationship between the presence of aspirin resistance and plasma HDL levels (r = -0.394; p = 0.005). There was no relationship observed between aspirin resistance and total cholesterol, triglycerides, LDL, HbA1c, ALT, ALP, urea and creatinine levels. There were no significant differences in demographic profiles or smoking status between the aspirin resistant and non-aspirin resistant groups. We did not find any link between ethnicity and aspirin resistance. Conclusions: Our results indicate that a lower HDL leve l is associa

Background: Aspirin use is known to reduce the recurrence of stroke. However, the clinical response to aspirin has been mixed. The rate of stroke recurrence whilst on aspirin treatment is still unacceptably high. A plausible explanation for this may be resistance to the effects of aspirin. The causes of aspirin resistance are manifold and multi-factorial. We conducted a study to investigate the prevalence rate of biochemical aspirin resistance in a cohort of aspirin-naïve stroke patients. We also sought to determine the inherent factors that may predispose towards the development of aspirin resistance. Method: This was a cross-sectional, observational study conducted on patients admitted to our centre with an acute stroke who were aspirin-naïve. The diagnosis of an acute stroke was confirmed by clinical history and brain imagi ng. Fifty consecutive patients were prospectively enrolled. Socio demographic data were collected and baseline blood investigations were performed. Patients were tested for biochemical aspirin resistance using Multiplate platelet analyser (Dynabyte, Munich, Germany) after 5 doses of aspirin, corresponding to a total dose of 900 mg. Results: The median age of patients was 65.5 years and 54 % of patients were female. There were 11 smokers; of these 10 were male. Twenty-six (52 %) patients were Chinese, 21 (41%) were Malay and 3 (6.0 %) were Indian. Aspirin resistance was present in 14 % of our patients.There was an inverse relationship between the presence of aspirin resistance and plasma HDL levels (r = -0.394; p = 0.005). There was no relationship observed between aspirin resistance and total cholesterol, triglycerides, LDL, HbA1c, ALT, ALP, urea and creatinine levels. There were no significant differences in demographic profiles or smoking status between the aspirin resistant and non-aspirin resistant groups. We did not find any link between ethnicity and aspirin resistance. Conclusions: Our results indicate that a lower HDL leve l is associa

This is a cross secti onal co mparison study to assess executive function and attention span in euthymic p atients with bipolar 1 disorder. It compares the performance of these two cogn itive domains in 40 patients with bipolar 1 disorder to that of 40 healthy normal subjects using Trail Maki ng (TMT), Digit Span (Forward and Backward) and Ver bal Fluency (VF) tests. The association between demographic, clinical characteristics and performance in all tests were examined. Patients wit h bipola r illness showed significant impairment with moderate to large e ffect siz es (VF= 0.67, TMT A= 0.52, TMT B = 0.81, Digit Forward= 0.97, Digit ba ckward= 1.10) in all tasks of executive and atte ntion functioning. These impairments a re observed in the absence of active mood symptoms while duration and severity of illness are not found to have an e ffect on both cognitive domains. Medications received by patients with bipolar disorder have significant association with performance on executive tasks. The results of this study add on to the existing global evidence of cognitive impair ment in bipolar illness despite its cross cultural differences. Its presenc e in the absence of mania, depression or mixed episode indicates that cognitive impairmen t is stable even af ter symptoms recovery.

This is a cross secti onal co mparison study to assess executive function and attention span in euthymic p atients with bipolar 1 disorder. It compares the performance of these two cogn itive domains in 40 patients with bipolar 1 disorder to that of 40 healthy normal subjects using Trail Maki ng (TMT), Digit Span (Forward and Backward) and Ver bal Fluency (VF) tests. The association between demographic, clinical characteristics and performance in all tests were examined. Patients wit h bipola r illness showed significant impairment with moderate to large e ffect siz es (VF= 0.67, TMT A= 0.52, TMT B = 0.81, Digit Forward= 0.97, Digit ba ckward= 1.10) in all tasks of executive and atte ntion functioning. These impairments a re observed in the absence of active mood symptoms while duration and severity of illness are not found to have an e ffect on both cognitive domains. Medications received by patients with bipolar disorder have significant association with performance on executive tasks. The results of this study add on to the existing global evidence of cognitive impair ment in bipolar illness despite its cross cultural differences. Its presenc e in the absence of mania, depression or mixed episode indicates that cognitive impairmen t is stable even af ter symptoms recovery.

