Displaying publications 1 - 20 of 21 in total

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  1. Chhoa KH, Zakaria H, Abd Rahman FN
    Pediatr Int, 2019 Mar;61(3):284-292.
    PMID: 30636372 DOI: 10.1111/ped.13789
    BACKGROUND: Alcohol consumption in the under-aged is one of the main concerns regarding Malaysian adolescents. There is no previous study on problematic alcohol use (PAU) in adolescents in Sarawak. The aim of this study was to determine the prevalence of PAU, its associated variables and its relationship with depression.

    METHODS: This was a cross-sectional study. A total of 327 secondary school students completed the Alcohol Use Disorder Identification Test and Children's Depression Inventory, and a sociodemographic questionnaire. Binary and multivariable logistic regression were used to examine the relationship between the different variables.

    RESULTS: A total of 42.2% of adolescents had PAU. Urban adolescents had a higher prevalence compared with rural adolescents (OR, 1.612; 95% CI: 1.036-2.508 P = 0.034). Female adolescents (56.8%) and Bumiputera Sarawak adolescents (76.8%) comprised a large proportion of the respondents with PAU. Cultural norm (78.3%) and curiosity (68.1%) were the two main reasons for PAU. Only family history of alcohol use (OR, 2.273; 95% CI: 1.013-5.107; P = 0.047), ever consumed alcohol (OR, 57.585; 95% CI: 21.885-151.525; P 

