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  1. Toh HM, Ghazali SE, Subramaniam P
    Int J Alzheimers Dis, 2016;2016:5131570.
    PMID: 27478677 DOI: 10.1155/2016/5131570
    Cognitive stimulation therapy (CST) is an evidence-based therapy for individuals with mild-to-moderate dementia. Past reviews have only synthesized outcomes obtained through quantitative study which does not fully represent the understanding on the acceptability and usefulness of CST. Therefore, the present review aims to integrate outcomes obtained from both quantitative and qualitative studies to provide a deeper understanding on the acceptability and usefulness of CST for older adults with dementia. Findings of literature were retrieved from searches of computerized databases in relation to CST for people with dementia. Literatures were selected according to selection criteria outlined. Results obtained in previous studies pertaining to the effects of CST were discussed in relation to variables such as cognitive function, quality of life, and family caregivers' wellbeing. The review also explores the use of CST in different cultural context, the perception on its effectiveness, and individualized CST (iCST). There is considerable evidence obtained through quantitative and qualitative studies on the usefulness and acceptability of CST for older adults with dementia. Recommendations for future research are provided to strengthen the evidence of CST's effectiveness.
  2. Vasu DT, Mohd Nordin NA, Ghazali SE
    Medicine (Baltimore), 2021 Aug 20;100(33):e26924.
    PMID: 34414949 DOI: 10.1097/MD.0000000000026924
    INTRODUCTION: The occurrence of post-stroke emotional problems is significant during the early post-stroke stage and affects the recovery of functionality among the survivors. Because stroke survivors require active engagement in rehabilitation to optimize the process of neuroplasticity in the initial stage of stroke, there is a need to integrate an intervention, preferably therapists-mediated during rehabilitation, which reduce emotional problems thus improve motivation level among the survivors. One such technique is autogenic relaxation training (ART). ART has been found to reduce anxiety and depression among patients with several medical conditions. However, its usage in stroke survivors during rehabilitation has been limited to date. Therefore, this study is intended to evaluate the effectiveness of ART in addition to usual physiotherapy in improving emotional state and functional level of stroke survivors during rehabilitation.

    METHODS: This is an assessor blinded randomized controlled trial comparing 2 intervention approaches namely ART-added physiotherapy (experimental group) and usual physiotherapy (control group). A total of 70 post-stroke patients will be recruited and allocated into either the ART-added physiotherapy or the usual physiotherapy group. The ART-added physiotherapy group will undergo a 20-minute ART session followed by 40 minutes of usual physiotherapy. While the usual physiotherapy group will receive usual physiotherapy alone for 60 minutes. All participants will be treated once a week and are required to carry out a set of home exercises for 2 times per week during the 12-week intervention. Assessment of emotional status and functional independence will be carried out at pre-intervention and week 13 of the intervention with the use of Hospital anxiety and depression scale, Barthel index, and EuroQol-5 dimensions-5 levels. All data will be analyzed using descriptive and inferential statistics.

    DISCUSSION: The expected main study outcome is an enhanced evidence-based physiotherapy program that may be used by physiotherapists in the rehabilitation of stroke patients with emotional disturbances.

    TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619001664134 (last updated on 28/11/2019).

