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Fulltext Health literacy-related knowledge, attitude, perceived barriers, and practice among primary care doctors in Malaysia

Mohamed-Yassin MS, Daher AM, Ramli AS, Ramli NF, Baharudin N

Sci Rep, 2023 Nov 13;13(1):19814.
PMID: 37957356 DOI: 10.1038/s41598-023-47242-1

This study aimed to assess the health literacy (HL) related knowledge, attitude, perceived barriers, and practice among primary care doctors (PCDs) in Malaysia, and to determine the factors associated with HL-related practice. A cross-sectional study was conducted using an online questionnaire. Sociodemographic and work-related details were collected. HL-related knowledge, attitude, perceived barriers, and practice were assessed. Descriptive and inferential analyses using linear regression were performed. 373 PCDs were included in the study with a mean (SD) age of 37.9 (8.1) years old. The mean (SD) HL-related knowledge, attitude, and practice scores were 6.89 (1.27), 36.33 (7.04), and 30.14 (4.7), respectively. 90.9% of the participants had good HL-related knowledge scores, and 89.5% had positive HL-related attitude. More than 80% of participants found that "time constraint to implement health literacy screening" and "lack of human resources to administer HL screening tools in their settings" were among the barriers for them to implement HL practices. PCDs of Chinese and other ethnicities had lower HL-related practice scores compared to those of Malay ethnicity (adjusted b = - 1.74; 95% CI - 2.93, - 0.54, and - 2.94; 95% CI - 5.27, - 0.60, respectively). PCDs who had heard of the term "health literacy" were associated with higher HL-related practice scores (adjusted b = 2.32; 95% CI 1.17, 3.47). Age (adjusted b = 0.10; 95% CI 0.04, 0.16) had significant linear positive relationship with HL-related practice. In conclusion, the HL-related knowledge, attitude, and practice among PCDs in Malaysia were at an acceptable level. Along with educating PCDs on HL, the perceived barriers identified need to be addressed to improve the HL-related practice and ultimately patient care.
Handgrip strength, and erectile dysfunction among men with metabolic syndrome attending an institutional primary care clinic in Malaysia: A cross-sectional study

Kadir NANA, Abdul-Razak S, Daher AM, Nasir NM

J Family Med Prim Care, 2024 Aug;13(8):2900-2911.
PMID: 39228540 DOI: 10.4103/jfmpc.jfmpc_1761_23

BACKGROUND: Erectile dysfunction (ED) is an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between handgrip strength (HGS) and ED, especially among men with a high risk of CVD. This study aimed to determine the prevalence of ED among men aged ≥40 years with metabolic syndrome (MetS) and its association with HGS.
MATERIALS AND METHODS: A cross-sectional study at an institutional primary care clinic in Malaysia was conducted between June 2021 and October 2021. HGS and erectile function were assessed using a hand dynamometer and International Index of Erectile Function (IIEF-5) questionnaire, respectively. Multiple logistic regression analyses were performed to determine the association between sociodemographics, clinical characteristics, and HGS with ED.
RESULTS: A total of 334 participants were recruited. The prevalence of ED was 79% (95% confidence interval [CI]: 0.75-0.84). ED was associated with elderly aged ≥60 years (odds ratio [OR] 3.27, 95%CI: 1.60-6.69), low HGS (OR 15.34, 95%CI: 5.64-41.81) and high total cholesterol (OR 0.36, 95%CI: 0.16-0.78).
CONCLUSION: In conclusion, age above 60 years and those with low HGS are at higher risk of ED. Thus, robust screening of ED among men with MetS and improving muscle strength and physical fitness may be warranted.
Fulltext Community practices of face mask use and associated knowledge and attitude in a Malaysian town during the COVID-19 pandemic

Jalaluddin HA, Burud IAS, Yew RPC, Loh XT, Tan QGJ, Nathan N, et al.

