A randomised controlled trial on the effects of a structural education module among women with polycystic ovarian syndrome on nutrition and physical activity changes.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is a complex metabolic, endocrine and reproductive disorder that has a huge impact on the life of women. To ascertain the effectiveness of health education module among women with PCOS. METHODS: This single-centre, randomised controlled trial was conducted on female staff of the University Putra Malaysia who were diagnosed with PCOS. Subjects were randomly assigned into intervention (n = 34) and control group (n = 35). In the intervention group, they need to take part in 8 education sessions in total over 6 months, and feedback was collected at the end of the session. RESULTS: Primary outcome was changes in knowledge, attitude and practise of nutrition. Secondary outcomes were eating attitude and behaviour as well as knowledge, attitude and practise towards physical activity. After 6-months of intervention, there was a significant difference observed in nutrition knowledge 1 score (p < 0.001) and nutrition knowledge 2 score (p = 0.01) between intervention and control groups. Similarly, there was a significant difference observed in international physical activity questionnaire score (p = 0.02) between intervention and control groups. However there was no significant changes for attitude and practice of nutrition, eating attitude as well as knowledge, attitude and practise of physical activity. CONCLUSIONS: Our study showed that 6-months of education intervention can improve nutrition and physical activity knowledge. Based on this study, the education module may be considered an effective intervention for women with PCOS. TRIAL REGISTRATION: Name of the registry: Australian New Zealand Clinical Trials Registry (ANZCTR). TRIAL REGISTRATION NUMBER: ACTRN12617000135314. Date of registration: 24/01/2017. URL of trial registry record: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372037.

Designing and Validating a Questionnaire on Healthy Lifestyle to Reduce Depressive Symptoms among Adolescents.

Objective: Most adolescents do not meet national recommendations for healthy lifestyle and reducing depressive symptom. A comprehensive educational program with its specified questionnaire is needed to improve healthy lifestyle to assess the lifestyle components. This study aimed to confirm the validity of a healthy lifestyle questionnaire to assess depressive symptoms among adolescents. Method : A descriptive predictive study using simple random sampling was performed in a secondary school in Kuala Lumpur, Malaysia, among 235 school-going adolescents (13-15 years old) with Malaysian nationality. The instrument consisted of a set of dual language (English and Malay) for both researcher-administered questionnaires (knowledge, attitude, eating behavior, and relaxation activities) and standard-validated questionnaires (Physical Activity questionnaire for Adolescents, Depression, Anxiety, and Stress Scale- 21, and Brief Copping). Data were analyzed using the kappa statistics (k) and the intraclass correlation coefficient test for reliability and Partial Least Squares (PLS) for validity. Results: The reliability of all variables was over the substantial level (ICC and/or k > 0.61). The model and construct variables were predictive of depressive symptoms by 49.4%. To analyze the validity of the questions, 11 questions were removed from the initial model for factorial loading less than 0.5. In convergent validity of theory of information-motivation-behavioral skills, AVE (average variance construct), the outer loading, was higher than 0.5. Conclusion: PLS confirmed the existence of sufficient correlations between different items of the construct. Thus, the weights of indicators appeared to be appropriate indicators for the model. The results proved that the information, motivation, and behavioral skills model was efficient for healthy lifestyle and can be a good base for further research.

Relationship between serum high sensitivity C-reactive protein with angiographic severity of coronary artery disease and traditional cardiovascular risk factors.

