The explosion of biomedical publishing makes keeping up with the primary studies an impossible ta... more The explosion of biomedical publishing makes keeping up with the primary studies an impossible task. The often disparate, confusing and contradicting findings of individual studies makes healthcare professionals turn to review articles where knowledge has been collated and published in summaries. Narrative reviews lack rigorous, systematic and reproducible synthesis. In contrast, systematic reviews are conducted using systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. The final pathway for systematic review is a statistical summary of the results of primary studies, or meta-analysis. This article provides some uidelines to health care providers in understanding the key aspects of systematic review and meta-analysis. Steps involved in systematic review are discussed. The potential pitfall of meta-analysis was also explored.
Certain human papillomavirus (HPV) types are strongly associated with cervical cancer. Recently-d... more Certain human papillomavirus (HPV) types are strongly associated with cervical cancer. Recently-described effective vaccines
against these HPV types represent a great medical breakthrough in preventing cervical cancer. In Malaysia, the vaccine has just
received regulatory approval. We are likely to face similar barriers to implementing HPV vaccination as reported by countries
where vaccination has been introduced. Most women have poor understanding of HPV and its link to cervical cancer. Physicians
who will be recommending HPV vaccines may not have extensive knowledge or experience with HPV-related disease.
Furthermore, a vaccine against a sexually-transmitted infection may elicit negative reactions from potential recipients or their
carers, particularly in a conservative society. Given the high cost of the vaccine, reaching the most vulnerable women is a
concern. To foster broad acceptance of HPV vaccine, education must be provided to health care providers, parents and young
women about the risks of HPV infection and the benefits of vaccination.
Systematic review is a comprehensive review of research findings in which all of the primary stud... more Systematic review is a comprehensive review of research findings in which all of the primary studies are systematically identified, appraised and summarised using an explicit and reproducible methodology. Meta-analysis is the statistical component of a systematic review in which combinable studies are drawn together via a statistical process. Systematic reviews and meta-analyses are routinely being used in the evidence-based approach to medicine. These short notes intend to
highlight important terms in systematic-review and meta-analysis. It is a beginner’s guide for health care professional of any discipline involved in research or practice who seeks to gain more comprehensive understanding of important terms used in systematic review and meta-analysis.
Prevalence and signs and symptoms of menopause have been extensively studied
among Malaysian wom... more Prevalence and signs and symptoms of menopause have been extensively studied
among Malaysian women but no one had investigated the level of knowledge and perception of
menopause. This study aimed to examine the knowledge and perception of menopause among young
to middle aged women (15 to 49 years old). A cross-sectional survey using 20-items questionnaire was conducted in three randomly chosen districts in Federal Territory, Kuala Lumpur. Women in this survey were aware of the meaning of the term menopause and its symptoms. However, the majority lacked comprehensive understanding about the health risks associated with menopause. Commonly cited sources of knowledge were magazines and family members. Lack of official sources for accurate information on menopause was reported. Communication with health care personnel regarding menopause was uncommon. An exploration into respondents’ perceptions on menopause revealed that the majority displayed positive thinking towards menopause. Young respondents seemed to have better perception regarding menopause compared to middle aged women. Although the women had good knowledge about menopause, they expressed feelings of sadness and nervousness upon the approach of their own menopause. Our data provides insight on the knowledge and perception of menopause that will guide future public health initiatives for premenopausal women in order for them to cope better when approaching this stage of life cycle
Purpose
HIV/AIDS poses a serious threat to young people, both in Malaysia and throughout the wor... more Purpose
HIV/AIDS poses a serious threat to young people, both in Malaysia and throughout the world. A nationwide cross-sectional survey was conducted to assess the knowledge, attitudes, and beliefs about HIV/AIDS among the Malaysian public. This article reports the findings of knowledge about HIV/AIDS among young adults.
Methods
A total of 1075 young adult respondents aged 15–24 years participated in this survey. The response rate was 82.2%.
Results
The data indicated that HIV/AIDS knowledge among the respondents was moderate, with a mean knowledge score of 20.1 out of 32 points. The great majority had adequate knowledge of the major routes of HIV transmission, but fewer were aware of other modes of transmission, such as tattooing and piercing, sharing personal items, and breast-feeding from an infected mother. The great majority knew that HIV is not transmitted by mosquito bites, sharing meals, casual contact, and using public swimming pools and toilets.
Conclusion
Misconceptions about HIV/AIDS exist although generally knowledge on HIV/AIDS transmission and prevention was accurate. Education and intervention programs are needed to increase the level of knowledge and awareness of HIV/AIDS. The findings have important implications for the development of primary HIV/AIDS prevention programs for young adults in Malaysia.
Qualitative data is often subjective, rich, and consists of in-depth information normally present... more Qualitative data is often subjective, rich, and consists of in-depth information normally presented in the form of words. Analysing qualitative data entails reading a large amount of transcripts looking for similarities or differences, and subsequently finding themes and developing categories. Traditionally, researchers ‘cut and paste’ and use coloured pens to categorise data. Recently, the use of software specifically designed for qualitative data management greatly reduces technical sophistication and eases the laborious task, thus making the process relatively easier. A number of computer software packages has been developed to mechanise this ‘coding’ process as well as to search and retrieve data. This paper illustrates the ways in which NVivo can be used in the qualitative data analysis process. The basic features and primary tools of NVivo which assist qualitative researchers in managing and analysing their data are described.
Objectives
This paper aimed to examine the temporal changes in psychobehavioral responses in rel... more Objectives
This paper aimed to examine the temporal changes in psychobehavioral responses in relation to reported 2009 H1N1 influenza deaths.
Methods
Telephone interviews with 1050 members of the lay public in the Kuala Lumpur metropolitan area, Malaysia, were conducted between July 11 and September 12, 2009.
