Displaying publications 661 - 680 of 1069 in total

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  1. Sahani M, Parashar UD, Ali R, Das P, Lye MS, Isa MM, et al.
    Int J Epidemiol, 2001 Oct;30(5):1017-20.
    PMID: 11689513
    BACKGROUND: An outbreak of encephalitis primarily affecting pig farmers occurred during 1998-1999 in Malaysia and was linked to a new paramyxovirus, Nipah virus, which infected pigs, humans, dogs, and cats. Because five abattoir workers were also affected, a survey was conducted to assess the risk of Nipah infection among abattoir workers.

    METHODS: Workers from all 143 registered abattoirs in 11 of 13 states in Malaysia were invited to participate in this cross-sectional study. Participants were interviewed to ascertain information on illness and activities performed at the abattoir. A serum sample was obtained to test for Nipah virus antibody.

    RESULTS: Seven (1.6 %) of 435 abattoir workers who slaughtered pigs versus zero (0%) of 233 workers who slaughtered ruminants showed antibody to Nipah virus (P = 0.05). All antibody-positive workers were from abattoirs in the three states that reported outbreak cases among pig farmers. Workers in these three states were more likely than those in other states to have Nipah antibody (7/144 [4.86%] versus 0/291 [0%], P < 0.001) and report symptoms suggestive of Nipah disease in pigs admitted to the abattoirs (P = 0.001).

    CONCLUSIONS: Nipah infection was not widespread among abattoir workers in Malaysia and was linked to exposure to pigs. Since it may be difficult to identify Nipah-infected pigs capable of transmitting virus by clinical symptoms, using personal protective equipment, conducting surveillance for Nipah infection on pig farms which supply abattoirs, and avoiding handling and processing of potentially infected pigs are presently the best strategies to prevent transmission of Nipah virus in abattoirs.