  2. Shahrul Azmin, Tan, Eng Liang, Law, Zhe Kang, Remli Rabani, Wan Yahya Nafisah, Sahathevan, Ramesh, et al.
    Neurology Asia, 2016;21(2):137-143.
    MyJurnal
    Background: Impulse control behaviours are repetitive and excessive activities that may be sub-syndromal and not fulfil the criteria for impulse control disorder. These activities have potential to negatively impact on the daily lives of sufferers. We conducted a study to investigate the prevalence of impulse control behaviours and its associated features in Parkinson’s disease in our population. Methods: We conducted a prospective cross-sectional study on consecutive patients attending neurology clinic. Inclusion criteria include idiopathic Parkinson’s disease patients with Hoehn & Yahr stage I-IV. Eighty patients were enrolled and screened for impulse control behaviours using the Questionnaire for Impulsive-Compulsive Disorder for Parkinson’s disease (QUIP). Results: Prevalence of impulse control behaviours among our cohort was 11.3%; the features significantly associated with it were higher level of education (p=0.02), advanced stage of disease (p=0.03) and higher levodopa dosage (p= 0.01). The commonest impulse control behaviour in our cohort was compulsive medication use (7.5%), followed by hobbyism (6.3%), hypersexuality (5%), compulsive buying (3.75%), punding (2.5%), walkabout (2.5%), compulsive eating (1.25%) and pathological gambling (1.3%).
    Conclusions: There is an association between impulse control behaviour and higher levodopa dosage in a study on patients with Parkinson’s disease in Malaysia. We also found a low prevalence of pathological gambling as compared to studies performed in the West.
    Study site: Neurology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  3. Woon LS, Kanapathy A, Zakaria H, Alfonso CA
    Psychodyn Psychiatry, 2017;45(2):237-257.
    PMID: 28590207 DOI: 10.1521/pdps.2017.45.2.237
    Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that often runs a chronic unremitting course. Treatment outcomes can be unsatisfactory despite the availability of various somatic and psychological therapies. Psychodynamic psychotherapy in combination with cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) could help patients with treatment-resistant OCD achieve better outcomes. An integrative approach can help patients gain insight, strengthen the therapeutic alliance, improve treatment adherence, and provide symptomatic relief when other treatments seem insufficient or have failed. We describe the treatment process of a person with treatment-resistant OCD who received pharmacotherapy, concurrent CBT/ERP, and a brief course of psychodynamic psychotherapy. Case formulations from cognitive behavioral and psychodynamic perspectives are presented. The authors discuss the advantages of doing a psychodynamic assessment and formulation in treatment refractory cases and the wisdom of integrating psychotherapy interventions for OCD, as well as the unique clinical features of cases that warrant a multimodal treatment approach.
  4. Lee SC, Sidi H, Zakaria H, Loo JL, Yahaya R
    MyJurnal
    Exhibitionism is a distressing condition which may have a link with the increasing availability and usage of online sexual activities (OSA). We highlight a 42-year-old man who presented with a constant craving for OSA to achieve his sexual satisfaction which included exposing his genitalia to virtual partners, unsuspected strangers, and colleagues in public areas. His sexual behaviours were further reinforced by an online video chatting with genitalia exposure, which ended commonly with an exchange of masturbatory acts. He denied any problem with his erection and able to achieve orgasm via common sexual acts. There was no past psychiatric history nor family history of mental disorder. He volunteered to seek psychiatric help and subsequently given a psycho education on his illness and how to cope with the distress associated with his sexual acts. He was scheduled for an intensive psychotherapy to instil insight and hope to deal with his sexual difficulties.
  5. Nordin AS, Kadir RA, Yahya NA, Zakaria H, Rashid RA, Habil MH
    Int Dent J, 2014 Aug;64(4):206-12.
    PMID: 24835463 DOI: 10.1111/idj.12110
    As a signatory to the World Health Organisation 2003 Framework Convention on Tobacco Control, Malaysia has policies in place and funded 300 public Quit clinics. Unfortunately, government dentists are not included to run tobacco dependence treatment. A cross-sectional exploratory survey was carried out to seek Malaysian dentists' opinion on their knowledge, perception and willingness to conduct tobacco dependence treatment. Participation was voluntary from those who attended a specially designed one-day, four-module workshop on tobacco cessation intervention. Data were collected using the Audience-Response-System equipment which tracked immediate responses covering four domains namely: smoking as a public health problem, smoking as an addiction, the role of dentists in the programme and confidence in conducting smoking cessation in the clinic. Sample comprised more female dentists (73.5%), mean age 33.6 (SD 8.99) years and with more than 3 years working experience. Findings indicated that the majority agreed Malaysia has a rising problem in the prevalence of smoking (71.6%) and predicted that it will affect mostly the young (81.9%). Only half of the dentists surveyed (58.9%) routinely recorded their patients' smoking habits. The majority (71.6%) believed that dentists are effective in helping their patient to stop smoking and 76.3% agreed that dentists should discuss the smoking habit with their patients; however, 60% agreed that doing so is too time consuming. In addition, only 24.7% knew of more ways to treat a smoking habit. The majority felt comfortable giving advice to patients about changing their habits (76.5%) or discussing treatment options (60.5%): 75% would opt for a combined programme of counselling and use of medication if they have to do, 15% would choose to go on counselling only, while 8% did not want to treat. In conclusion, the findings suggest that dentists have a strong potential to contribute significantly to providing smoking cessation treatment if adequately trained.