Results
The study demonstrated that public psychobehavioral responses closely mirrored the daily number of reported deaths due to 2009 H1N1 influenza. During the weeks of escalating reported deaths, sharp rises of various domains of fear, health avoidance and protective behaviors, and impact were observed. In particular, health avoidance and protective behaviors decreases were consistent with the decline of reported deaths, indicating the paramount importance of efforts to sustain behavioral change in the general public.
Conclusions
These temporal trends provide important guidance toward health promotion and prevention initiatives in future outbreaks.
Patients with hepatitis B face uncertainty at diagnosis. Information and support they receive at ... more Patients with hepatitis B face uncertainty at diagnosis. Information and support they receive at the early stage of the disease determine their adherence to follow up and treatment. This study aimed to explore the experiences and needs of patients with hepatitis B at diagnosis. A qualitative methodology was used. Nine focus groups (n = 44) were conducted to explore patients' feelings and reaction to the diagnosis, encounters with health care professionals, and their needs. The transcribed data were analyzed using a thematic approach. Most patients were not prepared for the diagnosis and many felt anxious and distressed. This was attributed to poor patients' knowledge, doctor's emphasis on disease complications, and associated stigma. Information about the disease was lacking and patients wanted to know more about the mode of transmission, natural progression of the disease, complications, and treatment options. There was a feeling of "passivity" among patients because there was often no active treatment available at diagnosis. This resulted in patients defaulting surveillance visits and missing the opportunity to start antiviral treatment. Therefore, there is an urgent need to provide sufficient information and education about hepatitis B to newly diagnosed patients, break "bad news" to patients with sensitivity, address their emotional needs, and emphasize on the rationale and importance of surveillance and treatment. This may entail public awareness campaign, implementation of pretest and posttest counseling, and educating doctors on how to communicate the diagnosis and management to patients accurately and sensitively.
Objective: Study aimed to determine the prevalence of dysmenorrhoea, its impact, and treatment-se... more Objective: Study aimed to determine the prevalence of dysmenorrhoea, its impact, and treatment-seeking behaviour of rural adolescent girls in Malaysia. Participants and setting: Large cross-sectional study on 1295 adolescent girls (aged 13-19 years) from 16 public secondary schools in rural districts of Kelantan, Malaysia conducted between February 2009 and April 2009. Results: Dysmenorrhoea was reported in 76.0% of the participants. Concentration at school (59.9%) and participation in social events (58.6%) have been most affected. Multivariate analysis shows that being in upper secondary level was the strongest predictor for poor concentration, absenteeism, and poor school grade due to dysmenorrhoea. In spite of its high prevalence and enormous impact on their lives, 76.1% believed that dysmenorrhoea is a normal part of the female menstrual cycle and only 14.8% sought medical treatment. The majority of adolescents obtained information from their mothers (62.3%) and peers (52.9%). Conclusion: The findings imply the need for educating adolescent girls on effective management of dysmenorrhoea. Education should be extended to parents and school peer leaders to address the reproductive health needs of adolescents.
Folk culture surrounding menstrual-related matters has considerable implications for symptom expr... more Folk culture surrounding menstrual-related matters has considerable implications for symptom expression and treatment-seeking behavior. A cross-sectional survey of 1,295 rural adolescent girls aged 13 to 19 years was conducted between February 4 and April 16, 2009 to examine these associations. With a higher score indicating a more positive attitude toward menstruation, the mean attitude score was 3.84 (SD +/- 1.62) out of a maximum of six. No significant association was observed between the severity of menstrual symptoms and attitudes. Most (63.1%) of the participants identified themselves as having premenstrual symptoms, and 61.1% viewed premenstrual symptoms as a normal part of menstrual cycle. Participants with a higher severity of symptoms in the premenstrual (OR 1.05, 95% CI 1.01-1.10) and menstrual phase (OR 1.04, 95% CI 1.01-1.07), were more likely to consult a physician for premenstrual symptoms, and having a divorced/separated parents was associated with a reduced odds of consulting a physician compared to those having parents that were married (OR 0.19, 95% CI 0.05-0.83). The findings imply the need for education to help adolescent girls manage menstrual symptoms and increase awareness of the benefit of treating them. Given that menstrual-related information was widely available from mothers, family, and social culture are potentially important in shaping good menstrual attitudes.
Hemoglobin disorders which include thalassemias are the most common heritable disorders. Effectiv... more Hemoglobin disorders which include thalassemias are the most common heritable disorders. Effective treatment is available, and these disorders can be avoided as identification of carriers is achievable using simple hematological tests. An in-depth understanding of the awareness, attitudes, perceptions, and screening reservations towards thalassemia is necessary, as Malaysia has a multi-ethnic population with different religious beliefs. A total of 13 focus group discussions (70 participants) with members of the general lay public were conducted between November 2008 and January 2009. Lack of knowledge and understanding about thalassemia leads to general confusions over differences between thalassemia carriers and thalassemia major, inheritance patterns, and the physical and psychologically impact of the disorder in affected individuals and their families. Although most of the participants have not been tested for thalassemia, a large majority expressed willingness to be screened. Views on prenatal diagnosis and termination of fetuses with thalassemia major received mixed opinions from participants with different religions and practices. Perceived stigma and discrimination attached to being a carrier emerged as a vital topic in some group discussions where disparity in the answers exhibited differences in levels of participants’ literacy and ethnic origins. The two most common needs identified from the discussion were information and screening facilities. Participants’ interest in knowing the severity of the disease and assessing their risk of getting the disorder may imply the health belief model as a possible means of predicting thalassemia public screening services. Findings provide valuable insights for the development of more effective educational, screening, and prenatal diagnostic services in the multi-ethnic Asian society.
