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  1. Harith S, Tan SL
    Ann Geriatr Med Res, 2020 Jun;24(2):115-124.
    PMID: 32743332 DOI: 10.4235/agmr.20.0005
    Background: This study aimed to translate and validate the comprehensive geriatric assessment (CGA) questionnaire among older adult patients in Malaysia in the Malay language.

    Methods: The questionnaire contained items on the socio-demographic characteristics, medical condition, quality of life (QOL), nutritional status, functional capacity, and depression status. The forward and backward translation processes of the original English language version of the questionnaire were undertaken by three independent linguistic translators, while its content was validated by an expert team consisting of seven geriatricians, physicians, dietitian, and lecturers. The Malay version of the questionnaire was tested for face validity in 10 older adult patients over 65 years of age. The internal consistency reliability and construct validity were evaluated among 166 older adult patients (mean age, 71.0 years; 73.5% male). The questionnaire was administered through face-to-face interviews with the patients. Minor amendments were made after the content and face validity tests.

    Results: The internal consistency reliability was good, as the Cronbach's alpha for most of the scales surpassed 0.70, ranging from 0.70 to 0.98, with only one exception (Mini Nutritional Assessment Short-Form, Cronbach's alpha=0.62). The factor loadings for all scales were satisfactory (>0.40), ranging from 0.45 to 0.90.

    Conclusion: The Malay-version CGA showed evidence of satisfactory internal consistency reliability and construct validity in Malaysian geriatric patients.

  2. Sowtali SN, Harith S
    MyJurnal
    This study was conducted to determine types of educational needs among stroke patients admitted to Hospital Universiti Sains Malaysia. Stroke patients (n = 41) were conveniently recruited from Medical and Surgical Ward between September to December 2012. Data were obtained using semi-guided administered questionnaires and from the medical reports. Patients were given adequate time to complete the lifestyle history and educational needs on stroke with researcher’s assistance. Instrument on the educational needs consisted of five themes including general information on stroke, management of risk factors, treatments of stroke, rehabilitation and post-stroke problems and post-stroke diet management. Findings indicated majority of the stroke patients were female (58.5%), between 56 to 65 years old (39.0%) and diagnosed with ischemic stroke (68.3%). Patients had history of hypertension (85.4%), diabetes (46.3%), hyperlipidemia (29.3%), ischemic heart disease (22.0%) and atrial fibrillation (2.4%). Eleven of them (26.9%) were ex-smokers and many practice unhealthy lifestyle such as lack of exercise (80.5%) and prefer fried foods (68.3%). Most patients were on multiple pharmacotherapies (92.7%) to treat their medical conditions. Educational needs rated highest need to know among stroke patients were on prevention (92.7%), fi rst aid management (85.4%), complications (85.4%) and recurrence (85.4%) of stroke in general. Other concerned were about possibility of cure with drug (92.7%), range of motion exercise (82.9%), fi sh intake (78.0%), fruit and vegetable consumption (78.0%) after stroke. Findings from this study provide a baseline information on types of educational needs among stroke patients. More patient educational intervention on primary and secondary stroke prevention should be structured in hospital and community settings in the future.
    Keywords: Types of educational needs; stroke; patient education; Hospital USM (HUSM)
  3. Zamri N, Harith S, Mat-Hassan N, Ong YQ
    Malays Orthop J, 2021 Jul;15(2):77-88.
    PMID: 34429826 DOI: 10.5704/MOJ.2107.012
    Introduction: The World Health Organisation (WHO) has estimated that 80% of people with osteoarthritis (OA) have movement limitations while 25% of them cannot perform their major daily activities, thus resulting in a decline of their nutritional status and quality of life (QOL). Therefore, this study aimed to compare the nutritional status and health-related quality of life (HRQOL) of OA patients between gender and age group.

    Material and Methods: A cross-sectional study was conducted on 131 OA patients in Rehabilitation Health Organisation, Terengganu. Socio-demographic, clinical, lifestyle histories, 24-hour dietary intake and HRQOL were assessed using a structured questionnaire.

    Results: Knee and/or hip OA patients recruited consisted of 19.1% of men and 80.9 % of women collectively with a mean age of 61.81 (9.28) years ranging from 38 to 83 years. The percentages of underweight, normal, overweight, and obese patients were 1.5%, 12.2%, 36.7%, and 49.6%, respectively. Further assessment of HRQOL showed that the highest mean score was obtained by the social functioning (SF) domain of 41.25 (27.16), while the mental domain scored the least mean score of 21.15 (20.92). In terms of gender breakdown, the males had significantly greater weight and height but lower body fat (BF) compared to their female counterparts, as well as a significantly higher energy, carbohydrate and protein intake. According to the age group, patients aged < 60 years had significantly greater weight, height, and BF than those aged ≥ 60 years.

