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@#Introduction: This study explored stroke survivors’ understanding regarding stroke, the perceived facilitators and barriers of healthy lifestyle changes, and provision of secondary prevention education. Methods: Semi-structured interviews were conducted with 22 stroke patients (13 males and nine females; aged 34-80 years) who were attending rehabilitation clinics in three Malaysian hospitals. Each interview was audiotaped, transcribed, and analysed using the framework approach. Results: Six themes were reported: understanding of stroke; facilitators of healthy lifestyle changes; barriers of healthy lifestyle changes; food taboos; recovery; and provision of secondary stroke prevention. A third of them were uncertain about the cause of stroke and the perception towards risk of recurrent stroke varied widely. The lack of secondary prevention education was obvious although many had received general verbal advices. Several personal, social, and environmental factors were identified as the facilitators or barriers in healthy lifestyle participation. Food taboos were common and had become one of the barriers in practising healthy eating practices. Families had a strong influence on the patient’s belief and behaviour changes, both in positive and negative ways. Besides, patients tended to have a problem in information recall, while some faced confusion during the early stages of stroke recovery. Conclusion: More efforts to improve knowledge regarding cause of stroke and secondary prevention strategies are needed. Use of appropriate behavioural changes strategies, family-centred approach and continuous health education are necessary to facilitate patients’ efforts at making successful lifestyle modification after stroke event.
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Obesity and overweight problems are serious global health issues today and despite many efforts, the prevalence has continued to rise for decades. Interestingly, hypnotherapy has been gaining recognition as an effective treatment for obesity and overweight problems. This review compiles contemporary scientific research on the effectiveness of hypnotherapy for weight reduction. Scopus, PubMed and EBSCO Host databases were applied in the study. The search identified 119 articles, of which seven met the inclusion criteria. A total of 539 respondents (82.7% women and 17.3% men) between the ages of 17 and 67 years were represented in the seven studies. Most studies incorporated lifestyle changes, such as changes of dietary habit and behavioral recommendations in the hypnotic procedure. Their results suggested that the use of hypnotherapy not only promoted weight reduction during the treatment period but also after treatment cessation, and in some cases, one to ten kilograms were lost during follow-up periods. In addition, one study even showed increased physical activity among the hypnotised individuals. This use of hypnotherapy also improved respondents' eating behavior and quality of life. However, a definitive conclusion could not be drawn due to several methodological flaws and the limited number of published studies in this area. Therefore, further well-designed studies are needed to substantiate the effectiveness of hypnotherapy for this modern-day health problem.
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@#Introduction: The number of breast cancer survivors in developing Asian countries is still lacking compared to Western countries. Health-related quality of life (HRQoL) of cancer patients is one of the significant predictors of survival. Hence, this study was conducted to determine HRQoL status among breast cancer survivors of different diagnosis duration in East Coast of Peninsular Malaysia. Methods: Cross-sectional data were collected for 128 breast cancer survivors, aged 37 to 72 years who were recruited by using purposive sampling method at two main government hospitals in Kelantan (n=67) and Terengganu (n=61). The validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ–C30) and Breast Cancer Supplementary Measure (EORTC QLQ-BR23) which had been translated into the Malay language were used to measure HRQoL. Independent t-test was used to compare HRQoL status among short term (≤5 years duration since diagnosis) and long term (>5 years duration since diagnosis) breast cancer survivors. Results: Overall, our breast cancer survivors reported good HRQoL, with high scores for global health status, functional status and low symptoms scores. Long term breast cancer survivors had better social functioning compared to short term survivors (p=.038). Nevertheless, there was no significant difference found for other HRQoL status between short and long term breast cancer survivors. Conclusion: Breast cancer survivors in East Coast of Peninsular Malaysia generally experienced good HRQoL. The relatively similar HRQoL status between long-term and short-term survivors indicated a constant HRQoL profile among survivors throughout their survivorship.