  3. Mohd Zulkifly MF, Ghazali SE, Che Din N, Subramaniam P
    Malays J Med Sci, 2016 Mar;23(2):53-64.
    PMID: 27547115 MyJurnal
    This study aims to estimate the prevalence and explore the predictors for post-stroke cognitive impairment at the community level in Malaysia.
  4. Mohd Zulkifly MF, Ghazali SE, Che Din N, Singh DK, Subramaniam P
    ScientificWorldJournal, 2016;2016:3456943.
    PMID: 27340686 DOI: 10.1155/2016/3456943
    In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.
  5. Ibrahim N, Din NC, Ahmad M, Ghazali SE, Said Z, Shahar S, et al.
    Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:59-66.
    PMID: 23857839 DOI: 10.1111/appy.12068
    INTRODUCTION: This study aimed to examine the role of social support and depression in predicting the quality of life among the elderly living in a rural Federal Land Development Authority (FELDA) community in Malaysia.
    METHODS: A total of 162 elderly settlers of FELDA Sungai Tengi, aged 60 years and above, were selected by universal sampling method in this cross-sectional study. Three standardized instruments - the 12-item Short Form (SF-12), 15-item Geriatric Depression Scale (GDS-15) and Medical Outcome Study Social Support (MOS-Social Support) - were used to assess for quality of life, depression and social support.
    RESULTS: Quality of life of the elderly people in this community was high, especially in terms of physical components as compared to mental components. The mean scores for emotional role in the SF-12 was relatively the highest (90.74 ± 21.59) with social functioning being the lowest (30.35 ± 22.29). The results also showed that the mean value was higher for physical component summary (74.40) as compared to mental component summary (51.51). Approximately 23.5% suffered mild depression and only 2.5% had severe depression.
    DISCUSSION: This study showed that the elderly FELDA settlers have a high quality of life, mainly on the physical components of life and low rate of severe depression, a positive indicator of their psychological well-being. Social support in the form of emotional/informational support, and depression were significant factors related to their good quality of life.
    KEYWORDS: depression; elderly; quality of life; rural community; social support
    Study site; FELDA Sungai Tengi, Selangor, Malaysia
    Device, Questionnaire & Scale: Short Form Health Survey (SF-12); Geriatric Depression Scale (GDS-15; Medical Outcome Study Social Support (MOS-Social Support)
  6. Kan KC, Subramaniam P, Shahrizaila N, Kamaruzzaman SB, Razali R, Ghazali SE
    Dement Geriatr Cogn Dis Extra, 2019 02 08;9(1):66-76.
    PMID: 31043965 DOI: 10.1159/000495107
    Background/Aims: This study aimed to investigate the validity and reliability of the Malay version of Addenbrooke's Cognitive Examination III (ACE-III) for detecting mild cognitive impairment (MCI) and dementia.

    Methods: A total of 152 participants (dementia = 53, MCI = 38, controls = 61) were recruited from two teaching hospitals. The Malay version of ACE-III was translated following the standard guidelines for cross-cultural adaptation of measure. All the participants were assessed with the Malay version of ACE-III and Mini-Mental State Examination (MMSE).

    Results: The reliability of the Malay version of ACE-III was good with Cronbach's α coefficient of 0.829 and intraclass correlation coefficient of 0.959. There was a strong positive correlation between the Malay version of ACE-III and MMSE (r = 0.806). Age (r = -0.335) and years of education (r = 0.536) exerted a significant correlation with total score performance. The cutoff score to discriminate dementia from healthy controls was 74/75 (sensitivity = 90.6%, specificity = 82.0%) whereas to discriminate MCI, the cutoff score was 77/78 (sensitivity = 63.2%, specificity = 63.9%). The diagnostic accuracy of ACE-III was higher than that of MMSE in the detection of dementia (area under the curve: ACE-III = 0.929 vs. MMSE = 0.915).

    Conclusions: The Malay version of ACE-III demonstrated to be a reliable and valid screening tool for dementia.