  2. Dzulkifli AR, Aishah AL, Ch'ng HS, Rose A, Rahmat A, Isa AM, et al.
    J Audiov Media Med, 1994 Jul;17(3):117-20.
    PMID: 7636117
    A number of health databases is now available in Malaysia, but few are accessible to the general public. However, recently a service was launched nationwide via a videotex system to also target the Malaysia public. This service is provided by the School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM) in collaboration with several Malaysian Government ministries and agencies. Access to health information via videotex, be it medical, pharmaceutical or environmental is viewed as an effective means of on-line information dissemination. It provides not only rapid retrieval but is also economical and interactive, particularly suitable for a developing country.
  3. Yusoff NM, Van Rostenberghe H, Shirakawa T, Nishiyama K, Amin N, Darus Z, et al.
    J Hum Genet, 2003;48(12):650-653.
    PMID: 14618420 DOI: 10.1007/s10038-003-0095-2
    Southeast Asian ovalocytosis (SAO) is a red blood cell abnormality common in malaria-endemic regions and caused by a 27 nt deletion of the band 3 protein gene. Since band 3 protein, also known as anion exchanger 1, is expressed in renal distal tubules, the incidence of SAO was examined in distal renal tubular acidosis (dRTA) in Malays in Kelantan, Malaysia. Twenty-two patients with dRTA and 50 healthy volunteers were examined for complication of SAO by both morphological and genetic analyses. SAO was identified in 18 of the 22 dRTA patients (81.8%), but only two of the 50 controls (4%). The incidence of SAO was significantly high in those with dRTA (p<0.001), indicating a dysfunctional role for band 3 protein/anion exchanger 1 in the development of dRTA.
  4. Natusch DJD, Aust PW, Khadiejah S, Ithnin H, Isa A, Zamzuri CK, et al.
    PLoS One, 2020;15(10):e0240176.
    PMID: 33022690 DOI: 10.1371/journal.pone.0240176
    The use of carbon dioxide (CO2) exposure as a means of animal euthanasia has received considerable attention in mammals and birds but remains virtually untested in reptiles. We measured the behavioral responses of four squamate reptile species (Homalopsis buccata, Malayopython reticulatus, Python bivitattus, and Varanus salvator) to exposure to 99.5% CO2 for durations of 15, 30, or 90 minutes. We also examined alterations in plasma corticosterone levels of M. reticulatus and V. salvator before and after 15 minutes of CO2 exposure relative to control individuals. The four reptile taxa showed consistent behavioral responses to CO2 exposure characterized by gaping and minor movements. The time taken to lose responsiveness to stimuli and cessation of movements varied between 240-4260 seconds (4-71 minutes), with considerable intra- and inter-specific variation. Duration of CO2 exposure influenced the likelihood of recovery, which also varied among species (e.g., from 0-100% recovery after 30-min exposure). Plasma corticosterone concentrations increased after CO2 exposure in both V. salvator (18%) and M. reticulatus (14%), but only significantly in the former species. Based on our results, CO2 appears to be a mild stressor for reptiles, but the relatively minor responses to CO2 suggest it may not cause considerable distress or pain. However, our results are preliminary, and further testing is required to understand optimal CO2 delivery mechanisms and interspecific responses to CO2 exposure before endorsing this method for reptile euthanasia.
  5. Alazawy A, Arshad SS, Bejo MH, Omar AR, Tengku Ibrahim TA, Sharif S, et al.
    J Electron Microsc (Tokyo), 2011;60(4):275-82.
    PMID: 21593079 DOI: 10.1093/jmicro/dfr031
    Feline coronavirus (FCoV) consists of two biotypes based on their growth in cell culture and their antigenicity. Infections with FCoV are highly prevalent in the cat population worldwide. In this study, Felis catus whole fetus (Fcwf-4)cell culture was infected with FCoV UPM11C/08. Virus multiplication in cell culture was monitored and examined under the transmission electron microscope. The virus particles revealed the characteristic morphology of feline FCoV represented by envelope viruses surrounded by peplomers. Virus attachment and entry into the cell occurred 15 h post-infection (pi), and the myriad of virus particles were observed both extracellularly and intracellularly after 48 h pi. Thereafter, intracellular virus particles were observed to be present in vacuoles or present freely in the cytoplasm.
  6. Mohd Isa NH, Selvarajah GT, Khor KH, Tan SW, Manoraj H, Omar NH, et al.
    Vet Microbiol, 2019 Sep;236:108382.
    PMID: 31500720 DOI: 10.1016/j.vetmic.2019.08.005
    Feline morbillivirus (FeMV), a novel virus from the family of Paramyxoviridae, was first identified in stray cat populations. The objectives of the current study were to (i) determine the molecular prevalence of FeMV in Malaysia; (ii) identify risk factors associated with FeMV infection; and (iii) characterise any FeMV isolates by phylogenetic analyses. Molecular analysis utilising nested RT-PCR assay targeting the L gene of FeMV performed on either urine, blood and/or kidney samples collected from 208 cats in this study revealed 82 (39.4%) positive cats. FeMV-positive samples were obtained from 63/124 (50.8%) urine and 20/25 (80.0%) kidneys while all blood samples were negative for FeMV. In addition, from the 35 cats that had more than one type of samples collected (blood and urine; blood and kidney; blood, urine and kidney), only one cat had FeMV RNA in the urine and kidney samples. Risk factors such as gender, presence of kidney-associated symptoms and cat source were also investigated. Male cats had a higher risk (p = 0.031) of FeMV infection than females. In addition, no significant association (p = 0.083) was observed between the presence of kidney-associated symptoms with FeMV status. From the 82 positive samples, FeMV RNA was detected from 48/82 (58.5%) pet cats and 34/126 (27.0%) shelter cats (p 
  7. Jesse FFA, Amira NA, Isa KM, Maqbool A, Ali NM, Chung ELT, et al.
    Vet World, 2019 Jul;12(7):978-983.
    PMID: 31528021 DOI: 10.14202/vetworld.2019.978-983
    Mannheimiosis or pneumonic pasteurellosis commonly occurs in small ruminants. Mannheimiosis is caused by Mannheimia haemolytica (M. haemolytica) a Gram-negative coccobacillus producing acute febrile and infectious condition resulting in death of animal if not diagnosed and treated promptly. M. haemolytica serotype A2 is a commensal of the nasopharynx, gaining access to the lungs when host defenses are compromised by stress or infection in small ruminants. Till date, there is a vast literature and research that has been conducted on the pathogenesis of M. haemolytica invariably on respiratory system and its related immune system and mechanisms. From the clinical point of view, infection or diseases involving vital organs will systemically affect the production and performance of the infected animal. Therefore, there is a huge gap of knowledge and research to answer the question whether there is any association between M. haemolytica infection with reproductive physiology and performance in small ruminants and how it affects the productivity level. This review will explore the possibilities of involvement and new potential research to be carried out to determine the involvement of male and female reproductive system with M. haemolytica infection among small ruminants.
  8. Ee Uli J, Yong CS, Yeap SK, Alitheen NB, Rovie-Ryan JJ, Mat Isa N, et al.
    BMC Res Notes, 2018 Dec 22;11(1):923.
    PMID: 30577850 DOI: 10.1186/s13104-018-4014-1
    OBJECTIVE: Using high-throughput RNA sequencing technology, this study aimed to sequence the transcriptome of kidney and liver tissues harvested from Peninsular Malaysia cynomolgus macaque (Macaca fascicularis). M. fascicularis are significant nonhuman primate models in the biomedical field, owing to the macaque's biological similarities with humans. The additional transcriptomic dataset will supplement the previously described Peninsular Malaysia M. fascicularis transcriptomes obtained in a past endeavour.