Serum high-sensitivity C-reactive protein (hs-CRP) is predictive of coronary artery disease (CAD). The aim of this study was to examine the possible association of hs-CRP with presence and severity of CAD and traditional CAD risk factors. This case-control study was carried out on 2,346 individuals from September 2011 to May 2013. Of these 1,187 had evidence of coronary disease, and were subject to coronary angiography, and the remainder were healthy controls (n = 1,159). Characteristics were determined using standard laboratory techniques and serum Hs-CRP levels were estimated using enzyme-linked immunosorbent assay (ELISA) kits, and severity of CAD was assessed according to the score of obstruction in coronary artery. Serum hs-CRP levels were higher in those with severe coronary disease, who had stenosis ≥ 50% stenosis of at least one coronary artery (all p < 0.001 vs. individuals in healthy control), and correlated significantly with the score for coronary artery disease (all p < 0.01). After adjustment for conventional risk factors, regression analysis revealed that smoking habits, fasting blood glucose, total cholesterol, high-density lipoprotein, hs-CRP, blood pressure, anxiety, dietary intake of vitamin E, and cholesterol remained as independent determinants for angiographic severity of CAD. The area under the receiving operating characteristic (ROC) curve for serum hs-CRP was 0.869 (CI 95% 0.721-0.872, p < 0.001). The optimal values for the cut-off point was a serum hs-CRP of 2.78 mg/l (sensitivity 80.20%, specificity 85%) to predict severity of CAD. Increased serum hs-CRP levels are significantly associated with angiographic severity of CAD, suggesting its value as a biomarkers for predicting CAD.

A Review on the Assessment of the Efficacy of Common Treatments in Polycystic Ovarian Syndrome on Prevention of Diabetes Mellitus.

Objective: Polycystic ovarian syndrome (PCOS) is a common condition amongst women of reproductive age that can result in increased mortality and morbidity in women due to increased risk of diabetes mellitus and cardiovascular diseases. The aim of this systematic review was to assess the effectiveness of common treatments of PCOS on the predictors of diabetes in non-diabetic PCOS women. Materials and methods: An extensive search was performed on the publications in three medical databases including pubmed, scopus and google scholar from 1995 till 2017. The articles were screened based on their quality and included in this systematic review. A total of 25 articles including cohort, randomised controlled trial, review and meta-analysis were included in the review. Results: This systematic review revealed that the effect of lifestyle modification might be low in PCOS subjects due to high drop-out rate while the benefits of this intervention including weight and fat reduction may not be achieved by medical interventions. Metformin treatment may result in improvements in insulin sensitivity while its weight reduction effect is still not documented in PCOS subjects. Thiazolidendiones might be tolerated by the PCOS subjects and may result in similar effects as metformin but this effect should be documented by further studies. Conclusion: Combination of lifestyle modification with metformin or thiazolidinedions might improve the outcome of the prevention strategies. On the other hand this study revealed a different response to treatments in non-obese compared with obese PCOS subjects.

Serum concentrations of MCP-1 and IL-6 in combination predict the presence of coronary artery disease and mortality in subjects undergoing coronary angiography.

Cytokines play a key role in the pathogenesis of coronary artery disease (CAD). The aim of current study was to investigate the relationship between the serum concentrations of 12 cytokines with mortality and extent of CAD in individuals undergoing angiography and healthy controls. 342 CAD patients were recruited and divided into 2 groups: those with ≥50% occlusion in at least one coronary artery [Angiography (+)] or <50% obstruction in coronary arteries [Angiography (-)]. Also 120 healthy subjects were enrolled as control group. Lipid profile, fasting blood glucose, body mass index, and blood pressure were evaluated in all the subjects. An Evidence Investigator® was used for measuring 12 cytokines (IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, MCP-1, IFN-γ, EGF, VEGF) using sandwich chemiluminescent assays. Univariate analysis, multivariate regression models, ROC, and Kaplan-Meier survival curves were used for exploring the candidate markers in CAD patients. Serum level of IFN-γ, IL-4, MCP-1, EGF, IL-6, and IL-8 were markedly higher in angiogram-positive patients, while VEGF concentrations were significantly (P < 0.05) lower, compared to control group. ROC analysis for MCP-1 showed that a cut-off of 61.95 pg/mL had 91% sensitivity and 91% specificity for predicting CAD patients. Moreover, >2.16 pg/mL IL-6 had a > 94% sensitivity and 70% specificity in predicting 2 years mortality in the subjects with a serum MCP-1 > 61.95 pg/ mL, and patients having IL-6/MCP-1 combination had a shorter survival.Our findings demonstrate that CAD patients with serum MCP-1 and IL-6 levels of >61.95 and >2.16 pg/mL had a higher mortality with 94.1% sensitivity and 70.5% specificity for predicting mortality in CAD patients.

