Development and validation of the information-motivation-behavioural skills model-based human immunodeficiency virus education kit for adolescents in Malaysia

The growing Human Immunodeficiency Virus (HIV) incidences and insufficient HIV knowledge among Malaysian late adolescents necessitate immediate attention to HIV prevention via education. This study aims to develop and validate an Information-Motivation-Behavioural skills (IMB) model-based education kit for adolescents, PREM-Kit, to educate on HIV prevention among Malaysian late adolescents. Utilizing the Analysis, Design, Development, Implementation, and Evaluation model, we conducted the study in three phases: needs assessment, development of PREM-Kit, and validation of PREM-Kit by applying the IMB model to map the PREM-Kit's contents. PREM-Kit, developed in Malay language, consisted of an infographic flip chart and videos. Five multi-disciplinary experts validated the PREM-Kit using the content validity index (CVI), and 13 end-users validated the PREM-Kit using the Malay version of the Patient Education Materials Assessment Tool for Printable and Audiovisual Materials. The infographic flip chart comprised three modules covering 15 topics, and an animated video accompanied each module. PREM-Kit achieved CVI scores of 1.0 and median scores of over 80% for understandability and actionability. Overall, the newly developed IMB model-based HIV education kit has good content validity, is simple to comprehend and apply, and is ready for testing its effectiveness in improving adolescents' knowledge, attitudes, and practices for HIV prevention.

Does Exercise Improve Health-Related Quality of Life of Colorectal Cancer Survivors? A Systematic Review and Meta-Analysis

INTRODUCTION

Early diagnostic and treatment advances have resulted in prolonged cancer survivorship. Therefore, exercise intervention in survivorship management is essential for enhancing cancer survivors' health-related quality of life (HRQoL).

OBJECTIVE

The systematic review and meta-analysis in this study aimed to explore the effect of exercise intervention on health-related quality of life of colorectal cancer survivors.

METHODS

The current study followed guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) to identify relevant literature. Comprehensive searches were conducted using EBSCOhost, Web of Science (WOS), Scopus, Science Direct, and PubMed. The inclusion criteria included are randomised control trials studies written in English, with no restrictions for the time of publication that reported the effects of exercise intervention on health-related quality of live among colorectal cancer survivors. Meta-analysis was conducted by pooling the mean and standard deviation of post-intervention scores across randomised control trial studies using a random effects model.

RESULT

A total of 467 articles were identified but only seven articles were randomised control trials (RCT) (n = 7) with PEDro scores ranging from 6 to 9 showing good internal validity were included in the review. The results of the meta-analysis of pooled data from six RCTs studies on HRQoL showed no significant effect of exercise intervention on HRQoL in the intervention group compared to control group [SMD = 0.25; 95% CI; -0.0, 0.51; Z = 1.88; p = 0.06; I2 = 30.8%].

CONCLUSION

This meta-analysis provides key insights into the effect of exercise on the health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. Therefore, more experimental studies should be carried out with rigorous methodology to evaluate the effectiveness of exercise interventions before it is recommended as a routine activity in post-treatment management for CRC survivors.

Subjective and objective financial toxicity among colorectal cancer patients: a systematic review

BACKGROUND

Colorectal cancer (CRC) is the third most common cancer type worldwide. Colorectal cancer treatment costs vary between countries as it depends on policy factors such as treatment algorithms, availability of treatments and whether the treatment is government-funded. Hence, the objective of this systematic review is to determine the prevalence and measurements of financial toxicity (FT), including the cost of treatment, among colorectal cancer patients.

METHODS

Medline via PubMed platform, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined CRC FT. There was no limit on the design or setting of the study.

RESULTS

Out of 819 papers identified through an online search, only 15 papers were included in this review. The majority (n = 12, 80%) were from high-income countries, and none from low-income countries. Few studies (n = 2) reported objective FT denoted by the prevalence of catastrophic health expenditure (CHE), 60% (9 out of 15) reported prevalence of subjective FT, which ranges from 7 to 80%, 40% (6 out of 15) included studies reported cost of CRC management- annual direct medical cost ranges from USD 2045 to 10,772 and indirect medical cost ranges from USD 551 to 795.

CONCLUSIONS

There is a lack of consensus in defining and quantifying financial toxicity hindered the comparability of the results to yield the mean cost of managing CRC. Over and beyond that, information from some low-income countries is missing, limiting global representativeness.

Prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in urban Selangor, Malaysia: a cross-sectional study

BACKGROUND

Cyberbullying is a growing public health concern with clear, negative impacts on the mental, physical and social health of targeted victims. Previous research on cyberbullying has largely focused on examining its occurrence among children and adolescents. The present study aims to examine the prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in Selangor, Malaysia.

METHODS

A cross-sectional study was conducted in a locality within Selangor, sampling a total of 1449 young adults. The Cyberbullying and Online Aggression Survey was used to measure cyberbullying victimisation. The Family APGAR scale, General Health Questionnaire, Pittsburgh Sleep Quality Index and single-item measures were used to assess family dysfunction, psychological distress and health behaviour, respectively.

RESULTS

The 1-month prevalence of cyberbullying victimisation among young adults was 2.4%. The most common cyberbullying act experienced was mean or hurtful comments about participants online (51.7%), whereas the most common online environment for cyberbullying to occur was social media (45.8%). Male participants (adjusted OR (AOR)=3.60, 95% CI=1.58 to 8.23) had at least three times the odds of being cyberbullied compared with female participants. Meanwhile, participants with higher levels of psychological distress had increased probability of being cyberbullied compared with their peers (AOR=1.13, 95% CI=1.05 to 1.21).

CONCLUSIONS

As evident from this study, cyberbullying victimisation prevails among young adults and is significantly related to gender and psychological distress. Given its devastating effects on targeted victims, a multipronged and collaborative approach is warranted to reduce incidences of cyberbullying and safeguard the health and well-being of young adults.

Analysis of Trauma Characteristics Between the Older and Younger Adult Patient from the Pan Asian Trauma Outcome Study Registry (PATOS)

OBJECTIVE

Asia is experiencing a demographic shift toward an aging population at an unrivaled rate. This can influence the characteristics and outcomes of trauma. We aim to examine different characteristics of older adult trauma patients compared to younger adult trauma patients and describe factors that affect the outcomes in Asian countries.

METHODS

This is a retrospective, international, multicenter study of trauma across participating centers in the Pan Asian Trauma Outcome Study (PATOS) registry, which included trauma cases aged ≥18 years, brought to the emergency department (ED) by emergency medical services (EMS) from October 2015 to November 2018. Data of older adults (≥65 years) and younger adults (<65 years) were analyzed and compared. The primary outcome measure was in-hospital mortality, and secondary outcomes were disability at discharge and hospital and intensive care unit (ICU) length of stays.

RESULTS

Of 39,804 trauma patients, 10,770 (27.1%) were older adults. Trauma occurred more among older adult women (54.7% vs 33.2%, p < 0.001). Falls were more frequent in older adults (66.3% vs 24.9%, p < 0.001) who also had higher mean Injury Severity Score (ISS) compared to the younger adult trauma patient (5.4 ± 6.78 vs 4.76 ± 8.60, p < 0.001). Older adult trauma patients had a greater incidence of poor Glasgow Outcome Scale (GOS) (13.4% vs 4.1%, p < 0.001), higher hospital mortality (1.5% vs 0.9%, p < 0.001) and longer median hospital length of stay (12.8 vs 9.8, p < 0.001). Multiple logistic regression revealed age (adjusted odds ratio [AOR] 1.06, 95%CI 1.02-1.04, p < 0.001), male sex (AOR 1.60, 95%CI 1.04-2.46, p = 0.032), head and face injuries (AOR 3.25, 95%CI 2.06-5.11, p < 0.001), abdominal and pelvic injuries (AOR 2.78, 95%CI 1.48-5.23, p = 0.002), cardiovascular (AOR 2.71, 95%CI 1.40-5.22, p = 0.003), pulmonary (AOR 3.13, 95%CI 1.30-7.53, p = 0.011) and cancer (AOR 2.03, 95%CI 1.02-4.06, p = 0.045) comorbidities, severe ISS (AOR 2.06, 95%CI 1.23-3.45, p = 0.006), and Glasgow Coma Scale (GCS) ≤8 (AOR 12.50, 95%CI 6.95-22.48, p < 0.001) were significant predictors of hospital mortality.

CONCLUSIONS

Older trauma patients in the Asian region have a higher mortality rate than their younger counterparts, with many significant predictors. These findings illustrate the different characteristics of older trauma patients and their potential to influence the outcome. Preventive measures for elderly trauma should be targeted based on these factors.

Development of the Malay Language of understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAPHQ C-19): content validity & face validity analysis

OBJECTIVE

This study aimed to assess the content and face validity index of the development of the understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAPHQ C-19) in the Malay language.

