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  1. Chua YP, Kwan MK, Saw A
    Med J Malaysia, 2005 Jul;60 Suppl C:78-82.
    PMID: 16381289
    The need for perioperative blood transfusion in elderly patients with trochanteric fracture scheduled for elective dynamic hip screw fixation has recently been questioned following reports on the association between allogeneic blood transfusion and post-operative infections. This retrospective study was undertaken to assess the amount of per operative blood loss and transfusion requirement in relation to pre-operative haemoglobin level in 198 patients with trochanteric fractures. The average per operative blood loss was 409 ml and it correlated well with the duration of the operation. More than half of the patients (52.5%) required blood transfusion and nearly three-quarters were anaemic prior to the surgery. Proactive pre-operative measures to optimize the patient's haemoglobin level and intra-operative minimization of blood loss are essential steps to obviate the need for perioperative allogeneic blood transfusion.
  2. Lee CK, Chua YP, Saw A
    Clin Orthop Relat Res, 2012 Feb;470(2):610-5.
    PMID: 21842299 DOI: 10.1007/s11999-011-1990-z
    Pin site infection is a common problem in external fixation. Plain gauze wetted with normal saline is commonly used for a pin site dressing owing to the simplicity and low cost. Evidence to support adding an antimicrobial agent in the dressing material is lacking.
  3. Tan B, Shanmugam R, Gunalan R, Chua Y, Hossain G, Saw A
    Malays Orthop J, 2014 Jul;8(2):35-9.
    PMID: 25279090 DOI: 10.5704/MOJ.1407.012
    Taylor's spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.
  4. Saw A, Chua YP, Hossain G, Sengupta S
    J Orthop Surg (Hong Kong), 2012 Aug;20(2):181-4.
    PMID: 22933675
    To assess the monthly rates of infection of individual pin sites in 7 patients during distraction osteogenesis.
  5. Ibrahim Alzamel LG, Abdullah KL, Chong MC, Chua YP
    J Egypt Public Health Assoc, 2020 Aug 14;95(1):20.
    PMID: 32813099 DOI: 10.1186/s42506-020-00048-9
    BACKGROUND: Understanding the factors influencing nurses' turnover intention, particularly the work life quality and commitment to organization, is important to all countries suffering from nursing shortage. The study aims to determine the mediating role of commitment to organization on work life quality and its relationship with turnover intention among Malaysian nurses.

    METHODS: A descriptive cross-sectional design, using a self-report survey was conducted on 430 nurses from a teaching hospital from February to April 2019. A structural equation model version 3 was used for testing study hypotheses.

    RESULTS: The mediating effect (indirect effect) of organizational commitment on the relationship between work life quality and turnover intention (QWL→OC→IT) was negative with path coefficient - 0.234, whereas the direct effect of work life quality on turnover intention (QWL→IT) was negative with smaller path coefficient - 0.228. This means that the relationship between work life quality and turnover intention was partially mediated by the organizational commitment (P < 0.001).

    CONCLUSION: Organizational commitment has a negative partial mediating effect between work life quality of nurses and intention of turnover in teaching hospitals where the organizational commitment significantly reduced the nurses' intention to leave. The study findings can guide nursing managers to be carefully attended to the levels of nurses' commitment to their organization.

  6. Loh SY, Sapihis M, Danaee M, Chua YP
    Disabil Rehabil, 2021 09;43(19):2729-2738.
    PMID: 31962056 DOI: 10.1080/09638288.2020.1715492
    PURPOSE: This novel study aims to explore the relationship between occupational participation, meaningful activity, and the health-related quality of life of people living with a diagnosis of colorectal cancer.

    METHODS: A cross-sectional study design with 113 colorectal cancer survivors (from two large public hospitals in Malaysia) was conducted. Data collection tools included the Occupational Participation Questionnaire, Engagement in Meaningful-activities, and the European Organization for Research and Treatment in Cancer Quality of Life (QOL) Questionnaire. Data analyses were conducted using SmartPLS to examine path analyses between the three measures.

