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Modified labels for long-term medications: influences on adherence, comprehension and preferences in Malaysia

Chan HK, Hassali MA

Int J Clin Pharm, 2014 Oct;36(5):904-13.
PMID: 25135804 DOI: 10.1007/s11096-014-0003-1

BACKGROUND: Inability to read instructions on drug labels has been identified among the Malaysian population since 1990's.
OBJECTIVE: To assess the impact of font-enlarged and pictogram-incorporated labels used for long-term medications on patients' adherence, comprehension and preferences.
SETTING: Outpatient pharmacy in one of the major general hospitals across Northern Malaysia.
METHOD: This was a three-arm, randomized controlled trial. Outpatients with refill prescriptions of selected oral antihypertensive or antidiabetic medications were screened for eligibility. They were randomly allocated with standard (n = 35), font-enlarged (n = 40) or pictogram-incorporated (n = 35) labels. Assessment of baseline adherence scores using the 8-item Morisky Medication Adherence Scale, comprehension scores using a structured questionnaire and preferences was conducted upon recruitment. Follow-up telephone interviews were conducted after 4 weeks.
MAIN OUTCOME MEASURE: The changes of patients' adherence and comprehension scores and their preferences.
RESULTS: Within-group comparisons demonstrated an increase of total adherence scores after 4 weeks in all three groups (mean changes 0.35, 0.58 and 0.67; p = 0.029, 0.013 and 0.011, respectively). The repeatedly measured total comprehension score of pictogram-incorporated label group was significantly higher than baseline (mean change 0.37, p = 0.010). Two intervention groups obtained significantly higher scores for few items in both adherence and comprehension measurements after 4 weeks as compared with baselines. As indicated by F tests, three groups did not significantly differ in the changes of both total adherence and comprehension scores (p = 0.573 and 0.069, respectively) with the subjects' age adjusted. Elderlies and those with a higher number of morbidity preferred pictogram-incorporated label over font-enlarged label.
CONCLUSION: We did not find a significant change of both adherence and comprehension levels after the introduction of modified medication labels. However, on the basis of within-group comparisons, they may have positive influences on certain aspects of patients' adherence and comprehension. Variations in preferences may reflect the unique need of different subgroups in receiving written medication instructions.
Study site: Outpatient pharmacy, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia

Matched MeSH terms: Middle Aged
Factors influencing decision-making role preferences: A qualitative study of Malaysian patients with type 2 diabetes during insulin initiation

Lee YK, Low WY, Lee PY, Ng CJ

Int J Nurs Pract, 2015 May;21 Suppl 2:125-31.
PMID: 24804909 DOI: 10.1111/ijn.12355

Patient decision-making role preference (DMRP) is a patient's preferred degree of control when making medical decisions. This descriptive qualitative study aimed to explore Malaysian patients' views on their DMRP. Between January 2011 and March 2012, 22 individual face-to-face in-depth interviews were conducted with patients with type 2 diabetes who were deciding about insulin initiation. The interviews were audio-recorded and analysed using a thematic approach. The age range of participants was 28-67 years old with 11 men. Ten patients preferred to make the decision themselves, six patients indicated that the clinician should make the decision and only one patient expressed a preference for a collaborative role. The following factors influenced DMRP: trust in clinicians, responsibility for diabetes care, level of knowledge and awareness, involvement of family and personal characteristics. In conclusion, the concept of shared decision-making is still alien, and a more participative communication style might help to facilitate patients' expression of DMRP.
Study site: Public university hospital-based primary care clinic, Public health-care clinics (Klinik Kesihatan), Private specialist clinic, Malaysia

Matched MeSH terms: Middle Aged
Measuring religiosity and its effects on personal well-being: a case study of Muslim female academicians in Malaysia

Achour M, Grine F, Mohd Nor MR, MohdYusoff MY

J Relig Health, 2015 Jun;54(3):984-97.
PMID: 24770892 DOI: 10.1007/s10943-014-9852-0