    RESULTS: A total of 75,350,240 sequence reads were obtained via Hi-seq 2500 sequencing technology. A total of 5473 significant differentially expressed genes were called. Gene ontology functional categorisation showed that cellular process, catalytic activity, and cell part categories had the highest number of expressed genes, while the metabolic pathways category possessed the highest number of expressed genes in the KEGG pathway analysis. The additional sequence dataset will further enrich existing M. fascicularis transcriptome assemblies, and provide a dataset for further downstream studies.

  9. Khan T, Binti Abd Manan TS, Isa MH, Ghanim AAJ, Beddu S, Jusoh H, et al.
    Molecules, 2020 Jul 17;25(14).
    PMID: 32708928 DOI: 10.3390/molecules25143263
    This research optimized the adsorption performance of rice husk char (RHC4) for copper (Cu(II)) from an aqueous solution. Various physicochemical analyses such as Fourier transform infrared spectroscopy (FTIR), field-emission scanning electron microscopy (FESEM), carbon, hydrogen, nitrogen, and sulfur (CHNS) analysis, Brunauer-Emmett-Teller (BET) surface area analysis, bulk density (g/mL), ash content (%), pH, and pHZPC were performed to determine the characteristics of RHC4. The effects of operating variables such as the influences of aqueous pH, contact time, Cu(II) concentration, and doses of RHC4 on adsorption were studied. The maximum adsorption was achieved at 120 min of contact time, pH 6, and at 8 g/L of RHC4 dose. The prediction of percentage Cu(II) adsorption was investigated via an artificial neural network (ANN). The Fletcher-Reeves conjugate gradient backpropagation (BP) algorithm was the best fit among all of the tested algorithms (mean squared error (MSE) of 3.84 and R2 of 0.989). The pseudo-second-order kinetic model fitted well with the experimental data, thus indicating chemical adsorption. The intraparticle analysis showed that the adsorption process proceeded by boundary layer adsorption initially and by intraparticle diffusion at the later stage. The Langmuir and Freundlich isotherm models interpreted well the adsorption capacity and intensity. The thermodynamic parameters indicated that the adsorption of Cu(II) by RHC4 was spontaneous. The RHC4 adsorption capacity is comparable to other agricultural material-based adsorbents, making RHC4 competent for Cu(II) removal from wastewater.
  10. Stear A, Ali AOA, Brujeni GN, Buitkamp J, Donskow-Łysoniewska K, Fairlie-Clarke K, et al.
    Int J Parasitol, 2019 09;49(10):797-804.
    PMID: 31306661 DOI: 10.1016/j.ijpara.2019.05.003
    Lambs with the Major Histocompatibility Complex DRB1*1101 allele have been shown to produce fewer nematode eggs following natural and deliberate infection. These sheep also possess fewer adult Teladorsagia circumcincta than sheep with alternative alleles at the DRB1 locus. However, it is unclear if this allele is responsible for the reduced egg counts or merely acts as a marker for a linked gene. This study defined the MHC haplotypes in a population of naturally infected Scottish Blackface sheep by PCR amplification and sequencing, and examined the associations between MHC haplotypes and faecal egg counts by generalised linear mixed modelling. The DRB1*1101 allele occurred predominately on one haplotype and a comparison of haplotypes indicated that the causal mutation or mutations occurred in or around this locus. Additional comparisons with another resistant haplotype indicated that mutations in or around the DQB2*GU191460 allele were also responsible for resistance to nematode infections. Further analyses identified six amino acid substitutions in the antigen binding site of DRB1*1101 that were significantly associated with reductions in the numbers of adult T. circumcincta.
  11. Ahmad Nazri MUI, Mahmud MH, Saidi B, Mat Isa MN, Ehsak Z, Ross O, et al.
    Heliyon, 2021 Feb;7(2):e06307.
    PMID: 33681499 DOI: 10.1016/j.heliyon.2021.e06307
    The polychaete Diopatra claparedii Grube, 1878 is among those organisms successfully carrying out full body regeneration, including the whole nervous system. Thus, D. claparedii potentially can be regarded for the nervous system regeneration (NSR) study. However, data on the property of its nervous system and the NSR profile are still lacking. In this study, we investigated the morphology of D. claparedii anterior nervous system (ANS) and examined the cellular and molecular profiles on its early anterior NSR. The nervous system of D. claparedii consists of a symmetry brain with nerves branching off, circumpharyngeal connectives that connect the brain and nerve cord as well as obvious segmental ganglia. Moreover, we identified changes in the cellular condition of the ganglionic cells in the regenerating tissue, such as the accumulation of lysosomes and lipofuscins, elongated mitochondria and multiple nucleoli. Furthermore, mRNA of tissues at two regenerating stages, as well as intact tissue (non-regenerating), were sequenced with Illumina sequencer. We identified from these tissues 37,248 sequences, 18 differential expressed proteins of which upregulated were involved in NSR with noelin-like isoform X2 turned up to be the highest being expressed. Our results highlight the cellular and molecular changes during early phase of NSR, thus providing essential insights on regeneration within Annelida and understanding the neurodegenerative diseases.
