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  1. Akhtari-Zavare, M., Mohd Yunus, A., Hassan, S. T. S., Salmiah, S., Kamali, M.
    MyJurnal
    Background: Patients’ satisfaction with their nursing care is an important issue in assessing the quality
    of nursing care. In Iran, cancer patients’ satisfaction at teaching hospitals of Tehran City has not been
    investigated. Aim: A cross sectional study was conducted to determine the level and identify factors that contributed to patients’ satisfaction in nursing care provided at selected teaching hospitals in Tehran City, Islamic Republic of Iran. Method: A proportional stratified sampling method was used and data were collected via face-to-face interview based on a validated Patient Satisfaction Questionnaire (PSQ). A total of 384 cancer patients aged 14 years and above were selected. Result: The majority of respondents were males (201, 52.4%), age group 45-54 years (102, 26.4%); employed (202, 52.6%) and with a family monthly income of US$200-500 (234, 60.9%).The majority (314, 81.8%) of respondents were hospitalized between 2 to 5 days, and most (204, 54.0%) of them were admitted to teaching hospital B of The University of Medical Science.1 A majority of the respondents (318, 82.8%) was satisfied with the nursing care provided, while the others (66, 17.2%) were not. Generally, most of the respondents were satisfied with the amount of information given by the nurses (294, 76.6%), technical quality (295, 76.8%), interpersonal relationship (371, 96.6%), and physical environment (267, 69.5%). There was a positive significant relationship between patients’ satisfaction and type of hospital ( 2=4.985; df=1; p=0.026, n=384). Using the University’s hospital type was found to be the best predictor for level of satisfaction. Conclusion: Most of the respondents were satisfied with the nursing care. However, the respondents suggested several improvements such as increasing the number of doctors, improving socioenvironment factors in terms of privacy and interpersonal relationship, and improving on the existing facilities. Further research is needed to study in depth the socio-cultural and environment parameters which are relevant to patients’ satisfaction with nursing care.
  2. Akhtari-Zavare M, Latiff LA
    Asian Pac. J. Cancer Prev., 2015;16(14):5595-7.
    PMID: 26320422
    Electrical impedance tomography (EIT) is a new non-invasive, mobile screening method which does not use ionizing radiation to the human breast. It is based on the theory that cancer cells display altered local dielectric properties, thus demonstrating measurably higher conductivity values. This article reviews the utilisation of EIT in breast cancer detection. It could be used as an adjunct to mammography and ultrasonography for breast cancer screening.
  3. Akhtari-Zavare M, Juni MH, Said SM, Ismail IZ
    Asian Pac. J. Cancer Prev., 2013;14(1):57-61.
    PMID: 23534796
    BACKGROUND: Breast cancer is the most common cancer and the second principal cause of cancer deaths among women worldwide, including Malaysia.

    METHODS: A cross-sectional study was carried out among 262 female undergraduate students in University Putra Malaysia using a validated questionnaire which was developed for this study.

    RESULTS: The mean age of respondents was 22∓2.3 years. Most of them were single (83.1%), Malay (42.3%) and 20.7% reported having a family history of breast cancer. Eighty-seven (36.7%) claimed they had practiced BSE. Motivation and self-efficacy of the respondents who performed BSE were significantly higher compared with women who did not (p<0.05).There was no association between BSE practice and demographic details (p<0.05). Logistic regression analysis indicated that women who perceived greater motivation (OR=1.089, 95%CI: 1.016-1.168) and had higher confidence of BSE (OR=1.076, 95%CI: 1.028-1.126) were more likely to perform the screening.

    CONCLUSIONS: The findings show that Malaysian young female's perception regarding breast cancer and the practice of BSE is low. Targeted education should be implemented to improve early detection of breast cancer.
  4. Akhtari-Zavare M, Ghanbari-Baghestan A, Latiff LA, Khaniki H
    Asian Pac. J. Cancer Prev., 2015;16(4):1337-41.
    PMID: 25743795
    BACKGROUND: Breast cancer is the most common cancer and the second principal cause of cancer deaths among women worldwide, including Malaysia. This study focused on media choice and attempted to determine the communication channels mostly used and preferred by women in seeking information and knowledge about breast cancer.