This study seeks to measure religiosity in an Islamic context and to assess its effects on the personal well-being of Muslims. The determinants of religiosity included under this research are prayer, beliefs, and worship. This research also attempts to examine the coping strategies Muslims use to deal with life problems and changes such as prayer, supplication, trust and reliance on God, remembrance of death, and concept of life after death. Today, many scales of religiosity are being put into use among Muslims. This study measures religiosity and its effects on the well-being of Muslim academicians. The researchers used 315 Muslim female of academic staff as respondents, working in Research Universities in the Klang Valley such as University of Malaya, National University and Putra University area of Kuala Lumpur, Malaysia. Their ages ranged from 30 to 60 years. The results of this study show that there exists a positive yet significant correlation between personal well-being and religiosity. The well-being also shows significant positive correlations with beliefs and worship and prayer.

Matched MeSH terms: Middle Aged
Sexual dysfunction among postmenopausal women

Masliza W, Daud W, Yazid Bajuri M, Shuhaila A, Hatta S, Rohaizat Hassan M, et al.

Clin Ter, 2014;165(2):83-9.
PMID: 24770809 DOI: 10.7471/CT.2014.1681

Female sexual dysfunction (FSD) has a major impact on interpersonal relationships and quality of life. For many women it has been emotionally distressing, physically disconcerting, and socially disruptive. To determine the prevalence and factors that contribute to female sexual dysfunction (FSD) and to evaluate the different sexual domains that influence sexual function amongst post menopausal women.

Matched MeSH terms: Middle Aged
Fulltext Balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis

Khalaj N, Abu Osman NA, Mokhtar AH, Mehdikhani M, Wan Abas WA

PLoS One, 2014;9(3):e92270.
PMID: 24642715 DOI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC39584

Balance is essential for mobility and performing activities of daily living. People with knee osteoarthritis display impairment in knee joint proprioception. Thus, the aim of this study was to evaluate balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis. Sixty subjects aged between 50 and 70 years volunteered in this study. They were categorized into three groups which were healthy (n = 20), mild (n = 20) and moderate (n = 20) bilateral knee osteoarthritis groups. Dynamic and static balance and risk of fall were assessed using Biodex Stability System. In addition, Timed Up and Go test was used as a clinical test for balance. Results of this study illustrated that there were significant differences in balance (dynamic and static) and risk of fall between three groups. In addition, the main (most significant) difference was found to be between healthy group and moderate group. Furthermore, on clinical scoring of balance, the "Timed Up and Go" test, all three groups showed significant difference. In conclusion, bilateral knee osteoarthritis impaired the balance and increased the risk of fall, particularly in people with moderate knee osteoarthritis.

Matched MeSH terms: Middle Aged
An updated Asia Pacific Consensus Recommendations on colorectal cancer screening

Sung JJ, Ng SC, Chan FK, Chiu HM, Kim HS, Matsuda T, et al.

Gut, 2015 Jan;64(1):121-32.
PMID: 24647008 DOI: 10.1136/gutjnl-2013-306503

OBJECTIVE: Since the publication of the first Asia Pacific Consensus on Colorectal Cancer (CRC) in 2008, there are substantial advancements in the science and experience of implementing CRC screening. The Asia Pacific Working Group aimed to provide an updated set of consensus recommendations.
DESIGN: Members from 14 Asian regions gathered to seek consensus using other national and international guidelines, and recent relevant literature published from 2008 to 2013. A modified Delphi process was adopted to develop the statements.
RESULTS: Age range for CRC screening is defined as 50-75 years. Advancing age, male, family history of CRC, smoking and obesity are confirmed risk factors for CRC and advanced neoplasia. A risk-stratified scoring system is recommended for selecting high-risk patients for colonoscopy. Quantitative faecal immunochemical test (FIT) instead of guaiac-based faecal occult blood test (gFOBT) is preferred for average-risk subjects. Ancillary methods in colonoscopy, with the exception of chromoendoscopy, have not proven to be superior to high-definition white light endoscopy in identifying adenoma. Quality of colonoscopy should be upheld and quality assurance programme should be in place to audit every aspects of CRC screening. Serrated adenoma is recognised as a risk for interval cancer. There is no consensus on the recruitment of trained endoscopy nurses for CRC screening.
CONCLUSIONS: Based on recent data on CRC screening, an updated list of recommendations on CRC screening is prepared. These consensus statements will further enhance the implementation of CRC screening in the Asia Pacific region.

