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  1. Fulltext Effectiveness of peer-led education on knowledge, attitude and risk behavior practices related to HIV among students at a Malaysian public university--a randomized controlled trial
    Ibrahim N, Rampal L, Jamil Z, Zain AM
    Prev Med, 2012 Nov;55(5):505-10.
    PMID: 22982947 DOI: 10.1016/j.ypmed.2012.09.003
    OBJECTIVE: Develop, implement and evaluate the effectiveness of a peer-led education program related to HIV/AIDS among university students.
    METHOD:
    DESIGN: randomized controlled trial with 276 university students at Faculty of Medicine and Health Sciences University Putra Malaysia (UPM), Serdang in 2011.
    INTERVENTION: A peer-led education program on HIV prevention by university students.
    OUTCOME: differences in knowledge, attitude and risk behavior practices related to HIV between baselines, immediate follow-up after intervention and after three months.
    RESULTS: Significant improvement in sound knowledge in the intervention group as compared to the control group (Odds ratio, 1.75; 95% CI 1.01, 3.00; p=0.04) and improvement in good attitude related to HIV (Odds ratio 2.22; 95% CI 1.37, 3.61; p=0.01). The odds of high substance risk behavior was significantly reduced in the intervention group as compared to the control group (Odds ratio 0.07; 95% CI 0.02, 0.34; p=0.01). The association between good knowledge and intervention was modified by the different time points (baseline, immediately after intervention and 3 months after intervention), ethnicity and gender.
    CONCLUSION:
    Peer-led education program in HIV prevention improves knowledge, attitude and substance risk behavior. Changes in sexual risk behavior may require a longer follow-up.
  2. Prevalence, awareness, treatment and control of hypertension in Malaysia: a national study of 16,440 subjects
    Rampal L, Rampal S, Azhar MZ, Rahman AR
    Public Health, 2008 Jan;122(1):11-8.
    PMID: 17981310 DOI: 10.1016/j.puhe.2007.05.008
    Study design: A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used.
    Methods: Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure >140 mmHg, diastolic blood pressure >90 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of <0.05 was considered to be statistically significant.
    Results: The overall prevalence of hypertension for subjects aged 15 years was 27.8% (95% confidence interval (CI) 26.9-28.8). The prevalence of hypertension was significantly higher in males (29.6%, 95% CI 28.3-31.0) compared with females (26.0%, 95% CI 25.0-27.1). Multivariate logistic regression showed that the odds of having hypertension increased with increasing age, in males, in subjects with a family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged 30 years has increased from 32.9% in 1996 to 40.5% in 2004.
    Conclusion: In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians.
  3. Fulltext A randomised controlled trial of peer-adult-led intervention on improvement of knowledge, attitudes and behaviour of university students regarding HIV/AIDS in Malaysia
    Jahanfar S, Lye MS, Rampal L
    Singapore Med J, 2009 Feb;50(2):173-80.
    PMID: 19296033
    INTRODUCTION: The aim of this study was to investigate the knowledge, attitudes and behaviour of university students regarding acquired immunodeficiency syndrome (AIDS) and the human immunodeficiency virus (HIV).
    METHODS: A randomised controlled trial of 530 university students was done using peer-adult facilitators. Participants completed a questionnaire before and after the intervention, which was a four-hour group session. A prevention programme was developed by local experts, health educators and peer facilitators. The peer-adult-led programme was designed to provide a conceptual model of HIV risk reduction through information, motivational and behavioural skills, a harm reduction module and health promotion theme.
    RESULTS: The main outcome measured was the level of knowledge, attitudes and behaviour scores. The results suggest that relative to the control group, participants in the intervention group had higher levels of knowledge (30.37 vs. 25.40; p-value is 0.001) and a better attitude (12.27 vs. 10.84; p-value is 0.001). However, there was no difference in the behavioural score (9.47 vs. 9.41; p-value is 0.530). The correlation between the level of knowledge and age and the level of education was found in the intervention group, but not in the control group (p-value is 0.01). Attitude and gender were found to be correlated in the intervention group only (p-value is 0.01).
