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Fulltext Exploration of barriers to breast-self examination among urban women in Shah Alam, Malaysia: a cross sectional study

Al-Dubai SA, Ganasegeran K, Alabsi AM, Abdul Manaf MR, Ijaz S, Kassim S

Asian Pac J Cancer Prev, 2012;13(4):1627-32.
PMID: 22799379

BACKGROUND: Breast cancer is the most common cancer among women in Malaysia. Barriers for practicing breast self examination (BSE) await exploration.

OBJECTIVE: To assess the practice of BSE and its correlated factors and particularly barriers amongst urban women in Malaysia.

METHODS: This cross-sectional study was conducted with 222 Malaysian women using a self-administered questionnaire.

RESULTS: The mean (SD) age was 28.5 (±9.2) years, 59.0% were university graduates. Of the total, 81.1% were aware of breast cancer and 55% practiced BSE. Amongst 45% of respondents who did not practice BSE, 79.8% did not know how to do it, 60.6% feared being diagnosed with breast cancer, 59.6% were worried about detecting breast cancer, 22% reported that they should not touch their bodies, 44% and 28% reported BSE is embarrassing or unpleasant, 29% time consuming, 22% thought they would never have breast cancer or it is ineffective and finally 20% perceived BSE as unimportant. Logistic regression modeling showed that respondents aged ≥45 years, being Malay, married and having a high education level were more likely to practice BSE (p<0.05).

CONCLUSION: In this study sample, a significant proportion of respondents was aware of breast cancer but did not practice BSE. Knowledge, psychological, cultural, perception and environmental factors were identified as barriers. BSE practice was associated significantly with socio-demographic factors and socioeconomic status.
Fulltext Social and psychological factors affecting eating habits among university students in a Malaysian medical school: a cross-sectional study

Ganasegeran K, Al-Dubai SA, Qureshi AM, Al-abed AA, Am R, Aljunid SM

Nutr J, 2012;11:48.
PMID: 22809556 DOI: 10.1186/1475-2891-11-48

BACKGROUND: Eating habits have been a major concern among university students as a determinant of health status. The aim of this study was to assess the pattern of eating habits and its associated social and psychological factors among medical students.
METHODS: A cross sectional study was conducted among 132 medical students of pre-clinical phase at a Malaysian university. A self-administered questionnaire was used which included questions on socio-demography, anthropometry, eating habits and psychosocial factors.
RESULTS: Mean (± SD) age of the respondents was 22.7 (± 2.4) years and (the age) ranged from 18 to 30 years. More than half had regular meals and breakfast (57.6% &, 56.1% respectively). Majority (73.5%) consumed fruits less than three times per week, 51.5% had fried food twice or more a week and 59.8% drank water less than 2 liters daily. Eating habits score was significantly low among younger students (18-22 years), smokers, alcohol drinkers and those who did not exercise. (p<0.05). Four psychological factors out of six, were significantly associated with eating habits (p<0.05). In multivariate analysis, age and 'eating because of feeling happy' were significantly associated with eating habits score (p<0.05).
CONCLUSION: Most of the students in this study had healthy eating habits. Social and psychological factors were important determinants of eating habits among medical students.
Study site: Management and Science University, Selangor, Malaysia
Scales & Questionnaires: Compulsive Eating Scale
Apoptosis induction, cell cycle arrest and in vitro anticancer activity of gonothalamin in a cancer cell lines

Alabsi AM, Ali R, Ali AM, Al-Dubai SA, Harun H, Abu Kasim NH, et al.

Asian Pac J Cancer Prev, 2012;13(10):5131-6.
PMID: 23244123

Cancer is one of the major health problems worldwide and its current treatments have a number of undesired adverse side effects. Natural compounds may reduce these. Currently, a few plant products are being used to treat cancer. In this study, goniothalamin, a natural occurring styryl-lactone extracted from Goniothalamus macrophyllus, was investigated for cytotoxic properties against cervical cancer (HeLa), breast carcinoma (MCF-7) and colon cancer (HT29) cells as well as normal mouse fibroblast (3T3) using MTT assay. Fluorescence microscopy showed that GTN is able to induce apoptosis in HeLa cells in a time dependent manner. Flow cytometry further revealed HeLa cells treated with GTN to be arrested in the S phase. Phosphatidyl serine properties present during apoptosis enable early detection of the apoptosis in the cells. Using annexin V/PI double staining it could be shown that GTN induces early apoptosis on HeLa cells after 24, 48 and 72 h. It could be concluded that goniothalamin showing a promising cytotoxicity effect against several cancer cell lines including cervical cancer cells (HeLa) with apoptosis as the mode of cell death induced on HeLa cells by Goniothalamin was.
Fulltext Awareness and knowledge of oral cancer among university students in Malaysia