METHODS

The development of the MUAPHQ C-19 was conducted in two stages. Stage I resulted in the generation of the instrument's items (development), and stage II resulted in the performance of the instrument's items (judgement and quantification). Six-panel experts related to the study field and ten general public participated to evaluate the validity of the MUAPHQ C-19. The content validity index (CVI), content validity ratio (CVR) and face validity index (FVI) were analysed using Microsoft Excel.

RESULTS

There were 54 items and four domains, namely the understanding, attitude, practice and health literacy towards COVID-19, identified in the MUAPHQ C-19 (Version 1.0). The scale-level CVI (S-CVI/Ave) for every domain was above 0.9, which is considered acceptable. The CVR for all items was above 0.7, except for one item in the health literacy domain. Ten items were revised to improve the item's clarity, and two items were deleted due to the low CVR value and redundancy, respectively. The I-FVI exceeded the cut-off value of 0.83 except for five items from the attitude domain and four from the practice domains. Thus, seven of these items were revised to increase the clarity of items, while another two were deleted due to low I-FVI scores. Otherwise, the S-FVI/Ave for every domain exceeded the cut-off point of 0.9, which is considered acceptable. Thus, 50-item MUAPHQ C-19 (Version 3.0) was generated following the content and face validity analysis.

CONCLUSIONS

The questionnaire development, content validity, and face validity process are lengthy and iterative. The assessment of the instruments' items by the content experts and the respondents is essential to guarantee the instrument's validity. Our content and face validity study has finalised the MUAPHQ C-19 version that is ready for the next phase of questionnaire validation, using Exploratory and Confirmatory Factor Analysis.

Improving Tuberculosis Medication Adherence: The Potential of Integrating Digital Technology and Health Belief Model

Tuberculosis (TB) is a significant public health concern. Globally, TB is among the top ten and the leading cause of death due to a single infectious agent. Providing standard anti-TB therapy for at least six months is recommended as one of the crucial strategies to control the TB epidemic. However, the long duration of TB treatment raised the issue of non-adherence. Nonadherence to TB therapy could negatively affect clinical and public health outcomes. Thus, directly observed therapy (DOT) has been introduced as a standard strategy to improve anti-TB medication adherence. Nonetheless, the DOT approach has been criticized due to inconvenience, stigma, reduced economic productivity, and reduced quality of life, which ultimately could complicate adherence issues. Apart from that, its effectiveness in improving anti-TB adherence is debatable. Therefore, digital technology could be an essential tool to enhance the implementation of DOT. Incorporating the health belief model (HBM) into digital technology can further increase its effectiveness in changing behavior and improving medication adherence. This article aimed to review the latest evidence regarding TB medication non-adherence, its associated factors, DOT's efficacy and its alternatives, and the use of digital technology and HBM in improving medication adherence. This paper used the narrative review methodology to analyze related articles to answer the study objectives. Conventional DOT has several disadvantages in TB management. Integrating HBM in digital technology development is potentially effective in improving medication adherence. Digital technology provides an opportunity to improve medication adherence to overcome various issues related to DOT implementation.

A Preliminary Study to Explore the Informed Consent Approach and the Ethical Challenges in the Malaysian Biobanking for Research

Since 2005, Malaysia has established several biobanks to keep in line with the advancement of biomedical research and development of biobanks in other countries such as the UK and the USA. Despite the establishment of several biobanks in Malaysia, little is known about the informed consent approach in biobanking research and its ethical challenges. This study aims to identify the approach in obtaining informed consent in the Malaysian biobanking for research and explore its ethical challenges. Using non-probability purposive sampling, an in-depth interview with the key informants was conducted in Klang Valley. Based on the interviews, broad consent is the main approach used in obtaining informed consent in biobanking for research in Malaysia and five major ethical challenges were identified. These challenges include the informants’ opinion on the current informed consent approach, understanding participants’ rights, the role of the research ethics committee, biobanking governance in Malaysia, and informants’ knowledge and awareness. In summary, there is a lack of understanding among those involved in biobanking on the ethical, legal, and social aspects of biobanking for research in Malaysia.

Colorectal cancer and potential predictors of never screened for faecal occult blood test: a narrative review

Colorectal cancer (CRC) is a major public health threat. Therefore, CRC screening uptake has been a focus with the established precancerous lesion and the strong association of early detection with staging and survival of the disease. However, CRC screening is relatively low in many countries. This article briefly discussed the current situation of CRC, recommendations, and current uptake of CRC screening in various countries. Besides that, this article also highlights the potential factors that help to predict the CRC screening uptake worldwide. Identification of those factors could guide policymakers to develop an effective strategy to improve the CRC screening uptake and ultimately improve the health outcome of the population.