Objective: The study aims to determine pattern of verbal memory and learning impairment and its associated factors among patients with bipolar I disorder in a psychiatric clinic of a university hospital. Methods: A case control study comparing verbal memory test performance in 40 patients with bipolar I disorder to that of 40 healthy normal subjects using Rey Auditory Verbal Learning Test (RAVLT). The association between demographic, clinical characteristics and poor verbal memory performance were examined. Results: Up to 92% of patients with bipolar I disorder have impaired short term working memory in this hospital-based study. They also recalled fewer words in all the RAVLT trials and had difficulties learning the word list in comparison to that of normal healthy individuals. Verbal memory and learning impairment are observed in bipolar illness in the absence of active mood symptoms while duration and severity of illness are not found to have any effect on verbal memory and learning. Conclusion: There is consistent verbal memory and learning problems in individuals with bipolar I disorder and their presence in the absence of mania, depression and mixed symptoms during the course of the illness suggests a trait related deficit.

INTRODUCTION: Psoriatic Arthritis (PsA) is an inflammatory arthritis associated with Psoriasis. Its recognition as an inflammatory disease distinct from Rheumatoid Arthritis has put forward for consideration several questions regarding its specific CVS mortality and morbidity (9, 11, 16, 26). Carotid intima media thickness is a useful surrogate and sensitive marker to determine atherosclerosis even in its subclinical stages (6, 14, 22, 27, 32). OBJECTIVE: Prevalence of carotid intima media thickness in patients with Psoriatic arthritis is unknown in Asian population. We aim to identify the presence of subclinical atherosclerosis in patients with psoriatic arthritis and disease activity association and its predictors in a series of patients with PsA attended to the rheumatology clinic, tertiary hospitals. METHODS: A total of 63 patients with PsA who fulfilled the CASPAR criteria were recruited from UKM Medical Centre and Hospital Putrajaya. Common carotid intima media thickness (IMT) was measured in both right and left carotid artery by using high resolution B-mode ultrasound. This was a cross sectional study first done in Malaysia for PsA patients. RESULTS: The positive IMT (IMT > 1.00 mm) among PsA was observed in 10 out of 63 patients (15.9 %) regardless of background cardiovascular risk. The mean +/- SD of IMT was 0.725 +/-0.260 mm for this study. Variables significantly associated with positive IMT (p < 0.05) included age at the time of study (p = 0.005), waist circumference (p = 0.001), Hypertension (p = 0.007), Diabetes (p = 0.002) and Metabolic syndrome (p = 0.001) and not associated with gender, ethnicity, duration of PsA disease, pattern of PsA, disease activity and severity. Above all, only age had positive IMT independent predictor (p = 0.032), with OR 1.116; 95 % CI (1.010-1.234). CONCLUSIONS: There was a significant association between CVS risk and positive Intima Media Thickness in Psoriatic Arthritis patients. Otherwise, there was no association in di

Objective: The study aims to determine pattern of verbal memory and learning impairment and its associated factors among patients with bipolar I disorder in a psychiatric clinic of a university hospital. Methods: A case control study comparing verbal memory test performance in 40 patients with bipolar I disorder to that of 40 healthy normal subjects using Rey Auditory Verbal Learning Test (RAVLT). The association between demographic, clinical characteristics and poor verbal memory performance were examined. Results: Up to 92% of patients with bipolar I disorder have impaired short term working memory in this hospital-based study. They also recalled fewer words in all the RAVLT trials and had difficulties learning the word list in comparison to that of normal healthy individuals. Verbal memory and learning impairment are observed in bipolar illness in the absence of active mood symptoms while duration and severity of illness are not found to have any effect on verbal memory and learning. Conclusion: There is consistent verbal memory and learning problems in individuals with bipolar I disorder and their presence in the absence of mania, depression and mixed symptoms during the course of the illness suggests a trait related deficit.