Ghana Med J, 2023 Jun;57(2):102-111.
PMID: 38504755 DOI: 10.4314/gmj.v57i2.4

OBJECTIVES: Among the vital measures to effectively curb the incidence of COVID-19 is the use of face masks. Little is known about what people understand and how they perceive and use face masks. This study aimed to determine the community's knowledge, attitude, and practice on the correct use of face masks.
DESIGN: A cross-sectional study.
SETTING: The study was carried out in Seremban 2, Malaysia using a self-administered questionnaire adapted from validated questionnaires of two previous studies.
PARTICIPANTS: Through opportunistic sampling, three hundred and ninety-two literate adults (above 18) residing in Seremban 2, Malaysia, participated in this study.
MAIN OUTCOME MEASURE: Knowledge, attitude, and practice scores were assessed among the participants.
RESULTS: Three hundred seventy (94.4%) respondents demonstrated satisfactory knowledge. A satisfactory attitude score was achieved by 349 (89%) respondents, while 281 (71.7%) achieved a satisfactory practice score. Better knowledge was significantly associated with college or university education (p=0.028). Female gender (p=0.011) and college or university education (p=0.043) were significantly associated with better practice (p<0.05). Significant but weak to fair correlations between knowledge, attitude and practice were observed.
CONCLUSION: Overall, there was satisfactory knowledge, attitude, and practice of face mask use among the Seremban 2 adult population in Malaysia. However, future public health education targeted toward the use of face masks requires more emphasis on proper usage and disposal to translate good knowledge into a good attitude and practice of face mask use to ensure the effectiveness in curbing the spread of infection.
FUNDING: None declared.
Fulltext High prevalence of dyslipidaemia subtypes and their associated personal and clinical attributes in Malaysian adults: the REDISCOVER study

Mohamed-Yassin MS, Baharudin N, Daher AM, Abu Bakar N, Ramli AS, Abdul-Razak S, et al.

BMC Cardiovasc Disord, 2021 03 23;21(1):149.
PMID: 33757445 DOI: 10.1186/s12872-021-01956-0

BACKGROUND: Dyslipidaemia refers to lipid abnormalities consisting of either one or any combination of the following: elevated total cholesterol (TC), elevated low-density lipoprotein cholesterol (LDL-c), elevated triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-c). The prevalence of hypercholesterolaemia is steadily increasing in Malaysia. However, data on the prevalence of dyslipidaemia subtypes among Malaysians are lacking. This is important as it may have implications for preventive and management strategies for this increasing public health challenge. This study is aimed at determining the prevalence of dyslipidaemia subtypes and their associated personal and clinical attributes in Malaysians.
METHODS: REDISCOVER, a prospective study, enrolled 11,288 adults where sociodemographic data, anthropometric and blood pressure measurements, fasting lipid profile and glucose, and history of diabetes, hypertension, and smoking were obtained. The cross-sectional analytic sample presented in this article comprised 10,482 participants from baseline recruitment. The data was analysed by descriptive statistics and multivariable logistic regression.
RESULTS: The overall prevalence of elevated TC, elevated LDL-c, elevated TG, low HDL-c, and elevated non-HDL-c were 64.0% (95% CI 63.0-65.0), 56.7% (CI 55.7-57.7), 37.4% (CI 36.5-38.4), 36.2% (CI 35.2-37.1), and 56.2% (CI 55.3-57.2), respectively. Overweight, obesity, and central obesity were highly prevalent and significantly associated with elevated TC and all dyslipidaemia subtypes. Older age was associated with elevated TC, elevated LDL-c and elevated non-HDL-c. Hypertension was associated with elevated TC, elevated TG, and elevated non-HDL-c, while diabetes was associated with elevated TG and low HDL-c.
CONCLUSIONS: Elevated TC and all dyslipidaemia subtypes are highly prevalent in Malaysia where increased body mass seems the main driver. Differences in the prevalence and associated personal and clinical attributes may facilitate specific preventive and management strategies.
Fulltext The Malaysia DREEM: perceptions of medical students about the learning environment in a medical school in Malaysia

Al-Naggar RA, Abdulghani M, Osman MT, Al-Kubaisy W, Daher AM, Nor Aripin KN, et al.