Al Dubai SA, Ganasegeran K, Alabsi AM, Alshagga MA, Ali RS

Asian Pac J Cancer Prev, 2012;13(1):165-8.
PMID: 22502661

OBJECTIVES: This study aimed to assess the level of knowledge of oral cancer and its associated factors among university students in Malaysia.

METHODS: A cross sectional study was conducted among 200 university students in Malaysia. A self administered questionnaire was used to collect data. It included questions on socio- demographic data, awareness and knowledge of oral cancer.

RESULTS: Mean age of the respondents was 21.5 ± 2.5 and the age ranged from 18 to 27 years. The majority of the respondents were aware of oral cancer (92.0%) and recognized the followings as signs and symptoms of oral cancer: ulcer and oral bleeding (71.0%), followed by swelling (61.5%). A satisfactory knowledge was observed on the following risk factors; smoking (95.5%), poor oral hygiene (90.5%), family history (90.0%), alcohol (84.5%) and poor fitting dentures (83.0%). However, unsatisfactory knowledge was observed about hot/spicy food (46.5%), obesity (36.0%), old age (31.5%), dietary factor (29.0%) and smokeless tobacco (25.5%). Knowledge of oral cancer was associated significantly with age (p<0.01), year of study (p<0.01) and course of study (p<0.01).

CONCLUSION: Instead of satisfactory awareness and knowledge of oral cancer and its clinical presentations, inadequate knowledge was observed about its risk factors. There is a need to introduce oral cancer education among university students.
Fulltext Use of complementary and alternative medicine among asthmatic patients in primary care clinics in Malaysia

Alshagga MA, Al-Dubai SA, Muhamad Faiq SS, Yusuf AA

Ann Thorac Med, 2011 Jul;6(3):115-9.
PMID: 21760841 DOI: 10.4103/1817-1737.82438

OBJECTIVES: This study aimed to determine the knowledge about asthma and the prevalence, disclosure and evaluation of the use of complementary and alternative medicine (CAM) among asthmatic patients.
METHODS: This cross-sectional study was conducted on 95 patients diagnosed with asthma in a primary healthcare centre in Kuala Lumpur, Malaysia using a self-administered questionnaire.
RESULTS: Ninety-five patients with a mean age of 47.06 years (±12.8) participated, the majority were female (66.7%), Malay (72.6%). The prevalence of ever-CAM use was 61.1%. The non-ever-CAM users' mean age was 51±13.9 years while the ever-CAM users' mean age was 44.5 ±11.5 years (P = 0.021). Sixty-three females (66.8%) used CAM compared to 14 males (43.8%) (P = 0.014). Thirty-six (62.1%) CAM users had not discussed use of CAM with their doctors. The main reason of non-disclosure was the doctor never asked (55.6%), and the main sources of information about CAM were family and relatives (46.6%). There was no significant difference between use of CAM and knowledge about asthma. The majority of asthmatic patients used rubs (39%), foods (16.9%) and herbs (16.9%). About 76% of asthmatic patients perceived CAM as good for their disease management. On linear multiple regression, Malay race (P = 0.026) and female gender (P = 0.006) were significant predictors of CAM use.
CONCLUSION: Use of CAM among asthmatic patients is relatively high, particularly among females. The majority of asthmatic patients valued the use of CAM. Non-disclosure was high in this study. Health education of asthmatic patients about CAM is highly recommended.
KEYWORDS: Asthma; Malaysia; complementary and alternative medicine; disclosure
Study site: Primary care clinic, Hospital Kuala Lumpur, Malaysia
Fulltext Stress and coping strategies of students in a medical faculty in malaysia