    Conclusion: This study is an important baseline reference for proper OA management and prevention by providing crucial nutritional status and HRQOL information.

  4. Sowtali SN, Mohd Rasani AA, Mohd. Shah AS, Mohd. Yusoff D, Harith S, Zainol NAJ, et al.
    IIUM Medical Journal Malaysia, 2019;18(3):154-164.
    MyJurnal
    There is widespread use of herbal and dietary supplements worldwide among patients despite robust clinical evidence of its efficacy. This may lead to adverse effects, such as diabetes, hypertension, stroke, cardiovascular risk and kidney problems due to inappropriate self-prescription. This study was performed to determine the prevalence of herbal and dietary supplements usage among patients with chronic kidney disease and its association with the socio-demographic background and the conventional medication adherence. Materials and methods: A survey was conducted among 78 chronic kidney disease patients attending the Nephrology Clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang. Data were collected using a questionnaire and analyzed using descriptive statistics, Chi Square Test and Fisher’s Exact Test. The p-valuewas set to be less 0.05 for its level of significance. Results: Most of the patients aged more than 50 years (89.7%), female (53.8%), unemployed (41%) and from lower socio-economic earners (75.6%). Only 5.2% of respondents reported using herbal and dietary supplements. There was no association between socio-demographic background with the herbal and dietary supplements usage. Similarly, there was no association between herbal and dietary supplements usage and the conventional medication adherence. Conclusion: This study provides a good baseline on the usage of herbal and dietary supplements use among chronic disease patients. It can be concluded that the level of awareness among the patients is good. Nevertheless, a larger study shall be performed in the future to explore the pattern of association.
  5. Sowtali SN, Yusoff DM, Harith S, Mohamed M
    J Arrhythm, 2016 Apr;32(2):112-8.
    PMID: 27092192 DOI: 10.1016/j.joa.2015.10.003
    To date, there is a lack of published studies on assessment tools to evaluate the effectiveness of stroke education programs.
  6. Wong HJ, Lua PL, Harith S, Ibrahim KA
    Health Qual Life Outcomes, 2021 Aug 30;19(1):210.
    PMID: 34461920 DOI: 10.1186/s12955-021-01847-0
    BACKGROUND: Apart from maximizing functional abilities and independence after stroke, improving overall health-related quality of life (HRQoL) should also become part of the stroke treatment and rehabilitation process goals. This study aimed to assess the HRQoL profiles and explore the dimension-specific associated factors of HRQoL among stroke survivors.

    METHODS: This was a cross-sectional study of stroke survivors attending post-stroke care clinics in three public hospitals in the states of Pahang and Terengganu, Malaysia. The HRQoL was assessed by EuroQol-5 dimension-5 levels. Data on socio-demographic, clinical profiles, malnutrition risk, and physical activity level were collected through an interviewer-administered survey. Descriptive analyses for HRQoL profiles and multiple logistic regression analyses for its associated factors were performed. Crude and adjusted odds ratios were reported.

    RESULTS: A total of 366 stroke survivors were recruited with a mean age of 59 ± 11 years. The most -commonly reported health problems were mobility (85%), followed by usual activities (82%), pain/discomfort (63%), anxiety/depression (51%) and self-care (41%). The mean of the EQ visual analogue scale and the median of the EQ5D summary index was reported at 60.3 ± 14.2 and 0.67 ± 0.37, respectively. Malnutrition risk (mobility, usual activities, and self-care), wheelchair users (self-care and usual activities), speech impairment (usual activities and pain/discomfort), number of stroke episodes (self-care and pain/discomfort), body mass index, physical activity level and types of strokes (usual activities), age and use of a proxy (anxiety/depression), working and smoking status (mobility), were factors associated with either single or multiple dimensions of HRQoL.

    CONCLUSION: Routine malnutrition screening, tailored program for speech therapy, prevention of recurrent stroke, and physical activity promotion should be addressed and further reinforced in current rehabilitation interventions to improve the HRQoL among stroke survivors in Malaysia.

  7. Othman NA, Abdul Manaf M, Harith S, Wan Ishak WR
    J Am Coll Nutr, 2018 04 13;37(7):583-588.
    PMID: 29652576 DOI: 10.1080/07315724.2018.1451408
    OBJECTIVE: The feasibility of developing reduced-fat muffins with avocado is investigated by preparing muffins with 25%, 50%, 75%, and 100% avocado purée as a fat (butter) replacer.