  7. Ghazali SE, Mohd Zulkifly MF, Che Din N, Desa A, Ali RA
    MyJurnal
    Stroke is a causal factor that commonly caused physical impairments and activity limitations among patients to perform daily activities until at certain level stroke patients will experience disability. The aim of this study is to examine the relationship of each demographic and clinical factors that is believed to associate with physical functioning of patients
    those who experienced stroke. This present study also try to compare physical functioning of patients with associated factors and then examine the correlation between those factors with physical functioning. A total of 147 respondents that pass for cognitive screening test involved in this study. Barthel Index (ADL) was administered to the respondents after 6 weeks of stroke attack in order to measure their physical functioning status. Results found that there was a significant difference [F(3, 143) = 4.06; p < 0.01] between level of educations with physical functioning of patients. With respect to clinical factors also showed a significant difference (p < 0.01) was higher in physical functioning when stroke attack
    occurred at right hemisphere of brain. There was a significant difference (p < 0.01) in physical functioning with respect to belief of recovery. Furthermore, number of stroke attack also showed a significant difference [F(1, 145) = 11.19; [p < 0.01] in physical functioning of patients. Correlation test that was carried out found a positive significant correlation
    (r = 0.24; p < 0.01) between physical functioning with respect to the affected lesion side. In conclusion, demographic and clinical factors also played the roles to determine level of physical functioning among stroke patients and thus these factors should be considered in any studies that intended to enhance physical functioning of patients in future.
    Keywords: stroke; physical functioning; disability; physical impairment
  8. Ibrahim N, Che Din N, Amit N, Ghazali SE, Mohd Safien A
    PLoS One, 2019;14(2):e0209971.
    PMID: 30811425 DOI: 10.1371/journal.pone.0209971
    INTRODUCTION: Despite suicide rate becoming a growing trend in research locally and globally, there is no standard measuring instrument developed in Malaysia. The aim of this study is to establish the first ever Malay version of suicide screening tool that is suitable and fit with multiracial and complex culture of Malaysia.

    METHODS: This study comprises of three phases, namely (1) items selection phase, (2) pilot study phase, and (3) scale validation phase. During the first phase, the items were selected from items pools which gathered from previous suicide ideation/ attitude scales. Then the pilot study was carried out to examine the items for Yatt Suicide Attitude Scale (YSAS). Lastly, the Yatt Suicide Attitude Scale (YSAS) validation study was conducted with 219 university students.

    RESULTS: Initial version of YSAS comprised 16 items and three components. After factor analysis, the questionnaire was reduced into only two components (Suicide Ideation and Suicide Attempt) with 5 items each. Both of the components obtained high reliability value (.89 and.86 respectively) and the questionnaire accounted for 67.84% of the total variance.

    CONCLUSION: The analysis showed that YSAS has an acceptable reliability and validity for Malaysian population. Although these findings corroborate literature on development of suicide ideation assessment instrument for specific cultural context, there is a need to further examine its reliability with clinical population and general population of different cultural context in Malaysia.

