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Seeking the ideal anti-hypertensive agent: a practical review of the hypertension drug trials

Ong HT, Cheah JS

N Z Med J, 2004 Feb 20;117(1189):U773.
PMID: 15014562

Numerous trials and meta-analyses have been conducted over the last five years to identify an ideal anti-hypertensive drug. These reports, and the JNC 7 and European hypertension guidelines, have generated some controversy and confusion. A review of the comparative anti-hypertensive drug trials shows that the differences between drugs are minor and not consistently demonstrated by different studies. However, much data have now accumulated on the safety and value of diuretics, beta blockers, calcium-channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) in reducing blood pressure and preventing clinical disease. The importance of tight blood pressure control in reducing adverse events has been clearly shown, and clinicians should concentrate on achieving target blood pressure levels, which often requires a combination of anti-hypertensive drugs. The choice of anti-hypertensive drug should be guided by the presence of concomitant clinical disease, as evidence has accumulated on the special efficacy of certain drugs in reducing damage to particular organ systems. In the absence of any associated clinical disease, it is good to initiate anti-hypertensive therapy with diuretics, provided the metabolic parameters are regularly reviewed.
Fulltext Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in patients at high risk of cardiovascular events: a meta-analysis of 10 randomised placebo-controlled trials

Ong HT, Ong LM, Ho JJ

ISRN Cardiol, 2013;2013:478597.
PMID: 24307952 DOI: 10.1155/2013/478597

Context. Whether angiotensin converting-enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) are useful in high risk patients without heart failure is unclear. We perform a meta-analysis of prospective randomized placebo-controlled ACEI or ARB trials studying patients with a combination of risk factors to assess treatment impact on all cause mortality, cardiovascular mortality, nonfatal myocardial infarction (MI) and stroke. Method. A PubMed search was made for placebo-controlled trials recruiting at least 1,200 high risk patients randomized to either ACEI or ARB, with follow-up of at least 2 years. Meta-analysis was performed using the RevMan 5 program and Mantel-Haenszel analysis was done with a fixed effects model. Results. Ten trials recruiting 77,633 patients were reviewed. All cause mortality was significantly reduced by ACEI (RR 0.89; P = 0.0008), but not by ARB treatment (RR 1.00; P = 0.89). Cardiovascular mortality and nonfatal MI were also reduced in the ACEI trials but not with ARB therapy. Stroke was significantly reduced in the ACEI trials (RR 0.75; P < 0.00001) and more modestly reduced in the ARB trials (RR 0.90; P = 0.01). Conclusion. ACEI treatment reduced stroke, nonfatal MI, cardiovascular and total mortality in high risk patients, while ARB modestly reduced stroke with no effect on nonfatal MI, cardiovascular and total mortality.
Fulltext Hypertension control in chronic kidney disease: don't miss the forest for the trees

Ong HT, Ong LM, Ho JJ

Med J Malaysia, 2012 Aug;67(4):359-62.
PMID: 23082441 MyJurnal
Fulltext Beta-blockers for heart failure: an evidence based review answering practical therapeutic questions

Ong HT, Ong LM, Kow FP

Med J Malaysia, 2012 Feb;67(1):7-11.
PMID: 22582541 MyJurnal

Beta-blockers are underutilised in heart failure because clinicians may be unsure whether all beta-blockers are useful, how therapy should be initiated and whether beta-blockers are contraindicated in some patients. Bisoprolol, carvedilol and metoprolol succinate have been clearly proven to reduce mortality and hospitalisation in patients with Class II to IV heart failure; limited evidence also support short-acting metoprolol tartrate and nebivolol. Initiating dose should be very low (1.25 mg bisoprolol, 3.125 mg carvedilol, 12.5 mg metoprolol succinate) and increased gradually over weeks. Treatment benefit appears proportional to magnitude of heart rate reduction and thus target dose should be the maximum tolerated for adequate bradycardia. Even in decompensated heart failure or those with coexisting bronchospasm, beta-blockers are not contraindicated although the dose may have to be reduced or withheld temporarily. The consistent trial data should reassure clinicians and encourage them to confidently initiate beta blockers in patients with systolic heart failure.
Fulltext Digoxin toxicity: clinical and laboratory assessment