  12. Zainal Abidin H, Omar SC, Mazlan MZ, Hassan MH, Isa R, Ali S, et al.
    Glob Pediatr Health, 2021;8:2333794X211007975.
    PMID: 33889680 DOI: 10.1177/2333794X211007975
    Over the years, the number of pediatric patients undergoing surgeries are increasing steadily. The types of surgery vary between elective to emergency with involvement of multidisciplinary teams. The development of day care surgery unit is expanding where the patients will only come to the hospital on the day of surgery and discharge home after such as satisfactory parameters achieved, minimal to no pain, minimal to no bleeding from surgical site and able to tolerate fluids. Hospitalization and surgery could contribute to significant psychological disturbance to the children. These issues are not being addressed as children have difficulty in conveying their problems and fear. They do however express it through negative behavioral changes.
  13. Md Dom S, Abdul Razak HR, Ahmad Zaiki FW, Saat NH, Abd Manan K, Che Isa IN, et al.
    Quant Imaging Med Surg, 2013 Feb;3(1):49-53.
    PMID: 23483040 DOI: 10.3978/j.issn.2223-4292.2013.02.06
    The aim of this study was to investigate the changes in parathyroid hormone (PTH) level of rabbit foetal bodies exposed to ultrasound at different gestational stages. A total of 9 pregnant rabbits (Oryctolagus cuniculus) were insonated for 60 minutes at the middle of 1(st), 2(nd) and 3(rd) gestational stages for group A (n=14 newborns), group B (n=7 newborns) and group C (n=24 newborns) respectively. Seven pregnant rabbits with 41 newborns severed as negative control group. Blood samples were withdrawn from each newborn rabbits for Parathyroid Hormone-Intact (PTH-I) test. Results of the independent samples t-test implied statistically significant differences (P<0.05) between the control group and the 1(st) stage (P=0.001), the 2(nd) stage (P<0.001) and the 3(rd) stage group (P<0.001). This in-vivo study revealed diagnostic ultrasound heating has the potential of affecting foetal PTH level. This study observed significantly low PTH level for all the treated groups. A further study should be instituted to determine whether this finding in rabbit may also occur in human by means of clinical trials.
  14. Abdul Hamid N, Sadiq MB, Ramanoon SZ, Mansor R, Watanabe M, Md Isa NM, et al.
    Animals (Basel), 2020 Jul 06;10(7).
    PMID: 32640507 DOI: 10.3390/ani10071139
    (1) Background: The objective of this study was to determine the prevalence of T. gondii in meats of cattle, goat and sheep from wet markets in Klang Valley, and abattoirs in Selangor, Malaysia; (2) Methods: A total of 192 meat samples were purchased from 51 wet markets in six districts in Klang Valley (Gombak, Klang, Kuala Lumpur, Hulu Langat, Petaling and Putrajaya). Meanwhile, a total of 200 diaphragm samples were collected from two government abattoirs located in Shah Alam and Banting, Selangor. All meat juices from samples were subjected to an indirect-ELISA kit for the presence of T. gondii IgG antibodies. Furthermore, all 184 meat samples of goat and sheep were subjected to conventional nested PCR (B1 genes) for the detection of T. gondii DNA; (3) Results: T. gondii antibodies were detected in 25% (n = 98/392) of the samples with seroprevalence of 9.1% (19/208, CI: 5.9%-13.8%) in cattle meat; 54.7% (41/75, 95% CI: 43.5%-65.4%) in goat meat and 34.9% (38/109, CI: 26.6%-44.2%) in sheep meat. No T. gondii DNA was detected in any of the meat samples of goat and sheep. T. gondii seropositivity in wet market samples was higher in goat (OR = 37.1 CI 12.4-110.3) and sheep meat (OR 9.03 CI: 3.28-24.8) compared to cattle meat (OR = 1.0) At univariate level, meat from non-licensed abattoirs (OR = 6.0 CI: 2.9-12.3) and female animals (OR = 6.7; CI 1.9-22.6) had higher risks of being seropositive for T. gondii antibodies than licensed abattoirs and male animals, respectively. (4) Conclusions: This is the first report of seroprevalence of T. gondii in ruminant meats for human consumption in Malaysia. The findings signified high exposure of meat samples from wet markets to T. gondii and the need for control measures to reduce the likelihood of infection when such raw or undercooked meats are consumed.
  15. Dakheel KH, Rahim RA, Neela VK, Al-Obaidi JR, Hun TG, Isa MNM, et al.
    BMC Microbiol, 2019 05 28;19(1):114.
    PMID: 31138130 DOI: 10.1186/s12866-019-1484-9
    BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) biofilm producers represent an important etiological agent of many chronic human infections. Antibiotics and host immune responses are largely ineffective against bacteria within biofilms. Alternative actions and novel antimicrobials should be considered. In this context, the use of phages to destroy MRSA biofilms presents an innovative alternative mechanism.