Al-Dubai SA, Al-Naggar RA, Alshagga MA, Rampal KG

Malays J Med Sci, 2011 Jul;18(3):57-64.
PMID: 22135602 MyJurnal

Stress may affect students' health and their academic performance. Coping strategies are specific efforts that individuals employ to manage stress. This study aimed to assess the perception of stress among medical students and their coping strategies.
Awareness and knowledge of breast cancer and mammography among a group of Malaysian women in Shah Alam

Al-Dubai SA, Qureshi AM, Saif-Ali R, Ganasegeran K, Alwan MR, Hadi JI

Asian Pac J Cancer Prev, 2011;12(10):2531-8.
PMID: 22320951

OBJECTIVES: The aim of this study was to assess awareness and knowledge of breast cancer and mammography among Malaysian women in Shah Alam.
METHODS: This cross sectional study was conducted among 250 Malaysian women. Data were collected using a self administrated questionnaire which included questions on socio-demographic data, knowledge of breast cancer and awareness of mammography.
RESULTS: Mean age of respondents was 28 ± 9.2 with 69.2% aged 18 to 29 years. The majority had heard about breast cancer (81.2%) and indicated books, magazines and brochures as their source of information (55.2%). However, most did not know about signs and symptoms of breast cancer and many of its risk factors. On multivariate analysis, significant predictors of breast cancer knowledge were age, race, marital status, level of education, occupation, family size and family history of other cancers (p<0.05). Fifty percent of women were aware of mammography, significant predictors being age, occupation, marital status and knowledge of breast cancer (p<0.05).
CONCLUSION: Most women were aware of breast cancer. However, the knowledge about signs and symptoms of breast cancer and awareness of mammography were inadequate. It is recommended that the level of knowledge should be raised among Malaysian women, particularly in the less educated young.
Fulltext Prevalence and of smoking and associated factors among Malaysian University students

Al-Naggar RA, Al-Dubai SA, Al-Naggar TH, Chen R, Al-Jashamy K

Asian Pac J Cancer Prev, 2011;12(3):619-24.
PMID: 21627354

OBJECTIVE: The objectives were to determine the prevalence and associated factors for smoking among university students in Malaysia.
METHODOLOGY: A cross-sectional study was conducted among 199 students in the period from December of academic year 2009 until April of academic year 2010 in Management and Science University (MSU), Shah Alam, Selangor, Malaysia. The questionnaire was distributed randomly to all faculties of MSU by choosing one of every 3 lecture rooms, as well as the library and cafeterias of the campus randomly by choosing one from every 3 tables. Questions concerned socio-demographic variables, knowledge, attitudes and practice toward smoking. Participant's consent was obtained and ethical approval was provided by the ethics committee of the University. Data entry and analysis were performed using descriptive statistics, chi square test, Student t- test and logistic multiple regression with the SPSS version 13.0, statistical significance being concluded at p < 0.05.
RESULTS: About one third of students were smokers (29%). The most important reason of smoking was stress (20%) followed by 'influenced by friends' (16 %). Prevalence of smoking was significantly higher among male and those in advanced semesters (p = >0.001, p = 0.047). Smokers had low level of knowledge (p < 0.05), had wrong beliefs on smoking (p < 0.05), and negative attitude toward tobacco control policies compared to non smokers (p < 0.05). On multiple logistic regression, significant predictors of smoking in the model were gender (p = 0.025), age (p = 0.037), semester of study (p = 0.025) and attitude toward smoking (p < 0.001).
CONCLUSION: This study found that 29% of university students were smokers. Males and students in advanced semesters were more likely to smoke. The results provide baseline data to develop an anti-smoking program to limit smoking in the university by implementing policies against smoking.
Fulltext Knowledge, attitudes and barriers for human papilloma virus (HPV) vaccines among Malaysian women

Al-Dubai SA, Alshagga MA, Al-Naggar RA, Al-Jashamy K, Baobaid MF, Tuang CP, et al.