  6. Alfonso CA, Sutanto L, Zakaria H, Kalayasiri R, Lukman PR, Elvira SD, et al.
    BJPsych Int, 2018 Feb;15(1):8-11.
    PMID: 29953132 DOI: 10.1192/bji.2017.5
  7. Adam RL, Sidi H, Midin M, Zakaria H, Das S, Mat KC
    Curr Drug Targets, 2018;19(12):1402-1411.
    PMID: 28464773 DOI: 10.2174/1389450118666170502130126
    Sexuality is an important dimension in human beings as a form of expression of individuality. For many decades, sexual functioning has been a neglected area among patients suffering from schizophrenia. It was a presumption that patients with schizophrenia could be asexual and this could be secondary to overwhelming situations of delusion, hallucination, hostility and negative symptoms among others. The deficient in sexual functioning are due to innate factors, i.e. negative symptoms (apathy, avolition and amotivation) and also as a result of prefrontal dysfunction, i.e. inability to plan and execute meaningful relationship. Adverse effects of the psychopharmacological agents, especially the typical antipsychotics, e.g. dystonia, excessive sedation and hyperprolactinemia may interfere with patients' sexual activity. In this review, we highlight the neurobiology of schizophrenia in the context of understanding sexual functioning and to integrate the knowledge of dopamine-serotonin neurotransmitter's interaction and the receptors' target. Interventional approaches consist of psychopharmacological and psychosocial interventions. In the perspective of sexuality, we recommend atypical antipsychotic should be placed as the first line treatment for both drug naïve patients and also to patients who are already receiving psychopharmacological agents in consideration for a drug-switch from typical to atypical antipsychotics. Aripiprazole, clozapine, olanzapine and quetiapine exert benefits in terms of sexual functioning recovery due to their atypical mechanism of action. However, the potential adverse effect like metabolic syndrome should be adequately managed to prevent negative consequences. Psychosocial interventions, i.e. psychoeducation, destigmatization, supportive psychotherapy and psychiatric rehabilitation also play a crucial role in the management. In conclusion, restoration of sexual function is an achievable recovery target in patients with schizophrenia through these biopsycho- social interventions.
  8. Deang KT, Sidi H, Zakaria H, Adam RL, Das S, Hatta NH, et al.
    Curr Drug Targets, 2019;20(2):210-219.
    PMID: 28494748 DOI: 10.2174/1389450118666170511145628
    Attention deficit hyperactive disorder (ADHD), a hyperactivity disorder prevalent among children may continue as an adulthood attention deficit. To date, treating an individual with an adult ADHD may be an arduous task as it involves numerous challenges, which include a need for high index of suspicion to diagnose this medical condition. Many psychiatric disorders masquerade as ADHD and delay the necessary assessment and proper treatment for this debilitating medical disorder. Adult ADHD is often misdiagnosed (or under diagnosed) due to the fact that this medical condition is being masked by the patients' high level of intellectual achievement. As the ADHD in adult persists, it may end-up with impairment in the personal-social-occupational function in which the management becomes a great challenge. The treatment of ADHD can be optimized by using various drugs targets agents like norepinephrine-dopamine reuptake inhibitor (NDRI), with or without psycho stimulants like methylphenidate, which is marketed as Ritalin. Bupropion, an NDRI has a novel effect on ADHD as the molecule exerts its effects by modulating the reward-pleasure mesolimbic dopaminergic system and at the same time regulates the elevating mood dimension of the noradrenergic neurotransmission. The role of Bupropion in the neural and psychopharmacological perspective treatment of ADHD was deliberated. The present review highlights the novel effects of Bupropion in ADHD treatment, together with the help of other successful bio-psycho-social measures. This may be of immense benefit to the psychiatrists for treating their patients.
  9. Loo JL, Ang JK, Subhas N, Ho BK, Zakaria H, Alfonso CA
    Psychodyn Psychiatry, 2017;45(1):45-57.
    PMID: 28248565 DOI: 10.1521/pdps.2017.45.1.45
    The subjective nature of psychodynamic psychotherapy (PP) makes training and supervision more abstract compared to other forms of psychotherapy. The issues encountered in the learning and supervision process of PP of Malaysian psychiatry trainees are discussed in this article. Issues of preparation before starting PP, case selection, assessment of patients, dynamic formulations, supervision, anxieties in the therapy, countertransference, termination of therapy, the treatment alliance, transfer of care, the therapeutic setting, and bioethical considerations are explored. Everyone's experience of learning PP is unique and there is no algorithmic approach to its practice. With creative thinking, effort, and "good enough" supervision, a trainee can improve PP skills, even in underserved areas of the world.
  10. Assa'edah Mahmud A, Zakaria H, Zaliman Mohd Yusoff M, Ruzyanei Nik Jaafar N, Baharudin A, Mohd Tamil A
    Alpha Psychiatry, 2022 Sep;23(5):223-229.
    PMID: 36426271 DOI: 10.5152/alphapsychiatry.2022.21781
    BACKGROUND: The primary purpose of this study is to examine the feasibility of a short-term virtual reality exposure therapy among healthy working adults sample. The secondary aim is to measure the effect of virtual reality exposure therapy on negative and positive emotions by comparing it to the standard stress management program and the wait-list groups.

