INTRODUCTION: Advanced presentation of breast cancer and the problem of late diagnosis is well documented. Patient delay beyond three months has been shown to reduce survival. This paper aims to explore the experience of Malaysian women presenting with advanced breast cancer with regards to their interpretation of breast symptoms.
METHOD: Purposive sampling of 19 breast cancer patients presenting with delayed treatment and/ or advanced cancer diagnosed within two years at the University Malaya Medical Centre, Kuala Lumpur were carried out. In-depth interviews were conducted using a self-devised interview guide. The interview guide covered the journey of the patient from discovering of symptoms to their present state. The audiotaped interviews were transcribed verbatim. NVivo 8 qualitative software was utilised for data management. Grounded theory with thematic analysis was utilised.
RESULTS: Nine women delayed seeking diagnosis although recognizing the symptom, five did not recognize symptom, three delayed treatment and two did not delay health attention. Themes that emerged with regards to triggering help seeking behavior were: a) poor symptom knowledge and recognition; b) importance of knowledge of the disease and its' outcomes; c) role of coping mechanisms and affect; and lastly d) role of significant others in appraising a breast symptom.
CONCLUSION: Symptom recognition remains an important public health issue in Malaysia. Educating women, their significant others and primary health and primary care providers in detecting early staged breast cancer are needed. Supporting and sanctioning women with breast symptoms are important. The psycho-social-cultural model of symptom appraisal may serve as an important addition to the fight against cancer in countries that do not have the resources for population based screening mammogram programmes.
The main objective of this paper is to examine the psychometric properties of the Malay Version of the Hospital Anxiety and Depression Scale (HADS), tested on 67 husbands of the women who were diagnosed with breast cancer. The eligible husbands were retrieved from the Clinical Oncology Clinic at three hospitals in Kuala Lumpur, Malaysia. Data was collected at three weeks and ten weeks following surgery for breast cancer of their wives. The psychometric properties of the HADS were reported based on Cronbach' alpha, Intraclass Correlation Coefficients (ICC), Effect Size Index (ESI), sensitivity and discriminity of the scale. Internal consistency of the scale is excellent, with Cronbach's alpha of 0.88 for Anxiety subscale and 0.79 for Depression subscale. Test-retest Intraclass Correlation Coefficient (ICC) is 0.35 and 0.42 for Anxiety and Depression Subscale, respectively. Small mean differences were observed at test-retest measurement with ESI of 0.21 for Anxiety and 0.19 for Depression. Non-significant result was revealed for the discriminant validity (mastectomy vs lumpectomy). The Malay Version of the HADS is appropriate to measure the anxiety and depression among the husbands of the women with breast cancer in Malaysia.
Study site: Oncology clinic, University of Malaya Medical Centre (UMMC), Hospital Kuala Lumpur, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
INTRODUCTION: Female sexual dysfunction (FSD) is a highly prevalent sexual health problem but poorly investigated at the primary care level.
AIM: This article examines the prevalence of sexual dysfunction and its possible risk factors associated with women at high risk of FSD in a hospital-based primary practice.
METHODS: A validated Malay version of the Female Sexual Function Index (MVFSFI) was utilized to determine FSD in a cross-sectional study design, involving 163 married women, aged 18-65 years, in a tertiary hospital-based primary care clinic in Kuala Lumpur, Malaysia. Sociodemographic, marital profile, health, and lifestyle for women at high risk of FSD and those who were not at high risk were compared and their risk factors were determined.
MAIN OUTCOME MEASURES: Prevalence of FSD in Malaysian women based on the MVFSFI, and its risk factors for developing FSD.
RESULTS: Some 42 (25.8%) out of 163 women had sexual dysfunction. Prevalence of sexual dysfunction increased significantly with age. Sexual dysfunctions were detected as desire problem (39.3%), arousal problem (25.8%), lubrication problem (21.5%), orgasm problem (16.6%), satisfaction problem (21.5%) and pain problems (16.6%). Women at high risk of FSD were significantly associated with age (OR 4.1, 95% CI 1.9 to 9.0), husband's age (OR 4.3 95% C.I 1.9 to 9.3), duration of marriage (OR 3.3, 95% CI 1.6 to 6.8), medical problems (OR 8.5, 95% CI 3.3 to 21.7), menopausal status (OR 6.6, 95% CI 3.1 to 14.3), and frequency of sexual intercourse (OR 10.7, 95% CI 3.6 to 31.7). Multivariate analysis showed that medical problem (adjusted OR 4.6, 95% CI 1.6 to 14.0) and frequency of sexual intercourse (adjusted OR 7.2, 95% CI 2.1 to 24.0) were associated with increased risk of having FSD. Those who practiced contraception were less likely to have FSD.