Asian Pac J Cancer Prev, 2010;11(4):887-92.
PMID: 21133596

A cross-sectional study was conducted among 300 Malaysian women in the obstetrics and gynecology outpatient clinic in a selected hospital in Bangi, Selangor to determine the level of knowledge of HPV and HPV vaccines, attitudes toward HPV vaccination and barriers of being vaccinated. Factors associated with knowledge and attitudes were also addressed with a questionnaire. Seventy eight women (26%) had heard about the HPV virus and 65 about HPV vaccines (21.7%). Marital status was associated significantly with awareness of HPV and HPV vaccine (p=0.002, p=0.002; respectively), in addition to level of education (p=0.042). The percentages of women who reported correct answers for the questions on knowledge of HPV and HPV vaccine ranged from 12% to 25%. One hundred fifty nine respondents (53%) had a positive attitude toward HPV vaccination. Age, marital status, and level of education were associated significantly with attitude (p<0.001, p<0.001, p=0.002; respectively). The most important barriers reported were 'unawareness of the vaccine' 'concerned about side effects' and 'afraid of needles'. This study found a very low level of knowledge of HPV and HPV vaccine. Education of population is highly recommended and barriers to being vaccinated should be dealt with seriously.
Study site: Hospital, Bangi, Selangor, Malaysia
Fulltext Prevalence and associated factors of burnout among doctors in Yemen

Al-Dubai SA, Rampal KG

J Occup Health, 2010;52(1):58-65.
PMID: 19907108

OBJECTIVES: This study aimed to determine the level and factors contributing to burnout among doctors in Sana'a City, Yemen and to determine the relationship between burnout and psychological morbidity.

METHODS: This was a cross-sectional study of 563 working doctors in the four main hospitals in Sana'a City, Yemen. The 12-item version of the General Health Questionnaire (GHQ12) was used as a measure of psychological morbidity and the 22-item Maslach Burnout Inventory (MBI) was used to measure emotional exhaustion, depersonalization, and personal accomplishment. Sources of job stress were determined using a 37-item scale questionnaire. The questionnaire elicited information about socio-demographic and work characteristics.

RESULTS: On the MBI, 356 doctors showed high emotional exhaustion (63.2%), 109 showed high depersonalization (19.4%) and 186 showed low personal accomplishment (33.0%). Sixty six doctors (11.7%) were identified as experiencing a high degree of burnout (high emotional exhaustion and depersonalization and low personal accomplishment). The prevalence of high degree of burnout was significantly higher in those with duration of work or=40 h/wk (OR=2.1, 95% CI 1.25-3.62) and in those who had psychological morbidity (OR=5.3, 95% CI 2.22-12.39). Thirteen out of 37 sources of stress were significantly associated with high degree of burnout. In multivariate analysis, the significant predictors of high burnout were: dealing with patient's psychosocial problems, feeling of isolation, disturbance of home/family life by work, not chewing khat, long working hours and psychological morbidity.

CONCLUSION: The prevalence of high degree of burnout as well as emotional exhaustion in Yemeni doctors was higher than those reported internationally and was associated with psychological morbidity and many important sources of job stress.
Eight year survival among breast cancer Malaysian women from University Kebangsaan Malaysia Medical Centre

Al-Naggar RA, Isa ZM, Shah SA, Nor MI, Chen R, Ismail F, et al.

Asian Pac J Cancer Prev, 2009;10(6):1075-8.
PMID: 20192587

Survival after diagnosis of cancer is one of the major outcome measurements and a key criterion for assessing quality of cancer control related to both the preventive and the therapeutic level. The purpose of this study was to determine the 8-year survival time in Malaysia based on socio-demographic and clinical characteristics. A retrospective study of 472 Malaysian women with breast cancer from the Medical Record Department at University Kebangsaan Malaysia Medical Centre (UKMMC) was therefore performed with survival analysis carried out using the Kaplan-Meier with log-rank test for univariate analysis and Cox-regression for multivariate analysis. Women who had cancer or family history of cancer had a longer 8-year survival time (p = 0.008) compared with others who did not have such a history. Tamoxifen use, positive oestrogen receptor status, and race were prognostic indicators for 8-year survival time (p = 0.036, p = 0.018, p = 0.053, respectively) in univariate analysis. Multivariate analysis showed that being Malays and having no family history of cancer were independent prognostic factors for shorter survival time (p = 0.008, p = 0.012, respectively). In conclusion, being Chinese and having a family history of cancer are predictors of longer survival among the Malaysian breast cancer women.

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