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Fulltext Assessment of monosodium glutamate (MSG) intake in a rural Thai community: questioning the methodological approach

Chinna K, Karupaiah T

Nutr Metab (Lond), 2013;10(1):52.
PMID: 23890489 DOI: 10.1186/1743-7075-10-52

We examined the methodological approach to the assessment of monosodium glutamate intake. The high carbohydrate and low fat consumption characteristic of this study population would be conducive to the development of metabolic syndrome. However, anomalies in the assessment of dietary information limits conclusion to a causal link of monosodium glutamate to metabolic syndrome and overweight because the study lacks data on the main dietary patterns of consumption. Given the current paucity of data from human studies on monosodium glutamate intake and risk, more studies with robust methodology are required to assess causal links to disease.
Fulltext Depression, distress and self-efficacy: The impact on diabetes self-care practices

Devarajooh C, Chinna K

PLoS One, 2017;12(3):e0175096.
PMID: 28362861 DOI: 10.1371/journal.pone.0175096

The prevalence of type 2 diabetes is increasing in Malaysia, and people with diabetes have been reported to suffer from depression and diabetes distress which influences their self-efficacy in performing diabetes self-care practices. This interviewer administered, cross sectional study, conducted in the district of Hulu Selangor, Malaysia, involving 371 randomly selected patients with type 2 diabetes, recruited from 6 health clinics, aimed to examine a conceptual model regarding the association between depression, diabetes distress and self-efficacy with diabetes self-care practices using the partial least square approach of structural equation modeling. In this study, diabetes self-care practices were similar regardless of sex, age group, ethnicity, education level, diabetes complications or type of diabetes medication. This study found that self-efficacy had a direct effect on diabetes self-care practice (path coefficient = 0.438, p<0.001). Self-care was not directly affected by depression and diabetes distress, but indirectly by depression (path coefficient = -0.115, p<0.01) and diabetes distress (path coefficient = -0.122, p<0.001) via self-efficacy. In conclusion, to improve self-care practices, effort must be focused on enhancing self-efficacy levels, while not forgetting to deal with depression and diabetes distress, especially among those with poorer levels of self-efficacy.
Study site: 6 primary health clinics (Klinik Kesihatan), Hulu Selangor. Selangor. Malaysia
Fulltext Effectiveness of progressive muscle relaxation therapy as a worksite health promotion program in the automobile assembly line

Sundram BM, Dahlui M, Chinna K

Ind Health, 2016 Jun 10;54(3):204-14.
PMID: 26726829 DOI: 10.2486/indhealth.2014-0091

The aim of this study was to examine the effectiveness of Progressive Muscle Relaxation (PMR) as part of a Worksite Health Promotion Program on self-perceived stress, anxiety and depression among male automotive assembly-line workers through a quasi-experimental trial. Two assembly plants were chosen with one receiving PMR therapy and the other Pamphlets. Intention-to-treat analysis was conducted to test the effectiveness of the relaxation therapy. Stress, Depression and Anxiety levels were measured using the shortened DASS-21 questionnaire. Data were analyzed using Chi-square, Independent sample t test and Repeated-measures analysis of variance to test the significance of the effects of intervention (time * group) for the measures of Stress, Depression and Anxiety. Significant favourable intervention effects on stress were found in the PMR group (Effect size=0.6) as compared to the Pamphlet group (Effect size=0.2). There was a significant group *time interaction effect (p<0.001) on Stress levels. Depression and Anxiety levels were minimal at baseline in both the groups with mild or no reduction in levels. The improvement in stress levels showed the potential of PMR therapy as a coping strategy at the workplace. Further research in this field is necessary to examine the beneficial effects of coping strategies in the workplace.
Fulltext Community knowledge, health beliefs, practices and experiences related to dengue fever and its association with IgG seropositivity

Wong LP, AbuBakar S, Chinna K

PLoS Negl Trop Dis, 2014 May;8(5):e2789.
PMID: 24853259 DOI: 10.1371/journal.pntd.0002789

Demographic, economic and behavioural factors are central features underpinning the successful management and biological control of dengue. This study aimed to examine these factors and their association with the seroprevalence of this disease.
Rate of decline of kidney function in patients with type 2 diabetes mellitus and the associated factors: a 10-year retrospective cohort study

Tan SF, Chia YC, Chinna K

Asia Pac J Public Health, 2015 Mar;27(2):NP640-9.
PMID: 23761589 DOI: 10.1177/1010539513490193

