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  1. Atiya AS
    Med J Malaysia, 2002 Dec;57 Suppl E:105-8.
    PMID: 12733204
    Medical practice is changing, and the foundations of the paradigm shift lie in the development in research over the last four decades. Today, it is no longer adequate to treat a patient purely on clinical experience alone without a clear demonstration of evidence based on research, particularly the use of randomised controlled clinical trials. What is thought to be an effective mode of treatment currently may not necessarily hold true by the time medical students begin his/her medical practice. As a consequence, many medical schools worldwide are increasingly promoting evidence-based medicine (EBM) teaching in their medical curriculum along with problem-based learning (PBL). Teaching of EBM requires a paradigm shift in itself, as students must possess additional skills that are not traditionally part of medical training. These include the ability to acquire the skills in 'means of answering questions' than just 'knowing the answer to questions'. This paper aims to describe what EBM is and to highlight the formative experience of the teaching of EBM at the medical undergraduate level in the University of Malaya. Challenges and opportunities towards successful adoption of evidence-based practice are discussed.
  2. Moy FM, Atiya AS, Wong ML
    MyJurnal
    Introduction: The objective was to evaluate the perceived risks, barriers and stages of change on smoking cessation among the Malay male security guards. Materials and Methods: In the year 2004, a cross sectional survey was conducted on a group of security guards working in the campus and the hospital of a public university in Kuala Lumpur. Universal sampling (n=210) was conducted with a response rate of 88.6%. A self-administered questionnaire was used to survey the participants on their smoking status, stages of change, perceived risks and barriers to smoking cessation. Results: There were 37% current smokers and 23.7% ex-smokers. The mean year of smoking was 19.2 + 8.1 and the number of cigarettes smoked was 16.4 + 8.0 per day among the current smokers. About two-third of the smokers perceived the amount smoked currently was bad for health. However, only 23.3% and 30.9% of the smokers perceived themselves to be at higher risk for lung cancer and heart disease respectively. The three main reasons to quit smoking were health reasons, doctors’ advice and cost. The main barriers were addiction (53.3%) and stress (28.3%). Most of the smokers (42%) were in the pre-contemplation stage with half of them not having thoughts of quitting. Conclusion: The smokers had misperception on smoking and majority was at the pre-contemplation stage of change in smoking cessation. The findings of this survey add on to the existing literature about the perception of risks, barriers and stages of change to smoking cessation. This will provide valuable information on the planning and delivering of smoking cessation programmes in the local context.
  3. Zulkifli A, Khairul Anuar A, Atiya AS
    PMID: 10695800
    A cross-sectional survey of the nutritional status of children aged 1-10 years old from the Kuala Betis resettlement villages was carried out. A total of 620 children were examined, of which 329 were preschool children and 291 were schoolchildren. The age was determined and anthropometric measurements such as weight, height and MUAC were taken. The nutritional status was assessed by looking at the distributions of the z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) in relation to the growth charts of the National Center for Health Statistics reference population. It was found that the nutritional status of the Orang Asli children was poor, with a prevalence of 33.7-65.3% underweight, 55.3-74.4% stunting and 4.4-29.7% wasting based on the NCHS reference values. The prevalence of malnutrition among the Malay children was lower, underweight--7.3-34.1%, stunting--9.8-34.1% and wasting--1.7-17.1%. The nutritional status of the Orang Asli children were poorer compared to the Malay children. More preschool Orang Asli children were stunted compared to the Orang Asli schoolchildren. This may be due to the poor economic base of the Orang Asli community during the transformation period after resettlement. A comprehensive primary health care program is essential, especially targeting the preschool Orang Asli children in these resettlement villages.
  4. Moy FM, Atiya AS
    Asia Pac J Public Health, 2003;15(2):99-104.
    PMID: 15038683
    Body Mass Index (BMI) is the most established anthropometric indicator used for assessment of nutritional status. Other anthropometric indicators which are related closely to BMI are waist hip ratio (WHR) and waist circumference. In this paper, receiver operating characteristics (ROC) curves were constructed to assess the value of waist circumference and waist hip ratio as a screening measure for the need of weight management using BMI as the reference test. Sensitivity and specificity were calculated at several cut-offs. The areas under the ROC curve calculated by comparing waist circumference with BMI were high (0.70 - 0.86) while the areas calculated for WHR were low (0.46 - 0.67). Sensitivities of 0.745 and 0.800 were observed at cut-off points of waist circumference at 90cm and 80cm for males and females respectively, while the false positive rates were 0.233 for males and 0.250 for females. These cut-off points could be considered as a fair trade-off. Therefore it is concluded that waist circumference performed better than WHR as a screening test. It is indicative that waist circumference could be used as a tool in raising awareness of weight management in this population.