Introduction: Poor neuro-cognitive performance in patients with schizophrenia has been described as a core symptom of the illness and is shown to be associated with poor psycho-social functioning. Management of schizophrenia has shifted its focus to treat this deficit apart from only emphasising on positive and negative symptoms, as it will subsequently improve patient functioning and outcome. Objective: The study aims to determine the proportion of neuro-cognitive impairment in patients with schizophrenia in a psychiatric clinic in Hospital Universiti Kebangsaan Malaysia and factors that are likely to be associated with the impairment. Method: Across-sectional study design was conducted in this hospital-based study and subjects were randomly chosen from the psychiatric clinic. Rey Auditory Verbal Learning Test (RAVLT), Digit Forward and Backward (DF and DB), Trail Making Test (TMT) and Verbal Fluency Test (VF) were used to assess subjects' neuro-cognitive performance that measured their verbal memory and executive functioning of the brain. Results: The proportion of neuro-cognitive impairment is estimated at about 80% in patients with schizophrenia in this hospital-based study. A higher percentages of respondents had abnormal scores for RAVLT1, RAVLT5 and RAVLTB tests(75.6%, 68.3% and 82.9% respectively). The majority of respondents had normal scores for DF, VF tests (80.5% and 73.2% respectively), and about 51.2% of respondents had normal scores for DB test. For TMT, overall performance of respondents in Set A and B was poor. The mean duration of time taken to complete both sets was longer than that of a normal population based on age group: (age group: 18-39 years; TMT A 68.98 vs 40 seconds; TMT B 174.09 vs 90 seconds and age group: 40-49 years; TMT A 58.57 vs 45 seconds; TMT B 162.43 vs 100 seconds). There was a significant association between duration of illness and scores of RAVLT1 and between age of onset of illness and RAVLTB scores (p<0.05). There was no si

Introduction: Poor neuro-cognitive performance in patients with schizophrenia has been described as a core symptom of the illness and is shown to be associated with poor psycho-social functioning. Management of schizophrenia has shifted its focus to treat this deficit apart from only emphasising on positive and negative symptoms, as it will subsequently improve patient functioning and outcome. Objective: The study aims to determine the proportion of neuro-cognitive impairment in patients with schizophrenia in a psychiatric clinic in Hospital Universiti Kebangsaan Malaysia and factors that are likely to be associated with the impairment. Method: Across-sectional study design was conducted in this hospital-based study and subjects were randomly chosen from the psychiatric clinic. Rey Auditory Verbal Learning Test (RAVLT), Digit Forward and Backward (DF and DB), Trail Making Test (TMT) and Verbal Fluency Test (VF) were used to assess subjects' neuro-cognitive performance that measured their verbal memory and executive functioning of the brain. Results: The proportion of neuro-cognitive impairment is estimated at about 80% in patients with schizophrenia in this hospital-based study. A higher percentages of respondents had abnormal scores for RAVLT1, RAVLT5 and RAVLTB tests(75.6%, 68.3% and 82.9% respectively). The majority of respondents had normal scores for DF, VF tests (80.5% and 73.2% respectively), and about 51.2% of respondents had normal scores for DB test. For TMT, overall performance of respondents in Set A and B was poor. The mean duration of time taken to complete both sets was longer than that of a normal population based on age group: (age group: 18-39 years; TMT A 68.98 vs 40 seconds; TMT B 174.09 vs 90 seconds and age group: 40-49 years; TMT A 58.57 vs 45 seconds; TMT B 162.43 vs 100 seconds). There was a significant association between duration of illness and scores of RAVLT1 and between age of onset of illness and RAVLTB scores (p<0.05). There was no si

A cross sectional study was conducted among military armoured vehicle drivers in the two largest mechanized battalions with the objective to determine the prevalence of low back pain (LBP), and its association with whole body vibration (WBV) and other associated factors. A self-administered questionnaire and Human Vibration Meter were used in this study. A total of 159 respondents participated in this study and 102 (64.2%) of them were subjected to WBV measurement. One-hundred-and-seventeen respondents complained of LBP for the past 12 months giving a prevalence of 73.6%. The prevalence of LBP among tracked armoured vehicle drivers was higher (81.7%) as compared to wheeled armoured vehicle drivers (67.0%). The mean acceleration at Z-axis in tracked armoured vehicles (1.09 ± 0.26 ms-2) and wheeled armoured vehicles (0.33 ± 0.07 ms-2) were the dominant vibration directions. The mean estimated vibration dose value (eVDV) for eight-hour daily exposure at Z-axis (19.86 ± 4.72 ms-1.75) in tracked armoured vehicles showed the highest estimation. Based on the European Vibration Directive (2002), the mean eVDV at Z-axis in tracked armoured vehicles exceeded exposure action value (EAV) (> 9.1 ms-1.75), but did not exceed exposure limit value (ELV) (<21.0 ms-1.75). Logistic regression analysis revealed that only driving in forward bending sitting posture (OR=3.63, 95% CI 1.06-12.42) and WBV exposure at X-axis (OR=1.94, 95% CI 1.02-3.69) were significant risk factors to LBP. Preventive measures should be implemented to minimize risk of WBV and to improve ergonomic postures among drivers.