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@#Background: Improving awareness, knowledge and attittude (AKA) of teachers and students about epilepsy is an important step to reduce the stigma experienced by children with epilepsy. To date there are no studies evaluating effectiveness of an information technology based epilepsy education programme in improving AKA among teachers and students. Method: Cross-sectional study was to assess the baseline AKA of epilepsy among Malaysian teachers and secondary school students, and to examine effectiveness improving their AKA using the Interactive Animated Epilepsy Education Programme (IAEEP). AKA of teachers and students were assessed pre- and post-implementation of IAEEP. Results: Total of 54 teachers and 67 secondary students participated in this study. The baseline AKA on epilepsy among Malaysian teachers was low in the awareness domain, moderate in the knowledge domain, and positive in the attitude domain. The baseline AKA on epilepsy among students was very low in the awareness domain, low in the knowledge domain, and indifferent in the attitude domain. The AKA scores in all domains of teachers and students improved significantly after introduction of IAEEP (P<0.001). Post-IAEEP the AKA of teachers was moderate in the awareness domain, high in the knowledge domain, and very positive in the attitude domain; the AKA of students was low in the awareness domain, very high in the knowledge domain, and very positive in the attitude domain Conclusion: Our findings highlight a need for epilepsy educational programmes to be implemented in Malaysian schools. The IAEEP is an effective educational programme to improve the AKA particularly in the knowledge domain among teachers and students
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Despite being effective in promoting healthy dietary behaviour, smartphone apps are scarcely available for our local communities and the majority of nutritional-related information is based on western food selections. Our new innovation aims to provide specific educational advice about recommended food intake, types, nutritional qualities and weight issues for cancer patients and survivors who suffer appetite problems and nutritional deficits. The Cancer Dietary (CanDiTM) app was developed as a convenient, flexible and attractively engaging smartphone app containing healthy tips which are uniquely tailored to the local food choices, preferences and ingredients. This helps customise users’ dietary needs besides permitting constant information up-dating. Features are broadly categorised into Healthy Eating Guide (advice from healthy eating to eating problems, weight loss prevention and increasing proteins and calories intake) and Malaysian Recipes For Cancer Patients (focusing on common Malaysian dishes, ingredients, treatment-based recipes and special diets). An additional Symptom Diary allows user’s personal profile to be recorded and stored virtually online. Its feasibility and acceptability were further tested among 30 cancer patients, family caregivers and dieticians recruited from a public hospital in Terengganu, Malaysia. Very good feasibility (> 80%) and excellent acceptability (> 90%) were reported regarding its ease of operation, suitability of language used, attractiveness, knowledge enhancement and perceived usefulness. With this scientific yet creative innovation, routine dietary habits related to cancer conditions could be easily facilitated for both patients/survivors as well as family caregivers for their independent and healthy living.
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@#Despite being effective in promoting healthy dietary behaviour, smartphone apps are scarcely available for our local communities and the majority of nutritional-related information is based on western food selections. Our new innovation aims to provide specific educational advice about recommended food intake, types, nutritional qualities and weight issues for cancer patients and survivors who suffer appetite problems and nutritional deficits. The Cancer Dietary (CanDiTM) app was developed as a convenient, flexible and attractively engaging smartphone app containing healthy tips which are uniquely tailored to the local food choices, preferences and ingredients. This helps customise users’ dietary needs besides permitting constant information up-dating. Features are broadly categorised into Healthy Eating Guide (advice from healthy eating to eating problems, weight loss prevention and increasing proteins and calories intake) and Malaysian Recipes For Cancer Patients (focusing on common Malaysian dishes, ingredients, treatment-based recipes and special diets). An additional Symptom Diary allows user’s personal profile to be recorded and stored virtually online. Its feasibility and acceptability were further tested among 30 cancer patients, family caregivers and dieticians recruited from a public hospital in Terengganu, Malaysia. Very good feasibility (> 80%) and excellent acceptability (> 90%) were reported regarding its ease of operation, suitability of language used, attractiveness, knowledge enhancement and perceived usefulness. With this scientific yet creative innovation, routine dietary habits related to cancer conditions could be easily facilitated for both patients/survivors as well as family caregivers for their independent and healthy living.
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Inappropriate use of medicine could lead to harmful effects on the user. In some cases it results in unnecessary adverse drug reactions and drug interactions. Knowledge about possible side effect and drug interaction may ensure better self-medication practices. This study aimed to explore the prevalence of self-medication practices among undergraduate students of a public university in Terengganu, Malaysia, and to identify the most common group of medicine used. Knowledge on adverse drug reactions (ADRs) and drug interactions was also explored. A structured questionnaire asking about self-medication, therapeutic classes, knowledge of ADRs and drug interactions was administered to 363 final year students of UniSZA. Statistical analyses were performed using SPSS version 20.0. Nearly half (46.6%) practised self-medication in the previous week and about 84.0% were aware of ADRs and drug interactions. Pain relievers were the most common group of medicines consumed (63.4%). Self-medication practices were moderately common among the undergraduates and they were aware of ADRs and drugs interactions. More awareness should be given to the students for continuous safe self-medication.