    METHODS: We enrolled 67 participants allocated into 3 groups to receive virtual reality exposure therapy, standard stress management, or wait-list group. The virtual reality exposure therapy group received a total of a 30-minute exposure to a virtual reality environment over 2 weeks. The standard stress management group received a stress management program once during the study period.

    RESULTS: The results showed a heterogeneous sample, whereby a significantly younger, less-working years, and higher anxiety baseline score were found in the virtual reality exposure therapy group compared to standard stress management and wait-list groups. Nonetheless, the virtual reality exposure therapy group showed a reduction in depression, anxiety, and stress score (P < .001). The standard stress management group showed a reduction in anxiety score only (P = .002), whereas no significant changes were observed in the wait-list group. For positive emotion, all 3 groups showed significant improvement.

    CONCLUSION: Short-term virtual reality exposure therapy is a feasible intervention for the negative and positive emotions; however, cautious interpretation is needed due to significant heterogeneous sample. Replication of study with comparable groups is recommended.

  11. Selamat Din SH, Nik Jaafar NR, Zakaria H, Mohamed Saini S, Ahmad SN, Midin M
    Asian Pac J Cancer Prev, 2017 Feb 01;18(2):465-471.
    PMID: 28345831
    Background: Anxiety is recognized as a normal psychological reaction of those caring for cancer patients. However, anxiety disorders in caregivers may interfere with their care-giving role and require further clinical attention. Objectives: To determine the prevalence and associated factors of anxiety disorders among caregivers of breast cancer patients receiving oncologic treatment in Kuala Lumpur Hospital. Methodology: A cross-sectional study was conducted on 130 caregiver-patient dyads, recruited by non-random sampling at Kuala Lumpur Hospital. Data were collected in 2 stages: 1) the caregivers were screened for psychological distress using the Depression, Anxiety, Stress, Scale (DASS-21) while other related factors for the patients and their caregivers were obtained; 2) the identified distressed caregivers (n=64) were then administered the Mini International Neuropsychiatric Interview (MINI) to diagnose anxiety disorders. Results: A total of 11.5% (n=15) of the caregivers reported suffering from anxiety disorders. Bivariate analysis found duration of caregiving (OR=3.31; CI=2.21-11.93), shared caregiving (OR=4.07; CI=1.34-12.36), and patients’ treatment type (OR=3.42; CI=1.92-12.76) were significantly associated with anxiety disorders (p value <0.05), with shared caregiving and patient’s treatment type remaining significant using logistic regression (p value < 0.05, R2 = 0.255). Conclusions: Every one in ten of the caregivers in this study had a diagnosable anxiety disorder, associated with certain care-giving factors and patients’ treatment. This should alert clinicians to such risk and indicates psychological support needs for family caregivers.
  12. Leong Abdullah MF, Nik Jaafar NR, Zakaria H, Rajandram RK, Mahadevan R, Mohamad Yunus MR, et al.
    Psychooncology, 2015 Aug;24(8):894-900.
    PMID: 25612065 DOI: 10.1002/pon.3740
    Positive and negative psychological reactions have been described in head and neck cancer patients. Nevertheless, the relationships between these responses across time need to be studied to understand the patients' strengths and vulnerabilities.
  13. Zakaria H, Hussain I, Zulkifli NS, Ibrahim N, Noriza NJ, Wong M, et al.
    PLoS One, 2023;18(7):e0283862.
    PMID: 37506072 DOI: 10.1371/journal.pone.0283862
    BACKGROUND AND AIMS: There is growing evidence on the contribution of psychological factors to internet addiction; yet it remains inconsistent and deserves further exploration. The aim of this study was to determine the relationship between the psychological symptoms (Attention Deficit Hyperactivity Disorder (ADHD) symptoms, stress, depression, anxiety and loneliness) and internet addiction (IA) among the university students in Malaysia.