Ong HT, Ch'ng SL, Masduki A, Chandrasekharan N

Med J Malaysia, 1989 Dec;44(4):296-301.
PMID: 2520037

A prospective study to correlate clinical digoxin toxicity with serum digoxin levels was carried out in 67 patients of whom 24 were clinically toxic and 43 were asymptomatic. The patients were clinically diagnosed to be toxic based on typical cardiac arrhythmias (n = 11) or non-cardiac symptoms (n = 13). Blood samples were collected at least six hours after the last digoxin dose and the sera assayed for digoxin using a radioimmunoassay method. The mean serum digoxin level in the toxic group (x1 = 2.09 +/- 1.28 ng/ml) was significantly higher than in the non-toxic group (x2 = 1.20 +/- 0.75 ng/ml), p less than 0.01. All the non-toxic patients had serum digoxin levels below 3 ng/ml. However, there was a considerable overlap of serum digoxin levels between the two groups of patients. Serum level cannot be the sole criterion in diagnosing digoxin toxicity. Nevertheless, raised serum digoxin levels especially above 3 ng/ml, in the presence of suggestive clinical features is strongly suggestive of toxicity.
Fulltext Impact of various continuing medical education activities on clinical practice - a survey of Malaysian doctors on its perceived importance

Loh LC, Ong HT, Quah SH

Ann Acad Med Singap, 2007 Apr;36(4):281-4.
PMID: 17483859

INTRODUCTION: Medical talks, newsletter circulars, scientific meetings and conferences, and interaction with members of the pharmaceutical industry, have become convenient means of carrying out continuing medical education (CME) for many busy doctors.

MATERIALS AND METHODS: To study the perceived importance of these various CME activities, a self-completed posted questionnaire survey was conducted among registered practitioners of a densely populated urban state in Malaysia.

RESULTS: Of the 172 respondents [male, 77%; hospital-based, 37%; general practitioner (GP), 55%; private practice, 70%; respondent rate of 19.5%], most preferred local conferences and endorsements by local experts to their foreign counterparts. Meetings or conferences sponsored by the pharmaceutical industry were ranked similarly with those without such links, while the reputation of the pharmaceutical firms was of foremost importance. Among GPs (n = 95) and non-GPs (n = 77), medical society newsletters were rated significantly higher by GPs while overseas conferences were rated higher by non-GPs.

CONCLUSION: Our findings provide an important first look at this under-explored area among Malaysian doctors and described a high degree of acceptance for the involvement of the pharmaceutical industry in CME activities.
Trypanosome infections in Orang Aslis (Aborigines) in West Malaysia

Dissanaike AS, Ong HT, Kan SP

Trans R Soc Trop Med Hyg, 1974;68(6):494-5.
PMID: 4460313
Migration of endocrine-disrupting chemicals into food from plastic packaging materials: an overview of chemical risk assessment, techniques to monitor migration, and international regulations

Ong HT, Samsudin H, Soto-Valdez H

Crit Rev Food Sci Nutr, 2022;62(4):957-979.
PMID: 33081493 DOI: 10.1080/10408398.2020.1830747

Plastic packaging materials (PPMs) protect food from contamination, maintain quality, and ease transportation and distribution. Additives included during the manufacturing and processing of PPMs improve flexibility, durability, barrier properties, and sometimes aid the processing itself. During processing, these additives, even the monomers used to produce the plastics, can produce side products or breakdown products as a result of degradation and various chemical reactions. These starting substances and reaction products include 2,2-bis(4-hydroxyphenyl)propane (bisphenol A), phthalates/phthalic acid esters, alkylphenols, and bis(2-ethylhexyl) adipate, which are considered endocrine-disrupting chemicals (EDCs) that may interfere with the human endocrine system and produce adverse reproductive, neurological, developmental, and immune effects. When in contact with food, EDCs can migrate into food if conditions are appropriate, thereby possibly jeopardizing food safety. Chemical risk assessment and regulatory control were developed to reduce human exposure to harmful migrated EDCs. This article gives an overview of the migration of EDCs from PPMs and control measures to reduce the risk of adverse impacts on human health.
Fulltext Reliability of computerised electrocardiographic reports