Background: Malaysia's organ and tissue donation rates are among the lowest in the world. The stu... more Background: Malaysia's organ and tissue donation rates are among the lowest in the world. The study aims to explore the knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in the diverse ethnic communities in the state of Selangor, Malaysia. Methods: A cross-sectional, population-based, computer-assisted telephone interview exploring multi-ethnic participants' knowledge, attitudes, practices and behavioral on deceased organ donation and transplantation was conducted from February to April 2009. Results: Although only 5.5% of the total participants (N = 1174) reported that they have registered to be organ donor, a further 35.2% of those who have not register for organ donation indicated willingness to donate their own. Significant socio-demographic disparities with respect to knowledge and attitudes scores were observed. In particular, Malays (20.7%) indicated lower willingness to donate organs compared to the Chinese (36.6%) and Indians (51.4%) (p < 0.001). In multivariate logistic regression analysis, willingness to donate one's own organ was associated with knowledge score (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.13-1.22), attitude score (OR = 1.17, 95% CI = 1.05-1.31), secondary school education (OR = 1.46, 95% CI = 1.05-2.02), and Malay ethnicity (OR = 0.18, 95% CI = 0.03-0.94). Conclusion: Findings assist organ donation and transplantation organizations to reach out the diverse socio-demographic and ethnic communities with cultural-specific information about organ donation.
The study was conducted to investigate issues surrounding human papillomavirus (HPV) vaccine deli... more The study was conducted to investigate issues surrounding human papillomavirus (HPV) vaccine delivery in a multi-ethnic, multi-religious and multi-cultural society. A qualitative in-depth interview study was conducted with a sample of 20 physicians. Physicians described the success of HPV vaccines recommendation as very poor. Many expressed reluctance to offer the vaccine to preadolescents. The most notable barrier to vaccination was the vaccine's high cost. Parents of eligible vaccinees were concerned about the efficacy and side effects of the new vaccine, while adult women have low risk perception for HPV infection. Promoters and inhibitors of HPV vaccination in our multi-ethnic, multi-religious and multi-cultural community were identified. This study suggests the need to strengthen the infrastructure necessary for HPV vaccine delivery and to specifically target poor underserved women.
Summary This study examines the knowledge of sexually transmitted diseases (STDs) among male yout... more Summary This study examines the knowledge of sexually transmitted diseases (STDs) among male youths in Malaysia. A self-administered survey was carried out on a sample of 952 never-married males aged 15-24 years. The respondents were asked about their knowledge of STDs, how these diseases get transmitted and their sexual behaviours. The data showed that 92% of the respondents knew of at least one STD (syphilis, gonorrhoea, chlamydia, herpes, genital warts, yeast infection, trichomoniasis or HIV/AIDS). About 95% of them knew of at least one method of STD transmission. Urban and tertiary-educated male youths showed a substantially higher proportion of awareness of STDs and transmission methods compared with their rural and less-educated counterparts. The data also indicated that 10% of the study sample admitted to having had sexual experiences. There were still a large proportion of the respondents who were not aware of STDs other than syphilis and HIV/AIDS and the means of transmission, such as multiple sex partners, including those who claimed to be sexually active. Thus there is a need for more concerted efforts to disseminate information on STDs and transmission methods to a wider audience in Malaysia, especially youths in rural areas.
Patients with hepatitis B face uncertainty at diagnosis. Information and support they receive at ... more Patients with hepatitis B face uncertainty at diagnosis. Information and support they receive at the early stage of the disease determine their adherence to follow up and treatment. This study aimed to explore the experiences and needs of patients with hepatitis B at diagnosis. A qualitative methodology was used. Nine focus groups (n = 44) were conducted to explore patients' feelings and reaction to the diagnosis, encounters with health care professionals, and their needs. The transcribed data were analyzed using a thematic approach. Most patients were not prepared for the diagnosis and many felt anxious and distressed. This was attributed to poor patients' knowledge, doctor's emphasis on disease complications, and associated stigma. Information about the disease was lacking and patients wanted to know more about the mode of transmission, natural progression of the disease, complications, and treatment options. There was a feeling of "passivity" among patients because there was often no active treatment available at diagnosis. This resulted in patients defaulting surveillance visits and missing the opportunity to start antiviral treatment. Therefore, there is an urgent need to provide sufficient information and education about hepatitis B to newly diagnosed patients, break "bad news" to patients with sensitivity, address their emotional needs, and emphasize on the rationale and importance of surveillance and treatment. This may entail public awareness campaign, implementation of pretest and posttest counseling, and educating doctors on how to communicate the diagnosis and management to patients accurately and sensitively.
The objective of this study was to identify demographic characteristics and correlates of the upt... more The objective of this study was to identify demographic characteristics and correlates of the uptake of HIV testing, willingness to be tested and perceived HIV-related stigma of Malaysian lay public. A cross-sectional computer-assisted telephone interview survey of a representative sample of multiracial Malaysians aged 18 years and above was conducted between December and July 2011. The survey collected information on demographics, knowledge about HIV transmission and religious beliefs on attitudes to HIV/AIDS. A total of 2271 households were successfully interviewed. The response rate was 48.65%. The HIV transmission knowledge score ranged from 0 to 15 (mean =10.56; SD±2.42). Three of the most common misconceptions about HIV transmission were mosquito bite (42.8%), eating in a restaurant where the cook is HIV positive (20.4%) and using a public toilet (20.1%). Only 20.6% reported ever having been tested for HIV, 49.1% reported a willingness to be tested for HIV and 30.3% had no intention of getting an HIV test. Low-risk perception (63.7%) constitutes a major barrier to HIV testing. Being Malay and Chinese (relative to Indian) were the strongest predictors of low-risk perception. Other significant predictors of low-risk perception were being male, being married and living in an urban locality. Perceived self-stigma if tested positive for HIV was prevalent (78.8%). Multivariate findings showed that being female, Malay, low income, living in rural localities and public stigma were significant correlates of self-stigma. These findings warrant interventions to reduce the disproportionate HIV transmission misconception, barriers to HIV testing and stigma and discriminative attitudes to involve considerations of sociocultural economic and demographic characteristics.