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The objective of this study was to compile and analyse existing scientific evidences reporting the effects of objectively measured physical activity on the levels of adiponectin and leptin. Articles related to the effects of objectively measured physical activity on the levels of adiponectin and leptin were searched from the Medline and PubMed databases. The search was limited to ‘objectively measured’ physical activity, and studies that did not objectively measure the physical activity were excluded. Only English articles were included in the search and review. A total of 18 articles encompassing 2,026 respondents met the inclusion criteria. The eligible articles included all forms of evidence (e.g., cross-sectional and intervention). Seventeen and 11 studies showed the effects of objectively measured physical activity on adiponectin and leptin, respectively. Five and four cross-sectional studies showed the effects of objectively measured physical activity on adiponectin and leptin, respectively. Two out of five studies showed a weak to moderate positive association between adiponectin and objectively measured physical activity, while three out of four studies showed a weak to moderate inverse association between leptin and objectively measured physical activity. For intervention studies, six out of 12 studies involving adiponectin and five out of seven studies involving leptin showed a significant effect between the proteins and objectively measured physical activity. However, a definitive conclusion could not be drawn due to several methodological flaws in the existing articles and the acute lack of additional research in this area. In conclusion, the existing evidences are encouraging but yet not compelling. Hence, further well-designed large trials are needed before the effectiveness of objectively measured physical activity in elevating adiponectin levels and in decreasing leptin levels could be strongly confirmed.
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Objective: Living with epilepsy imposes great challenges on both patients and their family caregivers but most researchers only explored the impact on patients, with less attention given to family caregivers. Our study intended to explore the needs and problems of epilepsy family caregivers of epilepsy patients encountered during the caregiving process. Methods: Respondents were recruited from the Neurology Clinic of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu. A semi-structured interview was conducted using openended and broad questions asking about their general experience in caregiving, daily routine activities, caregiving effects, caregiving difficulties and caregivers’ needs. The interviewed data were later transcribed into verbatim before further analysis using the QSR International’s NVivo10 software. Results: Fifteen Malay Muslim family caregivers between the age of 19 and 66 years participated. Most were females (53%), married (67%), with education level at secondary school or equivalent (73%) and were homemakers (40%). In particular, respondents expressed the need for extra support from their family members and experts in terms of physical (care relief), mental, and financial aspects. In addition, the major caregiving problems identified included: (i) emotional disturbances (sad, angry, depressed, and anxious); (ii) care giving challenges (family adjustments, physical burden, psychological burden, and time management); and (iii) financial issues (not working and limited family income). Some advantages in caregiving were also reported. Conclusion: In conclusion, their experiences while taking care of their loved ones in terms of feelings, beliefs and needs exposed the difficulties in caregiving, causing substantial emotional pressure which could later lead to poor quality of caregiving.
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Objective: The family caregiver has a pivotal role in the management of HIV/AIDS patients and their well-being is consequently crucial as it could impact negatively on the quality of caregiving. This preliminary qualitative investigation intended to explore and describe the challenges and experiences of HIV/AIDS family caregivers in Terengganu, Malaysia. Methods: A convenient sample of family caregivers of HIV/AIDS patients who were aware of the diagnosis was enrolled. Recruitment was conducted in Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia and semi-structured interviews were used. Results: Results were transcribed into verbatim before being subjected to analysis. Twelve Muslim caregivers consented participation (age range = 18.0 - 81.0; female = 75.0%, mother/wife = 50.0%; married = 83.3%; ≤ primary school = 50.0%; and self-employed = 66.7%). The four major themes that emerged were challenges of caregiving, financial issues, stigma and discrimination, and support for caregivers. Additionally, caregivers did mention several positive aspects of their caregiving role including satisfaction from helping family member and improved family relationships. Conclusion: A variety of life aspects were negatively affected by caring for HIV patients, thus requiring a multidisciplinary approach to address such issues.