    RESULTS: There were independent significant relationships between (1) occupational participation, and (2) meaningful activity engagements on the dependent variable of QOL in this cohort of cancer survivors. More importantly, the result showed that "meaningful-activity" positively and significantly mediates the path between occupational participation and quality of life [β = 0.250 (0.46*0.59), ρ 

  7. Liao SJ, Chong MC, Tan MP, Chua YP
    Geriatr Nurs, 2018 08 31;40(2):154-159.
    PMID: 30173939 DOI: 10.1016/j.gerinurse.2018.08.001
    Depression leads to a poorer quality of life (QOL) which is a determinant of healthy ageing. Cost-effective solutions for enhancing QOL in the older population are much needed in China, with its rapidly ageing population. We conducted a randomized controlled trial involving 112 community-dwelling older participants with mild to moderate depression, to evaluate the effect of Tai Chi with music on QOL (57 in intervention group, 55 in control group). WHO Quality of Life-BREF was used to measure QOL at baseline and at every month for three months. Following the adjustments for sociodemographic data, the effect of intervention on QOL was assured (F = 25.145, P 
  8. Liao SJ, Tan MP, Chong MC, Chua YP
    Issues Ment Health Nurs, 2018 May;39(5):398-402.
    PMID: 29436896 DOI: 10.1080/01612840.2017.1417519
    BACKGROUND: The effectiveness of pharmacological treatment may be limited in older persons. Several studies using Tai Chi or music therapy separately confirmed positive effects in the reduction of depressive symptoms. We conducted a cluster randomized controlled trial to evaluate the possible synergistic effect of combined music and Tai Chi on depressive symptoms.

    METHODS: One hundred and seven older adults with mild to moderate depressive symptoms were recruited from Ya'an city. Fifty-five participants were cluster randomized to combined music and Tai Chi group for three months, while the other fifty-two individuals were randomized to the control group that entailed routine health education delivered monthly by community nurses. The primary outcome of depressive symptoms was measured with the Geriatric Depression Scale (GDS) at baseline and monthly for three months.

    RESULTS: At three-month follow-up, a statistically significant improvement in depressive symptoms was found in the intervention group compared with control group (F(3,315) = 69.661, P < 0.001). Following adjustments for socio-demographic data, the true effect of intervention on depressive symptoms was significant (F = 41.725, P < 0.01, ηp2 = 0.574).

    CONCLUSIONS: Combined music and Tai Chi reduced depressive symptoms among community-dwelling older persons. This represents an economically viable solution to the management of depression in highly populous developing nations.

  9. Chua YP, Tan WJ, Yahya TS, Saw A
    Singapore Med J, 2013 Nov;54(11):630-3.
    PMID: 24276099
    INTRODUCTION: Foot pain is a common problem, especially in women, and studies have shown that it is related to footwear. This study was conducted to establish the prevalence of nontraumatic foot pain and its contributing factors in young working Malaysian women in an urban setting.

    METHODS: The survey was conducted on a group of working women (age range 21-40 years) selected using convenience sampling. Data on foot problems was collected through an investigator-directed questionnaire and during clinical inspection of the foot.

    RESULTS: A total of 400 women, with a mean age of 29.4 years, were recruited. Half (n = 200) of the women had experienced recurrent nontraumatic foot pain in the past one year. Subjective assessments of foot pain using the Numeric Intensity Scale gave an average score of 4.89 ± 1.78 (range 2-10), with most episodes occurring at the heel. There was no statistically significant association between foot pain and age, ethnicity or body mass index. However, there was a higher incidence of foot pain in women wearing high-heeled footwear than those wearing non-high-heeled footwear (p = 0.027, odds ratio 1.591).

    CONCLUSION: Nontraumatic foot pain is common among young working women in our society. More than half (68.4%) of the women with foot pain in our study attributed the pain to footwear. Wearing high-heeled shoes to work was a significant contributing factor. Increased public awareness on the importance of proper footwear may help to reduce the prevalence of nontraumatic foot pain in working women.
  10. Ling HT, Kwan MK, Chua YP, Deepak AS, Ahmad TS
    Med J Malaysia, 2006 Dec;61 Suppl B:8-12.
    PMID: 17600986
    Treatment of radius or ulna nonunion requires both osteogenic environment and mechanical stability. We would like to report three radial and six ulnar diaphyseal nonunions treated with 3.5 mm locking compression plate (LCP) fixation. To assess the effectiveness of 3.5 mm LCP in treating diaphyseal nonunion of the forearm bones, we prospectively reviewed nine patients with the mean age of 33 years with diaphyseal nonunion of the radius or ulna. All patients were treated with 3.5 mm LCP. Bone grafting was only performed for atrophic nonunion. Surgical and functional outcome were evaluated. There were three atrophic nonunion of the radius, four atrophic nonunion of the ulna and two hypertrophic nonunion of the ulna. All nonunion united successfully with satisfactory functional outcome. 3.5 mm LCP is effective in the treatment of nonunion of ulna or radius.
  11. Ramoo V, Abdullah KL, Tan PS, Wong LP, Chua YP, Tang LY
    Nurs Crit Care, 2017 May;22(3):141-149.
    PMID: 25913373 DOI: 10.1111/nicc.12180
    BACKGROUND: Inappropriate sedation assessment can jeopardize patient comfort and safety. Therefore, nurses' abilities in assessing and managing sedation are vital for effective care of mechanically ventilated patients.