Psychometric Properties of Geriatric Depression Scale (Malay Version) in Elderly with Cognitive Impairment

Background

Geriatric Depression Scale (GDS) has been widely used in assessing depression in elderly population. Using the Ministry of Health Malaysia definition for elderly, this study aimed to examine the construct validity and reliability of the GDS (Malay version) in elderly with cognitive impairment in Malaysia.

Methods

A cross-sectional validation study involving 219 elderlies with cognitive impairment was conducted using universal sampling method. Participants aged 60 years old and above, scored less than 11 for the short mini mental state examination (SMMSE), have sufficient command of the Malay or English language, residing in the government nursing homes and attending memory clinics in government hospitals in Klang Valley were sampled. The GDS-15 English version underwent adaptation, translation, face validation and field testing to produce the Malay version. Psychometric analysis was performed using the exploratory factor analysis and its internal consistency was examined.

Results

Mean age of participants were 72.61 ± 7.79. Majority were male (50.7%), Malay (50.2%), studied at least until primary school (71.7%) and stayed at nursing homes (50.2%). Construct validity showed significant Bartlett’s test of sphericity (Chi-square = 1,340.058, P < 0.001) and Kaiser-Meyer-Olkin (KMO) test of 0.90. Factor loadings for each item in the depression domain were satisfactory ranging from 0.42 to 0.83. Factor loadings for each item in the psychosocial activities’ domain were satisfactory ranging from 0.53 to 0.76. For the questionnaire reliability analysis, the total Cronbach’s alpha for the final model was satisfactory, with and overall Cronbach’s alpha of 0.89. Cronbach’s alpha value for the depression and psychosocial activities domain was 0.861 and 0.80, respectively.

Conclusion

The GDS (Malay version) is a valid and reliable tool to screen for depression in elderly with cognitive impairment.

Scrub Typhus and its Risk Factors in Asian Countries: A Meta-analysis

Background: Scrub typhus is an infectious disease with potentially fatal consequences. It is caused by Orientia tsutsugamushi and transmitted to humans via the bites of infected larval mites (chiggers). Scrub typhus is one of the most neglected and severe diseases despite its easy treatment. Delay in diagnosis and treatment is not uncommon, resulting in a 10% fatality rate in cases of inappropriate treatment. The main aim of this study was to determine the prevalence of scrub typhus in Southeast Asia and the risk factors contributing to the disease in order to aid the development of effective control and prevention strategies. Methods: In this meta-analysis, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were used as a guideline. The systematic literature search was performed for the relevant titles, abstracts, and keywords in the journal databases of PubMed, EBSCOhost, Ovid, and Google Scholar in November 2018. The keywords and terms were derived from population, intervention, comparison, outcome analysis, and a total of 720 studies were retrieved accordingly. Only original research, published articles, and articles written in the English language were selected for this purpose. Screening of abstracts had shortlisted 36 studies and data extraction was conducted accordingly. However, only 9 studies were accepted after a review of the full texts. The other 27 articles were excluded due to ecological studies and different outcome measures. Results: Several factors in this meta-analysis were identified to have significant risk of having scrub typhus (P<0.05), including people who are involved in the agriculture sector (OR: 2.90, 95% CI: 2.33, 3.77), those having direct contact or being exposed to the vector habitat (OR: 2.17, 95% CI: 1.49, 3.16), and house yard conditions (OR: 3.02, 95% CI: 2.1, 4.33). Other factors were indoor house conditions (OR: 1.96, 95% CI: 1.45, 2.67), those having close contact with rodents or domestic animals (OR: 2.51, 95% CI: 1.67, 3.77), those working in paddy fields or vegetable farms (OR: 5.17, 95% CI: 3.15, 8.47), and bad occupational safety practices (OR: 1.71, 95% CI: 1.12, 2.62). Conclusions: The identified risk factors from this meta-analysis highlight the importance of public health intervention strategies for the prevention of scrub typhus among high-risk populations.

The challenges and risk of laboratory handling on a histology specimen during COVID-19 pandemic

The Coronavirus Disease 2019 (COVID-19) pandemic has taken the world into turmoil by surprise. The rapid spreading of this virus has led to an exponential increase in the number of cases. It has created a public health disaster, causing a collapse of the health system in every part of the world. Many sectors in the health area are affected, including histopathology services. The challenges and risk of viral transmission can come from various aspects and levels. For COVID-19 tests, there are even cases of no direct contact with the specimens; the specimens received infection from individuals of unknown status. The fixatives used for histopathology specimens are believed to be inactivated viruses, which can be an inactivate coronavirus. Even so, precautions have to be put in place to prevent the spread of infection to laboratory personnel, especially to those handling underfixed and fresh frozen cytology samples. Precautions must also be taken when dealing with histopathology services, by wearing full personal protective equipment and by executing other standard safety measures. The purpose of this review is to highlight the challenges faced in managing histopathology services in our centre during the COVID-19 pandemic.