British Journal of Clinical Pharmacology, Sep 2004
Aims Impaired S-mephenytoin 4'-hydroxylation is a well-described genetic polymorphism affecting d... more Aims Impaired S-mephenytoin 4'-hydroxylation is a well-described genetic polymorphism affecting drug metabolism in humans. Although ethnic differences in its distribution of polymorphism has been described, it is not known whether there is an ethnic heterogeneity of the structure and expression of the CYP2C19 enzyme in the Malaysian population. Methods Study subjects were 142 healthy, unrelated Malaysians aged 18-29 years. Baseline omeprazole and 2-h postingestion omeprazole and 5'-hydroxyomeprazole concentrations were measured for CYP2C19 phenotype determination. Identification of CYP2C19 genotypes was performed with the use of polymerase chain reaction. Results Phenotyping of CYP2C19 revealed that the prevalence of poor metabolizers (PMs) in the Malaysian population was 14.1%, whereas prevalence of PMs in genotyping was 12.6%. The PM genotypic prevalence rate was 5.6% in Malays, 19.1% in Chinese and 10.0% in Indian subjects. There were significant differences in PM genotypic prevalence rates among the three primary ethnic groups (P less than or equal to 0.05). Conclusions Phenotyping and genotyping revealed significant differences in the prevalence rates among the three ethnic groups in Malaysia, with Chinese recording highest prevalence.
The explosion of biomedical publishing makes keeping up with the primary studies an impossible ta... more The explosion of biomedical publishing makes keeping up with the primary studies an impossible task. The often disparate, confusing and contradicting findings of individual studies makes healthcare professionals turn to review articles where knowledge has been collated and published in summaries. Narrative reviews lack rigorous, systematic and reproducible synthesis. In contrast, systematic reviews are conducted using systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. The final pathway for systematic review is a statistical summary of the results of primary studies, or meta-analysis. This article provides some uidelines to health care providers in understanding the key aspects of systematic review and meta-analysis. Steps involved in systematic review are discussed. The potential pitfall of meta-analysis was also explored.
Certain human papillomavirus (HPV) types are strongly associated with cervical cancer. Recently-d... more Certain human papillomavirus (HPV) types are strongly associated with cervical cancer. Recently-described effective vaccines
against these HPV types represent a great medical breakthrough in preventing cervical cancer. In Malaysia, the vaccine has just
received regulatory approval. We are likely to face similar barriers to implementing HPV vaccination as reported by countries
where vaccination has been introduced. Most women have poor understanding of HPV and its link to cervical cancer. Physicians
who will be recommending HPV vaccines may not have extensive knowledge or experience with HPV-related disease.
Furthermore, a vaccine against a sexually-transmitted infection may elicit negative reactions from potential recipients or their
carers, particularly in a conservative society. Given the high cost of the vaccine, reaching the most vulnerable women is a
concern. To foster broad acceptance of HPV vaccine, education must be provided to health care providers, parents and young
women about the risks of HPV infection and the benefits of vaccination.
Systematic review is a comprehensive review of research findings in which all of the primary stud... more Systematic review is a comprehensive review of research findings in which all of the primary studies are systematically identified, appraised and summarised using an explicit and reproducible methodology. Meta-analysis is the statistical component of a systematic review in which combinable studies are drawn together via a statistical process. Systematic reviews and meta-analyses are routinely being used in the evidence-based approach to medicine. These short notes intend to
highlight important terms in systematic-review and meta-analysis. It is a beginner’s guide for health care professional of any discipline involved in research or practice who seeks to gain more comprehensive understanding of important terms used in systematic review and meta-analysis.
Prevalence and signs and symptoms of menopause have been extensively studied
among Malaysian wom... more Prevalence and signs and symptoms of menopause have been extensively studied
among Malaysian women but no one had investigated the level of knowledge and perception of
menopause. This study aimed to examine the knowledge and perception of menopause among young
to middle aged women (15 to 49 years old). A cross-sectional survey using 20-items questionnaire was conducted in three randomly chosen districts in Federal Territory, Kuala Lumpur. Women in this survey were aware of the meaning of the term menopause and its symptoms. However, the majority lacked comprehensive understanding about the health risks associated with menopause. Commonly cited sources of knowledge were magazines and family members. Lack of official sources for accurate information on menopause was reported. Communication with health care personnel regarding menopause was uncommon. An exploration into respondents’ perceptions on menopause revealed that the majority displayed positive thinking towards menopause. Young respondents seemed to have better perception regarding menopause compared to middle aged women. Although the women had good knowledge about menopause, they expressed feelings of sadness and nervousness upon the approach of their own menopause. Our data provides insight on the knowledge and perception of menopause that will guide future public health initiatives for premenopausal women in order for them to cope better when approaching this stage of life cycle
Purpose
HIV/AIDS poses a serious threat to young people, both in Malaysia and throughout the wor... more Purpose
HIV/AIDS poses a serious threat to young people, both in Malaysia and throughout the world. A nationwide cross-sectional survey was conducted to assess the knowledge, attitudes, and beliefs about HIV/AIDS among the Malaysian public. This article reports the findings of knowledge about HIV/AIDS among young adults.
Methods
A total of 1075 young adult respondents aged 15–24 years participated in this survey. The response rate was 82.2%.