Adv Med Educ Pract, 2014;5:177-84.
PMID: 24959093 DOI: 10.2147/AMEP.S61805

BACKGROUND:
Students' perceptions of their learning environment, by defining its strengths and weaknesses, are important for continuous improvement of the educational environments and curriculum. Therefore, the aim of this study was to explore students' perceptions of their learning environment, among medical students in Malaysia. Various aspects of the education environment were compared between year levels and sex.

METHODS:
This cross-sectional study was conducted at the Management and Science University, Shah Alam, Malaysia in 2012. A total number of 438 medical students participated in this study, and the response rate was 87.6%. Data were analyzed using SPSS. Comparisons of the mean scores of Dundee Ready Education Environment Measure (DREEM) subscales were calculated. The t-test was used to determine statistically significant differences.

RESULTS:
The majority of the study participants were female, Malay, and from year 3 (68.7%, 65.3%, and 55.7%; respectively). Analysis of each of the 50 items of the DREEM inventory showed that 47 items scored ranged between 2.00 and 3.00, and three items scored below 2.00. These were identified as problem areas in this medical school that are required to be critically addressed. The overall score showed that the medical students' perceptions were positive. The students' perception toward educational environment was positive for all five DREEM subscales.

CONCLUSION:
The study found that, in general, the perceptions of the participants about the learning environment were positive. Nevertheless, the study also found there is a need for curriculum improvement in this school and identified priority areas for such improvement.

KEYWORDS:
DREEM; Malaysia; learning environment; medical education; students’ perceptions
Fulltext JIS definition identified more Malaysian adults with metabolic syndrome compared to the NCEP-ATP III and IDF criteria

Ramli AS, Daher AM, Nor-Ashikin MN, Mat-Nasir N, Ng KK, Miskan M, et al.

Biomed Res Int, 2013;2013:760963.
PMID: 24175300 DOI: 10.1155/2013/760963

Metabolic syndrome (MetS) is a steering force for the cardiovascular diseases epidemic in Asia. This study aimed to compare the prevalence of MetS in Malaysian adults using NCEP-ATP III, IDF, and JIS definitions, identify the demographic factors associated with MetS, and determine the level of agreement between these definitions. The analytic sample consisted of 8,836 adults aged ≥30 years recruited at baseline in 2007-2011 from the Cardiovascular Risk Prevention Study (CRisPS), an ongoing, prospective cohort study involving 18 urban and 22 rural communities in Malaysia. JIS definition gave the highest overall prevalence (43.4%) compared to NCEP-ATP III (26.5%) and IDF (37.4%), P < 0.001. Indians had significantly higher age-adjusted prevalence compared to other ethnic groups across all MetS definitions (30.1% by NCEP-ATP III, 50.8% by IDF, and 56.5% by JIS). The likelihood of having MetS amongst the rural and urban populations was similar across all definitions. A high level of agreement between the IDF and JIS was observed (Kappa index = 0.867), while there was a lower level of agreement between the IDF and NCEP-ATP III (Kappa index = 0.580). JIS definition identified more Malaysian adults with MetS and therefore should be recommended as the preferred diagnostic criterion.
Fulltext Prevalence, awareness, treatment, control and socio demographic determinants of hypertension in Malaysian adults

Abdul-Razak S, Daher AM, Ramli AS, Ariffin F, Mazapuspavina MY, Ambigga KS, et al.

BMC Public Health, 2016;16(1):351.
PMID: 27097542 DOI: 10.1186/s12889-016-3008-y

Hypertension is the leading cardiovascular risk factor globally as well as in Malaysia. This study aimed to estimate the prevalence, awareness, treatment, control and the socio demographic determinants of hypertension among Malaysian adults.
Fulltext Relationship between coping styles and lipid profile among public university staff

Ariaratnam S, Krishnapillai AD, Daher AM, Fadzil MA, Razali S, Omar SA, et al.