    CONCLUSION: Our programme was successful in increasing knowledge and improving attitudes towards AIDS and HIV. However, it did not improve risk-taking behaviour. Peer-adult-led educational programmes for youth using various interactional activities, such as small group discussions, poster activity and empathy exercises, can be successful in changing the prevailing youth perceptions of AIDS and HIV.
  4. Fulltext Physical and mental health problems of the elderly in a rural community of Sepang, Selangor
    Mohd Sidik S, Rampal L, Afifi M
    Malays J Med Sci, 2004 Jan;11(1):52-9.
    PMID: 22977360 MyJurnal
    The prevalence of aging population is increasing not only in developed countries, but also in developing countries like Malaysia. The aim of this study was: (1) to determine the prevalence of physical and mental health problems, and (2) to determine the association of these health problems with socio demographic factors among the elderly in a rural community in Sepang, Selangor. A cross sectional study design was used. Five out of nine villages were selected via random sampling. The elderly in the selected villages were interviewed using a pre-tested structured questionnaire which included the GDS-30, ECAQ and Barthel Index. Out of 263 elderly residents (6.2% of the total population), 223 agreed to participate in the study giving a response rate of 84.8%. The mean age of the respondents was 69.7 + 6.8 years with a median of 68 years. The prevalence of physical health problems such as chronic illness and functional dependence were 60.1% and 15.7%, respectively. While the prevalence of mental health problems such as depression and cognitive impairment were 7.6% and 22.4%, respectively. Among the health problems studied, depression was found to be significantly associated with unemployment (p<0.05), where as cognitive impairment was significantly associated with age, gender, ethnicity, marital status and level of education (p<0.05).
  5. Fulltext The utility of hepatocyte paraffin 1 antibody in the immunohistological distinction of hepatocellular carcinoma from cholangiocarcinoma and metastatic carcinoma
    Shiran MS, Isa MR, Mohd Sidik S, Rampal L, Hairuszah I, Sabariah AR
    Malays J Pathol, 2006 Dec;28(2):87-92.
    PMID: 18376797 MyJurnal
    Hepatocellular carcinoma (HCC) is the most common primary liver cancer and its diagnosis on routine stains is usually straightforward, except in some cases where there may be difficulty in distinguishing HCCs from metastatic carcinomas (MC) and cholangiocarcinomas (CC). Hepatocyte Paraffin 1 antibody (Hep Par 1) is a new monoclonal antibody which reacts with normal and neoplastic hepatocytes, and this study aims to determine its specificity and sensitivity in distinguishing hepatocellular carcinoma (HCC) from cholangiocarcinoma (CC) and metastatic carcinomas (MC). Hep Par 1 antibody was applied to 28 cases of HCC, 22 cases of MC from varying sites and 8 CCs, and produced a strong, diffuse, granular, cytoplasmic staining of all benign hepatocytes. 23 out of 28 cases of HCC showed heterogeneously positive staining for Hep Par 1 irrespective of their degree of differentiation, while 2 out of 8 cases of cholangiocarcinoma were positive for Hep Par 1, and all 22 cases of metastatic carcinoma were negative. The sensitivity and specificity of Hep Par 1 for HCC was 82.1% and 93.3% respectively; whereby the antibody was noted to show occasional false positivity in cases of cholangiocarcinoma and non-neoplastic bowel mucosa, while its variable staining in HCC produced false negative results in some small biopsies. Thus, Hep Par 1 should be used in a panel with other antibodies to obtain useful information in distinguishing HCC from CC and MC.
  6. Fulltext Self-esteem and its associated factors among secondary school students in Klang District, Selangor
    Mohd Sidik S, Rampal L, Loh JW, Chan CL, Teh PC, Tan PO
    Med J Malaysia, 2008 Mar;63(1):26-30.
    PMID: 18935727