This study examines the rate of decline of estimated glomerular filtration rate (eGFR) over a 10-year period and the associated risk factors in type 2 diabetes mellitus (T2DM) patients. Medical records of T2DM patients were randomly selected. The rate of fall in eGFR (simplified modification of diet in renal disease formula) was used as a measure of decline. Univariate and multivariate analysis were performed to determine the factors associated with decline of kidney function. A total of 504 patients were selected. Mean age was 57.8 ± 9 years; 65.3% were females. The mean decline rate of eGFR was 0.89 ± 2.16 mL/min/1.73 m(2)/y. Baseline proteinuria, glycosylated hemoglobin level, duration of T2DM, and Malay race were associated with faster decline in eGFR. The expected greater deterioration in kidney function in this cohort was not seen. Treatment of proteinuria and glycemia should be optimized early to retard the decline in kidney function in patients with T2DM.
Study site: Primary care clinics, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Psychometric properties of DAPonDEN: definitions, attitudes and practices in relation to diarrhea during enteral nutrition questionnaire

Majid HA, Bin Sidek MA, Chinna K

Prev Med, 2013;57 Suppl:S64-6.
PMID: 23298820 DOI: 10.1016/j.ypmed.2012.12.021

To investigate the psychometric properties of the developed 21 item questionnaire to measure definitions, attitudes and management practices in relation to diarrhea during enteral nutrition (DAPonDEN).
Fulltext [Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose]

Lim HJ, Hasan MS, Chinna K

Rev Bras Anestesiol, 2016 Jul-Aug;66(4):341-5.
PMID: 27155777 DOI: 10.1016/j.bjan.2016.04.006

A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline.
Fulltext Calcium intake, vitamin D and bone health status of post-menopausal Chinese women in Kuala Lumpur

Chee, W.S.S., Chong, P.N., Chuah, K.A., Karupaiah, T ., Norlaila Mustafa, Seri Suniza, S., et al.

Malays J Nutr, 2010;16(2):233-242.
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Bone health status was investigated in 178 free-living Chinese post-menopausal women in Kuala Lumpur. Body mass index (BMI), body composition (using whole body DXA), calcium intake and serum 25-OH vitamin D status were measured along with biochemical markers of bone turnover, that is, pro-collagen Type 1 N-terminal peptide (P1NP), osteocalcin (OC) and C-telopeptide ß cross
link of Type 1 collagen (CTX- β). Bone mineral density (BMD) was measured using DXA (Hologic, USA) at the lumbar spine, femoral neck and total hip. Results showed that osteopenia was present in 50% of the subjects at the spine and 57.9% at the femoral neck. Osteoporosis was diagnosed in 10% of the subjects at both the femoral neck and spine. A total of 29.3% of the subjects had high
levels of CTX- ß. Mean serum level of 25-OH vitamin D was 60.4+15.6 nmol/L and 50.6% of the subjects had hypovitaminosis D (defined as
Fulltext Factors associated with healthcare workers willingness to participate in disasters: a cross-sectional study in Sana'a, Yemen

Al-Hunaishi W, Hoe VC, Chinna K

BMJ Open, 2019 10 17;9(10):e030547.
PMID: 31628126 DOI: 10.1136/bmjopen-2019-030547

OBJECTIVES: Willingness to participate in disasters is usually overlooked and not addressed in disaster preparedness training courses to ensure health service coverage. This will lead to issues during the disaster's response. This study, therefore, aims to assess healthcare workers willingness to participate in biological and natural disasters, and to identify its associated factors.
DESIGN: This is a cross-sectional study using a self-administered questionnaire. The questionnaire was distributed to 1093 healthcare workers. The data were analysed using multiple logistic regression with significance level p<0.05. Ethical clearance and consent of the participants were duly obtained.
SETTING: In three public hospitals that provide tertiary-level healthcare in Sana'a City, Yemen.
PARTICIPANTS: There were 692 nurses and doctors (response rate 63.3%) completed the questionnaires.
RESULTS: Almost half of the participants 55.1% were nurses and 44.9% were doctors. The study found that self-efficacy was associated with willingness to participate in disaster response for any type of disasters (OR 1.319, 95% CI 1.197 to 1.453), natural disasters (OR 1.143, 95% CI 1.069 to 1.221) and influenza pandemic (OR 1.114, 95% CI 1.050 to 1.182). The results further show that willingness is associated with healthcare workers being young, male and having higher educational qualifications.
CONCLUSION: Self-efficacy has been found to be an important factor associated with willingness. Improving self-efficacy through training in disaster preparedness may increase willingness of healthcare workers to participate in a disaster.
Psychometrics assessment of HeartQoL questionnaire: A Rasch analysis