    MATERIALS AND METHODS: A total of 480 students from different faculties in a Malaysian public university participated in this study. They were selected by simple random sampling method. They completed self-administered questionnaires including the Malay Version of Internet Addiction Test (MVIAT)) to measure internet addiction and Adult Self-Report Scale (ASRS) Symptom Checklist, Depression Anxiety Stress Scales (DASS) and UCLA Loneliness Scale (Version 3) to assess for ADHD symptoms, depression, anxiety, stress, and loneliness respectively.

    RESULTS: The prevalence of IA among university students was 33.33% (n = 160). The respondents' mean age was 21.01 ± 1.29 years old and they were predominantly females (73.1%) and Malays (59.4%). Binary logistic regression showed that gender (p = 0.002; OR = 0.463, CI = 0.284-0.754), ADHD inattention (p = 0.003; OR = 2.063, CI = 1.273-3.345), ADHD hyperactivity (p<0.0001; OR = 2.427, CI = 1.495-3.939), stress (p = 0.048; OR = 1.795, CI = 1.004-3.210) and loneliness (p = 0.022; OR = 1.741, CI = 1.084-2.794) were significantly associated with IA.

    CONCLUSION: A third of university students had IA. In addition, we found that those who were at risk of IA were males, with ADHD symptoms of inattention and hyperactivity, who reported stress and loneliness. Preventive strategy to curb internet addiction and its negative sequelae may consider these factors in its development and implementation.

  14. Nik Jaafar NR, Abd Hamid N, Hamdan NA, Rajandram RK, Mahadevan R, Mohamad Yunus MR, et al.
    Front Psychol, 2021;12:716674.
    PMID: 34764904 DOI: 10.3389/fpsyg.2021.716674
    Despite an enormous number of studies addressing the importance of posttraumatic growth (PTG) among cancer patients, the literature lacks data regarding how different coping strategies affect PTG among head and neck cancer (HNC) patients over time. This longitudinal study investigated the PTG trend and coping over 5-7months among a cohort of HNC patients within the first year after their diagnosis. It determined an association between coping strategies and PTG over time. The study's HNC respondents were administered a socio-demographic and clinical characteristics questionnaire during their baseline assessments. Additionally, the Malay versions of the "PTG Inventory-Short Form" (PTGI-SF) and the "Brief Coping Orientation to Problems Experienced Inventory" (Brief COPE) were administered during respondents' baseline assessments and follow-up assessments (5-7months after the baseline assessments). In total, 200 respondents reported an increasing PTG trend and approach coping (active coping, planning, positive reframing, acceptance, emotional support, and instrumental support) and a decreasing trend of avoidant coping (self-distraction and denial) over time. Two approach coping strategies (acceptance and planning) significantly increased PTG while denial was the only avoidant coping strategy that significantly lowered PTG, after controlling for socio-demographic and clinical characteristics, over time. Our study's findings identified the need to incorporate psychosocial interventions that enhance approach coping and reduce avoidant coping into HNC patients' treatment regimes.
  15. Midin M, Razali R, Zamzam R, Fernandez A, Hum LC, Shah SA, et al.
    Int J Ment Health Syst, 2011 May 30;5:14.
    PMID: 21624111 DOI: 10.1186/1752-4458-5-14
    BACKGROUND: Gainful employment is one major area of functioning which is becoming an important goal in psychiatric rehabilitation of patients with schizophrenia. Studies in western countries are pointing to evidence that certain sociodemographic and clinical factors may contribute to employment outcomes in this group of people. However, the area is still largely unexplored in Malaysia. The aim of this study was to examine the sociodemographic, clinical and cognitive correlates of employment status among patients with Schizophrenia.