Matched MeSH terms: Middle Aged
Fulltext Psychological traits underlying different killing methods among Malaysian male murderers

Kamaluddin M, Shariff NS, Nurfarliza S, Othman A, Ismail KH, Mat Saat GA

Malays J Pathol, 2014 Apr;36(1):41-50.
PMID: 24763234 MyJurnal

Murder is the most notorious crime that violates religious, social and cultural norms. Examining the types and number of different killing methods that used are pivotal in a murder case. However, the psychological traits underlying specific and multiple killing methods are still understudied. The present study attempts to fill this gap in knowledge by identifying the underlying psychological traits of different killing methods among Malaysian murderers. The study adapted an observational cross-sectional methodology using a guided self-administered questionnaire for data collection. The sampling frame consisted of 71 Malaysian male murderers from 11 Malaysian prisons who were selected using purposive sampling method. The participants were also asked to provide the types and number of different killing methods used to kill their respective victims. An independent sample t-test was performed to establish the mean score difference of psychological traits between the murderers who used single and multiple types of killing methods. Kruskal-Wallis tests were carried out to ascertain the psychological trait differences between specific types of killing methods. The results suggest that specific psychological traits underlie the type and number of different killing methods used during murder. The majority (88.7%) of murderers used a single method of killing. Multiple methods of killing was evident in 'premeditated' murder compared to 'passion' murder, and revenge was a common motive. Examples of multiple methods are combinations of stabbing and strangulation or slashing and physical force. An exception was premeditated murder committed with shooting, when it was usually a single method, attributed to the high lethality of firearms. Shooting was also notable when the motive was financial gain or related to drug dealing. Murderers who used multiple killing methods were more aggressive and sadistic than those who used a single killing method. Those who used multiple methods or slashing also displayed a higher level of minimisation traits. Despite its limitations, this study has provided some light on the underlying psychological traits of different killing methods which is useful in the field of criminology.

Matched MeSH terms: Middle Aged
Fulltext The effects of prosthetic foot type and visual alteration on postural steadiness in below-knee amputees

Arifin N, Abu Osman NA, Ali S, Wan Abas WA

Biomed Eng Online, 2014;13(1):23.
PMID: 24597518 DOI: 10.1186/1475-925X-13-23

Achieving independent upright posture has known to be one of the main goals in rehabilitation following lower limb amputation. The purpose of this study was to compare postural steadiness of below knee amputees with visual alterations while wearing three different prosthetic feet.

Matched MeSH terms: Middle Aged
Mycobacterium brisbanense species nova isolated from a patient with chronic cavitary lung infection

Poh ME, Liam CK, Ng KP, Tan R

Chest, 2014 Apr;145(4):858-860.
PMID: 24687707 DOI: 10.1378/chest.13-1952

We describe the first case, to our knowledge, of Mycobacterium brisbanense species nova with the type strain W6743T (=ATCC 49938T=DSM 44680T) isolated from the lungs of a man with a 6-month history of productive cough and intermittent fever presenting with acute hypoglycemia. A CT scan of the thorax revealed multiple small nodules and consolidation over both lungs with cavitation. Sputum culture repeatedly grew M brisbanense species nova, a novel species never before isolated in Malaysia. The case met the American Thoracic Society criteria for the diagnosis of nontuberculous mycobacterial infection. There was dramatic clinical and radiologic response to treatment with an empirical combination of rifampicin, ethambutol, and levofloxacin and subsequently clarithromycin and levofloxacin once sensitivity was known. This report is the first, to our knowledge, of the pathogen isolated in a patient with chronic cavitary lung infection since it was first identified from an antral sinus in Brisbane, Queensland, Australia, and the first time it is isolated from a human subject in Malaysia.

Matched MeSH terms: Middle Aged
Fulltext A randomised controlled trial on hypolipidemic effects of Nigella Sativa seeds powder in menopausal women

Ibrahim RM, Hamdan NS, Mahmud R, Imam MU, Saini SM, Rashid SN, et al.