CONCLUSION: Sexual health problems are prevalent in women attending primary care clinic where one in four women were at high risk of FSD. Thus, primary care physician should be trained and prepared to address this issue.
Study site: Primary Care Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
INTRODUCTION: Erectile dysfunction (ED), lower urinary tract symptoms (LUTS), cardiovascular disease (CVD), depression, and androgen deficiency are common conditions affecting aging men over 50 years. However, data were limited in developing countries.
AIMS: To investigate the prevalence of ED, LUTS, chronic diseases, depression, androgen deficiency symptoms, and lifestyle of aging men in Malaysia, and to examine their associations with sociodemographic factors.
MAIN OUTCOME MEASURES: ED, LUTS, chronic diseases, depression, positive Androgen Deficiency in the Aging Male (ADAM) questionnaire
METHODS: A randomized survey of 351 men using structured questionnaires consisting of self-reported medical conditions, International Index for Erectile Function-5, International Prostate Symptom Score, Geriatric Depression Scale-15, and St Louis University questionnaire for ADAM. Blood samples were taken for glucose, lipid, prostate specific antigen (PSA), and hormones.
RESULTS: Mean age was 58+/-7 years. Prevalence of ED was 70.1% (mild ED 32.8%, mild to moderate ED 17.7%, moderate ED 5.1%, and severe ED 14.5%). There were 29% of men with moderate and severe LUTS; 11.1% had severe depression; 25.4% scored positive on ADAM questionnaire; 30.2% self-reported hypertension, 21.4% self-reported diabetes mellitus; 10.8% self-reported coronary artery disease; 19.1% were smokers; and 34% consumed alcohol. There were 78.6% of men that are overweight and obese; 28.8% had a fasting blood sugar (FBS) >or=6.1 mmol/L, 70.1% had total cholesterol >5.2 mmol/L, 19.1% had total testosterone >or=11.0 nmoL/L, 14.0% had calculated free testosterone <0.0225 nmoL/dL; 4% had PSA >4 microg/L; 9.4% had insulin-like growth factor-1 (IGF-1) level below age specific range, 5.1% had abnormal sex hormone binding globulin (<15 nmoL/L and >70 nmol/L). ED was found to be significantly associated with LUTS, depression (P<0.001 respectively). Similarly, LUTS was significantly associated with depression and ADAM questionnaire status (P<0.001 respectively); and ADAM questionnaire status was also significantly associated with depression (P<0.001).
CONCLUSION: ED, LUTS, depression, and androgen deficiency symptoms are common in urban aging men. As these conditions are possibly interrelated, strategies for early disease prevention and detection are warranted when one disease presents.
Sabah, located in Southeast Asia, hosts the highest number of non-Malaysian citizens (27.7%), predominantly the Indonesian and Filipino migrants in comparison to other states in Malaysia. Sabah has inadequate data on migrants' sexual and reproductive health and rights (SRHRs). Various migrant-related policies and laws are present, but they do not offer full protection and rights to legal migrants in terms of their SRHRs. The aim of the laws and policies appears to be controlling the migrants from having any negative impact on the locals, rather than protecting migrants' health and rights. This affected their rights to marriage, having children, increase their vulnerabilities to labour trafficking and sexual abuse and access to health-care services. Female migrant workers and undocumented migrants form the most vulnerable subgroups of migrants. This narrative review highlights the status of SRHRs of migrants in Sabah and the migrant-related Malaysian laws and policies affecting their SRHRs.