Lipids Health Dis, 2017 Feb 28;16(1):50.
PMID: 28245847 DOI: 10.1186/s12944-017-0438-1

BACKGROUND: The scarcity of data about coping styles with a biochemical marker namely lipid profile, potentially associated with cardiovascular risk factors is most striking among professionals working in public university. Hence, this research aimed to investigate the relationship between coping styles and lipid profile comprising total cholesterol (TC), triglyceride (TG), HDL-cholesterol (high density lipoprotein-cholesterol) and LDL-cholesterol (Low density lipoprotein-cholesterol) among this group of professionals.
METHODS: A cross sectional survey was conducted among staff from a tertiary education centre. Subjects were contacted to ascertain their medical history. A total of 320 subjects were interviewed and 195 subjects were eligible and subsequently recruited on a suitable date for taking blood and administration of the questionnaires. The subjects completed questionnaires pertaining to demographic details and coping styles. Pearson's correlation coefficient was used to measure the strength of association between lipid profile and coping styles.
RESULTS: Majority of the subjects were non-academic staff (60.0%), female (67.2%), Malay (91.8%), married (52.3%) and educated until Diploma level (34.9%). Academic staff scored significantly higher mean scores in task-oriented coping styles (Mean = 64.12). Non-academic staff scored significantly higher mean scores in emotion (Mean = 48.05) and avoidance-oriented coping styles (Mean = 57.61). Malay subjects had significantly higher mean scores in emotion (Mean = 47.14) and avoidance-oriented coping styles (Mean = 55.23). Non-malay subjects (Mean = 66.00) attained significantly higher mean scores in task-oriented coping styles. Single/divorced/widowed individuals scored significantly higher mean scores in emotion (Mean = 48.13) and avoidance-oriented coping styles (Mean = 56.86). There was a significant negative correlation between TC (r = -0.162) and LDL (r = -0.168) with avoidance-oriented coping styles (p = 0.023, p = 0.019 respectively).
CONCLUSION: Avoidance-oriented coping style was more likely to engender favourable lipid profile. Hence, assessment of coping styles would certainly assist health care practitioners in predicting subjects who would be at a greater risk of developing cardiovascular diseases.
Fulltext Self-medication of antibiotics: investigating practice among university students at the Malaysian National Defence University

Haque M, Rahman NAA, McKimm J, Kibria GM, Azim Majumder MA, Haque SZ, et al.

Infect Drug Resist, 2019;12:1333-1351.
PMID: 31190922 DOI: 10.2147/IDR.S203364

Background: Self-medication of drugs to alleviate symptoms is a common global behavior, helping relieve burdens on health services, but many drugs eg, antibiotics are prescription-only. Self-medication of antibiotics (SMA) is an irrational use of drugs, contributing to microbial resistance increasing health care costs and higher mortality and morbidity. This study aimed to assess SMA among university students. Methods: This was a cross-sectional study conducted among medical and non-medical students of the National Defence University of Malaysia. A validated instrument was used to gather data. Ethics approval was obtained. Random and universal sampling was adopted, and SPSS 21 was used for data analysis. Results: A total of 649 students participated in the study: 48.5% male and 51.5% female, 39.3% reported self-medicating with antibiotics. Penicillin, doxycycline, clarithromycin were the antibiotics most used with the majority reporting no adverse drug reactions. Cost savings and convenience were the principal reasons for SMA which were mainly obtained from local retail pharmacies. Despite medical students (particularly the more senior) having better knowledge of antibiotic use than non-medical students, 89% of all research participants responded that practicing SMA was a good/acceptable practice. Conclusion: SMA is common amongst Malaysian students and, despite understanding why SMA is unwise, even medical students self-medicate.