    MATERIALS AND METHODS: A cross sectional study was carried out to examine the breast cancer prevention information seeking behavior among 450 students at one private university in Malaysia.

    RESULTS: The mean age of respondents was 25±4.3 years. Common interpersonal information sources were doctors, friends, and nurses and common channel information sources were television, brochure, and internet. Overall, 89.9% used cell phones, 46.1% had an interest in receiving cell phone breast cancer prevention messages, 73.9% used text messaging, and 36.7% had an interest in receiving text breast cancer prevention messages. Bivariate analysis revealed significant differences among age, eduation, nationality and use of cell phones.

    CONCLUSIONS: Assessment of health information seeking behavior is important for community health educators to target populations for program development.

  5. Akhtari-Zavare M, Juni MH, Ismail IZ, Said SM, Latiff LA
    Asian Pac. J. Cancer Prev., 2015;16(9):4019-23.
    PMID: 25987079
    BACKGROUND: Breast cancer is the most frequently occurring cancer in women and the most common cause of cancer death worldwide.

    MATERIALS AND METHODS: A cross-sectional study was carried out among 792 female undergraduate students in public universities in Klang Valley, Malaysia, from January to April 2011. Data were collected using a validated questionnaire developed for this study.

    RESULTS: The mean age of respondents was 21.7±1.2 years. Most of them were single (96.8%), Malay (91.9%) and 150 (19.6%) claimed they had practiced BSE. There was a significant differences between performers and non-performers correlated to age, marital status, check breast by doctor, and being trained about BSE. Performers had lower mean scores for perceived barriers and susceptibility and higher mean score for confidence. Stepwise logistic regression analysis yielded four significant predictor variables.

    CONCLUSIONS: Overall our findings indicate that the practice of BSE while perceived as being important is not frequently practiced among female in Malaysia. Targeted education should be implemented to improve early detection of breast cancer.
  6. Akhtari-Zavare M, Ghanbari-Baghestan A, Latiff LA, Matinnia N, Hoseini M
    Asian Pac. J. Cancer Prev., 2014;15(16):6531-4.
    PMID: 25169482
    BACKGROUND: In Iran, breast cancer is the most prevalent cancer in women and a major public health problem.

    METHODS: A cross sectional study was carried out to determine knowledge on breast cancer and breast self- examination (BSE) practices of 384 females living in the city of Hamadan, Iran. A purposive sampling method was adopted and data were collected via face-to-face interviews based on a validated questionnaire developed for this study.

    RESULTS: Among respondents 268 (69.8%) were married and 144 (37.5%) of the respondents reported having a family history of breast cancer. One hundred respondents (26.0%) claimed they practiced BSE. Level of breast cancer knowledge was significantly associated with BSE practice (p=0.000). There was no association with demographic details (p<0.05).

    CONCLUSION: The findings showed that Iranian women's knowledge regarding breast cancer and the practice of BSE is inadequate. Targeted education should be implemented to improve early detection of breast cancer.

  7. Akhtari-Zavare M, Juni MH, Ismail IZ, Said SM, Latiff LA
    Springerplus, 2015;4:692.
    PMID: 26587360 DOI: 10.1186/s40064-015-1491-8
    Breast cancer is the most frequent cancer and the second reason of cancer deaths among woman worldwide, including Malaysia. The objective of this paper is to assess the practice of breast self-examination (BSE) and identify the barriers of BSE practice among undergraduate female students in Malaysia.
  8. Akhtari-Zavare M, Lattif LA, Juni MH, Md Said S, Ismail IZ
    J. Obstet. Gynaecol. Res., 2015 Dec;41(12):1982-7.
    PMID: 26554636 DOI: 10.1111/jog.12819
    Abstract
    AIM:
    Breast cancer is the most common cancer among women worldwide, including Malaysia. In developing countries, predictors affecting breast self-examination (BSE) practice are different. This cross-sectional study was conducted to determine the prevalence of BSE practice and the predictors affecting BSE practice among undergraduate female students in Klang Valley, Malaysia.

