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Tobacco Use Prevention for the Young (TUPY-S): Development, Validity and Reliability of an Interactive Multimedia Strategy from the Adolescents’ Perspective in Malaysia

Mohd Zin F, Hillaluddin AH, Mustaffa J

Asian Pac J Cancer Prev, 2017 05 01;18(5):1435-1443.
PMID: 28612599

Objective: This study aims to develop, validate and determine the reliability of an interactive multimedia strategy
to prevent tobacco use among the young (TUPY-S) from an adolescents’ perspective. Methods: A descriptive study
design was utilized. A modular instruction guideline by Russel (1974) was followed in the entire process, comprising
a feasibility study, a review of existing modules, specification of the objectives, identification of the construct criterion
items, learner analysis and entry behavior specification, establishment of the sequence instruction and media selection,
a tryout with students and a field test. Result: Feasibility was agreed among the researchers and the school authorities.
Culturally suitable rigorously developed tobacco use preventive strategies delivered using information technology (IT)
are lacking in the literature. The objective of TUPY-S is to prevent tobacco use among adolescents living in Malaysia.
Identified construct criterion items include knowledge, attitude, intention to use, self-efficacy, and refusal skill. The target
population was early adolescents belonging to generation-Z. Content was developed from the adolescents’ perspective
and delivered using IT in Malay language. Content validity, assessed by six experts in the field and module development,
was good at 86%. The students’ tryout showed satisfactory face validity subjectively and objectively (85.5%) and
high alpha Cronbach reliability (0.91). Conclusion: TUPY-S was confirmed to suit early adolescents of the current
generation living in Malaysia. It demonstrated good content validity among the experts, satisfactory face validity and
reliability among the target population. TUPY-S is ready to be evaluated for its effectiveness among early adolescents.
Fulltext An association of myasthenia gravis with Hashimoto's thyroiditis in a patient with a multinodular goitre

Mohamed N, Mohd Zin F, Mohd Yusoff SS

Malays Fam Physician, 2017;12(2):29-31.
PMID: 29423128

Introduction: The association of myasthenia gravis (MG) with other autoimmune diseases including autoimmune thyroid disease (ATD) is well recognised, although rare. The occurrence of both diseases can occur in two ways: either disease preceding the other, or concurrently. The presentation of MG in association with ATD can range from ocular to generalised disease.

Case Summary: A 26-year-old Malay female with persistent hyperthyroidism secondary to Hashimoto's thyroiditis in multinodular goitre was diagnosed with generalised MG after 2 years. She presented with right eye ptosis (ocular) and difficulty in swallowing and chewing (bulbar). The diagnosis of MG was confirmed by fatigability testing, electromyography and the presence of AChR antibodies. Her symptoms showed improvement with pyridostigmine (Mestinon) 60 mg 6-hourly. Her antithyroid drug was tapered down according to her thyroid function test. Throughout a year of follow-ups, her hyperthyroidism and fatigability symptoms improved with treatment. She was later counselled for total thyroidectomy and thymectomy.

Conclusion: Myasthenia gravis and hyperthyroidism may present with similar symptoms such as dysphagia due to neuromuscular weakness or fatigue. When the diseases occur together, one of the diagnoses may be missed. Therefore, the occurrence of new symptoms in a patient with underlying ATD should should trigger the early identification of other autoimmune diseases by primary care doctors.
Adolescents’ Perceptions Regarding Effective Tobacco Use Prevention Strategies for their Younger Counterparts: A Qualitative Study in Malaysia

Mohd Zin F, Hillaluddin AH, Mustaffa J

Asian Pac J Cancer Prev, 2016 Dec 01;17(12):5113-5119.
PMID: 28122443

Purpose:The present qualitative study explored adolescents’ perceptions regarding effective strategies to prevent adolescents from using tobacco products (TP). Apart from the commercial TPs, there has been emerging use of alternatives such as vapes, e-cigarettes and shisha. This unfortunate phenomenon continues despite the currently available preventive strategies. Thus, understanding of the perceptions of the current generation would be valuable to provide new insights. Methods: Purposive sampling was utilized to recruit 40 adolescents between the age of 15 and 16 years old attending public daily secondary schools. Eight focus group discussions were conducted among the TP users, ex-users and non-users. Data were analyzed using a thematic content analysis procedure with NVivo. Results: Among barriers with the currently available strategies were having teachers who smoke tobacco, addiction to nicotine and self-perceptions of being healthy. The content of any program should include knowledge on negative outcomes of using tobacco products and awareness of the legislation together with ways to overcome peer and family influence including improving self-efficacy and refusal skills. Strategies were suggested to be delivered using information technology which provides interactive learning and visual effects. Conclusions: Adolescents agreed that the content and delivery of tobacco use prevention strategies need to be revised to suit the current generation to ensure sustainability.
Fulltext Type 2 diabetes remission: How does it work?

Ahmad Fuat MS, Mohd Zin F, Mat Yudin Z

Malays Fam Physician, 2021 Mar 25;16(1):124-128.
PMID: 33948152 DOI: 10.51866/cr1026

Type 2 diabetes mellitus (Type 2 DM) is a chronic disease which rise is closely linked to the obesity epidemic and which requires long-term medical attention to limit the development of its wide-ranged complications. Many of these complications arise from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. The increasing evidence of its remission state has been discussed in the literature. Here we report on a patient with metabolic syndrome who underwent a structured therapeutic lifestyle changes (TLC) therapy which eventually led to remission of Type 2 DM.
Fulltext Quality of Life and Its Associated Factors among Patients with Psoriasis in a Semi-Urban Northeast Malaysia

Ahmad Fuat MS, Mat Yudin Z, Muhammad J, Mohd Zin F

Int J Environ Res Public Health, 2022 Sep 14;19(18).
PMID: 36141851 DOI: 10.3390/ijerph191811578