Results
The data indicated that HIV/AIDS knowledge among the respondents was moderate, with a mean knowledge score of 20.1 out of 32 points. The great majority had adequate knowledge of the major routes of HIV transmission, but fewer were aware of other modes of transmission, such as tattooing and piercing, sharing personal items, and breast-feeding from an infected mother. The great majority knew that HIV is not transmitted by mosquito bites, sharing meals, casual contact, and using public swimming pools and toilets.
Conclusion
Misconceptions about HIV/AIDS exist although generally knowledge on HIV/AIDS transmission and prevention was accurate. Education and intervention programs are needed to increase the level of knowledge and awareness of HIV/AIDS. The findings have important implications for the development of primary HIV/AIDS prevention programs for young adults in Malaysia.
Qualitative data is often subjective, rich, and consists of in-depth information normally present... more Qualitative data is often subjective, rich, and consists of in-depth information normally presented in the form of words. Analysing qualitative data entails reading a large amount of transcripts looking for similarities or differences, and subsequently finding themes and developing categories. Traditionally, researchers ‘cut and paste’ and use coloured pens to categorise data. Recently, the use of software specifically designed for qualitative data management greatly reduces technical sophistication and eases the laborious task, thus making the process relatively easier. A number of computer software packages has been developed to mechanise this ‘coding’ process as well as to search and retrieve data. This paper illustrates the ways in which NVivo can be used in the qualitative data analysis process. The basic features and primary tools of NVivo which assist qualitative researchers in managing and analysing their data are described.
Objectives
This paper aimed to examine the temporal changes in psychobehavioral responses in rel... more Objectives
This paper aimed to examine the temporal changes in psychobehavioral responses in relation to reported 2009 H1N1 influenza deaths.
Methods
Telephone interviews with 1050 members of the lay public in the Kuala Lumpur metropolitan area, Malaysia, were conducted between July 11 and September 12, 2009.
Results
The study demonstrated that public psychobehavioral responses closely mirrored the daily number of reported deaths due to 2009 H1N1 influenza. During the weeks of escalating reported deaths, sharp rises of various domains of fear, health avoidance and protective behaviors, and impact were observed. In particular, health avoidance and protective behaviors decreases were consistent with the decline of reported deaths, indicating the paramount importance of efforts to sustain behavioral change in the general public.
Conclusions
These temporal trends provide important guidance toward health promotion and prevention initiatives in future outbreaks.
Patients with hepatitis B face uncertainty at diagnosis. Information and support they receive at ... more Patients with hepatitis B face uncertainty at diagnosis. Information and support they receive at the early stage of the disease determine their adherence to follow up and treatment. This study aimed to explore the experiences and needs of patients with hepatitis B at diagnosis. A qualitative methodology was used. Nine focus groups (n = 44) were conducted to explore patients' feelings and reaction to the diagnosis, encounters with health care professionals, and their needs. The transcribed data were analyzed using a thematic approach. Most patients were not prepared for the diagnosis and many felt anxious and distressed. This was attributed to poor patients' knowledge, doctor's emphasis on disease complications, and associated stigma. Information about the disease was lacking and patients wanted to know more about the mode of transmission, natural progression of the disease, complications, and treatment options. There was a feeling of "passivity" among patients because there was often no active treatment available at diagnosis. This resulted in patients defaulting surveillance visits and missing the opportunity to start antiviral treatment. Therefore, there is an urgent need to provide sufficient information and education about hepatitis B to newly diagnosed patients, break "bad news" to patients with sensitivity, address their emotional needs, and emphasize on the rationale and importance of surveillance and treatment. This may entail public awareness campaign, implementation of pretest and posttest counseling, and educating doctors on how to communicate the diagnosis and management to patients accurately and sensitively.
Objective: Study aimed to determine the prevalence of dysmenorrhoea, its impact, and treatment-se... more Objective: Study aimed to determine the prevalence of dysmenorrhoea, its impact, and treatment-seeking behaviour of rural adolescent girls in Malaysia. Participants and setting: Large cross-sectional study on 1295 adolescent girls (aged 13-19 years) from 16 public secondary schools in rural districts of Kelantan, Malaysia conducted between February 2009 and April 2009. Results: Dysmenorrhoea was reported in 76.0% of the participants. Concentration at school (59.9%) and participation in social events (58.6%) have been most affected. Multivariate analysis shows that being in upper secondary level was the strongest predictor for poor concentration, absenteeism, and poor school grade due to dysmenorrhoea. In spite of its high prevalence and enormous impact on their lives, 76.1% believed that dysmenorrhoea is a normal part of the female menstrual cycle and only 14.8% sought medical treatment. The majority of adolescents obtained information from their mothers (62.3%) and peers (52.9%). Conclusion: The findings imply the need for educating adolescent girls on effective management of dysmenorrhoea. Education should be extended to parents and school peer leaders to address the reproductive health needs of adolescents.
Folk culture surrounding menstrual-related matters has considerable implications for symptom expr... more Folk culture surrounding menstrual-related matters has considerable implications for symptom expression and treatment-seeking behavior. A cross-sectional survey of 1,295 rural adolescent girls aged 13 to 19 years was conducted between February 4 and April 16, 2009 to examine these associations. With a higher score indicating a more positive attitude toward menstruation, the mean attitude score was 3.84 (SD +/- 1.62) out of a maximum of six. No significant association was observed between the severity of menstrual symptoms and attitudes. Most (63.1%) of the participants identified themselves as having premenstrual symptoms, and 61.1% viewed premenstrual symptoms as a normal part of menstrual cycle. Participants with a higher severity of symptoms in the premenstrual (OR 1.05, 95% CI 1.01-1.10) and menstrual phase (OR 1.04, 95% CI 1.01-1.07), were more likely to consult a physician for premenstrual symptoms, and having a divorced/separated parents was associated with a reduced odds of consulting a physician compared to those having parents that were married (OR 0.19, 95% CI 0.05-0.83). The findings imply the need for education to help adolescent girls manage menstrual symptoms and increase awareness of the benefit of treating them. Given that menstrual-related information was widely available from mothers, family, and social culture are potentially important in shaping good menstrual attitudes.