    METHODOLOGY: The resulting products were compared to the control muffin, which was made with 100% butter. Muffins were analyzed for nutritional content, fatty acid profiles, and sensory acceptability.

    RESULT: Muffins incorporated with avocado purée revealed a significant increase (p < 0.05) with respect to moisture, ash, and carbohydrate in comparison with the control sample. However, no significant changes (p > 0.05) were detected in all muffin formulations for protein and dietary fiber content. Both fat content and caloric value of muffins incorporated with avocado purée were significantly decreased (p < 0.05). The fatty acid profile showed that there was an increment in the monounsaturated fatty acids (MUFA) content by 16.51% at full-fat substitution. The sensory evaluation test demonstrated that muffins had acceptability at up to 50% substitution. Fat substitution at higher than 50% lead to undesirable flavor and aftertaste, which was significant (p < 0.05) to the panelists.

    CONCLUSION: The findings indicated the feasibility of avocado purée in fat-reduced muffin preparation with an optimal level of 50% avocado purée substitution.

  8. Harith S, Backhaus I, Mohbin N, Ngo HT, Khoo S
    PeerJ, 2022;10:e13111.
    PMID: 35382010 DOI: 10.7717/peerj.13111
    BACKGROUND: Poor mental health among university students remains a pressing public health issue. Over the past few years, digital health interventions have been developed and considered promising in increasing psychological wellbeing among university students. Therefore, this umbrella review aims to synthesize evidence on digital health interventions targeting university students and to evaluate their effectiveness.

    METHODS: A systematic literature search was performed in April 2021 searching PubMed, Psychology and Behavioural Science Collection, Web of Science, ERIC, and Scopus for systematic reviews and meta-analyses on digital mental health interventions targeting university students. The review protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO [CRD42021234773].

    RESULTS: The initital literature search resulted in 806 records of which seven remained after duplicates were removed and evaluated against the inclusion criteria. Effectiveness was reported and categorized into the following six delivery types: (a) web-based, online/computer-delivered interventions (b) computer-based Cognitive Behavior Therapy (CBT), (c) mobile applications and short message service (d) virtual reality interventions (e) skills training (f) relaxation and exposure-based therapy. Results indicated web-based online/computer delivered-interventions were effective or at least partially effective at decressing depression, anxiety, stress and eating disorder symptoms. This was similar for skills-training interventions, CBT-based intervention and mobile applications. However, digital mental health interventions using virtual reality and relaxation, exposure-based therapy was inconclusive. Due to the variation in study settings and inconsistencies in reporting, effectiveness was greatly dependent on the delivery format, targeted mental health problem and targeted purpose group.

    CONCLUSION: The findings provide evidence for the beneficial effect of digital mental health interventions for university students. However, this review calls for a more systematic approach in testing and reporting the effectiveness of digital mental health interventions.