A study on level of physical activity, depression, anxiety and stress symptoms among adolescents.

BACKGROUND: Inadequate physical activity has adverse health consequences among adolescents. Mental health problem can be developed by lack of physical activity however it is controversial. The current study aimed to examine the association between level of physical activity with depression, anxiety and stress symptoms among adolescents. METHODS: A representative sample of 1747 adolescents (13-14 years) was randomly selected from 6 schools in a south part of Malaysia. Respondents were asked to fill consent form, and questionnaires including Depression Anxiety and Stress Scale-21 and Physical Activity Questionnaire for Adolescents. RESULTS: Majority of respondents (71.9%) was Malay and more than half of the adolescents had low physical activity. About 40% had depression symptoms, followed by anxiety symptoms (65.9%) and stress symptoms (38.5%). Level of physical activity was significantly associated with gender, anxiety and stress (P<0.001). There were no associations with race, religion and depression symptom. CONCLUSIONS: This study provides some evidence among school-going adolescents related to anxiety and stress symptoms and low physical activities. Further studies are needed to show the protection effects of higher physical activity for depression, anxiety and stress symptoms in adolescents.

Sexual Dysfunction in Patients with Polycystic Ovary Syndrome in Malaysia.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a combination of chronic anovulation, obesity, and hyperandrogenism and can affect sexual function in women of reproductive age. It is also associated with endometrial cancer. Our aim was to evaluate the frequency and predisposing factors of sexual dysfunction in PCOS patients. MATERIALS AND METHODS: In this cross-sectional study, 16 married women with a definite diagnosis of PCOS were recruited. Sexual function was assessed in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain using the female sexual function index (FSFI) questionnaire. Patients were also assessed for mental health using the depression, anxiety and stress (DASS-21) questionnaire. Presence of hirsutism was assessed using the Ferriman-Gallwey (FG) scoring system. Demographic data were obtained from patients during in-person interview. RESULTS: Sexual dysfunction was present in 62.5% of patients with the domains of arousal and lubrication particularly affected (93.8% and 87.5%, respectively). Patients with symptoms of depression and anxiety were significantly more likely to suffer sexual dysfunction than those without these symptoms (p=0.04 and p=0.03 respectively). Patients with stress symptoms reported higher orgasm dysfunction than those without (p=0.02). No significant difference in any of the FSFI score domains was observed between patients with and without hirsutism. CONCLUSIONS: PCOS patients markedly suffer from sexual dysfunction and therefore it seems appropriate to be screened for intervention. Poor mental health conditions that may be the result of infertility or other complications of PCOS should also be considered as curable causes of sexual dysfunction in these patients.

Result of randomized control trial to increase breast health awareness among young females in Malaysia.

BACKGROUND: Breast cancer is the most common cancer and the second principal cause of cancer deaths in women worldwide as well as in Malaysia. Breast self-examination (BSE) has a role in raising breast cancer awareness among women and educational programs play an important role in breast cancer preventive behavior. The aim of this study is to develop, implement and evaluate the effectiveness of Breast Health Awareness program based on health belief model on knowledge of breast cancer and breast-selfexamination and BSE practice among female students in Malaysia. METHODS: A single-blind randomized controlled trial was carried out among 370 female undergraduate students from January 2011 to April 2012 in two selected public universities in Malaysia. Participants were randomized to either the intervention group or the control group. The educational program was delivered to the intervention group. The outcome measures were assessed at baseline, 6, and 12 months after implementing the health educational program. Chi-square, independent samples t-test and two-way repeated measures ANOVA (GLM) were conducted in the course of the data analyses. RESULTS: Mean scores of knowledge on breast cancer (p<0.003), knowledge on breast self examination (p<0.001), benefits of BSE (p<0.00), barrier of BSE (0.01) and confidence of BSE practice (p<0.00) in the intervention group had significant differences in comparison with those of the control group 6 and 12 months after the intervention. Also, among those who never practiced BSE at baseline, frequency of BSE practice increased 6 and 12 months after the intervention (p<0.05). CONCLUSION: The Breast Health Awareness program based on health the belief model had a positive effect on knowledge of breast cancer and breast self-examination and practice of BSE among females in Malaysia. TRIAL REGISTRATION: The ANZCTR clinical trial registry ( ACTRN12616000831482 ), retrospectively registered on Jun 23, 2016 in ANZCTR.org.au.

