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Fulltext Prevalence and determinants of pre-hypertension among undergraduate preclinical medical students in central Malaysia.

Mohd Yusoff H, Mohd Tamil A, Mohd Fauzi MF, Mat Saruan NA

IIUM Medical Journal Malaysia, 2019;18(3):65-72.
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Pre-hypertension, a classification of blood pressure ranging from 120–139 mm Hg systolic and/or 80–89 mm Hg diastolic, has been introduced to identify those high-risk group of developing hypertension to implement early intervention to halt disease progression. This study determines the prevalence of pre-hypertension and its determinants among undergraduate preclinical medical students in Malaysia.
Materials & Methods: This was a cross-sectional study conducted among 158 registered second year medical students at one research university in central Malaysia from January to April 2018.
Results: The prevalence of pre-hypertension was 20.6% among undergraduate preclinical medical students. The most respondent was female (69.9%), Malay ethnic (50.6%) who had normal body mass index (67.3%), no depression (79.5%), no anxiety (60.3%), no stress (68.6%), low physical activity level (44.9%), never smoked (95.5%), and never consumed alcohol (87.8%). Some respondents had positive family history of hypertension (43.6%) and diabetes mellitus (31.4%). After adjusted for all variables, gender (AOR=14.45, 95% CI 5.58-37.43) and depression status (AOR=6.37, 95% CI 1.29-31.49) were significantly associated with pre-hypertension.
Conclusion: The prevalence of pre-hypertension among preclinical medical students was lower compared to other country, predicted by gender and depression status. However, further comprehensive multicentered studies in Malaysia with larger sample size is recommended to get more precise results in identifying determinants for pre-hypertension so that early intervention could be implemented nationwide.
Fulltext Why so stressed? A comparative study on stressors and stress between hospital and non-hospital nurses

Muhamad Robat R, Mohd Fauzi MF, Mat Saruan NA, Mohd Yusoff H, Harith AA

BMC Nurs, 2021 Jan 04;20(1):2.
PMID: 33390159 DOI: 10.1186/s12912-020-00511-0

BACKGROUND: Stress, which can be attributed to household and workplace stressors, is prevalent among nurses. However, these stressors' attribution may differ between hospital and non-hospital nurses. It is currently unknown whether there are significant differences in the sociodemographic and occupational characteristics between hospital and non-hospital nurses which may potentially influence the type and magnitude of stressors, and subsequently the stress status. Therefore, this study aims to estimate the prevalence of stress and compare the roles of sociodemograhic characteristics, occupational profiles, workplace stressors and household stressors in determining the stress status between hospital and non-hospital female nurses in Malaysia.
METHODS: This cross-sectional study was conducted among randomly-selected 715 female nurses in Malaysia using pencil-and-paper self-reported questionnaires.
RESULTS: The majority of participants were ever married (87.0%), having children (76.2%), and work in hospital setting (64.8%). The level of household stressors was generally similar between hospital and non-hospital nurses. However, hospital nurses significantly perceived higher level of workplace stressors. Shift work is significantly associated with higher level of household and workplace stressors among nurses in both groups. The level of stress was significantly higher among hospital nurses. Both household and workplace stressors explained about 40% of stress status in both hospital and non-hospital nurses.
CONCLUSION: Hospital nurses are at higher risk of having stressors and stress as compared to non-hospital nurses, probably due to higher proportion of them involved in shift work. Hospital nurses should be given high priority in mitigating stress among nurses.
Fulltext Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time

Mohd Fauzi MF, Mohd Yusoff H, Mat Saruan NA, Muhamad Robat R, Abdul Manaf MR, Ghazali M

BMJ Open, 2020 09 25;10(9):e036849.
PMID: 32978189 DOI: 10.1136/bmjopen-2020-036849

OBJECTIVES: This paper aims to estimate the level of acute fatigue, chronic fatigue and intershift recovery among doctors working at public hospitals in Malaysia and determine their inter-relationship and their association with work-related activities during non-work time.
DESIGN: Cross-sectional.
SETTING: Seven core clinical disciplines from seven tertiary public hospitals in Malaysia.
PARTICIPANTS: Study was conducted among 330 randomly-sampled doctors. Response rate was 80.61% (n=266).
RESULTS: The mean score of acute fatigue, chronic fatigue and intershift recovery were 68.51 (SD=16.549), 54.60 (SD=21.259) and 37.29 (SD=19.540), respectively. All these scores were out of 100 points each. Acute and chronic fatigue were correlated (r=0.663), and both were negatively correlated with intershift recovery (r=-0.704 and r=-0.670, respectively). Among the work-related activities done during non-work time, work-related ruminations dominated both the more frequent activities and the association with poorer fatigue and recovery outcomes. Rumination on being scolded/violated was found to be positively associated with both acute fatigue (adjusted regression coefficient (Adj.b)=2.190, 95% CI=1.139 to 3.240) and chronic fatigue (Adj.b=5.089, 95% CI=3.876 to 6.303), and negatively associated with recovery (Adj.b=-3.316, 95% CI=-4.516 to -2.117). Doing work task at workplace or attending extra work-related activities such as locum and attending training were found to have negative associations with fatigue and positive associations with recovery. Nevertheless, doing work-related activities at home was positively associated with acute fatigue. In terms of communication, it was found that face-to-face conversation with partner did associate with higher recovery but virtual conversation with partner associated with higher acute fatigue and lower recovery.
CONCLUSIONS: Work-related ruminations during non-work time were common and associated with poor fatigue and recovery outcomes while overt work activities done at workplace during non-work time were associated with better fatigue and recovery levels. There is a need for future studies with design that allow causal inference to address these relationships.
Fulltext Maternal Mental Health following Ultrasonographic Detection of Fetal Structural Anomaly in the Midst of the COVID-19 Pandemic