J Transl Med, 2014;12:82.
PMID: 24685020 DOI: 10.1186/1479-5876-12-82

The risk of cardiovascular diseases (CVD) is increased tremendously among menopausal women, and there is an increasing demand for alternative therapies for managing factors like dyslipidemia that contribute to CVD development.

Matched MeSH terms: Middle Aged
Hardiness as a mediator between perceived stress and happiness in nurses

Abdollahi A, Abu Talib M, Yaacob SN, Ismail Z

J Psychiatr Ment Health Nurs, 2014;21(9):789-96.
PMID: 24661763 DOI: 10.1111/jpm.12142

The relevance of the study of happiness and stress in nurses has been emphasized. In this sense, the intelligent use of hardiness is enable nurses to cope better with stress and contribute to being happier. This study aimed to examine the relationship among hardiness, perceived stress, and happiness in nurses. Moreover, we examined the mediator role of hardiness on the relationship between perceived stress and happiness in nurses. Our study revealed that hardi-attitude nurses evaluate situations as less stressful which results in a higher happiness. This study showed hardiness as being a protective factor against perceived stress and a facilitating factor for happiness in nurses. The findings could be important in training future nurses so that hardiness can be imparted, thereby giving them the ability to control their stress. Nursing is a stressful occupation with high levels of stress within the health professions. Given that hardiness is an important construct to enable nurses to cope better with stress and contribute to being happier; therefore, it is necessary we advance our knowledge about the aetiology of happiness, especially the role of hardiness in decreasing stress levels and increasing happiness. The present study sought to investigate the role of hardiness as a mediator between perceived stress and happiness. The participants, comprising 252 nurses from six private hospitals in Tehran, completed the Personal Views Survey, the Perceived Stress Scale, and the Oxford Happiness Inventory. Structural Equation Modelling (SEM) was used to analyse the data and answer the research hypotheses. As expected, hardiness partially mediated between perceived stress and happiness among nurses, and nurses with low levels of perceived stress were more likely to report greater hardiness and happiness. In addition, nurses with high levels of hardiness were more likely to report happiness. This study showed hardiness as being a protective factor against perceived stress and a facilitating factor for happiness in nurses. The findings could be important in training future nurses so that hardiness can be imparted, thereby giving them the ability to control their stress.

Matched MeSH terms: Middle Aged
Black hairy tongue in older edentulous individuals

Kannan S, Muthusamy S, Chandrasekaran B, Gopal D, Sidhu P

J Am Geriatr Soc, 2014 May;62(5):992-4.
PMID: 24828937 DOI: 10.1111/jgs.12813
Matched MeSH terms: Middle Aged
Fulltext Non-face-to-face physical activity interventions in older adults: a systematic review

Müller AM, Khoo S

Int J Behav Nutr Phys Act, 2014;11(1):35.
PMID: 24612748 DOI: 10.1186/1479-5868-11-35

Physical activity is effective in preventing chronic diseases, increasing quality of life and promoting general health in older adults, but most older adults are not sufficiently active to gain those benefits. A novel and economically viable way to promote physical activity in older adults is through non-face-to-face interventions. These are conducted with reduced or no in-person interaction between intervention provider and program participants. The aim of this review was to summarize the scientific literature on non-face-to-face physical activity interventions targeting healthy, community dwelling older adults (≥ 50 years). A systematic search in six databases was conducted by combining multiple key words of the three main search categories "physical activity", "media" and "older adults". The search was restricted to English language articles published between 1st January 2000 and 31st May 2013. Reference lists of relevant articles were screened for additional publications. Seventeen articles describing sixteen non-face-to-face physical activity interventions were included in the review. All studies were conducted in developed countries, and eleven were randomized controlled trials. Sample size ranged from 31 to 2503 participants, and 13 studies included 60% or more women. Interventions were most frequently delivered via print materials and phone (n=11), compared to internet (n=3) and other media (n=2). Every intervention was theoretically framed with the Social Cognitive Theory (n=10) and the Transtheoretical Model of Behavior Change (n=6) applied mostly. Individual tailoring was reported in 15 studies. Physical activity levels were self-assessed in all studies. Fourteen studies reported significant increase in physical activity. Eight out of nine studies conducted post-intervention follow-up analysis found that physical activity was maintained over a longer time. In the six studies where intervention dose was assessed the results varied considerably. One study reported that 98% of the sample read the respective intervention newsletters, whereas another study found that only 4% of its participants visited the intervention website more than once. From this review, non-face-to-face physical activity interventions effectively promote physical activity in older adults. Future research should target diverse older adult populations in multiple regions while also exploring the potential of emerging technologies.