    AIMS AND OBJECTIVES: This study assessed nurses' sedation scoring and management abilities as primary outcomes following educational interventions. Nurses' perceived self-confidence and barriers to effective sedation management were assessed as secondary outcomes.

    DESIGN: A post-test-only quasi-experimental design was used. Data were collected at 3 and 9 months post-intervention.

    METHODS: A total of 66 nurses from a 14-bed intensive care unit of a Malaysian teaching hospital participated. The educational interventions included theoretical sessions, hands-on sedation assessment practice using the Richmond Agitation Sedation Scale, and a brief sedation assessment tool. Nurses' sedation scoring and management abilities and perceived self-confidence level were assessed at both time points using self-administered questionnaires with case scenarios. Sedation assessment and management barriers were assessed once at 9 months post-intervention.

    RESULTS: Median scores for overall accurate sedation scoring (9 months: 4·00; 3 months: 2·00, p = 0·0001) and overall sedation management (9 months: 14·0; 3 months: 7·0, p = 0·0001) were significantly higher at 9 months compared to 3 months post-intervention. There were no significant differences in the perceived self-confidence level for rating sedation level. Overall perceived barrier scores were low (M = 27·78, SD = 6·26, possible range = 11·0-55·0). Patient conditions (M = 3·68, SD = 1·13) and nurses' workload (M = 3·54, SD = 0·95) were the greatest barriers to effective sedation assessment and management. Demographic variables did not affect sedation scoring or management abilities.

    CONCLUSIONS: Positive changes in nurses' sedation assessment and management abilities were observed, indicating that adequate hands-on clinical practice following educational interventions can improve nurses' knowledge and skills.

    RELEVANCE TO CLINICAL PRACTICE: Educational initiatives are necessary to improve ICU practice, particularly in ICUs with inexperienced nurses.

  12. Tang YH, Chong MC, Chua YP, Chui PL, Tang LY, Rahmat N
    J Clin Nurs, 2018 Dec;27(23-24):4311-4320.
    PMID: 29777560 DOI: 10.1111/jocn.14538
    AIMS: To determine the effect mobile messaging apps on coronary artery disease patient knowledge of and adherence to a healthy lifestyle.

    BACKGROUND: Due to the increasing incidence of coronary artery disease in recent years, interventions targeting coronary artery disease risk factors are urgent public priorities. The use of mobile technology in healthcare services and medical education is relatively new with promising future prospects.

    DESIGN: This study used a quasiexperimental design that included pre- and posttest for intervention and control groups.

    METHODS: The study was conducted from January-April 2017 with both intervention and control groups, in a teaching hospital in Klang Valley. Convenience sampling was used with inclusive criteria in choosing the 94 patients with coronary artery disease (intervention group: 47 patients; control group: 47 patients). The pretest was conducted as a baseline measurement for both groups before they were given standard care from a hospital. However, only the intervention group was given a daily information update via WhatsApp for 1 month. After 1 month, both groups were assessed with a posttest.

    RESULTS: The split-plot ANOVA analysis indicates that there is a significant and positive effect of the intervention on coronary artery disease patients' knowledge on coronary artery disease risk factors [F(1, 92) = 168.15, p 

  13. Al Maghaireh DF, Abdullah KL, Chong MC, Chua YP, Al Kawafha MM
    J Pediatr Nurs, 2017 06 19;36:132-140.
    PMID: 28888494 DOI: 10.1016/j.pedn.2017.06.007
    PURPOSE: To investigate the stressors and stress levels among Jordanian parents of infants in the NICU and their relationship to three factors: anxiety, depression and sleep disturbance.

    DESIGN AND METHODS: A cross-sectional survey was conducted in two hospitals in Jordan among 310 parents of infants in the NICU by using PSS: NICU and PROMIS.