Ong HT, Kuah SH, Chew SP

Singapore Med J, 1993 Feb;34(1):53-4.
PMID: 8266130

The aim of this study is to assess the reliability of computerised reporting of electrocardiograms (ECG). Fifty ECG performed consecutively at the outpatient department of the Penang Adventist Hospital on the Marquette 12SL-SC were studied. Two physicians independently reviewed the ECG and the manual readings were compared with each other and to the computer reports. There was no significant difference in the measurement of rate. The PR and QT intervals measured by the two physicians were similar but each was significantly different from the computer reading. The QRS duration assessed by Physician 1 was similar to the computer reading but each was significantly different from that of Physician 2. The overall diagnosis was the same between the two physicians in 76%, between Physician 1 and the computer in 68%, and between Physician 2 and the computer in 78%. No ECG was reported as normal by the computer and said to be abnormal by either physician. Thus, the computer programme is reasonably reliable in ECG reporting with computer-physician variability being comparable to inter-physician variability.

Study site: outpatient department of the Penang Adventist Hospital
Fulltext Cardiovascular effects of common analgesics

Ong HT, Ong LM, Tan TE, Chean KY

Med J Malaysia, 2013 Apr;68(2):189-94.
PMID: 23629578 MyJurnal

The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the heart from metabolic change as well as fluid retention. Aspirin is an anti-thrombotic agent because of its ability to inhibit the COX-1 enzyme that produces the pro-aggregatory thromboxane. However, it increases gastrointestinal bleeding, can promote fluid retention and is nephrotoxic, all of which may lead to adverse cardiovascular outcomes. Patients at especially high risk of cardiovascular events from analgesic use include the elderly, and those with heart failure, hypertension, rheumatoid arthritis, chronic renal disease, chronic obstructive airway disease and previous myocardial infarction, cerebrovascular disease or peripheral vascular disease. Adverse cardiovascular events can occur within a week of initiation of analgesic treatment.
Fulltext Hypertension in a residential home for the elderly in Penang, Malaysia

Ong HT, Oung LS, Ong LM, Tan KP

Med J Malaysia, 2010 Mar;65(1):18-20.
PMID: 21265241 MyJurnal

A study of residents at the Silver Jubilee Home for the Aged was conducted to determine the prevalence, awareness and control of hypertension in this elderly community in Penang, Malaysia. Prevalence of hypertension was 36%, with 81% of patients being initially aware of this diagnosis. This relatively low hypertension prevalence rate may be because residents have a fairly sheltered lifestyle with less social stress and a daily routine that incorporates adequate exercise. Similarly, the high hypertension awareness rate compared to reported figures in the community may be because residents are more regularly monitored by the attending medical care-givers. At the beginning of the study, only 34% of hypertensive patients were well controlled with a blood pressure less than 140/90 mm Hg. This proportion rose to 53% at the end of study period. Compliance is better at a residential home because medication is served by their care-givers and cost is absorbed in this charitable organization. Our study suggests that hypertension awareness and control can be reasonable for the elderly in a residential home.
Studies on parasitic infections in Orang Asli (Aborigines) in Peninsular Malaysia

Dissanaike AS, Vijayamma T, Kan SP, Ong HT

Med J Malaysia, 1977 Sep;32(1):48-55.
PMID: 609344
Genetically engineered human umbilical cord-derived mesenchymal stem cells expressing human interleukin-12 and in vitro growth inhibition against lung adenocarcinoma cells