    Self-esteem is an important determinant of psychological well-being that is particularly problematic during adolescent life stage. There is a correlation between low self-esteem and other social problems among today's adolescents. This study was conducted to determine the mean self-esteem score, and to determine the association between self-esteem and age, sex, race, religion, number of siblings, ranking among siblings, family function, parental marital status and smoking among adolescents aged 12 to 20-years-old. A cross sectional study design using random cluster sampling method was done. Four out of a total of 35 secondary schools in Klang District, Selangor were selected. Respondents consisted of individual students in selected classes from the four selected schools. Data was collected using a self-administered, structured, pre-tested questionnaire and was analyzed using the SPSS version 12.0. Out of 1089 respondents, 793 completed the questionnaire (response rate 73.82%). The overall mean self-esteem score was 27.65. The mean self-esteem score for males (27.99) was slightly higher than females (27.31). The differences in the mean scores by race were statistically significant. There was a statistically significant relationship between mean self-esteem scores and sex, age, race, religion, number of siblings, smoking and family function. There was no statistically significant difference between mean self-esteem score with parental marital status and with ranking among siblings. The overall mean self-esteem score was 27.65. Self-esteem was associated with sex, age, race, religion, number of siblings, smoking and family function.
  7. Fulltext p63 as a complimentary basal cell specific marker to high molecular weight-cytokeratin in distinguishing prostatic carcinoma from benign prostatic lesions
    Shiran MS, Tan GC, Sabariah AR, Rampal L, Phang KS
    Med J Malaysia, 2007 Mar;62(1):36-9.
    PMID: 17682568 MyJurnal
    The diagnosis of prostatic carcinoma (Pca) on routine biopsies may be challenging, and to date the commonly used marker to distinguish prostate carcinoma from benign prostatic lesions has been High Molecular Weight-Cytokeratin (HMW-CK). However, the antigen of HMW-CK is susceptible to the effect of formalin fixation and causes frequent loss or patchy staining in the obviously benign glands. More recently, antibodies to p63 have been reported to be more sensitive than HMW-CK for the detection of prostatic basal cells. p63, a homologue of tumour suppressor gene p53, is essential for prostate development and is selectively expressed in the nuclei of basal cells of normal prostate glands. The objective of this study is to compare the sensitivity and specificity of HMW-CK and p63 in distinguishing prostatic carcinomas from benign prostatic lesions, as well as determining their positive predictive values. Seventy-two cases from HUKM (comprising 29 prostatic carcinomas and 43 benign prostatic hyperplasias) were stained for both HMW-CK and p63. The sensitivity of p63 and HMW-CK in identifying basal cells in benign glands was 88.37% and 90.70% respectively. The specificity of both reagents was 100%, and the positive predictive value for both reagents was also 100%. Thus, p63 is a useful complementary basal cell specific stain to HMW-CK, and would be very helpful to practicing pathologists in dealing with difficult cases.
  8. Fulltext The prevalence of depression among elderly warded in a tertiary care centre in Wilayah Persekutuan
    Mohd Sidik S, Rampal L, Hanim MA, Thong PL
    Med J Malaysia, 2006 Mar;61(1):15-21.
    PMID: 16708729
    Depression is characterized by symptoms like disturbance in behavior, cognition and mood. This is commonly known to affect people aged 60 years and above especially those who are also afflicted with illnesses. The objectives of this study were to determine the prevalence of depression and its associated factors among the elderly in a tertiary care centre in Wilayah Persekutuan. A cross sectional study design was done. Stratified cluster sampling method was used to select the respondents. All elderly patients were selected from the orthopaedic, surgical, gynaecology and medical wards in a government hospital in Wilayah Persekutuan. A 30-item Geriatric Depression Scale questionnaire was used as a screening instrument. Out of the 246 elderly subjects, 198 were interviewed giving a response rate of 80.5%. The results showed that 54% of the elderly respondents were found to have depressive symptoms. Age (p=0.022), sex (p=0.008), ethnicity (p=0.022) and functional disabilities in bathing (p=0.001), grooming (p=0.007), dressing (p= 0.007), using the toilet (p=0.002), transferring from bed to chair and back (p=0.000), mobility (p=0.000) and climbing stairs (p=0.000) were all found to be significantly associated with depression among the elderly respondents. The outcome of this study will have an important impact on the implementation of the health policy for the elderly patients admitted to hospitals.