Effect of Nigella sativa on reproductive system in experimental menopause rat model.

OBJECTIVE: Menopause is the condition when regular menstrual periods cease and may be accompanied by psychological and physical symptoms. The purpose of current study was to determine Nigella sativa effects on reproductive system in experimental menopause animal models. MATERIALS AND METHODS: A series of experiments was conducted to investigate the effects of different dosages of N. sativa (first experiment), various extracts of N. sativa (second experiment) and some of its ingredients (third experiment) on selected menopausal parameters of ovariectomized (OVX) rats. Forty different OVX rats were equally divided into 5 groups and administered with one of the following treatments for 21 days: conjugated equine estrogen (positive control), distilled water or olive oil (negative control), treatment groups (N. sativa300, 600 and 1200 mg/kg in the first experiment), (300mg/kg methanol, hexane and SFE extracts of N. sativa in the second experiment) and (linoleic acid 50 mg/kg, gamma linolenic acid 10mg/kg, and thymoquinone 15mg/kg in the third experiment). RESULTS: The results demonstrated that N.sativa exert estrogenic effect were exhibited through uterotrophic assay and vaginal cell cornification as well as blood estrogen level. Furthermore, low dose N. sativa, methanol extract and linoleic acid had prominent estrogenic like effects which were significantly different from those of control group (p<0.05) in different experiments. CONCLUSION: The finding indicated the probable beneficial role for N. sativa in the treatment of postmenopausal symptoms and possibility of using N. sativa as an alternative to hormone replacement therapy (HRT) for post menopause in human.

DEPRESSION AND ITS ASSOCIATED FACTORS AMONG SECONDARY SCHOOL STUDENTS IN MALAYSIA.

Research in the field of factors associated with depression among adolescents is lacking in Malaysia. The aims of the present study were to assess the current prevalence of depression and its related factors among secondary school students in Pasir Gudang, South Malaysia. In this cross sectional study, 2,927 secondary school students (13-17 years old) from urban areas were screened for symptoms of mental disorder as well as demographic and risk behaviors using a validated Depression, Anxiety and Stress Scale (DASS) 12 questionnaire. The majority of the respondents (53.8%) were Malay, of which 53.1% were female. Symptoms of mild depression were found in 33.2% of the respondents, while the prevalence of the symptoms of moderate, severe, and extremely severe depression was 21.5%, 18.1%, and 3.0%, respectively. Logistic regression suggested that participants who were Chinese or had a lower average grade were three times more likely to have depression, while those who came from a single-parent family were twice as likely to have this condition. This study indicated that academic performance and risk behaviors along with the demographic characteristics are important contributors to adolescent depression.

Barriers to breast self examination practice among Malaysian female students: a cross sectional study.

INTRODUCTION: Breast cancer is the most frequent cancer and the second reason of cancer deaths among woman worldwide, including Malaysia. The objective of this paper is to assess the practice of breast self-examination (BSE) and identify the barriers of BSE practice among undergraduate female students in Malaysia. METHODS: A cross-sectional study conducted among 810 female undergraduate students in Klang Valley, Malaysia between April-Jun 2012. Data was collected via self-administered questionnaire which was developed and pre-tested for this study. RESULTS: The majority of respondents were Malay 709 (95.6 %) and single 719 (96.9 %) with a mean age of 21.7 (1.1). Only hundred eleven (15 %) of the participants had a family history of breast cancer. 70.5 % of the respondents do not practice breast self-examination, 70.5 % do not know how to do it, 64.7 and 61.5 % reported no symptoms of breast cancer and worries to detect breast cancer, respectively. Univariate analysis showed that age, marital status and personal history of breast disease were statistically associated with the practice of breast self-examination. CONCLUSION: In this study, a high percentage of respondents were aware of breast cancer but do not perform breast self-examination. Knowledge, socio-cultural and environmental factors were identified as barriers; so it is recommended that knowledge among the public about breast cancer and promotion of public breast health awareness campaigns through the media should be carried out.

