Topologically associating domains in the POLLED region are the same for Angus- and Brahman-specific Hi-C reads from F1 hybrid fetal tissue

Horns, a form of headgear carried by Bovidae, have ethical and economic implications for ruminant production species such as cattle and goats. Hornless (polled) individuals are preferred. In cattle, four genetic variants (Celtic, Friesian, Mongolian and Guarani) are associated with the polled phenotype, which are clustered in a 300-kb region on chromosome 1. As the variants are intergenic, the functional effect is unknown. The aim of this study was to determine if the POLLED variants affect chromatin structure or disrupt enhancers using publicly available data. Topologically associating domains (TADs) were analyzed using Angus- and Brahman-specific Hi-C reads from lung tissue of an Angus (Celtic allele) cross Brahman (horned) fetus. Predicted bovine enhancers and chromatin immunoprecipitation sequencing peaks for histone modifications associated with enhancers (H3K27ac and H3K4me1) were mapped to the POLLED region. TADs analyzed from Angus- and Brahman-specific Hi-C reads were the same, therefore, the Celtic variant does not appear to affect this level of chromatin structure. The Celtic variant is located in a different TAD from the Friesian, Mongolian, and Guarani variants. Predicted enhancers and histone modifications overlapped with the Guarani and Friesian variants but not the Celtic or Mongolian variants. This study provides insight into the mechanisms of the POLLED variants for disrupting horn development. These results should be validated using data produced from the horn bud region of horned and polled bovine fetuses.

Opportunity to improve livestock traits using 3D genomics

The advent of high-throughput chromosome conformation capture and sequencing (Hi-C) has enabled researchers to probe the 3D architecture of the mammalian genome in a genome-wide manner. Simultaneously, advances in epigenomic assays, such as chromatin immunoprecipitation and sequencing (ChIP-seq) and DNase-seq, have enabled researchers to study cis-regulatory interactions and chromatin accessibility across the same genome-wide scale. The use of these data has revealed many unique insights into gene regulation and disease pathomechanisms in several model organisms. With the advent of these high-throughput sequencing technologies, there has been an ever-increasing number of datasets available for study; however, this is often limited to model organisms. Livestock species play critical roles in the economies of developing and developed nations alike. Despite this, they are greatly underrepresented in the 3D genomics space; Hi-C and related technologies have the potential to revolutionise livestock breeding by enabling a more comprehensive understanding of how production traits are controlled. The growth in human and model organism Hi-C data has seen a surge in the availability of computational tools for use in 3D genomics, with some tools using machine learning techniques to predict features and improve dataset quality. In this review, we provide an overview of the 3D genome and discuss the status of 3D genomics in livestock before delving into advancing the field by drawing inspiration from research in human and mouse. We end by offering future directions for livestock research in the field of 3D genomics.

Association of antimicrobial resistance and gut microbiota composition in human and non-human primates at an urban ecotourism site

Background

The rise of nature-based ecotourism in the past decade has introduced unprecedented challenges in managing the increasing interaction between humans and animals. The potential transmission of antibiotic resistant microbes between humans and non-human primate populations is a concern due to their genetic similarity. Malaysia is well known for hotspots of wildlife diversity where non-human primates like monkeys and orangutans have become popular tourist attractions. In this study, we assessed the prevalence of antimicrobial resistant Staphylococcus aureus, Enterococcus species, and other Enterobacteriaceae in the faeces of human (HS) and two non-human primates (NHP) in Malaysia, the Long-tailed macaque (Macaca fascicularis, MF) and Silvered leaf monkey (Trachypithecus cristatus, TC). In addition, the faecal bacterial composition was profiled to evaluate the potential association between antibiotic resistant profiles and composition of gut microbiota.

Results

We tested the isolated bacteria using a selection of antibiotics. The results showed that both the number of antibiotic resistant strains and resistance level were higher in humans than NHPs. Overall, the composition of gut microbiome and pattern of antibiotic resistance showed that there was higher similarity between MF and TC, the two NHPs, than with HS. In addition, samples with higher levels of antibiotic resistance showed lower bacterial richness. Homo sapiens had the lowest bacterial diversity and yet it had higher abundance of Bacteroides. In contrast, NHPs displayed higher bacterial richness and greater prevalence of Firmicutes such as Ruminococceae and Oscillospira.

Conclusion

Higher antibiotic susceptibility in NHPs is likely related to low direct exposure to antibiotics. The lack of resistance may also suggest limited antimicrobial resistance transmission between humans and NHP. Nonetheless, continued monitoring over a long period will help mitigate the risk of anthropozoonosis and zooanthroponosis.

The impact of epilepsy on academic achievement in children with normal intelligence and without major comorbidities: A systematic review

PURPOSE

To systematically examine published literature which assessed the prevalence of academic difficulties in children with epilepsy (CWE) of normal intelligence, and its associating factors.

METHODS

A search was conducted on five databases for articles published in English from 1980 till March 2015. Included were studies who recruited children (aged 5-18 years), with a diagnosis or newly/recurrent epilepsy, an intelligent quotient (IQ) of ≥70 or attending regular school, with or without a control group, which measured academic achievement using a standardised objective measure, and published in English. Excluded were children with learning difficulties, intellectual disabilities (IQ<70) and other comorbidities such as attention deficits hyperactive disorder or autism. Two pairs of reviewers extracted the data, and met to resolve any differences from the data extraction process.

RESULTS

Twenty studies were included. The majority of the studies assessed "low achievement" whist only two studies used the IQ-achievement discrepancy definition of "underachievement". Fourteen studies (70%) reported that CWE had significantly lower academic achievement scores compared to healthy controls, children with asthma or reported norms. The remaining six studies (30%) did not report any differences. CWE had stable academic achievement scores over time (2-4 years), even among those whose seizure frequency improved. Higher parental education and children with higher IQ, and had better attention or had a positive attitude towards epilepsy, were associated with higher academic achievement score. Older children were found to have lower academic achievement score.

CONCLUSIONS

In CWE of normal intelligence, the majority of published literature found that academic achievement was lower than controls or reported norms. The high percentages of low achievement in CWE, especially in the older age group, and the stability of scores even as seizure frequency improved, highlights the need for early screening of learning problems, and continued surveillance.