  9. Fulltext Cognitive impairment among the elderly in a rural community in Malaysia
    Sherina MS, Rampal L, Mustaqim A
    Med J Malaysia, 2004 Jun;59(2):252-7.
    PMID: 15559177 MyJurnal
    Cognitive impairment is common in late life and may be due to the normal process of ageing or associated with physical or mental disorders. The aim of this study was to determine the prevalence of cognitive impairment among the elderly in a rural community setting. A cross sectional study design using stratified proportionate cluster sampling method was used in this study. A questionnaire similar to the Elderly Cognitive Assessment Questionnaire (ECAQ) was used as a screening instrument for cognitive impairment. The prevalence of cognitive impairment was 22.4% (50/223) among the elderly respondents. Cognitive impairment among the elderly was significantly associated with age, gender, ethnicity, marital status and level of education.
  10. Fulltext Prevalence and causes of visual impairment and blindness in a rural population in Sepang district, Selangor
    Reddy SC, Rampal L, Nurulaini O
    Med J Malaysia, 2004 Jun;59(2):212-7.
    PMID: 15559172 MyJurnal
    A community based cross-sectional study was carried out to determine the prevalence and causes of visual impairment and blindness in residents aged forty years and above in kampung Jenderam Hilir of Sepang district, Selangor state. A total of 311 out of 341 (91.3%) respondents participated in this study. The prevalence of visual impairment and blindness observed was 18.9% and 2.9% respectively. The prevalence of visual impairment and blindness increased significantly with age. Amongst the 159 respondents who agreed for eye checkup, refractive errors (56%), cataract (20.1%), glaucoma (4.4%) and diabetic retinopathy (1.3%) were found to be causing visual impairment and blindness.
  11. Fulltext Psychological stress among undergraduate medical students
    Sherina MS, Rampal L, Kaneson N
    Med J Malaysia, 2004 Jun;59(2):207-11.
    PMID: 15559171 MyJurnal
    The aim of this study was to determine the prevalence of psychological stress among medical students and to identify its symptoms and association with depression. A cross-sectional study design was used. Three-hundred and ninety-six medical students at a university in Malaysia were included in the study. Tools similar to the General Health Questionnaire (GHQ-12) and Beck Depression Inventory (BDI) were used to screen for psychological stress and depression, respectively. 41.9% of the medical students were found to have psychological stress, which was significantly associated with depression (chi2=4.636, df=1, p<0.05). Psychological stress is common among medical students and is associated with depression.
  12. Fulltext The prevalence of depression among the elderly in Sepang, Selangor
    Sherina MS, Rampal L, Mustaqim A
    Med J Malaysia, 2004 Mar;59(1):45-9.
    PMID: 15535335 MyJurnal
    Objective: To determine the prevalence of depression among the elderly and to identify its associated factors.
    Methods: A cross sectional study design was used. Stratified proportionate cluster sampling method was used to select the respondents. A 30 item Geriatric Depression Scale questionnaire was used as a screening instrument.
    Results: 7.6% of the elderly were found to have depression. Only employment status was found to be significantly associated with depression.
    Discussion: The prevalence of depression in the elderly was 7.6%. Primary Care providers need to be vigilant when treating elderly patients as depression is commonly found in this age group .
    Study site: Nine villages in Mukim Sepang, Sepang District, Selangor, Malaysia
    Device, Questionnaire & Scale: Geriatric Depression Scale (GDS-30)
  13. Fulltext Prevalence and predictors of suicidality among medical students in a public university
    Tan ST, Sherina MS, Rampal L, Normala I
    Med J Malaysia, 2015 Feb;70(1):1-5.
    PMID: 26032521 MyJurnal
    BACKGROUND: Undergraduate medical students have been the most distressed group among the student population. Depression and anxiety have been found to be more prevalent in this group of students compared to others.