A cross sectional study was conducted among military armoured vehicle drivers in the two largest mechanized battalions with the objective to determine the prevalence of low back pain (LBP), and its association with whole body vibration (WBV) and other associated factors. A self-administered questionnaire and Human Vibration Meter were used in this study. A total of 159 respondents participated in this study and 102 (64.2%) of them were subjected to WBV measurement. One-hundred-and-seventeen respondents complained of LBP for the past 12 months giving a prevalence of 73.6%. The prevalence of LBP among tracked armoured vehicle drivers was higher (81.7%) as compared to wheeled armoured vehicle drivers (67.0%). The mean acceleration at Z-axis in tracked armoured vehicles (1.09 ± 0.26 ms-2) and wheeled armoured vehicles (0.33 ± 0.07 ms-2) were the dominant vibration directions. The mean estimated vibration dose value (eVDV) for eight-hour daily exposure at Z-axis (19.86 ± 4.72 ms-1.75) in tracked armoured vehicles showed the highest estimation. Based on the European Vibration Directive (2002), the mean eVDV at Z-axis in tracked armoured vehicles exceeded exposure action value (EAV) (> 9.1 ms-1.75), but did not exceed exposure limit value (ELV) (<21.0 ms-1.75). Logistic regression analysis revealed that only driving in forward bending sitting posture (OR=3.63, 95% CI 1.06-12.42) and WBV exposure at X-axis (OR=1.94, 95% CI 1.02-3.69) were significant risk factors to LBP. Preventive measures should be implemented to minimize risk of WBV and to improve ergonomic postures among drivers.

INTRODUCTION: Psoriatic Arthritis (PsA) is an inflammatory arthritis associated with Psoriasis. Its recognition as an inflammatory disease distinct from Rheumatoid Arthritis has put forward for consideration several questions regarding its specific CVS mortality and morbidity (9, 11, 16, 26). Carotid intima media thickness is a useful surrogate and sensitive marker to determine atherosclerosis even in its subclinical stages (6, 14, 22, 27, 32). OBJECTIVE: Prevalence of carotid intima media thickness in patients with Psoriatic arthritis is unknown in Asian population. We aim to identify the presence of subclinical atherosclerosis in patients with psoriatic arthritis and disease activity association and its predictors in a series of patients with PsA attended to the rheumatology clinic, tertiary hospitals. METHODS: A total of 63 patients with PsA who fulfilled the CASPAR criteria were recruited from UKM Medical Centre and Hospital Putrajaya. Common carotid intima media thickness (IMT) was measured in both right and left carotid artery by using high resolution B-mode ultrasound. This was a cross sectional study first done in Malaysia for PsA patients. RESULTS: The positive IMT (IMT > 1.00 mm) among PsA was observed in 10 out of 63 patients (15.9 %) regardless of background cardiovascular risk. The mean +/- SD of IMT was 0.725 +/-0.260 mm for this study. Variables significantly associated with positive IMT (p < 0.05) included age at the time of study (p = 0.005), waist circumference (p = 0.001), Hypertension (p = 0.007), Diabetes (p = 0.002) and Metabolic syndrome (p = 0.001) and not associated with gender, ethnicity, duration of PsA disease, pattern of PsA, disease activity and severity. Above all, only age had positive IMT independent predictor (p = 0.032), with OR 1.116; 95 % CI (1.010-1.234). CONCLUSIONS: There was a significant association between CVS risk and positive Intima Media Thickness in Psoriatic Arthritis patients. Otherwise, there was no association in di

Three urban public primary schools in the district of Petaling, Selangor were surveyed for obesity amongst the schoolchildren and factors related to it. The prevalence of obesity amongst primary schoolchildren, with the mean age of 8.91 years was 9.5%. In addition, it was more prevalent among the boys (p<0.05) as compared to the girls. However, there was no difference with regards to ethnicity, being breastfed, physical activity, time spent watching television or fast food intake in relation to obesity among these primary schoolchildren. A larger community study is required to determine if other specific factors and dietary energy intake are associated with obesity amongst primary schoolchildren, especially in rural or less urbanised regions.

Three urban public primary schools in the district of Petaling, Selangor were surveyed for obesity amongst the schoolchildren and factors related to it. The prevalence of obesity amongst primary schoolchildren, with the mean age of 8.91 years was 9.5%. In addition, it was more prevalent among the boys (p<0.05) as compared to the girls. However, there was no difference with regards to ethnicity, being breastfed, physical activity, time spent watching television or fast food intake in relation to obesity among these primary schoolchildren. A larger community study is required to determine if other specific factors and dietary energy intake are associated with obesity amongst primary schoolchildren, especially in rural or less urbanised regions.