Physical symptoms (e.g., vomiting) and psychological symptoms (stress, anxiety, and depression) during pregnancy are common. Various strategies such as hypnosis are available to reduce these symptoms. The objective of the authors in this study is to investigate the impact of a hypnosis intervention in reducing physical and psychological symptoms during pregnancy. A pre-test/post-test quasi-experimental design was employed in this study. The hypnosis intervention was given to the experimental group participants at weeks 16 (baseline), 20 (time point 1), 28 (time point 2), and 36 (time point 3) of their pregnancy. Participants in the control group received only the traditional antenatal care. Participants from both groups completed the Depression Anxiety Stress Scale-21 (DASS-21) and a Pregnancy Symptoms Checklist at weeks 16, 20, 28 and 36 of pregnancy. Results indicated that stress and anxiety symptoms were significantly reduced for the experimental group, but not for the control group. Although mean differences for the depressive symptoms were not significant, the experimental group had lower symptoms at time point 3. The physical symptoms' results showed significant group differences at time point 3, indicating a reduction in the experience of physical symptoms for the experimental group participants. Our study showed that hypnosis intervention during pregnancy aided in reducing physical and psychological symptoms during pregnancy.
BACKGROUND: Few studies on falls interventions have been conducted in South East Asia. Despite its population ageing rapidly, the acceptability of interventions among the older population in this region remains variable. This study aims to explore views and experiences regarding falls and their prevention among older persons at high risk of falls.
METHOD: Sixteen individuals aged 60 years and over with at least one fall in the preceding 12 months were recruited from our Primary Care clinics. A qualitative study using semi-structured interviews among individuals and focus-groups was conducted. Thematic analyses were conducted on transcriptions of audio-taped interviews using the WeftQDA software. The interviews ceased when data saturation was achieved.
RESULTS: The three themes included older persons' views on falls, help-seeking behaviour and views on falls interventions. Many older persons interviewed did not perceive falls as a serious problem, some reported a stigma surrounding falls, while others felt they had not sustained more serious injuries due to God's grace. Older persons sought traditional medicine and other alternative treatments for pain relief and other fall-related symptoms. Accessibility of healthcare facilities often prevented older persons from receiving physiotherapy or eye tests.
CONCLUSION: The delivery of complex interventions for a multifactorial condition such as falls in the older persons in our setting is inhibited by various cultural barriers, falls perceptions as well as logistic difficulties. Efforts to establish a multi-disciplinary intervention among our older population will need to include strategies to overcome these issues.
KEYWORDS: Accidental falls; Aged; Falls interventions; Falls preventions; Older adults; Qualitative study
Study site: Primary Care Clinics at University of Malaya Medical Centre (UMMC)
BACKGROUND: Diabetes Mellitus is a multifaceted chronic illness and its life-long treatment process requires patients to continuously engage with the healthcare system. The understanding of how patients manoeuvre through the healthcare system for treatment is crucial in assisting them to optimise their disease management. This study aims to explore issues determining patients' treatment strategies and the process of patients manoeuvring through the current healthcare system in selecting their choice of treatment for T2DM.
METHODS: The Grounded Theory methodology was used. Twelve patients with Type 2 Diabetes Mellitus, nine family members and five healthcare providers from the primary care clinics were interviewed using a semi-structured interview guide. Three focus group discussions were conducted among thirteen healthcare providers from public primary care clinics. Both purposive and theoretical samplings were used for data collection. The interviews were audio-taped and transcribed verbatim, followed by line-by-line coding and constant comparison to identify the categories and core category.
RESULTS: The concept of "experimentation" was observed in patients' help-seeking behaviour. The "experimentation" process required triggers, followed by information seeking related to treatment characteristics from trusted family members, friends and healthcare providers to enable decisions to be made on the choice of treatment modalities. The whole process was dynamic and iterative through interaction with the healthcare system. The decision-making process in choosing the types of treatment was complex with an element of trial-and-error. The anchor of this process was the desire to fulfil the patient's expected outcome.
CONCLUSION: Patients with Type 2 Diabetes Mellitus continuously used "experimentation" in their treatment strategies and help-seeking process. The "experimentation" process was experiential, with continuous evaluation, information seeking and decision-making tinged with the element of trial-and-error. The theoretical model generated from this study is abstract, is believed to have a broad applicability to other diseases, may be applied at varying stages of disease development and is non-context specific.