  9. Che Din N, Mohd Nawi L, Ghazali SE, Ahmad M, Ibrahim N, Said Z, et al.
    Int J Environ Res Public Health, 2019 Nov 28;16(23).
    PMID: 31795076 DOI: 10.3390/ijerph16234763
    This is a preliminary study to examine the factor structure, reliability, and validity of an obsessive-compulsive disorder (OCD) screening tool for use in the Malaysian setting. A total of 199 Malaysian adults were recruited for this study. After cleaning and normalizing the data, 190 samples were left to be analyzed. Principle component analysis using varimax rotation was then performed to examine various factors derived from psychometric tools commonly used to assess OCD patients. The screening tool exhibited three factors that fit the description of obsessions and compulsions from the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM 5), as well as other common symptoms that co-morbid with OCD. The labels given to the three factors were: Severity of Compulsions, Severity of Obsessions, and Symptoms of Depression and Anxiety. Reliability analysis showed high reliability with a Cronbach's alpha of 0.94, whereas convergent validity of the tool with the Yale Brown Obsessive-compulsive Scale-Self Report demonstrated good validity of r = 0.829. The three-factor model explained 68.91% of the total variance. Subsequent studies should focus on OCD factors that are culturally unique in the Malaysian context. Future research may also use online technology, which is cost-efficient and accessible, to further enhance the screening tool.
  10. Wan Mohd Azam WM, Din NC, Ahmad M, Ghazali SE, Ibrahim N, Said Z, et al.
    Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:134-9.
    PMID: 23857850 DOI: 10.1111/appy.12061
    INTRODUCTION: Loneliness has long been known to have strong association with depression. The relationship between loneliness and depression, however, has been associated with other risk factors including social support. The aim of this paper is to describe the role of social support in the association between loneliness and depression.
    METHODS: This cross-sectional study examined the mediating effects of social support among 161 community-based elderly in agricultural settlement of a rural area in Sungai Tengi, Malaysia. Subjects were investigated with De Jong Gierveld Loneliness Scale, Geriatric Depression Scale and Medical Outcome Survey Social Support Survey. Data were analyzed using Pearson correlation, linear and hierarchical regression.
    RESULTS: Results indicated that social support partially mediated the relationship between loneliness and depression.
    DISCUSSION: This suggests that social support affects the linear association between loneliness and depression in the elderly.
    KEYWORDS: depression; elderly; loneliness; rural community; social support
    Study site; FELDA Sungai Tengi, Selangor, Malaysia
    Device, Questionnaire & Scale: De Jong Gierveld Loneliness Scale; Geriatric Depression Scale (GDS-15): Medical Outcome Survey Social Support Survey
  11. Ghazali AR, Kamarulzaman F, Normah CD, Ahmad M, Ghazali SE, Ibrahim N, et al.
    Biol Trace Elem Res, 2013 Jun;153(1-3):16-21.
    PMID: 23475372 DOI: 10.1007/s12011-013-9642-7
    Exposure to toxic metals and excessive amount of trace elements is a risk factor of cognitive decline. Continuous monitoring of these elements by the use of metabolically inactive tissues such as fingernails may help in taking preventive measures to delay the cognitive decline process. In this study, the cognitive function of 54 elderlies (60-72 years old) from FELDA Sungai Tengi, Selangor, was evaluated using the Malay version of Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The levels of arsenic (As), cadmium (Cd), copper (Cu), manganese (Mn), lead (Pb), and zinc (Zn) in fingernail were detected using Inductively Coupled Plasma-Mass Spectrometry. Results showed that (92.6 %) our population was cognitively impaired based on the MoCA with mean score of 18.07 ± 5.11. The mean level of elements in fingernails for As, Cd, Cu, Mn, Pb, and Zn were 16.68 ± 3.52, 4.26 ± 0.91, 4.81 ± 1.16, 1.00 ± 0.23, 1.83 ± 0.47, and 40.86 ± 10.81 μg/g, respectively. Significant inverse correlations were observed between MoCA with age (r = -0.543, p 
  12. Ibrahim N, Che Din N, Ahmad M, Amit N, Ghazali SE, Wahab S, et al.
    BMC Public Health, 2019 Jun 13;19(Suppl 4):553.
    PMID: 31196009 DOI: 10.1186/s12889-019-6861-7
    BACKGROUND: The high number of adolescents and young adults harbouring suicidal ideation, as reported by the Ministry of Health Malaysia, is alarming. This cross-sectional study aims to examine the association between social support and spiritual wellbeing in predicting suicidal ideation among Malaysian adolescents.

    METHODS: A total of 176 adolescents in selected urban areas in the states of Wilayah Persekutuan and Selangor were selected. The Suicide Ideation Scale (SIS) was used to measure the level of severity or tendency of suicidal ideation. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure the perceived social support received by the respondent while the Spiritual Wellbeing Scale (SWBS) was used to measure the religious wellbeing (RWB), the existential wellbeing (EWB) and the overall score of spiritual wellbeing (SWB).

    RESULTS: The study found that both RWB and EWB showed significant negative correlation with suicidal ideation. Similarly, support from family and friends also showed a negative correlation with suicidal ideation. Further analysis using multiple regressions showed that RWB and SWB, and family support predict suicidal ideation in adolescents.

    CONCLUSION: Spiritual wellbeing in combination with family support plays a major role in predicting suicidal ideation. Therefore, intervention for encompassing spirituality and family support may contribute to a more positive outcome in suicidal adolescents.

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