Goh JJ, Ong HT, Lee BS, Teoh HK

Malays J Pathol, 2023 Aug;45(2):247-259.
PMID: 37658534

INTRODUCTION: Mesenchymal stromal cells (MSCs) are promising vehicles for cancer therapy due to their homing ability and potency to be genetically manipulated through either viral or non-viral methods. Interleukin-12 (IL-12) is one of the key immunomodulatory cytokines which has anti-tumour effect. However, systemic administration of the cytokine at therapeutic dosage can cause serious toxicity in the host system due to the high systemic level of interferon-γ (IFN-γ) induced.
OBJECTIVES: This study aimed to investigate the in vitro growth inhibition of genetically engineered human umbilical cord-derived mesenchymal stromal cells (hUCMSC) expressing IL-12 on H1975 human lung adenocarcinoma cells.
MATERIALS AND METHODS: Both adenoviral method and electroporation which used to generate hUCMSC-IL12 were compared. The method with better outcome was selected to generate hUCMSC-IL12 for the co-culture experiment with H1975 or MRC-5 cells. Characterisation of hUCMSC and hUCMSC-IL12 was performed.
RESULTS: Adenoviral method showed superior results in transfection efficiency (63.6%), post-transfection cell viability (82.6%) and hIL-12 protein expression (1.2 x 107 pg/ml) and thus was selected for the downstream experiments. Subsequently, hUCMSC-IL12 showed significant inhibition effect on H1975 cells after 5 days of co-culture. No significant difference was observed for all other co-culture groups, indicating that the inhibition effect was because of hIL-12. Lastly, the integrity of hUCMSC-IL12 remained unaffected by the transduction through examination of their surface markers and differentiation properties.
CONCLUSION: This study provided proof of concept that hUCMSC can be genetically engineered to express hIL-12 which exerts direct growth inhibition effect on human lung adenocarcinoma cells.
In vitro analysis of VEGF-mediated endothelial permeability and the potential therapeutic role of Anti-VEGF in severe dengue

Lim SJ, Gan SC, Ong HT, Ngeow YF

Biochem Biophys Rep, 2024 Sep;39:101814.
PMID: 39263317 DOI: 10.1016/j.bbrep.2024.101814

BACKGROUND: Vascular endothelial growth factor (VEGF) is one of the proteins involved in dengue immunopathogenesis. It is overexpressed in severe dengue and contributes to vascular permeability and plasma leakage. In this study, we investigated the effects of VEGF and anti-VEGF treatments on endothelial cells in vitro, to assess the potential use of anti-VEGF antibodies in managing severe dengue.
METHODS: Human pulmonary microvascular endothelial cells were treated with VEGF and a VEGF/anti-VEGF combination. The effects of the treatments were studied using an endothelial permeability assay and microarray gene expression profiling. In the permeability assay, the fluorescein isothiocyanate (FITC)-dextran fluorescence signal across the endothelial monolayer was recorded, and the cells were stained with PECAM-1 to detect gap formation. RNA was extracted from treated cells for microarray gene profiling and analysis. The results were analyzed for differentially expressed genes (DEGs) and gene enrichment analysis. The DEGs were subjected to STRING to construct the protein-protein interaction network and then Cytoscape to identify the hub genes.
RESULTS: VEGF-treated endothelial cells showed greater movement of FITC-dextran across the monolayer than VEGF/anti-VEGF-treated cells. There were 111 DEGs for VEGF-treated cells and 118 DEGs for VEGF/anti-VEGF-treated cells. The genes upregulated in VEGF-treated cells were enriched in inflammatory responses and regulation of the endothelial barrier, nitric oxide synthesis, angiogenesis, and the nucleotide-binding oligomerization domain-like receptor signaling pathway. Top 10 hub genes were identified from the DEGs.
CONCLUSIONS: VEGF treatment increased permeability across endothelial cells, while anti-VEGF reduced this leakage. Analysis of VEGF-treated endothelial cells identified hub genes implicated in severe dengue. The top 10 hub genes were TNF, IL1B, IL6, CCL2, PTGS2, ICAM1, CXCL2, CXCL1, CSF2, and TLR2. The results of this study show that using anti-VEGF antibodies to neutralize VEGF may be a promising therapy to prevent the progression of dengue to severe dengue.
Genotyping of hepatitis B virus in Malaysia based on the nucleotide sequence of preS and S genes