Ptyalism gravidarum, or sialorrhea, is the excessive secretion of saliva during pregnancy. Treatment of ptyalism gravidarum is often challenging due to its unknown etiologies. This article discusses a case of ptyalism gravidarum with concomitant hyperemesis in which the condition was successfully treated with hypnosis. A 28-year-old woman presented with ptyalism 2 months into her pregnancy and hyperemesis 3 months into pregnancy with associated vomiting that occurred following every meal. Hypnosis was administered at week 16 of pregnancy to eliminate ptyalism and hyperemesis, to prepare for childbirth, and to increase overall psychological well-being. Ptyalism resolved by week 36, concurrent with the final hypnosis session.
Non-communicable diseases (NCDs) lead to substantial mortality and morbidity worldwide. The most common NCDs are cardiovascular diseases (CVD), diabetes, cancer and chronic respiratory diseases. With the rapid increase in NCD-related deaths in Asia Pacific countries, NCDs are now the major cause of deaths and disease burden in the region. NCDs hamper achievement of the Millennium Development Goals (MDG). People in the low socio-economic group are most affected by NCDs as they have poor access to policies, legislations, regulations and healthcare services meant to combat NCDs. This results in loss of productivity by a decreasing labor force with implications at the macroeconomic level. The 3 major NCDs in the Asia Pacific region are CVDs, cancer and diabetes due to the increasing loss of disability adjusted life years (DALYs). The 4 major behavioral risk factors for NCDs are: tobacco use, alcohol consumption, inadequate physical activity and unhealthy diet. The underlying risk factors are urbanization, globalization, sedentary lifestyle, obesity and hypertension. Strategies to combat NCDs in the Asia Pacific region are as follows: population-based dietary salt reduction, health education, psychological interventions, i.e., cognitive behavioral therapy and motivational-interviewing, taxation and bans on tobacco-related advertisements, implementing smoke-free zones and surveillance by the World Health Organization. Control measures must focus on prevention and strengthening inter-sectorial collaboration.
Advanced breast cancer presentation remains a large obstacle in lowering mortality rates in low- and middle-resource countries. This study aims to explore the reasons why women present with breast cancer at an advanced stage.
Psychological symptoms, particularly postpartum depression, may impair women's well-being after childbirth. Mind-body treatments such as hypnosis are available to help prepare women to maintain or improve their well-being postpartum. The aims of the present study are to determine the effectiveness of a hypnosis intervention in alleviating psychological symptoms (stress, anxiety, and depression) and the symptoms of postpartum depression. A quasi-experimental design was utilized in this study. The experimental group participants (n = 28) received a hypnosis intervention at weeks 16, 20, 28, and 36 of their pregnancies. Participants in the control group (n = 28) received routine prenatal care. The final data collection, occurring at two months postpartum, included 16 women from the experimental group and 11 women from the control group. The Depression Anxiety Stress Scale-21 (DASS-21) was used to measure psychological symptoms, and postpartum depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). The results at two months postpartum showed that the experimental group had significantly lower postpartum anxiety than the control group (M = 2.88 versus M = 38.36, p = .023). Similarly, the experimental group had significantly lower postpartum depressive symptoms than the control group (M = 1.25 versus M = 6.73, p
Men's health concerns have evolved from the traditional andrology and male sexual health to a more holistic approach that encompasses male psychological, social and physical health. The poor state of health in men compared to their female counterparts is well documented. A review of the epidemiological data from Malaysia noted a similar trend in which men die at higher rates in under 1 and above 15 years old groups and most disease categories compared to women. In Malaysia, the main causes of death in men are non-communicable diseases and injuries. Risk factors, such as risk-taking behaviour, smoking and hypertension, are prevalent and amenable to early interventions. Erectile dysfunction, premature ejaculation and prostate disorders are also prevalent. However, many of these morbidities go unreported and are not diagnosed early; therefore, opportunities for early intervention are missed. This reflects poor health knowledge and inadequate health-care utilisation among Malaysian men. Their health-seeking behaviour has been shown to be strongly influenced by family members and friends. However, more research is needed to identify men's unmet health-care needs and to develop optimal strategies for addressing them. Because the Malaysian population is aging and there is an increase in sedentary lifestyles, optimizing men's health will remain a challenge unless effective measures are implemented. The existing male-unfriendly health-care system and the negative influence of masculinity on men's health behaviour must be addressed. A national men's health policy based on a male-friendly approach to health-care delivery is urgently needed to provide a framework for addressing these challenges.