Knowledge of Female Undergraduate Students on Breast Cancer and Breast Self-examination in Klang Valley, Malaysia.

BACKGROUND: In Malaysia, breast cancer is the first cancer among females regardness of race. AIM: The purpose of this study was to identify the knowledge and BSE practice among undergraduate female students at four public universities in Klang Valley, Malaysia. MATERIALS AND METHODS: This cross-sectional study was conducted among 820 undergraduate female students using a self-administered questionnaire covering socio-demographic data, knowledge of breast cancer and BSE practice. RESULTS: The mean age of the respondents was 21.7±1.2 years. The majority of them were single (96.8%), Malay (91.9%) and 16.5% of respondents had a family history of breast cancer. This study showed low level of knowledge on breast cancer and breast self-examination among participants. Only 19.6% participants were performing BSE regularly. Knowledge of breast self-examination was significantly associated with BSE practice (p=0.00). Also, there were significant associations between performing BSE with age, marital status and being trained by a doctor for doing BSE (p<0.05). CONCLUSIONS: Our findings showed that the rate of BSE practice and knowledge of breast cancer is inadequate among young Malaysian females. A public health education program is essential to improve breast cancer prevention among this group.

Electrical Impedance Tomography as a Primary Screening Technique for Breast Cancer Detection.

Electrical impedance tomography (EIT) is a new non-invasive, mobile screening method which does not use ionizing radiation to the human breast. It is based on the theory that cancer cells display altered local dielectric properties, thus demonstrating measurably higher conductivity values. This article reviews the utilisation of EIT in breast cancer detection. It could be used as an adjunct to mammography and ultrasonography for breast cancer screening.

Insufficient Knowledge of Breast Cancer Risk Factors Among Malaysian Female University Students.

BACKGROUND: Despite continuous argument about the efficacy of breast self-examination; it still could be a life-saving technique through inspiring and empowering women to take better control over their body/breast and health. This study investigated Malaysian female university students' knowledge about breast cancer risk factors, signs, and symptoms and assessed breast self-examination frequency among students. METHOD: A cross-sectional survey was conducted in 2013 in nine public and private universities in the Klang Valley and Selangor. 842 female students were respondents for the self-administered survey technique. Simple descriptive and inferential statistics were employed for data analysis. RESULTS: The uptake of breast self-examination (BSE) was less than 50% among the students. Most of students had insufficient knowledge on several breast cancer risk factors. CONCLUSION: Actions and efforts should be done to increase knowledge of breast cancer through the development of ethnically and traditionally sensitive educational training on BSE and breast cancer literacy.

Health Beliefs and Breast Self-Examination among Undergraduate Female Students in Public Universities in Klang Valley, Malaysia.

BACKGROUND: Breast cancer is the most frequently occurring cancer in women and the most common cause of cancer death worldwide. MATERIALS AND METHODS: A cross-sectional study was carried out among 792 female undergraduate students in public universities in Klang Valley, Malaysia, from January to April 2011. Data were collected using a validated questionnaire developed for this study. RESULTS: The mean age of respondents was 21.7±1.2 years. Most of them were single (96.8%), Malay (91.9%) and 150 (19.6%) claimed they had practiced BSE. There was a significant differences between performers and non-performers correlated to age, marital status, check breast by doctor, and being trained about BSE. Performers had lower mean scores for perceived barriers and susceptibility and higher mean score for confidence. Stepwise logistic regression analysis yielded four significant predictor variables. CONCLUSIONS: Overall our findings indicate that the practice of BSE while perceived as being important is not frequently practiced among female in Malaysia. Targeted education should be implemented to improve early detection of breast cancer.

Breast cancer prevention information seeking behavior and interest on cell phone and text use: a cross-sectional study in Malaysia.