Factors affecting Nutritional Status of Malaysian Primary School Children

This paper investigates the nutritional status of a randomly selected cohort of school children and the factors affecting it. This random survey was conducted in the state of Selangor, involving 1,405 primary students (aged 9-10 years from 54 national primary schools). Physical examination was carried out on all the students. Information on the students was also obtained from the parents. Blood samples were taken by using the finger pricking technique. Body mass index (BMI) was used as a measure of physical growth.

The students were mainly from urban areas (82.9%). The mean age was 9.71 years and a higher proportion was females (51%). Malays constituted 83.6%, Indians 11.6% and Chinese 4.2% of the study population. The mean weight and height were 32.30 kg and 135.18cm respectively. The mean BMI was 17.42 kg/m2, with 1.2% of the students underweight, 76.3% normal BMI, 16.3% overweight and 6.3% were obese. Nutritional status was significantly related to blood pressure, history of breast feeding, eating fast food, taking canned/bottled drinks, income and educational level of parents. Significant differences in nutritional status between sexes and locations (rural/ urban) were also found. The prevalence of overweight and obese children was of concern. There is thus an urgent need for the School Health Program to periodically monitor the school children's eating habits and physical growth. Appropriate counselling on nutritional intake and physical activities should be given not only to schoolchildren but also to their teachers and parents or caregivers. Asia Pac J Public Health 2005; 17(2): 71-80.

Effects of Nutritional Status on Academic Performance of Malaysian Primary School Children

Numerous factors are known to affect the academic performance of students. These include prenatal conditions, birth conditions, postnatal events, nutritional, socio-economic factors and environmental factors. This paper examines the nutritional status and its relationship with academic performance of 9-10 years old primary school children recruited randomly in Selangor, Malaysia. A standard self-administered questionnaire was utilized to obtain pertinent information and a face-to-face interview was also conducted with the parents. Results of the academic performances were extracted from the students' report cards. The intellectual performance was assessed using Raven's Coloured Progressive Matrices. Physical examination was also conducted on these students by doctors. Overall 1,405 students and 1,317 parents responded to the survey. Of these 83.6% were Malays, 11.6% Indians, and 4.2% Chinese. The majority of them (82.9%) were from urban areas. The female: male ratio was 51:49; mean age was 9.71 years. The mean height and weight were 32.3 kg and 135.2 cm respectively. Their mean BMI was 17.42 kg/cm 2, with 0.9% underweight, 76.3% normal BMI, 16.3% overweight, and 6.3% obese. Academic performance was significantly correlated with breast feeding, income and educational level of their parents, BMI, and whether they have been taking breakfast. There was a weak correlation between presence of anaemia and intellectual performance. Improving the socio-economic status of the parents will lend a helping hand in the academic performance of the students. Since breast feeding is associated with better academic and intellectual performance it must be emphasized, particularly to expectant mothers in the antenatal clinics. Asia Pac J Public Health 2005; 17(2): 81-87.

Parents' perspectives on the important aspects of care in children dying from life limiting conditions: A qualitative study

INTRODUCTION

The importance of Paediatric Palliative Care (PPC) is increasingly recognised worldwide, with the World Health Organzsation (WHO) and the American Academy of Pediatrics (AAP) endorsing the development and wide availability of PPC. When these children are in the terminal phase of their illness, PPC should be tailored to the different needs and desires of the child and the family, with the goal of providing the best possible quality of life (QOL) for the days that remain.

METHOD

Malaysia has yet to develop a national PPC policy. In anticipation of this, as part of a needs based qualitative study, parents' views were solicited, as to the unmet needs of their children during the terminal phases of their illness. A purposive sampling was conducted amongst fifteen parents of nine deceased children (ages 2-14 years, eight cancer, one Prader Willi Syndrome) who had received care in the Paediatric Department, Malacca General Hospital, a Malaysian government hospital. Two focus group discussions and three in-depth interviews were conducted, based on a semi-structured interview guideline. The interviews were audiotaped with permission and the tape recordings were transcribed verbatim. The data were managed and analysed by NVivo 9 software using a thematic analysis approach.

RESULTS

The frequently emerging themes were the strengths and weaknesses pertaining to the healthcare system, processes within palliative care. These were symptom control, closed communication and lack of support and anticipatory guidance as death approached.

CONCLUSION

Dying Malaysian children and their families deserve to receive care that is more consistent with optimal palliative care.

Differences between disease-associated endoplasmic reticulum aminopeptidase 1 (ERAP1) isoforms in cellular expression, interactions with tumour necrosis factor receptor 1 (TNF-R1) and regulation by cytokines

Endoplasmic reticulum aminopeptidase 1 (ERAP1) processes peptides for major histocompatibility complex (MHC) class I presentation and promotes cytokine receptor ectodomain shedding. These known functions of ERAP1 may explain its genetic association with several autoimmune inflammatory diseases. In this study, we identified four novel alternatively spliced variants of ERAP1 mRNA, designated as ΔExon-11, ΔExon-13, ΔExon-14 and ΔExon-15. We also observed a rapid and differential modulation of ERAP1 mRNA levels and spliced variants in different cell types pretreated with lipopolysaccharide (LPS). We have studied three full-length allelic forms of ERAP1 (R127-K528, P127-K528, P127-R528) and one spliced variant (ΔExon-11) and assessed their interactions with tumour necrosis factor receptor 1 (TNF-R1) in transfected cells. We observed variation in cellular expression of different ERAP1 isoforms, with R127-K528 being expressed at a much lower level. Furthermore, the cellular expression of full-length P127-K528 and ΔExon-11 spliced variant was enhanced significantly when co-transfected with TNF-R1. Isoforms P127-K528, P127-R528 and ΔExon-11 spliced variant associated with TNF-R1, and this interaction occurred in a region within the first 10 exons of ERAP1. Supernatant-derived vesicles from transfected cells contained the full-length and ectodomain form of soluble TNF-R1, as well as carrying the full-length ERAP1 isoforms. We observed marginal differences between TNF-R1 ectodomain levels when co-expressed with individual ERAP1 isoforms, and treatment of transfected cells with tumour necrosis factor (TNF), interleukin (IL)-1β and IL-10 exerted variable effects on TNF-R1 ectodomain cleavage. Our data suggest that ERAP1 isoforms may exhibit differential biological properties and inflammatory mediators could play critical roles in modulating ERAP1 expression, leading to altered functional activities of this enzyme.