Roslan NR, Mohd Fauzi MF, Wan Teng L, Nur Azurah AG

Int J Environ Res Public Health, 2021 12 07;18(24).
PMID: 34948508 DOI: 10.3390/ijerph182412900

Prenatal ultrasonographic detection of fetal structural anomaly may adversely affect maternal mental health throughout pregnancy, particularly in the current COVID-19 pandemic. This study aims to prospectively assess maternal stress, anxiety, and depression following ultrasonographic detection of fetal structural anomaly from diagnosis until delivery during the COVID-19 pandemic. A total of 141 pregnant women at a tertiary hospital who underwent detailed scans between 16 and 24 gestational weeks were included and categorized into the study (anomaly finding, n = 65) and comparison (normal finding, n = 76) groups. Self-administered questionnaires of 10-item Perceived Stress Scale (PSS-10) and Hospital Anxiety and Depression Scale (HADS) were used to assess maternal stress, anxiety, and depression at prior detection (T1), two-to-four weeks post-detection (T2), one-to-two weeks prior to delivery (T3), and one-to-two weeks post-delivery (T4). Repeated measures of analysis of variance (ANOVA) were conducted to assess time-, between-group, and time-group interaction effect. In general, maternal stress improved, but anxiety worsened, while depression persisted, over the time from T1 to T4. The average maternal stress and anxiety levels were significantly higher among groups with fetal anomaly. The maternal stress and anxiety level were significantly affected within one-to-two weeks post-detection of fetal structural anomaly. In conclusion, maternal mental health parameters were affected differently during the COVID-19 pandemic, with higher vulnerability of stress and anxiety among pregnant women with fetal structural anomaly particularly within one-to-two weeks post-detection.
Fulltext Development and validation of Work-Related Activities during Non-Work Time Scale (WANTS) for doctors

Mohd Fauzi MF, Mohd Yusoff H, Mat Saruan NA, Muhamad Robat R

PLoS One, 2020;15(11):e0241577.
PMID: 33206663 DOI: 10.1371/journal.pone.0241577

Work-related activities during non-work time may influence the intershift recovery of post-work fatigue. Currently there is no valid and reliable scale available to measure the frequency for such activities among doctors. Therefore, this study aims to develop and validate 'Work-Related Activities during Non-Work Time Scale' (WANTS) that measure the frequency of work-related activities during non-work time for doctors. This was a scale development and validation study among doctors involving item generation, content and construct validation, and reliability assessment. 23-item seven-point Likert-type scale was developed through deductive (literature search) and inductive (interview with source population, authors' experiences, and expert opinion) methods. The content-validated scale was pre-tested, and the improved scale was subsequently administered to randomly-selected 460 doctors working at public hospital setting. Response rate was 77.76% (n = 382). Initial exploratory factor analysis (EFA) with principal axis factoring (PAF) using varimax rotation revealed unstable six-factor structure consisting of 17 variables; thus, we tested one- to six-factor model, and found that four-factor model is the most stable. Further analysis with principal component analysis (PCA) with a single component on each factor found that 17-variables four-factor model is stable. These factors were labelled as 'work-related thought', 'work-to-home conversation', 'task spillover' and 'superior-subordinate communication'. It showed good internal consistency with overall alpha value of 0.837. The scale is thus valid and reliable for measuring the frequency of each construct of work-related activities during non-work time among doctors.
Fulltext Unplanned Absenteeism: The Role of Workplace and Non-Workplace Stressors

Mat Saruan NA, Mohd Yusoff H, Mohd Fauzi MF, Wan Puteh SE, Muhamad Robat R

Int J Environ Res Public Health, 2020 08 24;17(17).
PMID: 32846878 DOI: 10.3390/ijerph17176132