BACKGROUND: Breast cancer is the most common cancer and the second principal cause of cancer deaths among women worldwide, including Malaysia. This study focused on media choice and attempted to determine the communication channels mostly used and preferred by women in seeking information and knowledge about breast cancer. MATERIALS AND METHODS: A cross sectional study was carried out to examine the breast cancer prevention information seeking behavior among 450 students at one private university in Malaysia. RESULTS: The mean age of respondents was 25±4.3 years. Common interpersonal information sources were doctors, friends, and nurses and common channel information sources were television, brochure, and internet. Overall, 89.9% used cell phones, 46.1% had an interest in receiving cell phone breast cancer prevention messages, 73.9% used text messaging, and 36.7% had an interest in receiving text breast cancer prevention messages. Bivariate analysis revealed significant differences among age, eduation, nationality and use of cell phones. CONCLUSIONS: Assessment of health information seeking behavior is important for community health educators to target populations for program development.

Assessment of the reliability of a novel self-sampling device for performing cervical sampling in Malaysia.

BACKGROUND: The participation of women in cervical cancer screening in Malaysia is low. Self-sampling might be able to overcome this problem.The aim of this study was to assess the reliability of self-sampling for cervical smear in our country. MATERIALS AND METHODS: This cross-sectional study was conducted on 258 community dwelling women from urban and rural settings who participated in health campaigns. In order to reduce the sampling bias, half of the study population performed the self-sampling prior to the physician sampling while the other half performed the self-sampling after the physician sampling, randomly. Acquired samples were assessed for cytological changes as well as HPV DNA detection. RESULTS: The mean age of the subjects was 40.4±11.3 years. The prevalence of abnormal cervical changes was 2.7%. High risk and low risk HPV genotypes were found in 4.0% and 2.7% of the subjects, respectively. A substantial agreement was observed between self-sampling and the physician obtained sampling in cytological diagnosis (k=0.62, 95%CI=0.50, 0.74), micro-organism detection (k=0.77, 95%CI=0.66, 0.88) and detection of hormonal status (k=0.75, 95%CI=0.65, 0.85) as well as detection of high risk (k=0.77, 95%CI=0.4, 0.98) and low risk (K=0.77, 95%CI=0.50, 0.92) HPV. Menopausal state was found to be related with 8.39 times more adequate cell specimens for cytology but 0.13 times less adequate cell specimens for virological assessment. CONCLUSIONS: This study revealed that self-sampling has a good agreement with physician sampling in detecting HPV genotypes. Self-sampling can serve as a tool in HPV screening while it may be useful in detecting cytological abnormalities in Malaysia.

Predictor of cardiovascular risks in end stage renal failure patients on maintenance dialysis.

OBJECTIVE: Cardiovascular disease (CVD) is the main cause of morbidity and premature mortality in end stage renal failure patients (ESRD) receiving dialysis. The aim of our study was to evaluate the impact of various risk factors in this group of high CVD risk patients in local population. METHODS: We carried out a cross-sectional retrospective study in a single hospital. A total of 136 ESRF patients, consisted of 43 haemodialysis (HD) and 93 continuous ambulatory peritoneal dialysis (CAPD) patients, were recruited and followed up for 36 months duration. Midweek clinical and laboratory data were collected. The occurrence of existing and new CVD events was recorded. RESULTS: Multiple Logistic Regression showed pre-existing cardiovascular event (odds ratio, 4.124; 95% confidence interval [CI], 0.990 to 17.187), elevated total cholesterol level (odds ratio, 0.550; 95% CI, 0.315 to 0.963), elevated serum phosphate level (odds ratio, 5.862; 95% CI, 1.041 to 33.024) and elevated random blood glucose level (odds ratio, 1.193; 95% CI, 1.012 to 1.406) were significantly associated with occurrence of CVD events. CONCLUSIONS: History of cardiovascular event before the initiation of dialysis, elevated level of serum phosphate and random blood glucose levels are the risk factors of CVD whereas paradoxically a high total cholesterol level has CVD protective effect towards the ESRF patients.