    OBJECTIVE: This study was conducted to determine the prevalence and predictors of suicidality among undergraduate medical students in a public university.

    METHODS: This was an analytical cross-sectional study, conducted in a public university in Selangor, Malaysia. Data were collected using self-administered questionnaires from January to February 2013, and analysed using the Statistical Package for Social Sciences Software (version 21).

    RESULTS: Out of 625 undergraduate medical students, 537 (85.9%) participated in the study. The prevalence of the suicidality among undergraduate medical students was 7.0%. The significant predictors of suicidality based on multiple logistic regression were the respondent's lifetime suicide attempts (Adjusted Odds Ratio, AOR 10.4, 95% CI 2.7 to 40.9); depression (AOR 5.9, 95% CI 1.5 to 23.0); breaking off a steady love relationship (AOR 5.4, 95% CI 1.3 to 22.4); hopelessness (AOR 4.9, 95% CI 1.1 to 21.6); and something valued being lost or stolen (AOR 4.4, 95% CI 1.2 to 15.9).

    CONCLUSION: These findings indicate that mental health care services should be strengthened at university level. The results show a need for an intervention programme to reduce suicidality among the undergraduate medical students.
  14. Outcome of chemotherapy counseling by pharmacists on psychological effects and self esteem among oncology patients in a Government Hospital in Malaysia
    Ummavathy P, Sherina MS, Rampal L, Siti Irma Fadhilah I
    Med J Malaysia, 2015 Jun;70(3):131-41.
    PMID: 26248774 MyJurnal
    INTRODUCTION: Chemotherapy is the most common form of treatment among cancer patients. It is also known to cause many physical and psychological side-effects.

    OBJECTIVE: This study developed, implemented and evaluated the outcome of a chemotherapy counseling module among oncology patients by pharmacists based on their psychological effects (depression, anxiety) and selfesteem.

    METHODS: A randomized, single blind, placebo controlled study was conducted among 162 patients undergoing chemotherapy in a government hospital in Malaysia.

    INTERVENTION: Counseling sessions were conducted using the 'Managing Patients on Chemotherapy' module for oncology patients undergoing chemotherapy at each treatment cycle.

    OUTCOME: The outcome of repetitive chemotherapy counseling using the module was determined at baseline, first follow-up, second follow-up and third follow-up.

    RESULTS: The findings revealed that there was significant improvement in the intervention group as compared to the control group with large effect size on depression (p = 0.001, partial η(2) = 0.394), anxiety (p = 0.001, partial η(2) = 0.232) and self-esteem (p = 0.001, partial η(2) = 0.541).

    CONCLUSION: Repetitive counseling using the 'Managing Patients on Chemotherapy' module was found to be effective in improving psychological effects and self-esteem among patients undergoing chemotherapy.