    RESULTS: Both parents experienced high levels of stress, anxiety, depression and sleep disturbance. There was a significant difference in stress level between mothers and fathers [t (308)=3.471, p=0.001], with the mothers experiencing higher stress than the fathers [mean: mothers=108.58; fathers=101.68]. The highest and lowest sources of stress were infant behavior and appearance (M=4.09) and sights and sounds in the NICU (M=3.54), respectively. The correlation between stress levels with anxiety (r=0.79) and depression (r=0.75) was strong and positive while sleep disturbance was significant and moderate (r=0.43).

    CONCLUSIONS: The mothers experienced higher levels of stress compared to fathers, with positive correlations between stress and anxiety, depression and sleep disturbance.

    PRACTICAL IMPLICATIONS: The findings of this study create nursing awareness of parent stress and its impact, which will help them to improve nursing care for parents.

  14. Al Raimi AM, Chong MC, Tang LY, Chua YP, Al Ajeel LY
    Comput Inform Nurs, 2022 Sep 01;40(9):648-657.
    PMID: 35994240 DOI: 10.1097/CIN.0000000000000927
    Bronchial asthma among children is a common chronic disease that may impact quality of life. Health education is one of the strategies to improve knowledge and quality of life. This study aims to assess the effect of health education via a mobile application in promoting the quality of life among schoolchildren with asthma in urban Malaysia during the COVID-19 era. A quasi-experimental, pre- and post-intervention design was used in this study involving a total of 214 students, randomly assigned into two groups (an intervention group and a control group). The control group received face-to-face health education, whereas the experimental group received health education via a mobile application. The findings showed that the total score of quality of life improved from a mean total score at pre-intervention of 5.31 ± 1.27 to post-intervention of 5.66 ± 1.28 for the control group, compared with the experimental group with a mean total score of quality of life at pre-intervention of 5.01 ± 1.36 and post-intervention of 5.85 ± 1.29. A comparison between the experimental and control groups using an independent t test showed statistically significant differences in their mean quality of life scores. The effect of health education via a mobile application showed a statistically significant improvement in the mean quality of life score from pre- to post-intervention ( F1,288 = 57.46, P < .01). As recommended, the use of mobile technology in health education improved the quality of life of schoolchildren with asthma as compared with the traditional methods of a face-to-face lecture and/or a handbook. Thus, educational modules using mobile applications do improve quality of life.
  15. Ahmed J, Wong LP, Chua YP, Hydrie MZI, Channa N
    Environ Sci Pollut Res Int, 2022 Jan;29(1):1259-1277.
    PMID: 34355319 DOI: 10.1007/s11356-021-15681-w
    The United Nation's Sustainable Development Goals include the target of ensuring access to water and sanitation and hygiene (WASH) for all; however, very few studies have assessed comprehensive school WASH service in Pakistan. The purpose of this study was to identify WASH services in primary schools of Pakistan, and to assess how recent WASH interventions and policies are associated with the school's academic performance. A representative cross-sectional study was conducted in primary schools in the Sindh province of Pakistan. Structured observations and interviews were done to ascertain the schools' WASH conditions. The primary exposures of interest were the implementation of previous WASH interventions and National WASH policy in the school and the WASH coverage. Outcomes of interest included WASH conditions and school performance. The structural equation modeling (SEM) using a bootstrap resampling procedure was employed to characterize how WASH exposures were associated with WASH conditions and school performance. Data were collected from 425 schools. The Basic WASH facilities coverage in the primary schools of Sindh remains overall low according to WHO WASH service ladder criteria. Also, inconsistency in all three inclusive domains of WASH (availability, accessibility, and functionality) facilities were found. The school performance was significantly associated (P<0.001) with the presence of WASH interventions and/or WASH policy, while WASH policy and/or recent WASH intervention at the school were not associated with overall water quality. Our assessment unveiled several WASH gaps that exist, including high heavy metal and fecal contamination. Adoption of national WASH policy and financing of evidence-based WASH interventions are recommended in primary schools to improve educational outcomes.
  16. Zhang HY, Chong MC, Tan MP, Chua YP, Zhang JH
    J Geriatr Phys Ther, 2023 Jul 13.
    PMID: 37439875 DOI: 10.1519/JPT.0000000000000388
    BACKGROUND AND PURPOSE: Sarcopenia is a common muscle disease among the older population, posing an increased risk for functional decline and intervention for loss of independence in daily living. Early detection of sarcopenia among older people before functional decline would be beneficial in enhancing their quality of life. The Asian Working Group for Sarcopenia (AWGS) 2019 recommends the use of 3 screening methods for community-based sarcopenia detection: calf circumference (CC), or the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire, or the SARC-F in combination with CC (SARC-CalF) questionnaire. This study aims to compare the relative performance of these 3 methods as screening tools for sarcopenia within a community-dwelling older population.