Type II Diabetes Mellitus (T2DM) is a serious public health issue, affecting the global population, particularly those living in low- and middle-income countries. Worldwide, the prevalence of T2DM ranges between 10.4% and 13.5%, depending on the domiciliary. T2DM negatively affects individuals' quality of life and causes high economic burden due to the increasing cost of treatment and management of the disease. Risk factors associated with T2DMs include aging, lifestyle or behavior, genetics, and important biopsychological aspects, which are psychological stress and sleep deprivation. By understanding the associations of psychological stress and sleep deprivation, which contribute to pathophysiology of T2DM, policies, programs, and guidelines were developed in Malaysia to combat the issue among population at large. This narrative review examines 19 national public health policies, programs, and guidelines from the past 20 years in Malaysia that aimed to mitigate the negative health effects of psychological stress, sleep deprivation, and T2DM, both from the government and non-governmental organizations. Both psychological stress and sleep deprivation works independently or as combined effects in the pathophysiology of T2DM. Besides, in Malaysia, the government, in collaboration with non-governmental organizations, have been developing and implementing policies, programs, and guidelines to combat mental health and T2DM issues, targeted to population at large. Integration of digital technology, such as usage of social media for health promotion and dissemination of public health messages to the community and good governance from government were deemed important in the effective implementation of health policies and guidelines, resulting in better health outcome.
Objective: To determine the validity and reliability of the Chinese parent proxy and child self-report
health related quality of life measure for children with epilepsy (CHEQOL-25) in Malaysia. Methods:
Face and content validity of the Chinese parent proxy and child self-report CHEQOL-25 was verified
by an expert panel, and piloted in five children with epilepsy (CWE). The Chinese CHEQOL-25 was
then administered to 40 parent proxies and their CWE (aged 8-18 years), from two tertiary hospitals,
at baseline and 2 weeks later. Results: Forty parents and their CWE were recruited. Cronbach’s alpha
for each subscale ranged from 0.56-0.83. At test-retest, the interclass correlation for all items ranged
from 0.68-0.97. Items 8 and 25 were removed as their corrected item-total correlation values were
Hypnosis has been shown to help pregnant women experience improved labor and postpartum periods. The present study compares the differences between experimental (n = 23) and control groups (n = 22) on specific variables measured both during labor and 24 hr postpartum. The participants in the experimental group received the hypnosis intervention at weeks 16, 20, 28, and 36 of pregnancy, while those in the control group received only routine antenatal care. The data collected at the labor stage describe the length of the labor stage, pain relief used during labor, the method of delivery, and the type of assisted vaginal delivery. Within 24 hr of delivery, data on neonatal birth weight, neonatal Apgar scores, and self-reported pain were obtained. The labor stage results showed no significant differences in the length of the second and third stages of labor. Although the participants in the experimental group reported higher pain levels immediately prior to, during, and immediately after delivery, their use of pethidine during labor was significantly lower than the control group participants. None of the experimental group participants opted for an epidural, and they had a greater number of assisted vaginal deliveries than the control group participants. The 24 hr postpartum results showed that the neonates of the experimental group participants had nonsignificantly higher Apgar scores than those of the women in the control group. Group differences in neonatal weight were not significant. The results of the present study indicate that hypnosis is useful for assisting pregnant women during labor and the postpartum period.
RATIONALE, AIMS, AND OBJECTIVES: Patient concerns are often neglected in consultations, especially for chronic diseases where patients and providers fall into the routine of chronic disease management in consultations. One strategy to elicit patient concerns has been to ask patients to complete agenda lists before the consultation. This study aimed to explore the impact of a preconsultation agenda website in addressing patients' unmet needs during chronic disease consultations.