  15. Research training as pillars towards undergraduate medical education advancement in Malaysia
    Rampal L
    Med J Malaysia, 2002 Dec;57 Suppl E:102-4.
    PMID: 12733203
  16. Fulltext A community based study on the prevalence and factors affecting smoking in Kampong Jenderam Hilir, Sepang, Selangor
    Rampal L, Narasimman S
    Med J Malaysia, 2003 Mar;58(1):54-61.
    PMID: 14556326 MyJurnal
    Objectives: i) To determine the prevalence of smoking among the community aged 15 and above in Kg. Jenderam Hilir in Sepang District, Selangor state. ii) To determine the relationship between smoking and age, sex, household income and education. iii) To determine the parental and peer influence on smoking in Kg Jenderam Hilir.
    Materials and Methods: A study was conducted to Kg Jenderam Hilir, Sepang. All residents aged 15 years and above from all the 381 households of Kg Jenderam Hilir were included in this study. A standardized pre-tested structured questionnaire was used in this study.
    Results: Out of 894 respondents interviewed 69% were males compared to 3.9% of the females (overall 33.6%) reported to have smoked at least once in his/her lifetime. The difference was statistically significant. The mean duration of smoking was 17.7 years. The age at which smoking was first attempted ranged from 4 years to 51 years with a mean of 18.7 years. The mean initiation age for the males was significantly lower as compared to the mean initiation age for the females. The prevalence of current smokers was significantly higher amongst males (52.8%) as compared to the females (1.4%). The prevalence of smoking among current smokers increased with age (p<0.01). there was no significant difference in the prevalence of smoking by household income and educational level. The mean number of cigarettes smoked by current smokers per day was 14.9 cigarettes and ranged from 1 to 60 cigarettes. The mean number of cigarettes smoked by the males was significantly higher than the females (p<0.05). the mean duration of smoking among current smokers was 20 years. There was a significant difference in the level of addiction to smoking and the duration of smoking (p<0.05). sixty five percent of the current smokers reported to have tried to quit smoking while 26% of ever smokers had reported to quit smoking and remained non-smokers. The quit ratio was calculated to be 26.0%. the quit ratio was 52.6% among those with college or university education. There was a significant difference in the quit ratio by education level (p<0.01). There was no significant difference in smokers whose parents were smokers as compared to non-smokers whose parents were smokers. However, there was a significant association between smoking and peer influence (p<0.01).
  17. Fulltext Bacterial pathogens from the intestinal tracts of various species of cockroaches
    Rampal L, Oothuman P, Jeffery J, Daud MZ, Shekhar C, Senan P, et al.
    Med J Malaysia, 1983 Jun;38(2):104-7.
    PMID: 6353184
    Bacterial isolates were made from the intestinal tracts ofcarious species of cockroaches (Periplaneta americana, Periplaneta brunnea, Periplaneta australasiae, Neostylopyga rhombifolia, Nauphoeta cinerea) trapped from kitchens and stores (houses and hospital), Shigello, flexneri, Salmonella typhi, Escherichia coli and Salmonella sp. were some of the bacteria isolated and identified.
  18. Fulltext The prevalence of Enterobius vermicularis amongst primary school children in Pulau Ketam, Selangor--1988
    Oothuman P, Rampal L, Omar B, Marwsi MA, Mohammod CG, Jeffery J, et al.
    Med J Malaysia, 1989 Dec;44(4):312-6.
    PMID: 2520040
    A survey was conducted to investigate the prevalence of Enterobius vermicularis in 1352 Chinese children between the ages of 6-12 years from the three National Type Chinese Primary Schools in Pulau Ketam in 1988, using the scotch-tape technique on three successive days. The overall prevalence was high (56.88%). The prevalence in Sin Bin School was significantly lower (50.86%) compared to the other two schools (56.60% and 61.04%). Prevalence was significantly higher amongst the 6-7 years age group (61.61%-70.18%) compared to other age groups (47.9%-59.29%). There was no difference in the prevalence between the boys and girls being 56.15% and 57.55% respectively.
  19. Fulltext An outbreak of Bacillus cereus food poisoning in a school hostel, Klang
    Rampal L, Jegathesan M, Lim YS
    Med J Malaysia, 1984 Jun;39(2):116-22.
    PMID: 6439984
    A food poisoning outbreak affected 114 female Malay students staying in a religious secondary school hostel in Klang. The students developed an illness mainly characterized by abdominal pain, nausea, vomiting and giddiness. The median incubation period in this outbreak was 2.5 hours. Laboratory examination of suspected food revealed 2.3 X10^6 Bacillus cereus organisms per gram of fried noodles. B. cereus was determined as the probable cause of this outbreak and the fried. noodles the most likely vehicle for the organism. An outbreak of B. cereus food poisoning is being reported in Malaysia for the first time.
  20. Fulltext A study on the anti-smoking measures adopted by the local authorities in Malaysia, 1982
    Rampal L
    Med J Malaysia, 1983 Sep;38(3):203-5.
    PMID: 6672563
    Anti-smoking measures, adopted by local authorities before the guideline on the ban of cigarette advertisement and anti-smoking campaign launched by the Government, are limited in scope and area. The activity is limited mainly to a ban on cigarette advertisements in theatres. Legislative measures are instituted only in the City Council, Municipal Councils and 2 ofthe 20 district councils surveyed. There is an awareness among several local authorities on the need for an increase in anti-smoking activities but action. is lacking. A population of 7.4 million. people lioe in areas controlled by the local authorities. The local authorities are expected to play a more active role along with other Government departments following a directive in August 1982 from the Chief Secretary to the Government.
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