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HIV , Caregivers , Islam , Life Change Events , Patients , MalaysiaABSTRACT
Objective: The purpose of this study was to evaluate the effectiveness of nutrition education intervention among university students in terms of social, psychological factors and nutrition-related Quality of Life (NQoL) outcomes after receiving a 10-week nutrition education. Longitudinal and randomised study design was adopted for the study. Methods: A total of 417 respondents from four public universities in Terengganu were randomly assigned to either intervention group (IG = 205) or control group (CG = 212). The IG received nutrition education through three tools; 1) conventional lecture, 2) brochures and 3) text messages via short messaging system (SMS) while the CG not received any intervention. Students completed the Malay version of NQoL (6 domains; 49 items; Likert-type responses=1-5) and SF-36 (8 domains; 36 items) at pre-intervention and post-intervention. Data analysis was carried out by using SPSS 16.0 utilising descriptive and parametric statistics. Results: Ninety-one percent of participants (IG = 178; CG = 202) completed the study (age = 19.1±1.1 years; female = 87.6%; Malay = 98.2%). After controlling for possible confounders (eg. weight, waist, hip circumferences and pre-intervention scores for each domain), IG possessed relatively higher NQoL score in Food Impact (p = 0.001), Social / Interpersonal (p = 0.008), Physical Functioning (p = 0.011) and Overall NQoL (p = 0.001). However, Psychological Factors did not show any significant difference for both groups. Conclusion: Although the intervention did not generate significant impact in the psychological component over a period of 10 weeks, significant positive impacts in Social/Interpersonal aspects and NQoL were clearly shown.
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Quality of Life , Text MessagingABSTRACT
Objectives: This review aims to compile and evaluate all available randomised controlled trials (RCTs) of auricular acupuncture (AA) treatment in drug addiction population with emphasis on the length of treatment course, needle-points, outcome measures, reported side-effects and overall outcomes. Methods: Science Direct, Medline and EBSCOhost databases were searched. From the year 1990 until 2010, only full-length English articles incorporating RCTs related to AA studies (needlebased only) in drug addiction such as heroin, morphine, methamphetamine and cocaine were included. Studies involving the usage of various methods of electroacupuncture and investigations relating to cigarette-smoking or alcohol addiction were excluded. Results: Eight RCTs met all inclusion criteria comprising of 1,594 respondents (age = 19 - 46 years; male = 57% - 76%). Most were involved in cocaine addiction. Overall, trials were designed with brief periods of treatment course and utilised three to five standard National Acupuncture Detoxification Association (NADA) points (Sympathetic, Lung, Liver, Kidney and Shenmen), but inconsistent sham points. All trials included urine toxicology test as the main outcome measure while data on side-effects incidence was insufficient. Conclusions: Overall, four of the RCTs reported positive outcomes although at this point, AA’s effectiveness and safety could not be substantially confirmed. For the future, high-quality RCTs of AA are urgently required to provide a clearer understanding on the usefulness of this complementary therapy in drug addiction treatment.
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Objective: Despite the availability of modern anti-emetics, chemotherapy-induced nausea and vomiting (CINV) symptoms remain distressing to a high number of cancer patients. This study intended to (1) describe the incidence of CINV and antiemetic usage; (2) assess the health-related quality of life (HRQoL) and correlate its components with Global Health Status; (3) evaluate HRQoL status in relation to CINV among breast cancer patients receiving chemotherapy. Methods: A cross sectional study was conducted in two government hospitals located in the East Coast of Peninsular Malaysia (Terengganu, Kelantan). The Morrow Assessment of Nausea and Emesis Follow-up (MANE-FU) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were administered. Descriptive statistics and non-parametric tests were employed (SPSS 16). Results: Respondents included 41 female patients (age = 49 ± 9.6 years; Malay = 92.7%; no family history of breast cancer = 68.3% and on moderately emetogenic chemotherapy = 97.6%). Majority of patients experienced nausea during or after chemotherapy (90.2%) and rated it as ‘severe’. Most patients had taken anti-emetic (87.8%) and considered it ‘somewhat useful’. The median score for Global Health Status was 50 (IqR= 16.7). Emotional Functioning, Fatigue and Pain correlated fairly with HRQoL (rs= +0.435; -0.417; -0.387 respectively). Patients with ‘a lot’ and ‘moderate’ nausea displayed significantly more fatigue compared to those with little nausea (p=0.029). Those who experienced vomiting reported worse HRQoL profile compared to those who did not (p=0.011). Conclusion: These findings generally ascertained that CINV remains poorly controlled and significantly interferes with HRQoL, providing rooms for improvements in therapeutic intervention.