METHODS: Patients entered their concerns into a website (Values In Shared Interactions Tool (VISIT)). Doctors accessed this information via the electronic medical records before consultations. Individual in-depth interviews were then conducted with patients and doctors on the website's impact on consultations. Interviews were transcribed verbatim and analysed thematically.
RESULTS: The average age (years) was 65.7 for patients (n = 8) and 35.7 for doctors (n = 7). Patients in the study entered between 1 to 6 items in the website. From postconsultation interviews, we found that the website impacted the consultation in 5 ways: (1) It facilitated patients to communicate their full agenda to doctors; (2) it helped address unmet patient needs as it gave them opportunity to raise other issues besides their chronic condition; (3) it facilitated rapport between doctor and patient; (4) it facilitated doctors to organize their consultation around the concerns the patient had listed; and (5) it disrupted the doctor's usual consultation style if the list of concerns was lengthy.
CONCLUSIONS: Integrating patient concerns into electronic health records helped to facilitate patient-centred consultations. Doctors found this information useful but felt uneasy if the agenda list was too long or too complex. Areas for future studies include training doctors to manage complex agendas and formal evaluation of the VISIT tool.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Test anxiety comprises cognitive, physiological, and behavioral reactions due to anxiety about failure or a lower academic performance score on an exam or evaluation. This study examined the effect of self-hypnosis on reducing test anxiety among upper secondary school students using a quantitative methodology with a pre-experimental design. The prevalence of test anxiety was measured using the Friedben Test Anxiety Scale (FTAS) and students' demographic data were collected. Twenty-two 16-year-old students with moderate to high test anxiety were selected for a self-hypnosis intervention over a period of 5 weeks. The FTAS questionnaire was administered 4 times: at baseline, 3rd week, 5th week, and at follow-up (3 weeks after the intervention). Students' test anxiety differences were statistically significant across 4 time points. Self-hypnosis intervention decreased students' overall test anxiety scores and in the 3 constructs: social, cognitive, and tenseness. The outcomes indicate that self-hypnosis training can help students cope with test anxiety and should be further explored for managing test anxiety in school settings.
This study investigated sexual fluidity in attractions and subsequent fluidity in sexual identities, its associations with sexual orientation identity labels, and self-reported likelihood of future change in sexual identity labels in a sample of same-sex attracted Malaysian women and men. Participants completed an online questionnaire measuring sexual fluidity in attractions and sexual identity, sexual orientation identity labels and likelihood of future change in identity labels. Sexual fluidity in attractions was reported by 72% of women and 64% of men, with 44% of women and 38% of men reporting subsequent fluidity in sexual orientation identities. There were no significant gender differences observed in the frequency of sexual fluidity in attractions and change in sexual identity labels. There were also no significant gender differences in the self-reported likelihood of future change in sexual identity labels. Sexual fluidity was found to be associated with sexual identity labels representing non-exclusive sexual attractions for both men and women. Findings provide preliminary support for the presence of facilitative environments within a largely conservative and restrictive sociocultural and political landscape.
Pregnancy among unmarried women may have negative social and health implications in Malaysia. The number of pregnancies among unmarried women has increased in Malaysia, but the socio-demographic profile of these women is unclear. This study aims to evaluate the characteristics of unmarried pregnant women and the factors associated with unmarried pregnancies among young women in Malaysia. We conducted a cross sectional study at six hospitals and six women's shelters in Peninsular Malaysia during 2011-2012. Unmarried pregnant women were compared with married pregnant women. Participants were interviewed using a structured questionnaire asking for socio-demographic data, family background, risky sexual behavior, social support and pregnancy details. A total of 484 women (239 unmarried and 245 married) were included in the study. Most unmarried subjects were adolescents, from urban areas, from a low socioeconomic group, and lived with parents prior to pregnancy. Age (OR=0.67; 95% CI: 0.61-0.74), studying status (OR=17.33; 95% CI: 2.65-113.19), alcohol use (OR=40.46; 95% CI: 2.51-652.38) exposure to pornographic material (OR=13.48; 95% CI: 3.24-56.01), contraceptive use (OR=0.20; 95% CI: 0.08-0.51), and social support (OR=0.90; 95% CI: 0.86-0.94) were all associated with unmarried pregnancy. These factors need to be considered when.designing an intervention program.