    RESULTS: Twenty-five MRSA biofilm producers were used as substrates to isolate MRSA-specific phages. Despite the difficulties in obtaining an isolate of this phage, two phages (UPMK_1 and UPMK_2) were isolated. Both phages varied in their ability to produce halos around their plaques, host infectivity, one-step growth curves, and electron microscopy features. Furthermore, both phages demonstrated antagonistic infectivity on planktonic cultures. This was validated in an in vitro static biofilm assay (in microtiter-plates), followed by the visualization of the biofilm architecture in situ via confocal laser scanning microscopy before and after phage infection, and further supported by phages genome analysis. The UPMK_1 genome comprised 152,788 bp coding for 155 putative open reading frames (ORFs), and its genome characteristics were between the Myoviridae and Siphoviridae family, though the morphological features confined it more to the Siphoviridae family. The UPMK_2 has 40,955 bp with 62 putative ORFs; morphologically, it presented the features of the Podoviridae though its genome did not show similarity with any of the S. aureus in the Podoviridae family. Both phages possess lytic enzymes that were associated with a high ability to degrade biofilms as shown in the microtiter plate and CLSM analyses.

    CONCLUSIONS: The present work addressed the possibility of using phages as potential biocontrol agents for biofilm-producing MRSA.

  16. Luthfi AAI, Tan JP, Isa NFAM, Bukhari NA, Shah SSM, Mahmod SS, et al.
    Bioprocess Biosyst Eng, 2020 Jul;43(7):1153-1169.
    PMID: 32095989 DOI: 10.1007/s00449-020-02311-x
    This study aimed to enhance the crystallizability of bio-based succinic acid for its efficient recovery while maintaining the end product at the highest purity. Immobilization of Actinobacillus succinogenes was initially evaluated based on three different carriers: volcanic glass, clay pebbles, and silica particles. The adsorption capacity of metabolites with a low concentration (10 g/L) and a high concentration (40 g/L) was investigated. It was demonstrated that clay pebbles adsorbed the least succinic acid (
  17. Shaffiq Said Rahmat SM, Abdul Karim MK, Che Isa IN, Abd Rahman MA, Noor NM, Hoong NK
    Comput Biol Med, 2020 08;123:103840.
    PMID: 32658782 DOI: 10.1016/j.compbiomed.2020.103840
    BACKGROUND: Unoptimized protocols, including a miscentered position, might affect the outcome of diagnostic in CT examinations. In this study, we investigate the effects of miscentering position during CT head examination on the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).