Ong HT, Duraisamy G, Kee Peng N, Wen Siang T, Seow HF

Microbes Infect., 2005 Mar;7(3):494-500.
PMID: 15792534

Hepatitis B virus (HBV) has been classified into eight genotypes, designated A-H. These genotypes are known to have distinct geographic distributions. The clinical importance of genotype-related differences in the pathogenicity of HBV has been revealed recently. In Malaysia, the current distribution of HBV remains unclear. The aim of this study was to determine the genotypes and subtypes of HBV by using PCR, followed by DNA sequencing, as well as to analyse the mutations in the immunodominant region of preS and S proteins. The S gene sequence was determined from HBV DNA of four apparently healthy blood donors' sera and three sera from asymptomatic chronic hepatitis B carriers. Of this batch of sera, the preS gene sequence was obtained from HBV DNA from three out of the four blood donors and two out of the three chronic carriers. Due to insufficient sera, we had to resort to using sera from another blood donor to make up for the sixth DNA sequence of the preS gene. Based on the comparative analysis of the preS sequences with the reported sequences in the GenBank database, HBV DNA from two normal carriers was classified as genotype C. Genotype B was assigned to HBV from one blood donor and two hepatitis B chronic carriers, whereas HBV of one chronic carrier was of genotype D. Based on the S gene sequences, HBV from three blood donors was of genotype C, that of one blood donor and one chronic carrier was of genotype B, and the remaining, of genotype D. In the five cases where both preS and S gene sequences were determined, the genotypes assigned based on either the preS or S gene sequences were in concordance. The nature of the deduced amino acid (aa) sequences at positions 125, 127, 134, 143, 159, 161 and 168 of the S gene enabled the classification of these sequences into subtypes, namely, adrq+, adw2 and ayw2. The clustering of our DNA sequences into genotype groups corresponded to their respective subtype, that is, adw2 in genotype B, adrq in genotype C and ayw in genotype D. Analysis of the point mutations revealed that five of the sequences contained aa substitutions at immunodominant epitopes involved in B or/and T cell recognition. In conclusion, despite the low numbers of samples studied, due to budget constraints, these data are still worthwhile reporting, as it is important for the control of HBV infections. In addition, the genotype and mutational data obtained in this study may be useful for designing new treatment regimes for HBV patients.
Fulltext MicroRNA-362 negatively and positively regulates SMAD4 expression in TGF-β/SMAD signaling to suppress cell migration and invasion

Cheng HP, Huang CJ, Tsai ML, Ong HT, Cheong SK, Choo KB, et al.

Int J Med Sci, 2021;18(8):1798-1809.
PMID: 33746597 DOI: 10.7150/ijms.50871

Cell migration and invasion are modulated by epithelial-to-mesenchymal transition (EMT) and the reverse MET process. Despite the detection of microRNA-362 (miR-362, both the miR-362-5p and -3p species) in cancers, none of the identified miR-362 targets is a mesenchymal or epithelial factor to link miR-362 with EMT/MET and metastasis. Focusing on the TGF-β/SMAD signaling pathway in this work, luciferase assays and western blot data showed that miR-362 targeted and negatively regulated expression of SMAD4 and E-cadherin, but not SNAI1, which is regulated by SMAD4. However, miR-362 knockdown also down-regulated SMAD4 and SNAI1, but up-regulated E-cadherin expression. Wound-healing and transwell assays further showed that miR-362 knockdown suppressed cell migration and invasion, effects which were reversed by over-expressing SMAD4 or SNAI1, or by knocking down E-cadherin in the miR-362 knockdown cells. In orthotopic mice, miR-362 knockdown inhibited metastasis, and displayed the same SMAD4 and E-cadherin expression profiles in the tumors as in the in vitro studies. A scheme is proposed to integrate miR-362 negative regulation via SMAD4, and to explain miR-362 positive regulation of SMAD4 via miR-362 targeting of known SMAD4 suppressors, BRK and DACH1, which would have resulted in SMAD4 depletion and annulment of subsequent involvement in TGF-β signaling actions. Hence, miR-362 both negatively and positively regulates SMAD4 expression in TGF-β/SMAD signaling pathway to suppress cell motility and invasiveness and metastasis, and may explain the reported clinical association of anti-miR-362 with suppressed metastasis in various cancers. MiR-362 knockdown in miR-362-positive cancer cells may be used as a therapeutic strategy to suppress metastasis.
Fulltext Anxiety and coping strategies during the COVID-19 pandemic: A cross-sectional study of staff and students from a tertiary education center in Malaysia

Lee KW, Yap SF, Ong HT, Pheh KS, Lye MS

Front Public Health, 2022;10:936486.
PMID: 36276401 DOI: 10.3389/fpubh.2022.936486