Who decides? A qualitative study on the decisional roles of patients, their caregivers and doctors on the method of bladder drainage after spinal cord injury

STUDY DESIGN

Qualitative study using individual in-depth interviews.

OBJECTIVE

To explore the roles of patients, their caregivers and doctors when making decisions on the method of bladder drainage after spinal cord injury (SCI).

SETTING

Five public hospitals in Malaysia.

METHODS

Semistructured (one-to-one) interviews with 17 male patients with SCI, 4 caregivers and 10 rehabilitation professionals.

RESULTS

Eight themes describing the respective decisional roles of patients, their caregivers and doctors emerged from the analysis: patient's right and responsibilities, patient as an informed decision maker, forced to accept decision; surrogate decision maker, silent partner; doctor knows best, over-ride patient's decision, or reluctant decision maker. Both patients and doctors acknowledged the importance of patient autonomy but not all patients had the chance to practice it. Some felt that they were forced to accept the doctor's decision and even alleged that the doctor refused to accept their decision. Doctors considered the caregiver as the decision maker in cases that involved minors, elderly and those with tetraplegia. Some patients considered bladder problems an embarrassing subject to discuss with their caregivers and did not want their involvement. Doctors were described as knowledgeable and were trusted by patients and their caregivers to make the most appropriate option. Some doctors were happy to assume this role whereas some others saw themselves only as information providers.

CONCLUSIONS

A paternalistic model is prevalent in this decision-making process and there is a discrepancy between patients' preferred and actual decisional roles.

Somatisation disorder and its associated factors in multiethnic primary care clinic attenders

BACKGROUND

Somatisation disorder (SD) has been reported as common in all ethnic groups, but the estimates of its prevalence have varied and the evidence for its associated factors has been inconsistent.

PURPOSE

This study seeks to determine the prevalence of SD and its associated factors in multiethnic primary care clinic attenders.

METHODS

This cross-sectional study was on clinic attenders aged 18 years and above at three urban primary care clinics in Malaysia. The operational definition of SD was based on ICD-10 criteria for SD for research, frequent attendance, and excluded moderate to severe anxiety and depression. The instruments used were the ICD-10 symptom list, the Hospital Anxiety and Depression Scale, a semi-structured questionnaire, and SF-36.

RESULTS

We recruited 1,763 patients (response rate 63.8%). The mean age of respondents was 44.7 ± 15.8 years, 807 (45.8%) were male; there were 35.3% Malay, 30.1% Chinese and 34.6% Indian. SD prevalence was 3.7%; the prevalence in Malay was 5.8%, Indian 3.0% and Chinese 2.1%. Significant associations were found between SD prevalence and ethnicity, family history of alcoholism, blue-collar workers and the physical component summary (PCS) score of SF-36. Multivariate analysis showed that SD predictors were Malay ethnicity (OR 2.7, 95% CI 1.6, 4.6), blue-collar worker (OR 2.0, 95% CI 1.2, 3.5) and impaired PCS score of SF-36 (OR 0.92, 95% CI 0.90, 0.95).

CONCLUSION

The prevalence of SD was relatively uncommon with the stringent operational criteria used. SD preponderance in blue-collar workers may be attributable to secondary gain from getting sickness certificates and being paid for time off work.

Psychometric properties of the Malay version of the Breast Module (BR23)

INTRODUCTION

The Breast Module (BR23) is increasingly being used worldwide in breast cancer research. This study evaluates the appropriateness of the translated version (i.e. BR23-Malay version) as a useful tool for the Malaysian population who could understand Malay, and examines the reliability and validity of the BR23-Malay version.

METHODS

This was a prospective study involving 68 Malaysian women who could understand Malay very well. They answered the BR23-Malay version at two evaluation points--three and ten weeks following surgery for breast cancer. Internal consistency, test-retest intraclass correlation coefficients (ICC), effect size index, sensitivity and discriminity of the scale were calculated.

RESULTS

Internal consistencies were acceptable for the functional domains (0.87 for body image; 0.84 for sexual functioning) and symptomatology domains (0.82 for systemic therapy side effect; 0.82 for breast symptoms; 0.70 for arm symptoms). Test-retest ICC ranged from 0.26 to 1.00. Sensitivity of the scale was observed in all domains except sexual functioning.

CONCLUSION

The Malay version of BR23 is a suitable tool to measure the functional and symptomatology domains of women diagnosed with breast cancer.

Reliability and validity of the Brief COPE Scale (English version) among women with breast cancer undergoing treatment of adjuvant chemotherapy: a Malaysian study

This paper validates the Brief COPE Scale in Malaysian women with breast cancer. Test-retest evaluation was undertaken at two/three weeks and ten weeks following surgery. Internal consistencies ranged from 0.25 to 1.00. Meanwhile, the Intraclass Correlation Coefficient (ICC) ranged from 0.05 to 1.00. Sensitivity of the scale was indicated by the mean differences as observed in most of the domains with Effect Size Index (ESI) ranged from 0 to 0.53. Significant differences between mastectomy and lumpectomy were observed for Active coping, Planning and Acceptance. Brief COPE Scale showed fairly good reliability and validity.

Knowledge and barriers towards cervical cancer screening among young women in Malaysia

OBJECTIVES

This study examined the level of knowledge and barriers towards cervical cancer screening of female university students.

METHODOLOGY

A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty's registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13.

RESULTS

The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents was having more than one sex partner (77.5%), whereas the lowest was the relationship between HPV and cervical cancer (51.2%). Age, marital status, ethnicity, monthly family income and faculty were significantly associated with knowledge of cervical cancer screening (p=0.003; p=0.001; p=0.002; p=0.002; p=0.001 and p=0.002; respectively). The most common barriers of cervical cancer screening were the Pap smear test will make them worry (95.8%) whereas the least common barrier reported among participants was no encouragement from the partner (8.8%).

CONCLUSION

Some misconceptions and barriers in uptaking Pap smear test are still serious problems among young women. Although knowledge about cervical cancer screening is adequate they have a very poor practice of Pap smear test. The introduction of reproductive health subjects is warranted for all university students.

Development and validation of the osteoporosis patient satisfaction questionnaire (OPSQ)

OBJECTIVES

To develop and validate the Osteoporosis Patient Satisfaction Questionnaire (OPSQ) and to assess the opinion of postmenopausal osteoporotic women towards pharmaceutical care.