Ling Lee W, Chinna K, Sumintono B

Eur J Prev Cardiol, 2020 Feb 03.
PMID: 32013603 DOI: 10.1177/2047487320902322
Fulltext Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose

Lim HJ, Hasan MS, Chinna K

Braz J Anesthesiol, 2016 Jul-Aug;66(4):341-5.
PMID: 27343781 DOI: 10.1016/j.bjane.2014.11.012

BACKGROUND AND OBJECTIVES: A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline.

METHODS: Patients scheduled for upper limb surgery were randomized to receive ultrasound guided supraclavicular brachial plexus block with 0.5% ropivacaine. Evaluation of sensory and motor blockade was performed every 5min for 60min. Patients were followed-up on postoperative day 1, and between days 7 and 10 for the presence of any complications. Twenty-five patients in each group were analyzed.

RESULTS: Mean time for onset of analgesia for the dextrose group was 37.6±12.9min while the mean time for the saline group was 45.2±13.9min with a p-value of 0.05. The effect size was 0.567, which was moderate to large. No major complications were observed.

CONCLUSION: We conclude that there was a decrease in onset time of analgesia when dextrose was used as a diluent instead of saline for ultrasound guided supraclavicular block.
Sleep disturbances and their association with behaviour in children with autism spectrum disorder: A cross-sectional study

Kaur H, Chinna K, Sivanesom R

Singapore Med J, 2023 Apr 14.
PMID: 37077060 DOI: 10.4103/singaporemedj.SMJ-2021-425

INTRODUCTION: In this study, we aimed to determine the prevalence of sleep disturbances among children aged 2-5 years with autism spectrum disorder (ASD) and their association with behaviour in these children.
METHOD: A cross-sectional study was conducted at Hospital Tunku Azizah, Kuala Lumpur, Malaysia, from June 2020 to December 2020. Children between 2 and 5 years old, diagnosed with ASD based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, were recruited. Two parent-reported questionnaires, the Children's Sleep Habits Questionnaire (CSHQ) and the Child Behaviour Checklist (CBCL/1.5-5), were used to assess sleep and behaviour, respectively. Children were classified as good sleepers (CSHQ score <41) and poor sleepers (CSHQ score ≥41). Poor sleepers were further categorised into those with mild or moderate to severe sleep problems (based on the 75th percentile CSHQ score). The CBCL/1.5-5 raw scores were converted to standardise T-scores, yielding scores of three summary scales (internalising, externalising and total problems).
RESULTS: A total of 134 children participated in this study. Their mean age was 42.23 ± 9.95 months, and 81.3% were males. Mean CSHQ score was 49.77 ± 6.90, and 93.3% were poor sleepers. Internalising, externalising and total problems scores were significantly higher in poor sleepers (62, 59 and 62, respectively) compared to good sleepers (56, 47 and 51, respectively). Children with moderate to severe sleep problems had clinical scores of internalising (median 65) and externalising (median 65) problems, as compared to mild sleep problems (median internalising score 61, median externalising score 57).
CONCLUSION: Sleep disturbances are prevalent among children with ASD. Poor sleep quality is associated with more behavioural problems.
"Taking my breath away by keeping stress at bay" - an employee assistance program in the automotive assembly plant

Sundram BM, Dahlui M, Chinna K

Iran J Public Health, 2014 Mar;43(3):263-72.
PMID: 25988085

The aim of this study was to evaluate the effectiveness of individual-focused stress management training namely Deep Breathing Exercise (DBE) on self-perceived occupational stress among male automotive assembly-line workers.
Metering Self-Reported Adherence to Clinical Outcomes in Malaysian Patients With Hypertension: Applying the Stages of Change Model to Healthful Behaviors in the CORFIS Study

Karupaiah T, Wong K, Chinna K, Arasu K, Chee WS

Health Educ Behav, 2015 Jun;42(3):339-51.
PMID: 25512075 DOI: 10.1177/1090198114558588