Psoriasis is a chronic relapsing dermatological disorder that significantly affects the patients' psychosocial well-being and quality of life (QOL). This study aimed to determine the proportion of severely impaired QOL, the factors associated with severely impaired QOL, and its correlation with depression among semi-urban populations on the Northeast Coast of the Peninsular Malaysia. A cross-sectional study was conducted among 257 patients with psoriasis at the Dermatology Clinic of Hospital Sultanah Bahiyah via a self-administered questionnaire that included sociodemographic profiles, the validated Malay version of the Dermatology Life Quality Index (DLQI), and the Malay version of the Beck depression scale. The data were analysed using logistic and linear regression models. About 20.5% of the patients had severely impaired QOL quality of life, while 79.5% of the patients had non-impaired QOL. Multiple logistic regression analysis showed that the psoriatic severity [Adjusted OR = 1.91, 95% CI: 1.76, 9.93; p < 0.001] and exposed area [Adjusted OR 2.93, 95% CI: 0.38, 2.29; p = 0.050] had a significant association with severely impaired QOL. Among the patients, 18.7% had a positive result in the screening for depression, which revealed a significant association between QOL and depression scores [r = 0.47, 95% CI: 0.35, 0.56, p < 0.001]. Psoriasis can impair QOL and have a relation with mental health. Regular screening for depression among patients with psoriasis is a beneficial strategy for the early detection of depression, especially in semi-urban areas.
Fulltext The Effectiveness of Smoking Prevention Module Towards Knowledge and Smoking Refusal Skills among Adolescents in Kota Bharu, Kelantan, Malaysia

Anuar N, Idris NS, Mohd Zin F, Abdul Rahman R, Ahmad I, Ibrahim MI

Asian Pac J Cancer Prev, 2019 Nov 01;20(11):3353-3359.
PMID: 31759359 DOI: 10.31557/APJCP.2019.20.11.3353

OBJECTIVE: To study the effectiveness of the smoking prevention module towards knowledge on smoking and its harmful effects and smoking refusal skills among secondary school students in Kelantan, Malaysia.
METHODS: A quasi experimental interventional study involving 166 non-smokers adolescents, aged 13 to 14 years old were carried out in two schools located in two different suburbs. Both schools had equal number of participants. One school was given the smoking prevention module for intervention while the control school only received the module after the study had been completed. The knowledge on smoking and its harmful effects and smoking refusal skill score were assessed using a set of validated Malay questionnaires at baseline, two weeks and eight weeks after the intervention. Repeated measure ANCOVA was used to analyse the mean score difference of both groups at baseline and after intervention.
RESULT: Baseline analysis shows no significant difference in knowledge score between the study groups (p = 0.713) while post intervention, it shows significant inclination of knowledge score in intervention group and the difference was significant after controlling the gender [F(df) = 15.96(1.5), p <0.001]. The mean baseline for refusal skills score in the control and intervention groups were 30.89(6.164) and 28.02(6.241) respectively (p= 0.003). Post intervention, there is a significant difference in the crude mean and the estimated marginal means for smoking refusal skills score between the two groups after controlling for sex [F(df) = 5.66(1.8), p = 0.005].
CONCLUSION: This smoking prevention module increased the level of knowledge on smoking and its harmful effects and smoking refusal skill among the secondary school students. Thus, it is advocated to be used as one of the standard modules to improve the current method of teaching in delivering knowledge related to harmful effects of smoking and smoking refusal skill to the adolescents in Malaysia.
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Fulltext Autonomy in refusing life saving interventions: religious and cultural misconceptions

van Rostenberghe H, Yong A, Mohd Zin F, Fuad MDF, Idris B, Tahir NA, et al.

Education in Medicine Journal, 2014;6(1):70-73.
MyJurnal

Autonomy is widely accepted to be the third pillar of medical ethics. However, if it comes to refusal of life saving treatments, some extra considerations are necessary, especially if decisions are made by surrogate decision makers. Four cases of problematic decision making are presented here, followed by a discussion about the cultural and religious misconceptions about the rights of surrogate decision makers.
Fulltext Development and Validation of Positive Smoker Identity Questionnaire (PSmoQi): A New Instrument for Smoking Cessation Correlates

Ahmad MH, Ibrahim MI, Ab Rahman A, Musa KI, Mohd Zin F, Mohd Zain R, et al.

Int J Environ Res Public Health, 2019 01 26;16(3).
PMID: 30691181 DOI: 10.3390/ijerph16030351

Background: The positive smoker identity construct, which was based on West's PRIME Theory, affected the smoking prevalence, quit attempts and cessation success. A validated questionnaire which could measure this rich and complex construct may facilitate prediction models of successful cessation. We aimed to develop and validate a questionnaire that assesses positive smoker identity based on West's PRIME Theory. Method: The initial item pool was developed based on a theoretical framework, empirical literature, existing scales and expert review. The questionnaire was conveniently distributed to 100 smokers. Exploratory factor analysis was utilized to explore domains in the questionnaire. Construct and criterion validity, internal consistency and reliability of the domains were analyzed. Results: The final positive smoker identity questionnaire (PSmoQi) has 26 items under four internally-consistent and reliable domains: Contributory factors, contextual and temporal patterning, identity related to smoking, and behaviour in relation to smoking. The full scale demonstrated good internal consistency (∝ = 0.78), acceptable convergent and divergent validity, and good concurrent validity with the smoker self-concept scale. Conclusion: The current study provides fundamental evidence for the PSmoQi as a valid instrument in research related to smoking cessation and interventional strategy. The PSmoQi contained validated domains which could measure almost a full spectrum of smoking cessation components.