AIM: We examined the anxiety levels and coping strategies among staff and students of a tertiary educational institution during the COVID-19 pandemic and determined the association between anxiety level and coping strategies.
METHOD: Through an online survey, we used Coronavirus Anxiety Scale (CAS) to measure the level of anxiety associated with the COVID-19 crisis and Brief Coping Orientation to Problems Experienced (COPE) to assess the coping responses adopted to handle stressful life events. Coping strategies were classified as adaptive and maladaptive, for which the aggregate sores were calculated. Multiple linear regression was used to determine the predictors of anxiety adjusted for potentially confounding variables. Results from 434 participants were available for analysis.
RESULTS: The mean score (SD) of the CAS was 1.1 (1.8). The mean scores of adaptive and maladaptive coping strategies were 35.69 and 19.28, respectively. Multiple linear regression revealed that maladaptive coping [Adjusted B coefficient = 4.106, p-value < 0.001] and presence of comorbidities [Adjusted B coefficient = 1.376, p-value = 0.025] significantly predicted anxiety.
CONCLUSION: Maladaptive coping and presence of comorbidities were the predictors of coronavirus anxiety. The apparent lack of anxiety in relation to COVID-19 and movement restriction is reflective of the reported high level of satisfaction with the support and services provided during the COVID-19 outbreak in Malaysia. Adaptive coping strategies were adopted more frequently than maladaptive. Nevertheless, public education on positive coping strategies and anxiety management may be still be relevant to provide mental health support to address the needs of the general population.
COVID-19 Vaccine Booster Hesitancy in Malaysia: A Web-Based Cross-Sectional Study

Lee KW, Yap SF, Ong HT, Oo M, Swe KMM

Vaccines (Basel), 2023 Mar 13;11(3).
PMID: 36992222 DOI: 10.3390/vaccines11030638

Vaccination is a key public health strategy that is known to be effective in mitigating the risk of infection and severe disease. However, in the context of the COVID-19 pandemic, the percentage (<50%) of Malaysians who have received a booster for the COVID-19 vaccine has remained stagnant over a year. This study aimed to determine the prevalence of and the factors associated with hesitancy toward the second dose of booster for the COVID-19 vaccine. A web-based cross-sectional study was conducted from August to November 2022. The Oxford Vaccine Hesitancy Scale was used to assess the hesitancy toward the second dose of booster for the COVID-19 vaccine. Simple and multiple factors logistic regressions were used to determine the predictors of hesitancy. A p-value less than 0.05 was considered to be statistically significant. Data from 798 respondents were included in the analysis. The prevalence of hesitancy toward the second booster of the COVID-19 vaccine was 26.7%. The predictors of second-booster hesitancy were older age (AOR = 1.040, 95 CI = 1.022, 1.058), having received the third dose (first booster) because of instruction by the government (AOR = 2.125, 95% CI = 1.380, 3.274), concern about serious long term side effects of the vaccine (AOR = 4.010, 95% CI = 2.218, 7.250), and opinions of close friends and immediate family members that the booster is harmful (AOR = 2.201, 95% CI = 1.280, 3.785). Conversely, factors that appear to reduce vaccine booster hesitancy were acceptance of the third dose due to the high number of cases and the increasing rate of infection (AOR = 0.548, 95% CI = 0.317, 0.947), the belief that the vaccine will decrease the risk of getting the infection (AOR = 0.491, 95% CI = 0.277, 0.870), and opinions of close friends and immediate family members that the booster is helpful (AOR = 0.479, 95% CI = 0.273, 0.840). In conclusion, more than one-fifth of Malaysians were hesitant to take the second booster of the COVID-19 vaccine. This suggests that appropriate steps that increase vaccine acceptance, taking into consideration the findings of the present study, are needed to address this issue and to foster more positive attitudes toward vaccination. The survey was available in three main languages but limited to people with internet access; hence, it would likely be biased toward younger adults and social media users and exclude those with limited or no internet access, in particular older people. Therefore, the results are not representative of the Malaysian population at large and caution should be exercised when interpreting the findings.
Fulltext Factorial structure, reliability, and construct validity of the Generalized Anxiety Disorder 7-item (GAD-7): Evidence from Malaysia