    MATERIAL AND METHODS:
    A cross-sectional study was conducted among 820 female undergraduate students to assess the BSE performance and related determinants of BSE practice in Klang Valley, Malaysia. Data were collected via a self-administered structured questionnaire that was developed for this study.

    RESULTS:
    The mean age of the respondents was 21.7 ± 1.2 years old. Most of them were single (96.8%), Malay (91.9%) and 19.6% of the participants performed BSE regularly. Multivariate logistic regression modeling revealed that BSE performance was more likely among women who have checked their breast with a doctor (odds ratio = 2.04, P = 0.00), and women who have personal history of breast disease (odds ratio = 4.43, P = 0.03).

    CONCLUSION:
    The findings showed a low BSE practice rate among young Malaysian women. Hence, the community's breast health awareness is needed to improve breast cancer prevention among young Malaysian women.

    KEYWORDS:
    Malaysia; breast self-examination; predictors
  9. Akhtari-Zavare M, Latiff LA, Juni MH, Said SM, Ismail IZ
    Asian Pac. J. Cancer Prev., 2015;16(15):6231-5.
    PMID: 26434821
    BACKGROUND: In Malaysia, breast cancer is the first cancer among females regardness of race.

    AIM: The purpose of this study was to identify the knowledge and BSE practice among undergraduate female students at four public universities in Klang Valley, Malaysia.

    MATERIALS AND METHODS: This cross-sectional study was conducted among 820 undergraduate female students using a self-administered questionnaire covering socio-demographic data, knowledge of breast cancer and BSE practice.

    RESULTS: The mean age of the respondents was 21.7±1.2 years. The majority of them were single (96.8%), Malay (91.9%) and 16.5% of respondents had a family history of breast cancer. This study showed low level of knowledge on breast cancer and breast self-examination among participants. Only 19.6% participants were performing BSE regularly. Knowledge of breast self-examination was significantly associated with BSE practice (p=0.00). Also, there were significant associations between performing BSE with age, marital status and being trained by a doctor for doing BSE (p<0.05).

    CONCLUSIONS: Our findings showed that the rate of BSE practice and knowledge of breast cancer is inadequate among young Malaysian females. A public health education program is essential to improve breast cancer prevention among this group.
  10. Latiff LA, Ibrahim Z, Pei CP, Rahman SA, Akhtari-Zavare M
    Asian Pac. J. Cancer Prev., 2015;16(18):8495-501.
    PMID: 26745108
    PURPOSE: This study was conducted to assess the agreement and differences between cervical self-sampling with a Kato device (KSSD) and gynecologist sampling for Pap cytology and human papillomavirus DNA (HPV DNA) detection.

    MATERIALS AND METHODS: Women underwent self-sampling followed by gynecologist sampling during screening at two primary health clinics. Pap cytology of cervical specimens was evaluated for specimen adequacy, presence of endocervical cells or transformation zone cells and cytological interpretation for cells abnormalities. Cervical specimens were also extracted and tested for HPV DNA detection. Positive HPV smears underwent gene sequencing and HPV genotyping by referring to the online NCBI gene bank. Results were compared between samplings by Kappa agreement and McNemar test.

    RESULTS: For Pap specimen adequacy, KSSD showed 100% agreement with gynecologist sampling but had only 32.3% agreement for presence of endocervical cells. Both sampling showed 100% agreement with only 1 case detected HSIL favouring CIN2 for cytology result. HPV DNA detection showed 86.2%agreement (K=0.64, 95% CI 0.524-0.756, p=0.001) between samplings. KSSD and gynaecologist sampling identified high risk HPV in 17.3% and 23.9% respectively (p= 0.014).

    CONCLUSION: The self-sampling using Kato device can serve as a tool in Pap cytology and HPV DNA detection in low resource settings in Malaysia. Self-sampling devices such as KSSD can be used as an alternative technique to gynaecologist sampling for cervical cancer screening among rural populations in Malaysia.