Matched MeSH terms: Middle Aged
Unusually large breast tumour in a middle-aged woman

Khajotia R, Poovaneswaran S, Pavadai T, Sabaratnam S, Khairan H

Can Fam Physician, 2014 Feb;60(2):142-6.
PMID: 24522677
Matched MeSH terms: Middle Aged
Effect of exercise and gait retraining on knee adduction moment in people with knee osteoarthritis

Khalaj N, Abu Osman NA, Mokhtar AH, Mehdikhani M, Wan Abas WA

Proc Inst Mech Eng H, 2014 Feb;228(2):190-9.
PMID: 24458100 DOI: 10.1177/0954411914521155

The knee adduction moment represents the medial knee joint load, and greater value is associated with higher load. In people with knee osteoarthritis, it is important to apply proper treatment with the least side effects to reduce knee adduction moment and, consequently, reduce medial knee joint load. This reduction may slow the progression of knee osteoarthritis. The research team performed a literature search of electronic databases. The search keywords were as follows: knee osteoarthritis, knee adduction moment, exercise program, exercise therapy, gait retraining, gait modification and knee joint loading. In total, 12 studies were selected, according to the selection criteria. Findings from previous studies illustrated that exercise and gait retraining programs could alter knee adduction moment in people with knee osteoarthritis. These treatments are noninvasive and nonpharmacological which so far have no or few side effects, as well as being low cost. The results of this review revealed that gait retraining programs were helpful in reducing the knee adduction moment. In contrast, not all the exercise programs were beneficial in reducing knee adduction moment. Future studies are needed to indicate best clinical exercise and gait retraining programs, which are most effective in reducing knee adduction moment in people with knee osteoarthritis.
Study design: systematic review

Matched MeSH terms: Middle Aged
An ethnobotanical study of medicinal plants used by tribal and native people of Madhupur forest area, Bangladesh

Islam MK, Saha S, Mahmud I, Mohamad K, Awang K, Jamal Uddin S, et al.

J Ethnopharmacol, 2014 Feb 3;151(2):921-30.
PMID: 24342778 DOI: 10.1016/j.jep.2013.11.056

Madhupur forest area, Tangail is one of early human settlements in Bangladesh. Having abode in the vicinity of the forest, a strong ethnobotanical practice has prevailed in this area since ancient time. Due to the rapid deforestation during the last few decades, many plants have already disappeared or are facing extinction. Thus we attempted to document the medicinal plant use of Madhupur forest area with a view to preserve the ethnobotanical knowledge and in order to protect the biodiversity of this area.

Matched MeSH terms: Middle Aged
Fulltext Influence of age on patellar tendon reflex response

Chandrasekhar A, Abu Osman NA, Tham LK, Lim KS, Wan Abas WA

PLoS One, 2013;8(11):e80799.
PMID: 24260483 DOI: 10.1371/journal.pone.0080799

BACKGROUND: A clinical parameter commonly used to assess the neurological status of an individual is the tendon reflex response. However, the clinical method of evaluation often leads to subjective conclusions that may differ between examiners. Moreover, attempts to quantify the reflex response, especially in older age groups, have produced inconsistent results. This study aims to examine the influence of age on the magnitude of the patellar tendon reflex response.
METHODOLOGY/PRINCIPAL FINDINGS: This study was conducted using the motion analysis technique with the reflex responses measured in terms of knee angles. Forty healthy subjects were selected and categorized into three different age groups. Patellar reflexes were elicited from both the left and right patellar tendons of each subject at three different tapping angles and using the Jendrassik maneuver. The findings suggested that age has a significant effect on the magnitude of the reflex response. An angle of 45° may be the ideal tapping angle at which the reflex can be elicited to detect age-related differences in reflex response. The reflex responses were also not influenced by gender and were observed to be fairly symmetrical.
CONCLUSIONS/SIGNIFICANCE: Neurologically normal individuals will experience an age-dependent decline in patellar reflex response.