METHODS

A 16-item instrument was designed. Each response consists of a five-point Likert-like scale with higher scores indicating greater satisfaction. The face and content validity was established via consultation with an endocrinologist and three pharmacists as well as feedback from participants in a preliminary study. Postmenopausal osteoporotic women taking bisphosphonates were recruited and randomly allocated to the intervention (n=90) and control groups (n=90). Pharmaceutical care was provided at month 2 to the intervention group while the control group received standard pharmacy services. The OPSQ was administered at month 6 (end of the intervention period), to assess patients' satisfaction. Factor analysis was performed using varimax rotation. Internal reliability was established using Cronbach's alpha. Construct validity was performed by using the Mann-Whitney U test.

RESULTS

The internal reliability of the OPSQ produced a Cronbach's alpha of 0.86. Factor analysis identified one component in the OPSQ, which measured patient satisfaction. The intervention group showed significantly better overall OPSQ score than the control group (91.89+/-7.22% versus 84.32+/-7.48%, p<0.001). This indicates that the OPSQ was able to differentiate between participants who received pharmaceutical care from those who did not.

CONCLUSIONS

The 16-item OPSQ developed in this study has high internal reliability and is a valid instrument for assessing osteoporotic women's satisfaction with pharmaceutical care service in Malaysia.

Mental health knowledge, attitude and help-seeking tendency: a Malaysian context

INTRODUCTION

This study examines the general public's knowledge of mental health and explores effective tools to promote good mental health through a household survey of a representative sample of the Malaysian population residing in Klang Valley, Malaysia.

METHODS

A total of 587 respondents, aged 18 years and older, responded to a series of questions in relation to mental health issues. Respondents were requested to specify how they learned about the information. Following that, an attitude scale was presented to the participants, and they were requested to rate how much they agreed to the statements.

RESULTS

The findings indicated that the majority of the respondents did not have good knowledge of mental health. However, all respondents displayed a neutral attitude towards mental health issues. It was found that ethnic background, religion, educational level and residential location were the few demographic characteristics found to be significantly related to either the respondent's knowledge or attitude towards mental health issues. With regard to seeking help, while the respondents' ethnic background influenced their decisions, younger respondents and respondents with better attitude towards mental health were more willing to seek help.

CONCLUSION

This study has implications for promoting the understanding of the general mental well-being as well as the importance of seeking help for mental health in the local population. Steps should be taken to improve the public's understanding of, and attitude towards mental health. These include the presentation of a positive image and the dissemination of accurate information by the mass media, the primary source for information on mental health.

Cervical cancer screening attitudes and beliefs of Malaysian women who have never had a pap smear: a qualitative study

BACKGROUND

Attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms.

PURPOSE

This study explored the attitudes and sociocultural beliefs on cervical cancer screening among Malaysian women.

METHOD

In this qualitative study, in-depth interviews were conducted with 20 Malaysian women, ages 21 to 56 years, who have never had a Papanicolaou (Pap) smear.

RESULTS

Respondents generally showed a lack of knowledge about cervical cancer screening using Pap smear, and the need for early detection for cervical cancer. Many believed the Pap smear was a diagnostic test for cervical cancer, and since they had no symptoms, they did not go for Pap screening. Other main reasons for not doing the screening included lack of awareness of Pap smear indications and benefits, perceived low susceptibility to cervical cancer, and embarrassment. Other reasons for not being screened were related to fear of pain, misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own health needs versus those of the family.

CONCLUSION

Women need to be educated about the benefits of cervical cancer screening. Health education, counseling, outreach programs, and community-based interventions are needed to improve the uptake of Pap smear in Malaysia.

Knowledge and awareness of cervical cancer and screening among Malaysian women who have never had a Pap smear: a qualitative study

INTRODUCTION

Cervical cancer is one of the commonest cancers in women worldwide. Despite the existence of effective screening using Pap smear, the uptake of screening is poor. A qualitative study was undertaken using face-to-face in-depth interviews to investigate knowledge, attitudes and beliefs on cervical cancer screening of Malaysian women.

METHODS

In-depth interviews were conducted with 20 Malaysian women aged 21-56 years and who have never had a Pap smear test, with the aim to explore their knowledge and awareness of cervical cancer and its screening.

RESULTS

A lack of knowledge on cervical cancer and the Pap smear test was found among the respondents. Many women did not have a clear understanding of the meaning of an abnormal cervical smear and the need for the early detection of cervical cancer. Many believe the purpose of the Pap smear test is to detect existing cervical cancer, leading to the belief that Pap smear screening is not required because the respondents had no symptoms. Despite considerable awareness of a link between cervical cancer and sexual activity, as well as the role of a sexually-transmitted infection, none of the respondents had heard of the human papillomavirus.

CONCLUSION

The findings highlight the importance of emphasising accurate information about cervical cancer and the purpose of Pap smear screening when designing interventions aimed at improving cervical cancer screening for Malaysian women.

Perceived barriers to self-management in Malaysian women with breast cancer

Naturalistic inquiry using focus group interviews was undertaken to explore experiences and perceived barriers to self management in women with breast cancer. The aim was to identify their perceived barriers to self management to aid the development of rehabilitation programmes. Successful programmes are strongly linked to patients' perceived needs. Four focus groups consisted of 39 women, were purposively recruited. Women's needs within the three areas of medical, emotional and role management of breast cancer were explored. The main barriers were unavailability of information, inability to access services-and-support, and socioeconomic-cultural issues (entrenched myths, low-socioeconomic status, and inadequate insurance-health legislative coverage). The findings provide the critically lacking 'expert-view' of survivors, who verified the importance of the medical, emotional and role management tasks, and highlighted barriers and structural solutions. With breast cancer becoming recognised as a form of chronic illness, this study is timely.