  9. Wong HJ, Harith S, Lua PL, Ibrahim KA
    Sci Rep, 2023 Mar 30;13(1):5189.
    PMID: 36997594 DOI: 10.1038/s41598-023-31006-y
    Individuals with stroke are at high malnutrition risk in both the acute and chronic phases. This study aimed to assess the validity of different malnutrition screening tools for stroke patients in rehabilitation phase. Participants in this study were 304 stroke patients from three hospitals in the East-Coast region of Peninsular Malaysia from May-August 2019. The concurrent validity of the Malnutrition Risk Screening Tool-Hospital (MRST-H), Mini Nutritional Assessment-Short Form (MNA-SF), Malnutrition Screening Tool (MST), Malnutrition Universal Screening (MUST) and Nutritional Risk Screening (NRS-2002) was assessed with the diagnostic criteria for malnutrition proposed by the Global Leadership Initiative on Malnutrition (GLIM-DCM). Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the curve were computed. MUST and MRST-H demonstrated good validity regardless of different age groups (> 80% sensitivity and specificity); meanwhile, MST and MNA-SF had fair validity, yet NRS-2002 had poor to fair validity with GLIM-DCM. Only MRST-H and NRS-2002 were significantly correlated with all anthropometric indices, dietary energy intake, and health-related quality of life in both age groups. In conclusion, MRST-H and MUST showed good concurrent validity with GLIM-DCM and can be considered as appropriate malnutrition screening tool in discriminating malnutrition among stroke individuals attending rehabilitation centre in Malaysia regardless of their age groups.
  10. Wong HJ, Harith S, Lua PL, Ibrahim KA
    Nutr Health, 2023 Dec;29(4):695-705.
    PMID: 35763460 DOI: 10.1177/02601060221097459
    Background: Stroke survivors are at high risk for recurrent cardiovascular events if no prevention strategies are undertaken. Aim: This study aimed to investigate the fasting serum lipid profiles and lifestyle habits in stroke survivors, and the factors associated with suboptimal lipid profiles. Methods: A cross-sectional retrospective study was conducted in three public hospitals in Malaysia. Stroke survivors' data regarding the socio-demographic characteristics, clinical profiles, fasting serum lipid profiles, dietary adherence, and physical activity levels were acquired. Binary logistic regression was used to examine the factors associated with suboptimal lipid goals. Results: A total of 104 stroke survivors were recruited from patients attending the neurology and rehabilitation departments. Only 22% of the stroke survivors attained the targeted low-density lipoprotein cholesterol level (LDL-C < 1.8 mmol/L). Meanwhile, more than two thirds of patients achieved the targeted total cholesterol, triglyceride, and high-density lipoprotein cholesterol goals. Patients with a longer stroke duration (Adjusted odds ratio, AOR 3.33, 95% confidence intervals, CI: 1.09, 10.13, p  =  0.034), elevated blood pressure (AOR 4.74, 95% CI: 1.65, 13.62, p  =  0.004), chronic kidney disease (AOR 3.30, 95% CI: 1.05, 10.34, p  =  0.041), abdominal obesity (AOR 3.14, 95% CI: 1.20, 8.21, p  =  0.020), excessive energy intake (AOR 2.72, 95% CI: 1.07, 6.91, p  =  0.036), and excessive saturated fatty acids intake (AOR 2.85, 95% CI: 1.02, 7.93, p  =  0.045) were significantly associated with suboptimal lipid profiles. Conclusion: The lipid goals attainment was low, particularly the LDL-C levels among Malaysian stroke survivors. Greater efforts are warranted to fully utilise the lipid-lowering therapy and the lifestyle changes in these high-risk patients.
  11. Wong HJ, Harith S, Lua PL, Ibrahim KA
    Malays J Med Sci, 2020 Jul;27(4):72-84.
    PMID: 32863747 MyJurnal DOI: 10.21315/mjms2020.27.4.7
    Background: The present study examined the prevalence and predictors of malnutrition risk among post-stroke patients.

    Methods: Post-stroke patients who attended the outpatient clinics in three hospitals of Peninsular Malaysia were enrolled in the study. The risk of malnutrition was assessed using the Malnutrition Risk Screening Tool-Hospital. Data including demographic characteristics, clinical profiles, dietary nutrients intake, body mass index (BMI) and hand grip strength were collected during the survey. The crude odds ratio (OR) and adjusted odds ratio (AOR) were reported for univariate and multivariate logistic regression analyses, respectively.

    Results: Among 398 patients included in the study, 40% were classified as high-risk for malnutrition. In the multivariable logistic regression, tube feeding (AOR: 13.16, 95% confidence interval [CI]: 3.22-53.77), loss of appetite (AOR: 8.15, 95% CI: 4.71-14.12), unemployment (AOR: 4.26, 95% CI: 1.64-11.12), wheelchair-bound (AOR: 2.23, 95% CI: 1.22-4.09) and BMI (AOR: 0.87, 95% CI: 0.82-0.93) were found to be significant predictors of malnutrition risk among stroke patients.

    Conclusion: The risk of malnutrition is highly prevalent among post-stroke patients. Routine nutritional screening, identification of risk factors, and continuous monitoring of dietary intake and nutritional status are highly recommended even after the stroke patient is discharged.

  12. Jaafar NH, Othman A, Majid NA, Harith S, Zabidi-Hussin Z
    Dev Med Child Neurol, 2019 02;61(2):135-144.
    PMID: 30079517 DOI: 10.1111/dmcn.13986
    AIM: This study aimed to review the psychometric properties and clinical application of parent-report instruments that assess feeding difficulties in children with neurological impairments.

    METHOD: Papers were identified through five electronic databases based on 15 keywords and were included if they met the following criteria: published in English, described the implementation of parent-report instruments, and included children with neurological impairments (either in the report or a related study population).

    RESULTS: In total, 1220 relevant abstracts were screened and 22 full-text articles were evaluated. The following six parent-report instruments met the inclusion criteria: (1) Screening Tool of Feeding Problems applied to children, (2) Paediatric Eating Assessment Tool, (3) Paediatric Assessment Scale for Severe Feeding Problems, (4) Montreal Children's Hospital Feeding Scale, (5) Children's Eating Behaviour Inventory, and (6) Behavioural Paediatric Feeding Assessment Scale (BPFAS). Based on comprehensive psychometric testing and consistently good results, the BPFAS was considered the most valid and reliable instrument. The BPFAS also showed good clinical applicability because it was readily available, required a short administration time, and used a simple scoring system.