Unplanned absenteeism (UA), which includes medically certified leave (MC) or emergency leave (EL), among nurses may disturb the work performance of their team and disrupt the quality of patient care. Currently, there is limited study in Malaysia that examines the role of stressors in determining absenteeism among nurses. Therefore, apart from estimating the prevalence and the reasons of UA among nurses in Malaysia, this study aims to determine its stressor-related determinants. A cross-sectional study was conducted among 697 randomly sampled nurses working in Selangor, Malaysia. Most of them were female (97.3%), married (83.4%), and working in shifts (64.4%) in hospital settings (64.3%). In the past year, the prevalence of ever taking MC and EL were 49.1% and 48.4%, respectively. The mean frequency of MC and EL were 1.80 (SD = 1.593) and 1.92 (SD = 1.272) times, respectively. Meanwhile, the mean duration of MC and EL were 4.24 (SD = 10.355) and 2.39 (SD = 1.966) days, respectively. The most common reason for MC and EL was unspecified fever (39.2%) and child sickness (51.9%), respectively. The stressor-related determinants of durations of MC were inadequate preparation at the workplace (Adj.b = -1.065) and conflict with doctors (adjusted regression coefficient (Adj.b) = 0.491). On the other hand, the stressor-related determinants of durations of EL were conflict with spouse (Adj.b = 0.536), sexual conflict (Adj.b = -0.435), no babysitter (Adj.b = 0.440), inadequate preparation at workplace (Adj.b = 0.257), lack of staff support (Adj.b = -0.190) and conflict with doctors (Adj.b = -0.112). The stressor-related determinants of the frequency of MC were conflicts over household tasks (Adj.b = -0.261), no time with family (Adj.b = 0.257), dangerous surroundings (Adj.b = 0.734), conflict with close friends (Adj.b = -0.467), and death and dying (Adj.b = 0.051). In contrast, the stressor-related determinants of frequency of EL were not enough money (Adj.b = -0.334), conflicts with spouse (Adj.b = 0.383), pressure from relatives (Adj.b = 0.207), and inadequate preparation (Adj.b = 0.090). In conclusion, apart from the considerably high prevalence of unplanned absenteeism and its varying frequency, duration and reasons, there is no clear distinction in the role between workplace and non-workplace stressors in determining MC or EL among nurses in Malaysia; thus, preventive measures that target both type of stressors are warranted. Future studies should consider longitudinal design and mixed-method approaches using a comprehensive model of absenteeism.
Fulltext Doctors' Mental Health in the Midst of COVID-19 Pandemic: The Roles of Work Demands and Recovery Experiences

Mohd Fauzi MF, Mohd Yusoff H, Muhamad Robat R, Mat Saruan NA, Ismail KI, Mohd Haris AF

Int J Environ Res Public Health, 2020 10 08;17(19).
PMID: 33050004 DOI: 10.3390/ijerph17197340

The COVID-19 pandemic potentially increases doctors' work demands and limits their recovery opportunity; this consequently puts them at a high risk of adverse mental health impacts. This study aims to estimate the level of doctors' fatigue, recovery, depression, anxiety, and stress, and exploring their association with work demands and recovery experiences. This was a cross-sectional study among all medical doctors working at all government health facilities in Selangor, Malaysia. Data were collected in May 2020 immediately following the COVID-19 contagion peak in Malaysia by using self-reported questionnaires through an online medium. The total participants were 1050 doctors. The majority of participants were non-resident non-specialist medical officers (55.7%) and work in the hospital setting (76.3%). The highest magnitude of work demands was mental demand (M = 7.54, SD = 1.998) while the lowest magnitude of recovery experiences was detachment (M = 9.22, SD = 5.043). Participants reported a higher acute fatigue level (M = 63.33, SD = 19.025) than chronic fatigue (M = 49.37, SD = 24.473) and intershift recovery (M = 49.97, SD = 19.480). The majority of them had no depression (69.0%), no anxiety (70.3%), and no stress (76.5%). Higher work demands and lower recovery experiences were generally associated with adverse mental health. For instance, emotional demands were positively associated with acute fatigue (adj. b = 2.73), chronic fatigue (adj. b = 3.64), depression (adj. b = 0.57), anxiety (adj. b = 0.47), and stress (adj. b = 0.64), while relaxation experiences were negatively associated with acute fatigue (adj. b = -0.53), chronic fatigue (adj. b = -0.53), depression (adj. b = -0.14), anxiety (adj. b = -0.11), and stress (adj. b = -0.15). However, higher detachment experience was associated with multiple mental health parameters in the opposite of the expected direction such as higher level of chronic fatigue (adj. b = 0.74), depression (adj. b = 0.15), anxiety (adj. b = 0.11), and stress (adj. b = 0.11), and lower level of intershift recovery (adj. b = -0.21). In conclusion, work demands generally worsen, while recovery experiences protect mental health during the COVID-19 pandemic with the caveat of the role of detachment experiences.