  5. Azimi YN, Atiya AS
    Med J Malaysia, 2003 Jun;58(2):218-28.
    PMID: 14569742 MyJurnal
    The role of husband-wife communication in the practice of family planning was studied among the rural Malay couples in Mukim Rusila, Terengganu. It was a cross-sectional study in which a cluster sampling was used to select the study sample. A total of 193 (100.0%) wives and 74 (38.3%) husbands responded to a face-to-face interview. Visual Analogue Scale was used to measure the level of husband-wife communication. Husband-wife communication score was lower on family planning compared to other matters. There was a significant fair agreement on the scores between the husbands and the wives (p > 0.05) on family planning. There was a significant association between husband-wife communication on family planning and the current practice of family planning (p = 0.002). The 'likelihood' that couples who had had good husband-wife communication to practice family planning was about 2.8 times higher compared to those couples with poor husband-wife communication (95% C.I.: 1.4, 5.3). Further research need to be carried out, as the study was limited by certain constraints.
  6. Zulkifli A, Anuar AK, Atiya AS, Yano A
    PMID: 11127336
    A cross-sectional study of the nutritional status of schoolchildren aged 7-10 years from the Kuala Betis Resettlement Scheme in Gua Musang, Kelantan was done. A total of 291 schoolchildren were examined but only 183 (62.9%) fecal samples were returned for geo-helminth infection analysis. The prevalence of stunting was 40.4% and underweight was 28.4%. A total of 127 schoolchildren (69.4%) were positive for at least one of the 3 geo-helminth infections. The most common geo-helminth was Ascaris lumbricoides (62.8%), followed by Trichuris trichiura (38.9%), and hookworm infection was relatively low (12.6%). All the anthropometric indices measured were lower in the geo-helminth infected children compared to the uninfected childen, except for the weight-for-height z-score. However the differences were insignificant Geo-helminth infections may not be a significant factor in malnutrition of these schoolchildren. However, with the availability of safe, efficacious and cheap broad spectrum anthelmintics, regular mass treatment should be given in selected areas where the prevalence of geo-helminth infections is still high, so that these schoolchildren will be able to achieve their growth potential during their school years.
  7. Azila NM, Sim SM, Atiya AS
    Ann Acad Med Singap, 2001 Jul;30(4):375-8.
    PMID: 11503543
    INTRODUCTION: Encouraging teaching practices such as problem-based learning (PBL) amongst undergraduate students within a lecture-based, system-based integrated curriculum is a challenge. Students are apprehensive about developing an organised framework for acquiring knowledge while lecturers are required to reframe their views on the educational process and their role as educators.

    MATERIALS AND METHODS: Lecturers and students in the Phase (Year) II programme were asked to fill questionnaires following the second and fourth PBL cases. The two sets of survey responses were compared to see whether the students' and teachers' perceptions had changed over the 5-month period.

    RESULTS: Students' responses from both surveys (1 and 2) were similar in that a majority agreed that the PBL tutorials had encouraged the seeking of information (66% and 67%, respectively), had improved understanding (57% and 56%), integration (65% and 70%) and application (50% and 64%) of knowledge. However, the views given in the form of written comments, following their positive responses, were somewhat contradictory. A large number of students (38% and 40%) faced difficulties in getting involved in discussions during the PBL tutorial and a majority (73% and 82%) preferred the normal subject-based tutorials. The reasons given by approximately 20% of the students were that the subject-based tutorials were more efficient for obtaining information and/or that the information had been pre-selected by the lecturers. More than 80% of the lecturers (in both surveys) perceived that the students had identified the appropriate learning objectives and covered the subject matter. The percentage of lecturers who agreed that PBL tutorials encouraged rapport and teamwork amongst students had increased in the second survey, from 70% to 92% and 55% to 83% respectively.

    CONCLUSION: Implementing PBL is not simply a matter of developing new teaching materials and new effective ways of presenting them. It requires a paradigm shift, a change in the roles of students and teachers, and time.

  8. Moy FM, Atiya AS, Wong ML
    Malays J Nutr, 2008 Mar;14(1):57-63.