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Objectives: This paper mainly intended to review the experiences and challenges encountered particularly in mental health issues and to additionally analyze the methodologies used in studies involving HIV/AIDS informal caregivers. Methods: Four electronic databases; Science Direct, EBSCOhost, Ovid and Springer Link were searched for articles published in the past 10 years (2002 – 2012). Only full-text English articles related to research on care giving of HIV-infected adult patients were selected. Results: Twenty two out of 293 articles (7.5%) were reviewed, involving 2,765 caregivers in the USA (n=1,610), Africa (n=253), Asia (n=838) and Oceania (n=64) regions. A variety of age categories was involved in care giving with the youngest carer being 12 years old and the oldest, 60 years on average. Females and whites appeared to be dominant and 603 caregivers themselves were HIVpositive. The main outcomes measured were care giving burden, challenges and coping. Stress and depression, stigma and discrimination, insufficient support, role overload and extreme poverty were the main challenges experienced in care giving. Both qualitative (n=11) and quantitative (n=9) were the equally preferred types of study. Purposive sampling emerged as the most preferred sampling technique. Various instruments were utilized, but the Beck Depression Inventory (BDI) was the most popular particularly in quantitative studies. Conclusion: A variety of life aspects were negatively affected in the process of care giving for HIV/AIDS patients and studies of such nature commonly focused on caregivers’ psychosocial burden.
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Objective: This interventional study was aimed to investigate the effects of dark chocolate consumption on anxiety, depression, and stress (ADS) among trainee nurses. Methods: A parallel and open-label experimental study was conducted. Of the 128 nurses enrolled, only 47 participated in the intervention study (mean age = 20.32 years; ranging from 19 to 22 years old). They were randomly assigned to an intervention group (IG, n = 25) or a control group (CG, n = 22). The IG consumed dark chocolate and CG ingested mineral water for 3 consecutive days. The validated Malay Hospital Anxiety and Depression Scale (HADS) and Depression, Anxiety and Stress Scale (DASS-21) were utilised for measuring ADS levels. Data were analysed descriptively and score comparisons were conducted using non-parametric tests. Results: No significant differences between IG and CG in ADS scores were detected at baseline (all p > 0.05). At post-consumption, ADS score were significantly reduced in IG (all p < 0.01) compared with CG (all p < 0.05). Larger effect sizes among these respondents had also revealed that there were mood-elevating effects of dark chocolate consumption. Conclusion: This study has discovered that 3-day consumption of dark chocolate may alleviate ADS status among trainee nurses suggesting that dark chocolate may have a more prominent role in improving emotional and mood generally. Further investigations are however warranted to confirm this finding.
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Objective: The relationships between awareness, knowledge and attitudes (AKA) and coping mechanisms among people with epilepsy (PWE) have not been well-explored particularly in Asia. This study aimed to: identify preferred coping strategies, correlate between AKA and coping mechanisms and compare coping strategies of PWE with different AKA levels. Methods: A cross-sectional sample of epilepsy out-patients was recruited from the Neurology Clinic, Hospital Sultanah Nur Zahirah, Kuala Terengganu. The participants completed the Malay AKA Epilepsy and the Malay Brief COPE instruments. The data was analysed using non-parametric statistics. Results: Sixty out of 72 patients (response rate = 83.3%) consented participation (median age = 27.5 years; male = 53.3%; unmarried = 63.3%; Malay = 90.0%; SPM education = 54.2%; unemployed = 35.0%; rural residents = 70.0%). Religion was the most preferred coping strategy (93.3%), followed by Emotional Support (86.7%) and Instrumental Support (81.7%). Awareness was negatively correlated with Instrumental Support (rs = -0.268; p<0.05) while Knowledge was positively linked to Humour (rs = +0.267; p<0.05). Positive associations between Attitudes versus Active Coping and Positive Reframing were also detected (rs = +0.284 to +0.331; p<0.05). Patients with good AKA levels coped significantly better through Self Distraction, Positive Reframing and Humour (p<0.01). Conclusion: AKA levels seemed to influence the type of coping strategies adopted by PWE in dealing with their illness suggesting that, efforts in improving AKA level should be combined with appropriate coping strategies to provide better health outcomes in epilepsy management.