Hemoglobin disorders which include thalassemias are the most common heritable disorders. Effectiv... more Hemoglobin disorders which include thalassemias are the most common heritable disorders. Effective treatment is available, and these disorders can be avoided as identification of carriers is achievable using simple hematological tests. An in-depth understanding of the awareness, attitudes, perceptions, and screening reservations towards thalassemia is necessary, as Malaysia has a multi-ethnic population with different religious beliefs. A total of 13 focus group discussions (70 participants) with members of the general lay public were conducted between November 2008 and January 2009. Lack of knowledge and understanding about thalassemia leads to general confusions over differences between thalassemia carriers and thalassemia major, inheritance patterns, and the physical and psychologically impact of the disorder in affected individuals and their families. Although most of the participants have not been tested for thalassemia, a large majority expressed willingness to be screened. Views on prenatal diagnosis and termination of fetuses with thalassemia major received mixed opinions from participants with different religions and practices. Perceived stigma and discrimination attached to being a carrier emerged as a vital topic in some group discussions where disparity in the answers exhibited differences in levels of participants’ literacy and ethnic origins. The two most common needs identified from the discussion were information and screening facilities. Participants’ interest in knowing the severity of the disease and assessing their risk of getting the disorder may imply the health belief model as a possible means of predicting thalassemia public screening services. Findings provide valuable insights for the development of more effective educational, screening, and prenatal diagnostic services in the multi-ethnic Asian society.
Background: Malaysia's organ and tissue donation rates are among the lowest in the world. The stu... more Background: Malaysia's organ and tissue donation rates are among the lowest in the world. The study aims to explore the knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in the diverse ethnic communities in the state of Selangor, Malaysia. Methods: A cross-sectional, population-based, computer-assisted telephone interview exploring multi-ethnic participants' knowledge, attitudes, practices and behavioral on deceased organ donation and transplantation was conducted from February to April 2009. Results: Although only 5.5% of the total participants (N = 1174) reported that they have registered to be organ donor, a further 35.2% of those who have not register for organ donation indicated willingness to donate their own. Significant socio-demographic disparities with respect to knowledge and attitudes scores were observed. In particular, Malays (20.7%) indicated lower willingness to donate organs compared to the Chinese (36.6%) and Indians (51.4%) (p < 0.001). In multivariate logistic regression analysis, willingness to donate one's own organ was associated with knowledge score (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.13-1.22), attitude score (OR = 1.17, 95% CI = 1.05-1.31), secondary school education (OR = 1.46, 95% CI = 1.05-2.02), and Malay ethnicity (OR = 0.18, 95% CI = 0.03-0.94). Conclusion: Findings assist organ donation and transplantation organizations to reach out the diverse socio-demographic and ethnic communities with cultural-specific information about organ donation.
The study was conducted to investigate issues surrounding human papillomavirus (HPV) vaccine deli... more The study was conducted to investigate issues surrounding human papillomavirus (HPV) vaccine delivery in a multi-ethnic, multi-religious and multi-cultural society. A qualitative in-depth interview study was conducted with a sample of 20 physicians. Physicians described the success of HPV vaccines recommendation as very poor. Many expressed reluctance to offer the vaccine to preadolescents. The most notable barrier to vaccination was the vaccine's high cost. Parents of eligible vaccinees were concerned about the efficacy and side effects of the new vaccine, while adult women have low risk perception for HPV infection. Promoters and inhibitors of HPV vaccination in our multi-ethnic, multi-religious and multi-cultural community were identified. This study suggests the need to strengthen the infrastructure necessary for HPV vaccine delivery and to specifically target poor underserved women.
Summary This study examines the knowledge of sexually transmitted diseases (STDs) among male yout... more Summary This study examines the knowledge of sexually transmitted diseases (STDs) among male youths in Malaysia. A self-administered survey was carried out on a sample of 952 never-married males aged 15-24 years. The respondents were asked about their knowledge of STDs, how these diseases get transmitted and their sexual behaviours. The data showed that 92% of the respondents knew of at least one STD (syphilis, gonorrhoea, chlamydia, herpes, genital warts, yeast infection, trichomoniasis or HIV/AIDS). About 95% of them knew of at least one method of STD transmission. Urban and tertiary-educated male youths showed a substantially higher proportion of awareness of STDs and transmission methods compared with their rural and less-educated counterparts. The data also indicated that 10% of the study sample admitted to having had sexual experiences. There were still a large proportion of the respondents who were not aware of STDs other than syphilis and HIV/AIDS and the means of transmission, such as multiple sex partners, including those who claimed to be sexually active. Thus there is a need for more concerted efforts to disseminate information on STDs and transmission methods to a wider audience in Malaysia, especially youths in rural areas.