The CORFIS (Community-Based Cardiovascular Risk Factors Intervention Strategies) program was piloted in community clinics in Malaysia to address the lack of health education in chronic disease management. The stages of change model was applied in a multicenter quasi-experimental design to evaluate adherence to advocated behaviors in CORFIS patients with hypertension. Based on submitted diet and exercise records (n = 209), adherence to sodium reduction, regular exercise, and increasing fruit and vegetable intake behaviors were quantified against weight, waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) changes. Patients were categorized at 6 months into nonadherent/N-A (Precontemplation, Contemplation, and Preparation), newly adherent/NA (Action) and totally adherent/TA (Maintenance) groups. Self-reported adherence records did not meet recommended targets for healthful behaviors, but clinical benefits were achieved by adherent groups as indicated by effect size (Cohen's d) comparisons. SBP reduction was associated with adherence to sodium reduction in NA (d = 0.60, p < .001) and TA (d = 0.45, p < .001) compared to N-A (d = 0.13, p > .05). Marginally increasing fruit and vegetable consumption (Δ = 0.41 servings) resulted in sizeable reductions in weight for NA (d = 0.81, p < .001) > TA (d = 0.54, p < .001) > N-A (d = 0.21, p > .05) and in WC for NA (d = 0.68, p < .00) > TA (d = 0.53, p < .001) > N-A (d = 0.52, p > .05). Exercise behavior was least successful as pedometer counting was below 10,000 steps but sizeable weight and WC reductions were largest for NA (d = 0.71 and 0.79, respectively) > TA (d = 0.60 and 0.53, respectively) > N-A (d = 0.33 and 0.35, respectively). Patients reporting a shift to positive stages of change behaviors enjoyed clinically beneficial reductions in SBP, DBP, weight, and WC.
Fulltext High producing tumor necrosis factor alpha gene alleles in protection against severe manifestations of dengue

Sam SS, Teoh BT, Chinna K, AbuBakar S

Int J Med Sci, 2015;12(2):177-86.
PMID: 25589894 DOI: 10.7150/ijms.8988

Dengue virus (DENV) infection usually presents with mild self-limiting dengue fever (DF). Few however, would present with the more severe form of the disease, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). In the present study, the association between IL-12B, IL-10 and TNF-α gene polymorphisms and dengue severity was investigated.
METHODS: A case-control study was performed on a total of 120 unrelated controls, 86 DF patients and 196 DHF/DSS patients. The polymorphisms in IL-12B, IL-10 and TNF-α genes were genotyped using PCR-RFLP and PCR-sequencing methods.
RESULTS: A protective association of TNF-α -308A allele and -308GA genotype against DHF/DSS was observed, while TNF-α -238A allele and -238GA genotype were associated with DHF/DSS. A combination of TNF-α -308GA+AA genotype and IL-10 non-GCC haplotypes, IL-12B pro homozygotes (pro1/pro1, pro2/pro2) and IL-12B 3'UTR AC were significantly correlated with protective effects against DHF/DSS. An association between the cytokine gene polymorphisms and protection against the clinical features of severe dengue including thrombocytopenia and increased liver enzymes was observed in this study.
CONCLUSION: The overall findings of the study support the correlation of high-producer TNF-α genotypes combined with low-producer IL-10 haplotypes and IL-12B genotypes in reduced risk of DHF/DSS.
KEYWORDS: Infectious disease; cytokine; dengue; genetics; polymorphism.; tropical
Insight into elder abuse among urban poor of Kuala Lumpur, Malaysia-a middle-income developing country

Sooryanarayana R, Choo WY, Hairi NN, Chinna K, Bulgiba A

J Am Geriatr Soc, 2015 Jan;63(1):180-2.
PMID: 25597571 DOI: 10.1111/jgs.13217
Fulltext Effect of vitamin D supplementation on cardiometabolic risks and health-related quality of life among urban premenopausal women in a tropical country--a randomized controlled trial

Ramly M, Ming MF, Chinna K, Suboh S, Pendek R

PLoS One, 2014;9(10):e110476.
PMID: 25350669 DOI: 10.1371/journal.pone.0110476

Many observational studies linked vitamin D to cardiometabolic risks besides its pivotal role in musculoskeletal diseases, but evidence from trials is lacking and inconsistent.
Pain experience and satisfaction with postoperative pain control among surgical patients