  11. Akhtari-Zavare M, Juni MH, Said SM, Ismail IZ, Latiff LA, Ataollahi Eshkoor S
    BMC Public Health, 2016 08 08;16:738.
    PMID: 27502284 DOI: 10.1186/s12889-016-3414-1
    BACKGROUND: Breast cancer is the most common cancer and the second principal cause of cancer deaths in women worldwide as well as in Malaysia. Breast self-examination (BSE) has a role in raising breast cancer awareness among women and educational programs play an important role in breast cancer preventive behavior. The aim of this study is to develop, implement and evaluate the effectiveness of Breast Health Awareness program based on health belief model on knowledge of breast cancer and breast-selfexamination and BSE practice among female students in Malaysia.

    METHODS: A single-blind randomized controlled trial was carried out among 370 female undergraduate students from January 2011 to April 2012 in two selected public universities in Malaysia. Participants were randomized to either the intervention group or the control group. The educational program was delivered to the intervention group. The outcome measures were assessed at baseline, 6, and 12 months after implementing the health educational program. Chi-square, independent samples t-test and two-way repeated measures ANOVA (GLM) were conducted in the course of the data analyses.

    RESULTS: Mean scores of knowledge on breast cancer (p<0.003), knowledge on breast self examination (p<0.001), benefits of BSE (p<0.00), barrier of BSE (0.01) and confidence of BSE practice (p<0.00) in the intervention group had significant differences in comparison with those of the control group 6 and 12 months after the intervention. Also, among those who never practiced BSE at baseline, frequency of BSE practice increased 6 and 12 months after the intervention (p<0.05).

    CONCLUSION: The Breast Health Awareness program based on health the belief model had a positive effect on knowledge of breast cancer and breast self-examination and practice of BSE among females in Malaysia.

    TRIAL REGISTRATION: The ANZCTR clinical trial registry ( ACTRN12616000831482 ), retrospectively registered on Jun 23, 2016 in ANZCTR.org.au.

  12. Periasamy U, Mohd Sidik S, Rampal L, Fadhilah SI, Akhtari-Zavare M, Mahmud R
    Health Qual Life Outcomes, 2017 May 15;15(1):104.
    PMID: 28506305 DOI: 10.1186/s12955-017-0680-2
    BACKGROUND: Cancer is now becoming a leading cause of death. Chemotherapy is an important treatment for cancer patients. These patients also need consultation during their treatment to improve quality of life and decrease psychological disorders. The objectives of the study were to develop, implement and evaluate the effectiveness of a chemotherapy counseling module by pharmacists among oncology patients on their quality of life and psychological outcomes in Malaysia.

    METHOD: A single-blind randomized controlled trial was carried out among 162 oncology patients undergoing chemotherapy from July 2013 to February 2014 in a government hospital with oncology facilities in Malaysia. Participants were randomized to either the intervention group or the control group. Chemotherapy counseling using the module on 'Managing Patients on Chemotherapy' by Pharmacists was delivered to the intervention group. The outcome measures were assessed at baseline, first follow-up and second follow-up and third follow-up post-intervention. Chi-square, independent samples t-test and two-way repeated measures ANOVA were conducted in the course of the data analyses.

    RESULTS: In assessing the impact of the chemotherapy counseling module, the study revealed that the module along with repetitive counseling showed significant improvement of quality of life in the intervention group as compared to the control group with a large effect size in physical health (p = 0.001, partial Ƞ2 = 0.66), psychological (p = 0.001, partial Ƞ2 = 0.65), social relationships (p = 0.001, partial Ƞ2 = 0.30), and environment (p = 0.001, partial Ƞ2 = 0.67) and decrease in the anxiety (p = 0.000; partial Ƞ2 = 0.23), depression (p = 0.000; partial Ƞ2 = 0.40).

    CONCLUSION: The module on 'Managing Patients on Chemotherapy' along with repetitive counseling by pharmacists has been shown to be effective in improving quality of life and decreasing anxiety and depression among oncology patients undergoing chemotherapy.

    TRIAL REGISTRATION NUMBER: National Medical Research Register (NMRR) of Malaysia and given a registration number NMRR-12-1057-12,363 on 21 December 2012.

  13. Mohd-Sidik S, Akhtari-Zavare M, Periasamy U, Rampal L, Fadhilah SI, Mahmud R
    Patient Educ Couns, 2018 05;101(5):862-871.
    PMID: 29336859 DOI: 10.1016/j.pec.2018.01.004
    OBJECTIVES: The aim of this study was to implement and evaluate the outcomes of chemotherapy counselling based on the "Managing Patients on Chemotherapy" module on self-esteem and psychological affect (anxiety, depression) of cancer patients by pharmacists in ten selected government hospitals in Peninsular Malaysia.