Determinants of snakebite mortality in Asia: A systematic review

PURPOSE

This systemic review summarizes the evidence exploring the determinants of mortality due to snakebite envenomation in Asia.

MATERIALS AND METHODS

The database PubMed, Web of Science and Science Direct were searched to identify the relevant literatures concerning mortality due to snakebites mortality in Asia. All the articles chosen were critically appraised for its quality using a mixed-method assessment tool by two independent reviewers with discrepancies sorted by a third person.

RESULTS

A total of 7 studies were included in the final analysis which was 3 cross-sectional studies, 2 case reports, 1 observation prospective study and 1 randomized control trial study. Two studies were conducted in India and two studies in Sri Lanka while one study was conducted in Taiwan, Vietnam and Nepal respectively. The cases of snakebite victims were retrieved from the year of 1987 until 2017. In total, there were 762 cases of snakebite victims recorded, with 61 of those victims succumbed to death. From the final total of 7 studies, 4 of the studies showed snakebites mortality were related to delayed treatment access and 3 studies due to suboptimal care.

CONCLUSION

Mortality and morbidity can be reduced if there is a quick access for victims to emergency medical care, rapid transfer time to hospital and receiving immediate optimal medical treatment from trained medical staff once in the hospital or dispensary.

Factors of Never Screened with Faecal Occult Blood Test in Public Primary Care Facilities

BACKGROUND

Colorectal cancer (CRC) is still a major public health threat. In the effort to reduce CRC incidence and mortality, faecal occult blood test (FOBT) is currently the screening tools used for early detection of CRC. However, the uptake of FOBT screening is less than promising. This study aims to identify the prevalence and predictors of Never Screened with FOBT (NS-FOBT).

METHODS

A cross sectional study was conducted in five health clinics under Kota Kinabalu district, Sabah, Malaysia Borneo involving 162 attendees with age of 50 years old and above. A validated self-administered questionnaire was used to collect the data. Multiple logistic regression analysis was used to determine the predictors of NS-FOBT.

RESULTS

The prevalence of NS-FOBT was 85.8% (n=139). Important predictors of NS-FOBT were age (aOR: 0.922; 95% CI: 0.855, 0.995; p=0.035), Bumiputera ethnicity (vs Non Bumiputera; aOR: 4.285; 95% CI: 1.384, 13.263; p=0.012), knowledge score (aOR: 0.921; 95% CI: 0.856, 0.99; p=0.027), and attitude score (aOR: 0.801; 95% CI: 0.702, 0.913; p=0.001).

CONCLUSION

There is high prevalence of NS-FOBT. Age, ethnicity, knowledge, and attitude were important predictors of NS-FOBT. Strategies are needed to improve FOBT screening rate among the public. Socio-culturally tailored health promotion strategies as well as strengthening the communication, collaboration, and education to enhance the role of family physician is vital in improving the CRC prevention and care.

Poor Knowledge and Practice Towards Breast Cancer among Women in Baghdad City, Iraq

BACKGROUND

Breast cancer is one of the most common cancers among females worldwide. The aim of this study was to assess the knowledge and practice about breast cancer and its related factors among women in Baghdad city, Iraq.

MATERIALS AND METHODS

A cross-sectional study was conducted among 508 women aged 18 to 55 years from four non-governmental organizations (NGO) in Baghdad city, Iraq. A self-administered questionnaire on breast cancer knowledge and practice was distributed to participants during weekly activity of the NGO.

RESULTS

A total of 61.2% of the respondents had poor knowledge, only 30.3% performed breast self-examination (BSE) and 41.8% said that they did not know the technique to perform BSE. Associations between knowledge and marital status and age were significant. For practice, working status, education, age and family income were significant. After controlling for cofounders, the most important contributing factors for poor knowledge among respondents were marital status and not performing BSE, with adjusted odds ratio of 1.6 and 1.8 respectively.

CONCLUSIONS

Breast cancer knowledge and practice of BSE are poor among women in Baghdad city, Iraq. More promotion regarding breast cancer signs and symptoms and also how to perform BSE should be conducted using media such as television and internet as these constituted the main sources of information for most women in our study.