Patients with hepatitis B face uncertainty at diagnosis. Information and support they receive at ... more Patients with hepatitis B face uncertainty at diagnosis. Information and support they receive at the early stage of the disease determine their adherence to follow up and treatment. This study aimed to explore the experiences and needs of patients with hepatitis B at diagnosis. A qualitative methodology was used. Nine focus groups (n = 44) were conducted to explore patients' feelings and reaction to the diagnosis, encounters with health care professionals, and their needs. The transcribed data were analyzed using a thematic approach. Most patients were not prepared for the diagnosis and many felt anxious and distressed. This was attributed to poor patients' knowledge, doctor's emphasis on disease complications, and associated stigma. Information about the disease was lacking and patients wanted to know more about the mode of transmission, natural progression of the disease, complications, and treatment options. There was a feeling of "passivity" among patients because there was often no active treatment available at diagnosis. This resulted in patients defaulting surveillance visits and missing the opportunity to start antiviral treatment. Therefore, there is an urgent need to provide sufficient information and education about hepatitis B to newly diagnosed patients, break "bad news" to patients with sensitivity, address their emotional needs, and emphasize on the rationale and importance of surveillance and treatment. This may entail public awareness campaign, implementation of pretest and posttest counseling, and educating doctors on how to communicate the diagnosis and management to patients accurately and sensitively.
The objective of this study was to identify demographic characteristics and correlates of the upt... more The objective of this study was to identify demographic characteristics and correlates of the uptake of HIV testing, willingness to be tested and perceived HIV-related stigma of Malaysian lay public. A cross-sectional computer-assisted telephone interview survey of a representative sample of multiracial Malaysians aged 18 years and above was conducted between December and July 2011. The survey collected information on demographics, knowledge about HIV transmission and religious beliefs on attitudes to HIV/AIDS. A total of 2271 households were successfully interviewed. The response rate was 48.65%. The HIV transmission knowledge score ranged from 0 to 15 (mean =10.56; SD±2.42). Three of the most common misconceptions about HIV transmission were mosquito bite (42.8%), eating in a restaurant where the cook is HIV positive (20.4%) and using a public toilet (20.1%). Only 20.6% reported ever having been tested for HIV, 49.1% reported a willingness to be tested for HIV and 30.3% had no intention of getting an HIV test. Low-risk perception (63.7%) constitutes a major barrier to HIV testing. Being Malay and Chinese (relative to Indian) were the strongest predictors of low-risk perception. Other significant predictors of low-risk perception were being male, being married and living in an urban locality. Perceived self-stigma if tested positive for HIV was prevalent (78.8%). Multivariate findings showed that being female, Malay, low income, living in rural localities and public stigma were significant correlates of self-stigma. These findings warrant interventions to reduce the disproportionate HIV transmission misconception, barriers to HIV testing and stigma and discriminative attitudes to involve considerations of sociocultural economic and demographic characteristics.
British Journal of Clinical Pharmacology, Sep 2004
Aims Impaired S-mephenytoin 4'-hydroxylation is a well-described genetic polymorphism affecting d... more Aims Impaired S-mephenytoin 4'-hydroxylation is a well-described genetic polymorphism affecting drug metabolism in humans. Although ethnic differences in its distribution of polymorphism has been described, it is not known whether there is an ethnic heterogeneity of the structure and expression of the CYP2C19 enzyme in the Malaysian population. Methods Study subjects were 142 healthy, unrelated Malaysians aged 18-29 years. Baseline omeprazole and 2-h postingestion omeprazole and 5'-hydroxyomeprazole concentrations were measured for CYP2C19 phenotype determination. Identification of CYP2C19 genotypes was performed with the use of polymerase chain reaction. Results Phenotyping of CYP2C19 revealed that the prevalence of poor metabolizers (PMs) in the Malaysian population was 14.1%, whereas prevalence of PMs in genotyping was 12.6%. The PM genotypic prevalence rate was 5.6% in Malays, 19.1% in Chinese and 10.0% in Indian subjects. There were significant differences in PM genotypic prevalence rates among the three primary ethnic groups (P less than or equal to 0.05). Conclusions Phenotyping and genotyping revealed significant differences in the prevalence rates among the three ethnic groups in Malaysia, with Chinese recording highest prevalence.
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Papers by Wong Li Ping
against these HPV types represent a great medical breakthrough in preventing cervical cancer. In Malaysia, the vaccine has just
received regulatory approval. We are likely to face similar barriers to implementing HPV vaccination as reported by countries
where vaccination has been introduced. Most women have poor understanding of HPV and its link to cervical cancer. Physicians
who will be recommending HPV vaccines may not have extensive knowledge or experience with HPV-related disease.
Furthermore, a vaccine against a sexually-transmitted infection may elicit negative reactions from potential recipients or their
carers, particularly in a conservative society. Given the high cost of the vaccine, reaching the most vulnerable women is a
concern. To foster broad acceptance of HPV vaccine, education must be provided to health care providers, parents and young
women about the risks of HPV infection and the benefits of vaccination.
highlight important terms in systematic-review and meta-analysis. It is a beginner’s guide for health care professional of any discipline involved in research or practice who seeks to gain more comprehensive understanding of important terms used in systematic review and meta-analysis.
among Malaysian women but no one had investigated the level of knowledge and perception of
menopause. This study aimed to examine the knowledge and perception of menopause among young
to middle aged women (15 to 49 years old). A cross-sectional survey using 20-items questionnaire was conducted in three randomly chosen districts in Federal Territory, Kuala Lumpur. Women in this survey were aware of the meaning of the term menopause and its symptoms. However, the majority lacked comprehensive understanding about the health risks associated with menopause. Commonly cited sources of knowledge were magazines and family members. Lack of official sources for accurate information on menopause was reported. Communication with health care personnel regarding menopause was uncommon. An exploration into respondents’ perceptions on menopause revealed that the majority displayed positive thinking towards menopause. Young respondents seemed to have better perception regarding menopause compared to middle aged women. Although the women had good knowledge about menopause, they expressed feelings of sadness and nervousness upon the approach of their own menopause. Our data provides insight on the knowledge and perception of menopause that will guide future public health initiatives for premenopausal women in order for them to cope better when approaching this stage of life cycle
HIV/AIDS poses a serious threat to young people, both in Malaysia and throughout the world. A nationwide cross-sectional survey was conducted to assess the knowledge, attitudes, and beliefs about HIV/AIDS among the Malaysian public. This article reports the findings of knowledge about HIV/AIDS among young adults.