Impact of sexual health course on Malaysian university students

A sexual health course was offered and taught by academic staff from the Faculty of Medicine, University of Malaya during semester II of every year as a university elective course to other university students apart from medical students. The course covered a wide range of topics: adolescent sexuality, family planning and pregnancy, violence against women, alternative sexual behavior, physiology of sex, sex and the disabled, gender bias in sexuality, relationship and marriage, sexual dysfunctions, clarification of sexual attitudes and STDs and AIDS. The Sexual Knowledge and Attitude Test (SKAT-II) was used to measure students' pre- and post-course scores on sexual knowledge and attitudes. Fifty-four students who completed both the pre- and post-course tests showed a significant change in sexual knowledge and their attitudes towards sexual myths and autoeroticism. Sexual knowledge was also positively correlated with age, heterosexual relations, autoeroticism and sexual myths scores. However, sexual knowledge is negatively related to religiosity and the influence of religious beliefs on one's attitudes towards sexual matters. This study showed that the sexual health course offered does have a positive impact in increasing one's knowledge and changing one's attitudes towards sexual issues.

Reliability and validity of the Spielberger State-Trait Anxiety Inventory (STAI) among urological patients: a Malaysian study

To validate the English version of the Spielberger State-Trait Anxiety Inventory (STAI) in a sample of Malaysia patients with and without urinary symptoms. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Reliability was evaluated using the test-retest method and internal consistency was assessed using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in additional patients with LUTS who underwent transurethral resection of the prostate (TURP). Internal consistency was excellent. A high degree of internal consistency was observed for each of the 40 items with Cronbach's alpha value = 0.38 to 0.89 while the Cronbach's alpha for the total scores was 0.86. Test-retest correlation coefficients for the 40 items score were highly significant. Intraclass correlation coefficient was high (ICC=0.39 to 0.89). A high degree of sensitivity and specificity to the effects of treatment was observed. A high degree of significant level between baseline and post-treatment scores was observed across nearly half of the items in surgical group but not in the non-LUTS group (control subjects). The STAI is reliable, valid and sensitive to clinical change in a sample of Malaysian patients with and without urinary symptoms.

The role of general practitioners in the management of erectile dysfunction—a qualitative study

The objective of this study was to explore the roles and perceptions of general practitioners (GPs) in the management of erectile dysfunction (ED). This qualitative study used focus group discussions and in-depth interviews. This study was conducted based on 28 GPs from an urban area in Malaysia who had managed patients with ED and prescribed anti-ED drugs. Main outcome measures included the roles of GPs in managing patients with ED (active or passive), perceptions regarding ED and the treatment, and factors influencing their decision to prescribe. Majority of the GPs assumed a passive role when managing patients with ED. This was partly due to their perception of the disease being nonserious. Some also perceived ED as mainly psychological in nature. The anti-ED drugs were often viewed as a lifestyle drug with potentially serious side effects. The fear of being perceived by patients as 'pushing' for the drug and being blamed if the patients were to develop serious side effects also hampered the management of this disease. GPs who participated in this study remained passive in identifying and treating patients with ED and this was attributed to their perception of the disease, drug treatment and patient's background.

Sexual function outcomes following treatment for lower urinary tract symptoms. A one-year study

The aim of this study was to assess the effects of treating lower urinary tract symptoms (LUTS) on the quality of sexual function in a one-year follow up. A total of 116 patients with LUTS received alpha-blocker treatment, 111 patients underwent transurethral resection of the prostate (TURP) and 70 patients with renal stones, with no or mild symptoms served as a control group. The patients were assessed at baseline, three months, six months and twelve months using the International Index of Erectile Function (IIEF-15). The surgical group exhibited some changes in the domain of IIEF-15. Patients in the medical group showed improvement in erectile function and intercourse satisfaction, while orgasmic, overall sexual satisfaction and sexual drive were relatively unchanged. In contrast, the surgical group suffered retrograde ejaculation and overall sexual dissatisfaction after undergoing TURP. TURP has been found to be associated with retrograde ejaculation intercourse and overall sexual dissatisfaction.

The sensitivity of the Malay version of Brief Manual of Sexual Function Inventory in assessing erectile dysfunction secondary to benign prostatic hyperplasia

This study aimed to assess the sensitivity of the Malay version of the Brief Manual Sexual Function Inventory (BMSFI) on patients with and without urinary symptoms in Malaysian population. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Reliability and validity was evaluated by using the test-retest method while internal consistency was assessed by Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in patients who underwent transurethral resection of the prostate (TURP). Internal consistency was excellent. A high degree of internal consistency was observed for each of the 11 items and 5 domains (Cronbach's alpha value = 0.67 and higher and 0.73 and higher respectively). Test-retest correlation coefficient for the 11 items scores was highly significant. Intraclass correlation coefficient was high (ICC = 0.68 and above). The sensitivity and specificity showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significant level between baseline and post-treatment scores were observed across 3 domains in the treatment corresponds cohort but not in the control group. The Mal-BMSFI is a suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

Malaysian cultural differences in knowledge, attitudes and practices related to erectile dysfunction: focus group discussions

This qualitative study aimed to examine cultural differences in knowledge, attitudes and practices related to erectile dysfunction (ED) utilizing focus group discussion. Six focus groups consisting of 66 men, 45-70-y-old were conducted-two Malay groups (n=18), two Chinese groups (n=25) and two Indian groups (n=23). Participants were purposely recruited from the general public on a voluntary basis with informed consent. Transcripts were analyzed using qualitative data analysis software ATLASti. The Malay and Chinese traditional remedies for preventing or treating ED are commonly recognized among all races. Many have a negative perception of someone with ED. Malay and Chinese men tended to blame their wife for their problem and thought that the problem might lead to extra-marital affairs, unlike the Indian men who attributed their condition to fate. Malays would prefer traditional medicine for the problem. The Chinese felt they would be more comfortable with a male doctor whilst this is not so with the Malays or Indians. Almost all prefer the doctor to initiate discussion on sexual issues related to their medical condition. There is a need for doctors to consider cultural perspectives in a multicultural society as a lack of understanding of this often contributes to an inadequate consultation.

The performance properties of the International Index of Erectile Function (IIEF-15) in assessing erectile dysfunction in patients with lower urinary tract symptoms

To validate the International Index of Erectile Function (IIEF-15) in Malaysian population. Reliability and internal consistency were evaluated using the test-retest method and Cronbach's alpha. Sensitivity to change was expressed as the effect size index. Internal consistency was excellent (Cronbach's alpha value = 0.75 to 0.90) Test-retest correlation coefficient and intraclass correlation coefficient were highly significant (ICC = 0.75 and above) and a high degree of sensitivity and specificity was observed. The IIEF-15 is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

The effects of treating lower urinary tract symptoms on health-related quality of life: a short-term outcome

OBJECTIVES

This study examined the effects of treatment of lower urinary tract symptoms (LUTS) on the health-related quality of life (physical/functional, mental, social and global aspect), pain and prostatic symptoms.