Pheh KS, Tan CS, Lee KW, Tay KW, Ong HT, Yap SF

PLoS One, 2023;18(5):e0285435.
PMID: 37167230 DOI: 10.1371/journal.pone.0285435

Generalized anxiety disorder (GAD) is one of the most common mental disorders in Malaysia. Psychometrically sound measurements are urgently needed to assess anxiety symptoms. The extensively used Generalized Anxiety Disorder 7-item (GAD-7) is a promising candidate. However, studies on its factorial validity show mixed findings. While the one-factor solution has been replicated in different cultural contexts, some studies found different factorial structures instead. This study aimed to clarify the factorial validity of the English version of the GAD-7 in the Malaysian context. The responses collected from 1272 emerging to older adults in Malaysia were randomly divided into two halves and submitted to exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) respectively. Four acceptable models were explored in EFA ranging from unidimensional factor with 7 items to 3-factor models with 6 items. The four models revealed in EFA and the other competing models found in past studies were then examined and compared using CFA. The 6-item second-order model with a general factor of anxiety and three first-order factors with two items respectively (i.e., GAD-6) showed a more harmonic result and hence, is preferable. Moreover, the GAD-6 and its three subscales also showed satisfactory internal consistency and construct validity. This study uncovers a new and unique factorial structure of the GAD screening tool that fits in the Malaysian context. The scale may reveal GAD symptomatic dimensions that guide clinical interventions.
Fulltext Knowledge, Perceptions and Behaviors Related to COVID-19 in a University Setting in Malaysia

Lee KW, Yap SF, Ong HT, Leong PP, Mohamad Hatta N, Lye MS

Front Public Health, 2022;10:873022.
PMID: 35480574 DOI: 10.3389/fpubh.2022.873022

BACKGROUND: In Malaysia the COVID-19 disease (COVID-19) has continued to escalate since its first detection in late January 2020, despite widespread implementation of control measures. This study aims to determine the knowledge, perception and behaviors with respect to COVID-19 in the midst of the third wave of the infection.
METHODS: A cross-sectional study was carried out among staffs and students of Universiti Tunku Abdul Rahman (UTAR). The survey consists of basic sociodemographic information, 22 items on knowledge on COVID-19, 3 items on perceived self-risk, 2 items on preparedness & perceived self-efficacy, 10 items on preventive (own) measures, 9 items assessing unwanted and desirable behaviors during the pandemic. Simple and multiple linear regression were performed to determine the factors associated with knowledge, preventive measures adopted, self-risk perception, preparedness & perceived self-efficacy, and behaviors.
RESULTS: A total of 434 responded to the survey of whom the majority (85.1%) had high scores for knowledge (mean score of 18.72 out of 22). A significant positive association was found between knowledge and older age (adjusted B coefficient (SE) = 0.046 (0.022), p = 0.039), those from medical faculty (adjusted B coefficient (SE) = 0.870 (0.420), p = 0.039) and residence in high-risk areas (adjusted B coefficient (SE) = 0.831 (0.295), p = 0.005). Predictors for higher perception of COVID-19 risk included presence of COVID-19 cases among social contacts (adjusted B coefficient (SE) = 0.751 (0.308), p = 0.015) and living with elderly (adjusted B coefficient (SE) = 1.137 (0.296), p < 0.001), while that for perception of preparedness and self-efficacy were living with children (adjusted Beta coefficient (SE) = 0.440 (0.173), p = 0.011) and absence of positive cases among social contacts (adjusted B coefficient (SE) = 0.418 (0.183), p = 0.023). Good preventive measures among the respondents were positively associated with knowledge (adjusted B coefficient (SE) = 0.116 (0.025), p < 0.001), as well as with female gender (adjusted B coefficient (SE) = 0.348 (0.142), p = 0.014). Unwanted behavior was significantly associated with male gender (adjusted B coefficient (SE) = 0.664 (0.321), p = 0.039) and COVID-19 positive status (adjusted B coefficient (SE) = 9.736 (3.297), p = 0.003). Knowledge of COVID-19 (adjusted B coefficient (SE) = 0.069 (0.035), p = 0.048) and being married (adjusted B coefficient (SE) = 0.917 (0.462), p = 0.048) were the predictors of desirable behavior.
CONCLUSION: Overall, the UTAR community had demonstrated a good level of knowledge and preventive behaviors, albeit with some areas for improvement.

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