    METHODS: A total number of 700 community-dwelling older adults participated in the current study. Muscle mass, muscle strength, and physical performance were measured with bioelectrical impedance analysis, handgrip strength, and gait speed, respectively. The AWGS 2019 criteria were considered the criterion standard The sensitivity/specificity, receiver operating characteristic (ROC) curve, and area under the receiver operating characteristic curve (AUROC) analyses were determined for CC, SARC-F, and SARC-CalF to determine their relative diagnostic performance.

    RESULTS: Sarcopenia was identified in 21.4% of participants according to the AWGS2019 criteria. The overall prevalence of sarcopenia was 56.6%, 14.7%, and 22.9% according to CC, SARC-F, and SARC-CalF, respectively. Calf circumference showed the highest sensitivity but lowest specificity based on AWGS 2019 as the criterion standard regardless of age, gender, and body mass index. The SARC-CalF showed better sensitivity but similar specificity than the SARC-F. The AUROC of CC was significantly better than that of SARC-F and SARC-CalF. The AUROCs of CC, SARC-F, and SARC-CalF were statistically significant in all populations, as well as in the categories of age, gender, and body mass index ( P < .05).

    CONCLUSIONS: Calf circumference is useful in ruling out the presence of sarcopenia while the SARC-F is more effective in ruling in sarcopenia, especially in the context of population-based screening. Future studies should be carried out to investigate the value of population-based sarcopenia detection using these screening tools.

  17. Ahmed J, Wong LP, Chua YP, Channa N, Memon UU, Garn JV, et al.
    PMID: 33910486 DOI: 10.1080/10934529.2021.1915653
    The purpose of this study was to characterize the concentrations of lead (Pb), cadmium (Cd), manganese (Mn), and Fe (Fe) in drinking water sources in primary schools in Sindh Province, Pakistan and to quantify potential health risks among those school children. We conducted a representative, cross-sectional study among 425 primary schools in Sindh province of Pakistan. We used risk assessment models to estimate the metal index, pollution index, lifetime cancer risk, and hazard quotient index. Across the 425 sampled schools, the levels of heavy metals in the drinking water often exceeded the WHO permissible limits (67% of schools exceeded Pb limit, 17% for Cd, 15% for Fe). The average incremental lifetime cancer risk (ILCR) for Pb exceeded tolerable limits in all of the districts under study. The findings, particularly for Pb, are of concern, as Pb may negatively influence children's growth, development, school performance, and long-term health.
  18. Ahmed J, Wong LP, Chua YP, Channa N, Mahar RB, Yasmin A, et al.
    PMID: 32316585 DOI: 10.3390/ijerph17082774
    Primary-school children in low- and middle-income countries are often deprived of microbiologically safe water and sanitation, often resulting in a high prevalence of gastrointestinal diseases and poor school performance. We used Quantitative Microbial Risk Assessment (QMRA) to predict the probability of infection in schoolchildren due to consumption of unsafe school water. A multistage random-sampling technique was used to randomly select 425 primary schools from ten districts of Sindh, Pakistan, to produce a representative sample of the province. We characterized water supplies in selected schools. Microbiological testing of water resulted in inputs for the QMRA model, to estimate the risks of infections to schoolchildren. Groundwater (62%) and surface water (38%) were identified as two major sources of drinking water in the selected schools, presenting varying degrees of health risks. Around half of the drinking-water samples were contaminated with Escherichia coli (49%), Shigella spp. (63%), Salmonella spp. (53%), and Vibrio cholerae (49%). Southern Sindh was found to have the highest risk of infection and illness from Campylobacter and Rotavirus. Central and Northern Sindh had a comparatively lower risk of waterborne diseases. Schoolchildren of Karachi were estimated to have the highest probability of illness per year, due to Campylobacter (70%) and Rotavirus (22.6%). Pearson correlation was run to assess the relationship between selected pathogens. V. cholerae was correlated with Salmonella spp., Campylobacter, Rotavirus, and Salmonella spp. Overall, the risk of illness due to the bacterial infection (E. coli, Salmonella spp., V. cholerae, Shigella, and Campylobacter) was high. There is a dire need for management plans in the schools of Sindh, to halt the progression of waterborne diseases in school-going children.
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