Methods
A total of 1075 young adult respondents aged 15–24 years participated in this survey. The response rate was 82.2%.
Results
The data indicated that HIV/AIDS knowledge among the respondents was moderate, with a mean knowledge score of 20.1 out of 32 points. The great majority had adequate knowledge of the major routes of HIV transmission, but fewer were aware of other modes of transmission, such as tattooing and piercing, sharing personal items, and breast-feeding from an infected mother. The great majority knew that HIV is not transmitted by mosquito bites, sharing meals, casual contact, and using public swimming pools and toilets.
Conclusion
Misconceptions about HIV/AIDS exist although generally knowledge on HIV/AIDS transmission and prevention was accurate. Education and intervention programs are needed to increase the level of knowledge and awareness of HIV/AIDS. The findings have important implications for the development of primary HIV/AIDS prevention programs for young adults in Malaysia.
This paper aimed to examine the temporal changes in psychobehavioral responses in relation to reported 2009 H1N1 influenza deaths.
Methods
Telephone interviews with 1050 members of the lay public in the Kuala Lumpur metropolitan area, Malaysia, were conducted between July 11 and September 12, 2009.
Results
The study demonstrated that public psychobehavioral responses closely mirrored the daily number of reported deaths due to 2009 H1N1 influenza. During the weeks of escalating reported deaths, sharp rises of various domains of fear, health avoidance and protective behaviors, and impact were observed. In particular, health avoidance and protective behaviors decreases were consistent with the decline of reported deaths, indicating the paramount importance of efforts to sustain behavioral change in the general public.
Conclusions
These temporal trends provide important guidance toward health promotion and prevention initiatives in future outbreaks.
against these HPV types represent a great medical breakthrough in preventing cervical cancer. In Malaysia, the vaccine has just
received regulatory approval. We are likely to face similar barriers to implementing HPV vaccination as reported by countries
where vaccination has been introduced. Most women have poor understanding of HPV and its link to cervical cancer. Physicians
who will be recommending HPV vaccines may not have extensive knowledge or experience with HPV-related disease.
Furthermore, a vaccine against a sexually-transmitted infection may elicit negative reactions from potential recipients or their
carers, particularly in a conservative society. Given the high cost of the vaccine, reaching the most vulnerable women is a
concern. To foster broad acceptance of HPV vaccine, education must be provided to health care providers, parents and young
women about the risks of HPV infection and the benefits of vaccination.
highlight important terms in systematic-review and meta-analysis. It is a beginner’s guide for health care professional of any discipline involved in research or practice who seeks to gain more comprehensive understanding of important terms used in systematic review and meta-analysis.
among Malaysian women but no one had investigated the level of knowledge and perception of
menopause. This study aimed to examine the knowledge and perception of menopause among young
to middle aged women (15 to 49 years old). A cross-sectional survey using 20-items questionnaire was conducted in three randomly chosen districts in Federal Territory, Kuala Lumpur. Women in this survey were aware of the meaning of the term menopause and its symptoms. However, the majority lacked comprehensive understanding about the health risks associated with menopause. Commonly cited sources of knowledge were magazines and family members. Lack of official sources for accurate information on menopause was reported. Communication with health care personnel regarding menopause was uncommon. An exploration into respondents’ perceptions on menopause revealed that the majority displayed positive thinking towards menopause. Young respondents seemed to have better perception regarding menopause compared to middle aged women. Although the women had good knowledge about menopause, they expressed feelings of sadness and nervousness upon the approach of their own menopause. Our data provides insight on the knowledge and perception of menopause that will guide future public health initiatives for premenopausal women in order for them to cope better when approaching this stage of life cycle
HIV/AIDS poses a serious threat to young people, both in Malaysia and throughout the world. A nationwide cross-sectional survey was conducted to assess the knowledge, attitudes, and beliefs about HIV/AIDS among the Malaysian public. This article reports the findings of knowledge about HIV/AIDS among young adults.
Methods
A total of 1075 young adult respondents aged 15–24 years participated in this survey. The response rate was 82.2%.
Results
The data indicated that HIV/AIDS knowledge among the respondents was moderate, with a mean knowledge score of 20.1 out of 32 points. The great majority had adequate knowledge of the major routes of HIV transmission, but fewer were aware of other modes of transmission, such as tattooing and piercing, sharing personal items, and breast-feeding from an infected mother. The great majority knew that HIV is not transmitted by mosquito bites, sharing meals, casual contact, and using public swimming pools and toilets.
Conclusion
Misconceptions about HIV/AIDS exist although generally knowledge on HIV/AIDS transmission and prevention was accurate. Education and intervention programs are needed to increase the level of knowledge and awareness of HIV/AIDS. The findings have important implications for the development of primary HIV/AIDS prevention programs for young adults in Malaysia.
This paper aimed to examine the temporal changes in psychobehavioral responses in relation to reported 2009 H1N1 influenza deaths.
Methods
Telephone interviews with 1050 members of the lay public in the Kuala Lumpur metropolitan area, Malaysia, were conducted between July 11 and September 12, 2009.
Results
The study demonstrated that public psychobehavioral responses closely mirrored the daily number of reported deaths due to 2009 H1N1 influenza. During the weeks of escalating reported deaths, sharp rises of various domains of fear, health avoidance and protective behaviors, and impact were observed. In particular, health avoidance and protective behaviors decreases were consistent with the decline of reported deaths, indicating the paramount importance of efforts to sustain behavioral change in the general public.
Conclusions
These temporal trends provide important guidance toward health promotion and prevention initiatives in future outbreaks.