Matched MeSH terms: Middle Aged
Stratifying patients with haematuria into high or low risk groups for bladder cancer: a novel clinical scoring system

Hee TG, Shah SA, Ann HS, Hemdan SN, Shen LC, Al-Fahmi Abdul Galib N, et al.

Asian Pac J Cancer Prev, 2013;14(11):6327-30.
PMID: 24377526

Haematuria is a common presentation of bladder cancer and requires a full urologic evaluation. This study aimed to develop a scoring system capable of stratifying patients with haematuria into high or low risk groups for having bladder cancer to help clinicians decide which patients need more urgent assessment. This cross- sectional study included all adult patients referred for haematuria and subsequently undergoing full urological evaluation in the years 2001 to 2011. Risk factors with strong association with bladder cancer in the study population were used to design the scoring system. Accuracy was determined by the area under the receiver operating characteristic (ROC) curve. A total of 325 patients with haematuria were included, out of which 70 (21.5%) were diagnosed to have bladder cancer. Significant risk factors associated with bladder cancer were male gender, a history of cigarette smoking and the presence of gross haematuria. A scoring system using 4 clinical parameters as variables was created. The scores ranged between 6 to 14, and a score of 10 and above indicated high risk for having bladder cancer. It was found to have good accuracy with an area under the ROC curve of 80.4%, while the sensitivity and specificity were 90.0% and 55.7%, respectively. The scoring system designed in this study has the potential to help clinicians stratify patients who present with haematuria into high or low risk for having bladder cancer. This will enable high-risk patients to undergo urologic assessment earlier.

Matched MeSH terms: Middle Aged
Does simultaneous inversion during extracorporeal shock wave lithotripsy improve stone clearance: a long-term, prospective, single-blind, randomized controlled study

Leong WS, Liong ML, Liong YV, Wu DB, Lee SW

Urology, 2014 Jan;83(1):40-4.
PMID: 24044912 DOI: 10.1016/j.urology.2013.08.004

To determine the efficacy of a combination of simultaneous shock wave lithotripsy (SWL), hydration with controlled inversion therapy compared with SWL with hydration alone in patients with lower pole calyx stones.

Matched MeSH terms: Middle Aged
Quality of life among Malaysian mothers with a child with Down syndrome

Geok CK, Abdullah KL, Kee LH

Int J Nurs Pract, 2013 Aug;19(4):381-9.
PMID: 23915407 DOI: 10.1111/ijn.12083

The purpose of this paper is to examine the quality of life (QOL) among mothers with a child with Down syndrome using The World Health Organization Quality of Life scale instrument. A convenience sample of 161 mothers was accessed through the various institutions which provide interventional or educational programmes to children with disabilities within two of the regions of the Borneo State of Malaysia (Sarawak). Nearly half of the group of mothers perceived their QOL as neither poor nor good (n = 73). An overall QOL score of 14.0 ± 1.84 was obtained. The highest and lowest domain scores were found for social relationship domain (Mean = 14.9 ± 2.1) and environmental support domain (Mean = 13.3 ± 2.1) respectively. Correlation analysis of selected background variables (i.e. locality, education, income and marital status) and overall QOL indicated rho (161) = 0.22-0.28 (P < 0.01). Inverse correlation between maternal age and overall QOL score was indicated, with rho (161) = -0.17 (P < 0.05). Linear regression analysis indicated that the combination of these few variables together accounted for 14.5% of the QOL variability in the sample. Findings point to implications for priorities of care provisions by policy-makers and care professionals in their practice.

Matched MeSH terms: Middle Aged

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