    METHODS: This was a cross-sectional study. All participants who fulfilled the requirements of the study according to the inclusion and exclusion criteria were enrolled. Study instruments included a demographic data questionnaire, Positive and Negative Symptom Scale (PANSS), Trail Making Tests, Rey's Auditory Verbal Learning Test (RAVLT) and Digit Span. Bivariate analyses were done using chi-square for categorical data and t-test for continuous data and multiple logistic regression analysis was done to identify predictors of employment status.

    RESULTS: A total of 95 participants who fulfilled the inclusion criteria were enrolled into the study. Among the sociodemographic, clinical and cognitive variables studied marital status, educational level, mean scores of negative symptoms, Digit Span and RAVLT and Trail Making Tests were found to show significant association with employment status on bivariate analyses. However, when entered into a logistic regression model, only cognitive variables ie. Trail A and B, Digit Span and RAVLT were significant predictors of employment status.

    CONCLUSIONS: The results from this study support the role of cognitive function, particularly, attention, working memory and executive functioning on attaining and maintaining employment in persons with schizophrenia as measured by the RAVLT, Digit Span and Trail Making Tests. These findings may act as preliminary evidence suggesting the importance of integrating cognitive rehabilitation in the psychosocial rehabilitation program for patients with schizophrenia in Malaysia.

  16. Sidi H, Loh SF, Mahadevan R, Puteh SE, Musa R, Wong CY, et al.
    Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:103-9.
    PMID: 23857845 DOI: 10.1111/appy.12053
    INTRODUCTION: The objective of this study was to determine the relationship between clinical/socio-demographic factors with knowledge and attitude on sex among medical students of the National University of Malaysia (UKM).
    METHODS: A cross-sectional study assessing 452 students using a self-administered questionnaire of knowledge and attitude was performed and had a response rate of 80%.
    RESULTS: The majority of respondents were Malays (56%), females (57.5%), lived in urban areas (66.4%), had a median family income of RM3000 and perceived themselves as moderately religious (60%). The overall score on knowledge about sex was 21.7 of 35 (a higher score indicates better knowledge about sex). It was noted that 73.2% of students felt that they did not receive adequate training in medical school to deal with patients' sexuality and sexual problems, while 51.5% felt uncomfortable talking to patients about these issues. Students in the clinical year were more knowledgeable than those in pre-clinical years (22.67 versus 20.71, P 22 marks [median score]).
    DISCUSSION: The students' attitude on sex was considered conservative as the majority of them disagreed on premarital sex, masturbation, abortion, homosexuality and oral sex. Gender and religiosity have a large influence on attitudes on controversial sexual issues, whereas clinical status plays a small role. Knowledge on sex among UKM medical students is inadequate and their attitudes on sex are considered conservative. Integration of sexual medicine and health modules in the medical curriculum is crucial for students to more effectively address patients' sexual problems and promote non-judgmental attitudes towards patients.
    KEYWORDS: attitude; knowledge; medical student; sex
  17. Javed A, Lee C, Zakaria H, Buenaventura RD, Cetkovich-Bakmas M, Duailibi K, et al.
    Asian J Psychiatr, 2021 Apr;58:102601.
    PMID: 33611083 DOI: 10.1016/j.ajp.2021.102601
    Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.
  18. Alfonso CA, Michael MC, Elvira SD, Zakaria H, Kalayasiri R, Adlan ASA, et al.
    Psychiatr. Clin. North Am., 2018 06;41(2):305-318.
    PMID: 29739528 DOI: 10.1016/j.psc.2018.01.010
    Psychodynamic psychiatry remains a challenging subject to teach in underserved areas, where enthusiasm to learn is substantial. Besides logistical and psychiatric workforce shortcomings, sensible cultural adaptations to make psychodynamic psychiatry relevant outside of high-income countries require creative effort. Innovative pedagogical methods that include carefully crafted mentoring and incorporate videoconferencing in combination with site visits can be implemented through international collaborations. Emphasis on mentoring is essential to adequately train future psychodynamic psychotherapy supervisors. Examples of World Psychiatric Association initiatives in countries such as Indonesia, Iran, Malaysia, and Thailand are presented as possible models to emulate elsewhere.
  19. Castillo-Carandang NT, Buenaventura RD, Chia YC, Do Van D, Lee C, Duong NL, et al.
    Risk Manag Healthc Policy, 2020;13:803-819.
    PMID: 32765135 DOI: 10.2147/RMHP.S256165
    Introduction: Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality in the Association of Southeast Asian Nations (ASEAN) member states. Progress has been slow despite the World Health Organization action plan for the prevention and control of NCDs in the region. This paper presents recommendations focused on practical strategies for optimizing NCD management in the ASEAN region.