PATIENTS AND METHODS

The study consisted of 123 LUTS patients on medical treatment (alpha blockers) and 52 who underwent surgical treatment (TURP). The patients were assessed one week before and three months after medical and surgical treatment by using the Health-Related Quality of Life (HRQOL-20), the Visual Analogue Scale of Pain (VAS), the Present Pain Intensity (PPI) and the International Prostate Symptom Score (I-PSS) inventories and questionnaires.

RESULTS

Prior to treatment, the surgically treated patients were found to suffer more pain, severe prostatic symptoms, bothersomeness and deterioration in health-related quality of life than the medically treated patients. Postoperatively, the surgical group showed a significant reduction and improvement in all aspects of pain, prostatic symptoms, bothersomeness and overall health-related quality of life, as compared with the medication group. The mean ages of the surgical and medical treated groups were 69.56 years (SD=7.94 years) and 64.62 years (SD=7.94 years) respectively.

CONCLUSIONS

The result showed that operative procedure had significantly improved the overall health-related quality of life of LUTS patients compared to those on medical treatment.

Reliability and validity of the Malay version of the International Index of Erectile Function (IIEF-15) in the Malaysian population

The objective of this study was to validate the Malay version of the International Index of Erectile Function (IIEF-15) in patients with lower urinary tract symptoms. Reliability and validity was assessed by using the test-retest while Cronbach's alpha was used to assess internal consistency. Effect size 5was evaluated to assess the sensitivity to change in the pre-transurethral resection of the prostate (TURP) vs post-TURP. Internal consistency was excellent. A high degree of internal consistency was observed for each of the 15 items and five domains (Cronbach's alpha value=0.56 and higher and 0.74 and higher, respectively). Test-retest correlation coefficient for the 15 items and domains scores showed no significant changes. Intraclass correlation coefficient for 15 items and domains were high (ICC=0.59 and above). It can be concluded that the Mal-IIEF-15 is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

Reliability and validity of the Malay version of the Health-Related Quality of Life instrument in a Malaysian population

OBJECTIVE

To validate the Malay version of the Health-Related Quality of Life (Mal-HRQOL-20) questionnaire in patients with and without urinary symptoms in a Malaysian population.

PATIENTS AND METHODS

The validity and reliability of the Mal-HRQOL-20 were assessed in patients with and without lower urinary tract symptoms (LUTS). The reliability was evaluated using the test-retest method and the internal consistency using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the score before and after intervention in additional patients with LUTS who underwent transurethral resection of the prostate.

RESULTS

The internal consistency was excellent; there was a high degree of internal consistency for each of the 20 items and for the overall score (Cronbach's alpha > or = 0.57 and 0.79, respectively) in the population study. The test-retest correlation coefficient for the 20 item scores was highly significant. The intra-class correlation coefficient was high (> or = 0.55). The sensitivity and specificity were high for the effects of treatment. There was a very significant agreement between scores before and after treatment across all domains in the treatment cohort, but not in the control group.

CONCLUSION

The Mal-HRQOL-20 is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

Reliability and Validity of the Malay Version of the General Health Questionnaire (GHQ - 12) Among Urological Patients

The aim of the study was to validate the Malay version of the General Quentionnaire (GHQ-12) in patients with psychiatric morbidity secondary to urological disorder. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Internal consistency was excellent. A high degree of internal consistency was observed for each of the 12 items and total scores (Cronbach's alpha value = 0.50 and higher and 0.65 respectively. Test-retest correlation coefficient for the 12 items scores was highly significant. Intraclass correlation coefficient was high (ICC=0.47 and above). A significant level between baseline and post-treatment scores were observed across 3 items in the surgical group. The Mal-GHQ-12 is a suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

The quality of life outcome following treatment for lower urinary tract symptoms

This study aims to assess the impact of medical and surgical treatment on treating lower urinary tract symptoms (LUTS) on pain, prostatic symptoms, disease-specific quality of life and health-related quality of life. Patients scheduled for medical (alpha-blockers) and surgical treatment (transurethral resection of the prostate, TURP) were recruited in the study. The patients were assessed using the Visual Analogue Scale (VAS), Present Pain Intensity (PPI), International Prostate Symptom Score (I-PSS) and Health-Related Quality of Life (HRQOL) at 3-month, 6-month and 12-month (baseline). Before treatment, most of the patients with LUTS had severe pain, LUTS and deterioration of health-related quality of life. Following treatment, both medical and surgical treatment improved their pain, LUTS and health-related quality of life. Both treatments are effective in relieving the symptoms of pain, LUTS and health-related quality of life.

What Malaysian women believe about Viagra: a qualitative inquiry

This paper highlights women's perceptions of sildenafil citrate (Viagra, Pfizer). It is based on a qualitative study on perceptions of erectile dysfunction in the Malaysian multicultural society. Six focus groups were conducted, consisting of 69 women, aged between 40 and 70 years, recruited from the general public and who had given informed consent. The findings revealed that the women were aware of erectile dysfunction and Viagra. Due to their concern about the negative aspects of Viagra, the Chinese and Malay traditional methods of treatment were commonly mentioned. The women from three ethnic groups viewed the possibility of their husband starting to take Viagra with lots of suspicion, mistrust and fear. They would prefer their husband discussing with them the issue of resorting to taking Viagra. The Chinese and Indian women perceived that if a man takes Viagra, it will boost his ego and he will feel more manly. Indian women felt that a man taking Viagra is proof of his love for his wife. The Malay women felt that a man would be ashamed and have a low self-esteem if he were to resort to taking Viagra. Although Viagra is meant for the male, understanding of women's perception of it is beneficial for a couple's sexual relationship.

Quality of life assessment before and after transurethral resection of the prostate in patients with lower urinary tract symptoms

OBJECTIVES

The aim of this study was to determine the effects of surgical treatment of lower urinary tract symptoms (LUTS) in a Malaysian population by evaluating the quality of life before and after treatment.