    INTERPRETATION: We reviewed the available parent-report instruments for assessing feeding difficulties in children with neurological impairments. The BPFAS had the best psychometric properties and clinical applicability.

    WHAT THIS PAPER ADDS: Six parent-report instruments were suitable for assessing feeding in children with neurological impairments. The Behavioural Paediatric Feeding Assessment Scale (BPFAS) has the strongest psychometric properties. The BPFAS also has good clinical applicability.

  13. Sowtali SN, Harith S, Mohd Shah AS, Ishak NA, Yusoff DM, Draman CR, et al.
    Saudi J Kidney Dis Transpl, 2020 3 5;31(1):118-128.
    PMID: 32129204 DOI: 10.4103/1319-2442.279931
    Knowledge limitation is a major cause of the increasing number of chronic kidney disease (CKD) patients in Malaysia and the world. Nurses are responsible for identifying the patients' needs to come up with appropriate discharge plans which might include educational activities. The objective of this study was to determine the baseline information (socio- demographic background, as well as medical and lifestyle histories), along with educational needs of CKD patients. A total of 116 CKD patients who attended the Nephrology Clinic of Hospital Tengku Ampuan Afzan were recruited. Patients who fulfilled the inclusion criteria were selected between April and May 2017. Data were obtained via semi-guided questionnaires; the patients were given enough time to complete the required items. The CKD educational needs' assessment consisted of seven domains: general information, chronic illness management, complications, self-management, medications, treatment, and financial status. Majority of the patients were men (53.4%), aged 54.65 ± 16.49 years, secondary school-finishers (49.1%), and jobless (48.3%). In terms of medical and life-style histories, most patients were diagnosed with end-stage renal disease (51.7%), hypertension (96.6%), diabetes (51.7%), and anemia (25.9%). The patients were interested to know the complications of kidney disease (57.8%), management of diseases like hypertension (58.6%), complications like edema (55.2%), indications for medication (73.3%), self-management or fluid control (37.9%), hemodialysis (37.1%), and financial status (21.6%). Thus, strengthening patient education strategies in the clinics, hospitals, and community settings should be given due attention by relevant healthcare professionals.
  14. Isa SN, Aziz AA, Rahman AA, Ibrahim MI, Ibrahim WP, Mohamad N, et al.
    J Dev Behav Pediatr, 2013 May;34(4):262-8.
    PMID: 23538932 DOI: 10.1097/DBP.0b013e318287cdfe
    Caring for children with disabilities brings about a significant impact on the parents and families. The purposes of this study were to determine the impact of having children with disabilities on parents' health-related quality of life (HRQOL), family functioning, and total family impact and to identify the associated factors.
  15. Rahman AA, Mohamad N, Imran MK, Ibrahim WP, Othman A, Aziz AA, et al.
    Malays J Med Sci, 2011 Oct;18(4):63-8.
    PMID: 22589674 MyJurnal
    No previous study has assessed the impact of childhood disability on parents and family in the context of Malaysia, and no instrument to measure this impact has previously been available. The objective of this cross-sectional study was to determine the reliability of a Malay version of the PedsQL™ Family Impact Module that measures the impact of children with disabilities (CWD) on their parents and family in a Malaysian context.
  16. Zainal Arifen ZN, Shahril MR, Shahar S, Mohamad H, Mohd Yazid SFZ, Michael V, et al.
    Foods, 2023 Mar 14;12(6).
    PMID: 36981160 DOI: 10.3390/foods12061234
    Despite growing evidence of increased saturated and trans fat contents in street foods, little is known about their fatty acid (FA) compositions. This study aimed to analyse the saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and trans fatty acids (TFAs) content of 70 selected and most commonly available street foods in Malaysia. The street foods were categorised into main meals, snacks, and desserts. TFAs were not detected in any of the street foods. Descriptively, all three categories mainly contained SFAs, followed by MUFAs, and PUFAs. However, the one-way ANOVA testing showed that the differences between each category were insignificant (p > 0.05), and each FA was not significantly different (p > 0.05) from one to another. Nearly half of the deep-fried street foods contained medium to high SFAs content (1.7 g/100 g-24.3 g/100 g), while the MUFAs were also high (32.0-44.4%). The Chi-square test of association showed that the type of preparation methods (low or high fat) used was significantly associated (p < 0.05) with the number of SFAs. These findings provide valuable information about fat composition in local street foods for the Malaysian Food Composition Database and highlight the urgency to improve nutritional composition.
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