    METHOD: We simulate the CT head examination using a water phantom with a standard protocol (120 kVp/180 mAs) and a low dose protocol (100 kVp/142 mAs). The table height was adjusted to simulate miscentering by 5 cm from the isocenter, where the height was miscentered superiorly (MCS) at 109, 114, 119, and 124 cm, and miscentered inferiorly (MCI) at 99, 94, 89, and 84 cm. Seven circular regions of interest were used, with one drawn at the center, four at the peripheral area of the phantom, and two at the background area of the image.

    RESULTS: For the standard protocol, the mean CNR decreased uniformly as table height increased and significantly differed (p 

  18. James GL, Latif MT, Isa MNM, Bakar MFA, Yusuf NYM, Broughton W, et al.
    Data Brief, 2021 Jun;36:107124.
    PMID: 34095374 DOI: 10.1016/j.dib.2021.107124
    Transboundary emissions of smoke-haze from land and forest fires have recurred annually during the dry period (June to October, over the past few decades) in South East Asia. Hazardous air quality has been recorded in Malaysia during these episodes. Agricultural practices such as slash-and-burn of biomass and peat fires particularly in Sumatera and Kalimantan, Indonesia, have been implicated as the major causes of the haze. Past findings have shown that a diversity of microbes can thrive in air including in smoke-haze polluted air. In this study, metagenomic data were generated to reveal the diversity of microorganisms in air during days with and without haze. Air samples were collected during non-haze (2013A01) and two haze (2013A04 and 2013A05) periods in the month of June 2013. DNA was extracted from the samples, subjected to Multiple Displacement Amplification and whole genome sequencing (Next Generation Sequencing) using the HiSeq 2000 Platform. Extensive bio-informatic analyses of the raw sequence data then followed. Raw reads from these six air samples were deposited in the NCBI SRA databases under Bioproject PRJNA662021 with accession numbers SRX9087478, SRX9087479 and SRX9087480.
  19. Bahrom NH, Ramli AS, Isa MR, Abdul-Hamid H, Badlishah-Sham SF, Baharudin N, et al.
    J Prim Care Community Health, 2020 6 9;11:2150132720931301.
    PMID: 32507012 DOI: 10.1177/2150132720931301
    Background: High activation level has been associated with higher education background, better self-rated health status, and having adequate health literacy. However, there is a gap in the literature regarding the level of activation and the factors associated with it among patients with metabolic syndrome (MetS) in the Malaysian primary care setting. Objectives: This study aims to determine activation levels and the factors associated with high activation among individuals with MetS in primary care. Methods: A cross-sectional study was conducted at a university primary care clinic. Patient activation was measured using the Patient Activation Measure®-13 Malay version. Activation levels were dichotomized into "low activation" (levels 1 and 2) and "high activation" (levels 3 and 4). To determine the factors associated with high activation, simple logistic regressions (SLogR) followed by multiple logistic regressions (MLogR) were performed. Results: Of 333 participants, 280 (84.1%) were included in the final analysis. The mean activation score was 59.4 (SD ±10.20) and 61.8% had high activation level. Two variables were found to be significant on MLogR. Those who were employed have the odds of 3.135 (95% CI 1.442-6.816) of having high activation compared with those who were unemployed. Those with good self-reported health status have the odds of 6.482 (95% CI 1.243-33.792) of having high activation compared to those with poor self-reported health status. Conclusions: The majority of participants had high activation levels. Those who were employed and those who had good self-reported health status were more likely to have high activation levels. Findings of this study could be used to develop patient activation interventions to improve self-management skills among individuals with MetS in primary care. These may include problem solving support, individualized care plans, peer or family support, and skill building. Those in high activation group can be trained to become mentors to support their peers who have low activation level.
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