PATIENTS AND METHODS

The study group comprised 111 LUTS patients (age 69.56 +/- 7.94 years, mean +/- SD ) who were assessed 1 week before and at 3, 6 and 12 months after treatment using the health-related quality of life (HRQOL-20) questionnaire, a visual analogue scale (VAS), the present pain intensity (PPI) scale and the international prostate symptom score (I-PSS).

RESULTS

Preoperatively the patients suffered more pain, severe prostatic symptoms, impaired disease-specific quality of life and a reduction in health-related quality of life. Postoperatively the patients showed a significant reduction and improvement in pain, prostatic symptoms, and disease-specific and health-related quality of life.

CONCLUSIONS

The results showed that the operative procedure significantly improved the overall quality of life of patients with LUTS.

Reliability and validity of the General Health Questionnaire (GHQ-12) among urological patients: a Malaysian study

This present study was undertaken to validate the English version of the General Health Questionnaire (GHQ-12) in urological patients. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Reliability was evaluated using the test-retest method and internal consistency was assessed using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in additional patients with benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP). Internal consistency was excellent. A high degree of internal consistency was observed for each of the 12 items with Cronbach's alpha value of 0.37-0.79, while total scores was 0.79 in the population study. Test-retest correlation coefficient for the 12 items score were highly significant. Intraclass correlation coefficient was high (0.35-0.79). It showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significant level between baseline and post-treatment scores were observed across all 12 items in the treatment cohort but not in the control group. The GHQ-12 is suitable, reliable, valid and sensitive to clinical change in urological disorders.

Beck Depression Inventory (BDI): a reliability and validity test in the Malaysian urological population

This study aimed to validate the Beck Depression Inventory (BDI) in the Malaysian urological population. Reliability and internal consistency were evaluated using the test-retest method and internal consistency was assessed using Cronbach's alpha. Responsiveness was expressed as the effect size. Internal consistency was high (Cronbach's alpha value = 0.56 to 0.87). Test-retest correlation coefficient and intraclass correlation coefficient were significant (ICC = 0.56 to 0.87) and a high degree of sensitivity and specificity. The BDI is thus a reliable and a valid instrument to be used in Malaysia.

A Malaysian Study on the reliability and validity of the Health-Related Quality of Life Questionnaire (HRQOL-20) in urological patients

Main objective of this study is to validate the Health-Related Quality of Life (HRQOL-20) in the Malaysian population. Reliability and internal consistency were evaluated using the test-retest method and Cronbach's alpha. Responsiveness was expressed as the effect size. Internal consistency was excellent (Cronbach's alpha value = 0.68 to 0.87). Test-retest correlation coefficients and intraclass correlation coefficient were significant (ICC = 0.58 and 0.91) as well as the high degree of sensitivity and specificity. The HRQOL-20 is a reliable, valid and sensitive to clinical changes in the Malaysian urological population.

Reliability and validity of the International Prostate Symptom Score in a Malaysian population

OBJECTIVE

To validate the English version of the International Prostate Symptom Score (IPSS) in patients with and without urinary symptoms in a Malaysian population.

PATIENTS AND METHODS

Validity and reliability were assessed in patients with lower urinary tract symptoms (LUTS) and in patients with no LUTS. Reliability was evaluated using the test-retest method and internal consistency using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the score before and after intervention in additional patients with LUTS who underwent transurethral resection of the prostate (TURP).

RESULTS

Internal consistency was excellent; there was a high degree of internal consistency for each of the seven domains and for the total score (Cronbach's alpha > or = 0.60 and > or = 0.79, respectively) in the populations studied. The test-retest correlation coefficient for the seven domain scores was highly significant. The intra-class correlation coefficient was high (> or = 0.59). There was a high level of sensitivity and specificity for the effects of treatment, with a very significant change between the seven scores domains in the treated group but not in the control group.

CONCLUSIONS

The IPSS is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.

Sexual health education for youths--a Malaysian experience

A survey was conducted to assess student's sexual knowledge and attitudes using a questionnaire based on the Sex Knowledge and Attitude Test (SKAT-II) to compare medical and nursing students with students (non-medical/nursing) who registered for a sexual health course. 85 Sexual Health, 115 medical and 81 nursing students voluntarily participated in the survey. This study showed that all the student groups showed relatively low scores in knowledge. Furthermore, average knowledge scores differed significantly between the three student groups with medical students scoring highest and nursing students lowest. Besides student groups, several other factors were found to be significantly associated with Knowledge score namely, race, religion, age, perception of the importance of religion and the extent to which religious beliefs influence sexual attitudes. Furthermore, multivariate statistical analyses showed that among these factors, student group, race/religion and religious importance were significant predictors of sexual knowledge. Specifically, being a medical student was associated with higher scores relative to a non-medical student, being a Malay student was independently associated with a lower average score compared to other races, and perceiving religion as extremely important was associated with a lower score.

Sexual issues of the disabled: implications for public health education

Sexuality of persons with spinal cord injury has received increased attention especially in the Western countries. However, in the local context, studies pertaining to the sexuality of the disabled are almost nil. This paper utilized a qualitative approach in assessing sexual knowledge, attitudes and practices of persons with spinal cord injury. Eight focus group discussions consisting of 28 adult spinal cord injured persons were carried out. The results showed that the frequency of sexual activity decreased following injury. The disabled themselves have a negative self-concept and a low self-esteem and this affects their attitudes towards sexuality and their sexual behaviour. Health care professionals tend to neglect this issue perhaps due to their insensitivity to the sexual needs for the disabled or a lack of understanding and expertise in this area. A need for sexual information related to their disability is warranted in the areas of reproduction, contraception and their ability/disability in achieving an erection or ejaculation. This study indicated a need for more comprehensive research in this neglected area of sexual issues of persons with disabilities. Public health education and counseling is deemed necessary for the disabled themselves so as to accommodate their sexual lives to their physical capabilities and desires. Attitudes and misconceptions of the public need to be corrected. Above all, there is a need for education and training for health care professionals in the area of sexual rehabilitation, which is currently non-existent in the country. Perhaps, it is timely to incorporate sexual rehabilitation as part of a holistic medical rehabilitation of the disabled.