    METHODS: A randomized control trial was conducted among 2120 cancer patients from April 2016 to January 2017 in ten selected government hospitals in Peninsular Malaysia. Cancer patients were randomly assigned to intervention and control groups. The intervention group received chemotherapy counselling by pharmacists based on the "Managing Patients on Chemotherapy" module. The outcomes were assessed at baseline, 1st, 2nd and 3rd follow-ups after counselling. In the course of data analysis; independent sample t-test, chi-square and two-way repeated measures ANOVA were conducted.

    RESULTS: Mean scores of self-esteem in the intervention group had significant difference in comparison with those of the control group in the 1st, 2nd and 3rd follow-ups after counselling (P 

  14. Akhtari-Zavare M, Mohd-Sidik S, Periasamy U, Rampal L, Fadhilah SI, Mahmud R
    Health Qual Life Outcomes, 2018 Aug 13;16(1):163.
    PMID: 30103759 DOI: 10.1186/s12955-018-0989-5
    BACKGROUND: Cancer is a serious public health problem not only in Malaysia, also worldwide. The aim of this study was to determine the determinants of quality of life (QOL) among cancer patients in Peninsular Malaysia.

    METHODS: A cross sectional study was conducted among 2120 cancer patients in Peninsular Malaysia, between April 2016 to January 2017. All cancer patients aged 18 years old and above, Malaysian citizens and undergoing cancer treatment at government hospitals were approached to participate in this study and requested to complete a set of validated questionnaires. Inferential statistical tests such as t-test and one-way ANOVA were used to determine the differences between demographic variables, physical effects, clinical factors, psychological effects and self-esteem with the quality of life of cancer patients. Predictor(s) of quality of life were determined by using Multivariate linear regression models.

    RESULT: A total 1620 out of 2120 cancer patients participated in this study, giving a response rate of 92%. The majority of cancer patients were female 922 (56.9%), Malays 1031 (63.6%), Muslim 1031 (63.6%), received chemotherapy treatment 1483 (91.5%). Overall, 1138 (70.2%) of the patients had depression and 1500 (92.6%) had anxiety. Statistically significant associations were found between QOL and clinical factors, physical side effects of cancer, psychological effects and self-esteem (p 

  15. Dashti S, Latiff LA, Hamid HA, Sani SM, Akhtari-Zavare M, Abu Bakar AS, et al.
    Asian Pac. J. Cancer Prev., 2016;17(8):3747-51.
    PMID: 27644611
    BACKGROUND: Polycystic ovary syndrome (PCOS) is a combination of chronic anovulation, obesity, and hyperandrogenism and can affect sexual function in women of reproductive age. It is also associated with endometrial cancer. Our aim was to evaluate the frequency and predisposing factors of sexual dysfunction in PCOS patients.

    MATERIALS AND METHODS: In this cross-sectional study, 16 married women with a definite diagnosis of PCOS were recruited. Sexual function was assessed in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain using the female sexual function index (FSFI) questionnaire. Patients were also assessed for mental health using the depression, anxiety and stress (DASS-21) questionnaire. Presence of hirsutism was assessed using the Ferriman-Gallwey (FG) scoring system. Demographic data were obtained from patients during in-person interview.

    RESULTS: Sexual dysfunction was present in 62.5% of patients with the domains of arousal and lubrication particularly affected (93.8% and 87.5%, respectively). Patients with symptoms of depression and anxiety were significantly more likely to suffer sexual dysfunction than those without these symptoms (p=0.04 and p=0.03 respectively). Patients with stress symptoms reported higher orgasm dysfunction than those without (p=0.02). No significant difference in any of the FSFI score domains was observed between patients with and without hirsutism.

    CONCLUSIONS: PCOS patients markedly suffer from sexual dysfunction and therefore it seems appropriate to be screened for intervention. Poor mental health conditions that may be the result of infertility or other complications of PCOS should also be considered as curable causes of sexual dysfunction in these patients.
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