Subramanian P, Ramasamy S, Ng KH, Chinna K, Rosli R

Int J Nurs Pract, 2016 Jun;22(3):232-8.
PMID: 25355297 DOI: 10.1111/ijn.12363

Alleviating acute pain and providing pain relief are central to caring for surgical patients as pain can lead to many adverse medical consequences. This study aimed to explore patients' experience of pain and satisfaction with postoperative pain control. A cross-sectional survey was carried out among 107 respondents who had undergone abdominal surgery in the surgical ward of an urban hospital using the Revised American Pain Society's Patient Outcome and Satisfaction Survey Questionnaires (APS-POQ-R). Data were analysed using descriptive statistics and chi-square test. Chi-square test showed significant association between race (P = 0.038), education level (P ≤ 0.001), previous operation status (P = 0.032) and operation status (P ≤ 0.001). Further analysis on nominal regression, association between dissatisfaction with factors of operation status (46.09 (95% CI 7.456, 284.947)) and previous operation status (13.38 (95% CI 1.39, 128.74)) was found to be significant. Moderate to high levels of pain intensity in the last 24 h after surgery, as well as moderate to high rates of pain-related interference with care activities were most reported. Pain still remains an issue among surgical patients, and effective pain management and health education are needed to manage pain more effectively after surgery.
Fulltext Reliability and validity of the Nigerian (Hausa) version of the Stroke Impact Scale (SIS) 3.0 index

Mohammad AH, Al-Sadat N, Siew Yim L, Chinna K

Biomed Res Int, 2014;2014:302097.
PMID: 25276774 DOI: 10.1155/2014/302097

This study aims to test the translated Hausa version of the stroke impact scale SIS (3.0) and further evaluate its psychometric properties. The SIS 3.0 was translated from English into Hausa and was tested for its reliability and validity on a stratified random sample adult stroke survivors attending rehabilitation services at stroke referral hospitals in Kano, Nigeria. Psychometric analysis of the Hausa-SIS 3.0 involved face, content, criterion, and construct validity tests as well as internal and test-retest reliability. In reliability analyses, the Cronbach's alpha values for the items in Strength, Hand function, Mobility, ADL/IADL, Memory and thinking, Communication, Emotion, and Social participation domains were 0.80, 0.92, 0.90, 0.78, 0.84, 0.89, 0.58, and 0.74, respectively. There are 8 domains in stroke impact scale 3.0 in confirmatory factory analysis; some of the items in the Hausa-SIS questionnaire have to be dropped due to lack of discriminate validity. In the final analysis, a parsimonious model was obtained with two items per construct for the 8 constructs (Chi-square/df < 3, TLI and CFI > 0.9, and RMSEA < 0.08). Cross validation with 1000 bootstrap samples gave a satisfactory result (P = 0.011). In conclusion, the shorter 16-item Hausa-SIS seems to measure adequately the QOL outcomes in the 8 domains.
Depressive symptoms in children with chronic gastrointestinal disorders

Jayanath S, Lee WS, Chinna K, Boey CC

Pediatr Int, 2014 Aug;56(4):583-7.
PMID: 24617982 DOI: 10.1111/ped.12335

BACKGROUND: Children with chronic illness may have depressive symptoms. The purpose of this study was to determine the prevalence of depressive symptoms among children attending a pediatric gastroenterology outpatient clinic in Malaysia, and whether it differed by age, gender and diagnosis.
METHODS: This was a cross-sectional study, with data collected over a 16 month period (April 2010-July 2011). Patients aged 7-17 years on follow up at the pediatric gastroenterology clinic at University Malaya Medical Centre, Kuala Lumpur, were recruited consecutively. They were classified into high, average and low scores based on responses to questions in the Children's Depression Inventory (CDI; high, T-score >55; average, T-score 45-55; low, T-score <45). Children with high scores were considered to have depressive symptoms.
RESULTS: The response rate was 93%. One hundred children (44 boys; 56 girls) were studied. Major diagnoses were: functional abdominal pain (n = 22), inflammatory bowel disease (n = 26), biliary atresia (n = 17) and miscellaneous gastrointestinal conditions (n = 35). The overall prevalence of high CDI for depressive symptoms was 27.0%, while 43.0% and 30.0% had average and low scores, respectively. There were no significant differences in the prevalence of high scores among children with different diagnoses.
CONCLUSIONS: Depressive symptoms were common among children attending a pediatric gastroenterology clinic. It is important to recognize symptoms of depression in children with gastrointestinal disorders.
KEYWORDS: Children's Depression Inventory; depression; gastrointestinal disorders; outpatient; pediatric

Study site: Pediatric gastroenterology clinic, University Malaya Medical Centre (UMMC)

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