The effects of treating lower urinary tract symptoms on sexual function

We prospectively evaluated the effect of the treatment of lower urinary tract symptoms (LUTS) on sexual function. The patients were assessed by using the International Index of Erectile Function (IIEF-15) inventory at baseline and three months after medical (alpha-blockers) or surgical treatment (transurethral resection of the prostate, TURP). Following treatment, there were improvement in erectile function and intercourse satisfaction while orgasmic, overall satisfaction and sexual drive were relatively unchanged in the medication group. Patients who had surgical treatment suffered retrograde ejaculation, dissatisfaction in sexual intercourse and overall sexual satisfaction compared to patients who were on alpha-blockers.

Sexual practices in Malaysia: determinants of sexual intercourse among unmarried youths

This paper describes findings on selected determinants of sexual intercourse among 468 unmarried adolescents from a survey in Malaysia. Data on respondents' background, sexual experience, contraceptive use, and sexual attitudes are provided. Based on multiple logistic regressions, factors significantly predictive of sexual experience are gender, employment, and sexual attitudes.

The psychological effects of treatments for lower urinary tract symptoms

OBJECTIVE

To assess and evaluate the level of depression, anxiety and psychiatric status in patients with lower urinary tract symptoms (LUTS) before and after treatment by surgery or drugs.

PATIENTS AND METHODS

The study included 123 patients (mean age 64.6 years, SD 7. 95) with LUTS who were treated medically (with alpha-blockers, i.e. terazosin, prazosin, doxazosin and alfuzosin), and 52 patients (mean age 69.6 years, SD 7.94) with LUTS and confirmed to have benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP). Both groups were assessed at baseline and 3 months after treatment using standardized questionnaires (the Beck Depression Inventory, the State-Trait Anxiety Inventory and the General Health Questionnaire-12).

RESULTS

Patients before TURP were significantly more depressed, worried and psychiatrically morbid than were those before medical treatment. Three months after medical and surgical treatment, there was significantly less depression, anxiety and psychiatric morbidity in the TURP than in the medication group.

CONCLUSIONS

TURP is a better treatment than medication for minimising anxiety, depression and psychiatric morbidity after treatment in patients with LUTS, but causes greater psychological stress before treatment.

The drug abuse problem in Peninsular Malaysia: parent and child differences in knowledge, attitudes and perceptions

A survey was carried out to gather information on knowledge, attitudes and perception of parents and their children in relation to drug abuse matters. Significantly more teenagers knew more of the cause of drug addiction, as well as places for treatment and rehabilitation. Both teenagers and parents were also aware of reasons why drug addicts find it difficult to change their habits, mainly lacking motivation to stop taking drugs and that drug addicts do not have the power to control themselves. Teenagers were significantly more aware of effects of negative parental attitudes contributing to drug abuse, apart from school factors. Personal experiences before abusing drugs such as knowledge of pleasurable effects of drugs and where to obtain them has also a role to play in leading to drug abuse. There was also agreement that unfulfilled needs such as 'not being respected recognised for ones capabilities' and 'not being loved or treated fairly by parents', were causes of drug abuse. Significantly more teenagers knew of the ways of abusing drugs, mainly by injection, smoking and sniffing, and also sources of information via the mass media, social clubs, rehabilitation centres and schools. However, both the parents and teenagers were relatively ignorant of the long term effects of abusing drugs.

Sexual activities of Malaysian adolescents

This paper examines data on the sexual activities of 1,200 Malaysian adolescents aged 15-21 years based on a probability household sampled survey carried out in Kuala Lumpur in 1986. Sexual behaviours like premarital sexual intercourse, contraceptive usage and masturbation were presented. Of the 1,181 unmarried respondents, 9% (105) reported having had sexual intercourse; males were significantly more experienced compared to females. Older age groups were also found to be more sexually active than the younger ones. Among those who had experience dating (n = 521), 20% (105) have experienced sexual intercourse, 44% (228) have kissed and necked, and 35% (183) have experienced petting, while 24% (130) have had no physical intimacies. Poor use of contraception was also revealed. The most commonly used were condoms, oral contraceptives and withdrawal. With regard to masturbation, males begin this practice relatively earlier than females. Almost half of those who indulged in masturbation were worried by the act, especially the females. Implications of the findings are discussed.

Knowledge, attitudes and perceptions related to drug abuse in peninsula Malaysia: a survey report

Given the magnitude of drug addiction in Malaysia, the government has given top priority to this issue. It is timely that an assessment of knowledge, attitudes and perceptions related to drug abuse and drug dependents among the general public be carried out. Thus, a nationwide survey was undertaken. A representative sample of 2,591 respondents aged 13 years and above from households were surveyed throughout the 11 states and the Federal Territory of Kuala Lumpur in Peninsula Malaysia. The results revealed that the respondents are moderately knowledgeable on drug abuse, especially information pertaining to treatment, rehabilitation and aftercare services, including education to families against drug abuse. The public possess a negative attitude towards drug dependents. Majority felt that drug addicts do not have the will power to rid themselves of drugs and they also lack a supportive family network system. Many believe that the most vulnerable group are the adolescents. Respondents were aware of the type of drugs commonly abused, although they failed to realise their long-term effects. Respondents do not attribute low education, large family and marginal income to the background of drug dependents. The findings showed gaps and misconceptions in terms of knowledge, attitudes and perceptions of the public. Accurate knowledge on, and right attitudes and perceptions towards drug related issues would certainly benefit the public in timely prevention of drug abuse.

Patients with chronic pelvic pain and/or infertility: psychological differences pre- and post-treatment

This study investigated the psychological differences between gynecological clinic attenders with either pelvic pain or infertility, or with both pelvic pain and infertility both before and after laparoscopic investigation with concurrent treatment. Given the differing meaning attached to the procedure by these groups, it was hypothesized that infertility patients would be more anxious but with less evidence of psychopathology in comparison with the pain group prior to laparoscopic surgery. Postsurgery and in the short term, pain reduction was expected to be associated with decreased pathology for the pain group. Contrary to the hypotheses, pain patients obtained higher anxiety scores in comparison with the infertility group both pretreatment as well as post-treatment. The latter group's scores were comparable to normative data. Other results were generally in line with the hypotheses, pain reduction for both pain groups being associated with a reduction in psychopathology. Patients with pain plus infertility resembled pain patients at pretreatment, while at post-treatment, they bore a closer resemblance to infertility patients in their psychological profile. This was despite the fact that for both pain groups, pain relief was similar. This reinforces the notion that in the patient groups studied anxiety is associated with pain rather than with infertility.