    Methods: A multidisciplinary group of experts from six ASEAN member states convened for two face-to-face meetings to discuss barriers and possible recommendations for optimizing NCD management, focused on cardiovascular diseases and mental disorders, in the region. Multiple approaches, ie, analysis of insights from the meetings and a review of existing literature on NCD programs in the ASEAN region were followed. The proposed recommendations were also based on selected successful interventions in ASEAN member states, thus providing actionable strategies.

    Results: The gaps identified in NCD management for cardiovascular diseases and mental disorders in the ASEAN region were classified into gaps relating to policies and to clinical and public health practice. The proposed solutions addressing policy gaps include fostering multisectoral public-private partnerships, employing "whole-of-government" and "whole-of-society" approaches and promoting "health-in-all policies approach" to manage issues with financing, accessibility, efficiency and quality of health services. Whereas proposed solutions to bridge clinical and public health practice gaps entail strengthening primary care services, building the capacity of trained healthcare workers and employing collaborative care for holistic management of patients.

    Conclusion: The scale of premature and preventable deaths from NCDs in the ASEAN region remains a serious public health concern and requires a "whole-of-system approach". The interventions proposed in this paper build on regional collaborations and knowledge sharing to help develop a concerted and targeted response to NCDs.

  20. Lim JTY, Cheng Q, Ng YP, Pheh KS, Panirselvam RR, Tay KW, et al.
    Front Psychol, 2021;12:666027.
    PMID: 34975604 DOI: 10.3389/fpsyg.2021.666027
    Background: Suicide remains an important cause of premature deaths and draws much media attention. However, unsafe reporting and portrayal of suicides by the media have been associated with increased risk of suicidal behavior. Current evidence suggests that media capacity-building could potentially prevent suicide. However, there are still knowledge gaps in terms of a lack of data on effective strategies for improving awareness and safe reporting of suicide-related media content. This study aims to investigate the effectiveness of a workshop conducted with members of the media community on the safe reporting of suicide-related content. Methods: An interventional single-arm pre and post pilot study was conducted on a sample of the Malaysian media community recruited through purposive and snowball sampling. The media safe reporting workshop was conducted by a suicide prevention expert with a media industry background. Thirty participants completed a self-reported evaluation questionnaire on their awareness and knowledge of reporting on suicide-related media content; before and after the interventional workshop. Results: There was a significant difference between the total scores before and after the intervention, with a large effect size. Post-intervention scores were significantly improved in 8 items, namely those related to the reporting of: (i) the content of any suicide note; (ii) headlines with methods of suicide; (iii) headlines with the location of suicide; (iv) cases of suspected suicide despite the unconfirmed cause of death; (v) suicide news to cater to readers' interests; (vi) cause of suicide; (vii) details of the location of suicide; and (viii) the negative impact to media community when reporting suicide stories. In particular, there was an improvement in the majority of items for people from the media community with no lived experience of suicidal behavior. Conclusion: The media safe reporting workshop is a potentially effective intervention for improving awareness and knowledge measures relating to safe reporting on suicide among the media community, with a more pronounced effect in those without lived experience of suicidal behavior. Limitations in the sample size, generalizability, short-term evaluation, and lack of a control group warrant future larger, longer-term controlled, and more representative studies.
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