    PMID: 22691764 MyJurnal
    Framingham Risk Scores is an established method to predict an individual's 10-year risk for coronary heart disease (CHD). It provides a more precise delineation of risk which might lead to appropriate selection of therapy and opportunities for patient education and motivation. A Healthy Lifestyle Project was initiated to decrease the modifiable risk factors for CHD in a worksite in Kuala Lumpur. The participants were Malay men (n=186) working as security guards in a public university. Their mean age was 46.6 + 6.6 years. The majority had secondary education and were married. The participants' 10-year risks based on the Framingham Risk Scores were 55.4%, 39.8% and 4.8% respectively for categories of low (< 10%), intermediate (10 to 20%) and high (>20%) risk. Their Framingham Risk Scores were then correlated with anthropometric measurements such as the Body Mass Index (BMI), waist circumference and waist-hip-ratio (WHR). All the anthropometric measurements had weak but significant correlation with the Framingham Risk Scores (WHR: r=0.26; waist circumference: r=0.23; BMI: r=0.16). In conclusion, 44.6% of our participants had more than 10% risk in developing CHD in the coming ten years. Hence, they are suitable target candidates for the promotion of a healthy lifestyle such as smoking cessation, weight control, healthy dietary patterns and increased physical activities. Indicators of abdominal obesity like WHR or waist circumference may be used to complement the Framingham Risk Scores for the prediction of CHD risk in this population.
  9. Dipak S, Prepageran N, Haslinda S, Atiya A, Raman R
    PMID: 22319710 DOI: 10.1007/s12070-010-0067-8
    To assess if sensation of nasal mucosa affect the subjective sensation of nasal patency. This is a case control study with 50 patients, using 2% lignocaine as the active drug and normal saline as the placebo (2 groups of 25 patients each). Each subject had 2 ml of solution sprayed into the test nose. These subjects had no prior nasal symptoms, allergy or surgery. They were evaluated subjectively using Likert scale and objectively by acoustic rhinometry before and after lignocaine or normal saline. The patients in both normal saline and lignocaine groups demonstrated no significant change based upon Likert scale. The study also demonstrated the mean cross sectional area 1 (CSA1), mean cross sectional area 2 (CSA2), with mean Volume 1 and mean Volume 2, these results did not vary significantly in both groups with Acoustic Rhinometry. The analysis thus shows that the use of topical anesthetic spray on nasal mucosa produces no objective effect on nasal resistance or subjective sensation of altered nasal patency. Thus the study concludes that, tactile sensation of nasal mucosa does not play a role in the sensation of nasal obstruction.
  10. Zulkifli A, Khairul AA, Atiya AS, Abdullah B, Yano A
    Med J Malaysia, 1999 Dec;54(4):453-8.
    PMID: 11072462
    A study of the prevalence and intensity of soil-transmitted helminthiasis among pre-school children aged 0 to 7 years from an Orang Asli village resettlement scheme in Gua Musang, Kelantan was undertaken. The overall prevalence of soil transmitted helminthic (STH) infections was 56.0%. The predominant helminth found was Ascaris lumbricoides while the commonest type of infection was a mixed infection with Ascaris lumbricoides and Trichuris trichiura. The prevalence rates of Ascaris, Trichuris and hookworm infections were 47.5%, 33.9% and 6.2% respectively. The intensity of Ascaris infections were 64.5% light, 27.3% moderate and 8.3% heavy whilst the intensity of Trichuris infections were 80.5% light, 18.3% moderate and 1.2% heavy. However, the intensity of hookworm infections were 86.7% light, 13.3% moderate and no heavy infection. The prevalence of helminthiasis (STH) shows an-age dependent relationship, with the lowest prevalence in 0-< 1 year age group and highest in the 6-< 7 year age group.
  11. Quek KF, Atiya AS, Heng NGC, Beng CC
    Int J Impot Res, 2007 May-Jun;19(3):321-5.
    PMID: 17136103 DOI: 10.1038/sj.ijir.3901528
    Premature ejaculation (PE) is a common sexual dysfunction among the general population. PE has often been associated with a psychological state of mind. Hospital Anxiety and Depression Scale (HADS) can be used as an instrument to assess the emotional and psychological state. The present study was designed to assess the reliability and validity of the HADS in a Malaysian population. The validity and reliability were studied in subjects with and without PE. Test-retest methodology was used to assess the reliability whereas Cronbach's alpha was used to assess the internal consistency. In the control and the PE groups, the internal consistency was good and a high degree of internal consistency was observed for all 14 items. In the control group, the Cronbach's alpha values at baseline were from 0.811 to 0.834, whereas for retest, the Cronbach's alpha values were from 0.821-0.838 items. Intraclass correlation coefficient (ICC) was high for the control (0.797-0.868: baseline and 0.805-0.872: retest) and PE group (0.822-0.906: baseline and 0.785-0.887: retest). The high value of ICC and the internal consistency was due to high reliability and consistency of the items at 2-week interval. A degree of significance between the baseline and week-2 scores was observed across all items in the PE group but not in the control group. The HADS is a suitable, reliable, valid and sensitive instrument to measure the clinical change for anxiety and depression in the Malaysian population.
  12. Hesham Al-Mekhlafi M, Surin J, Atiya AS, Ariffin WA, Mohammed Mahdy AK, Che Abdullah H
    Acta Trop, 2008 Aug;107(2):200-4.
    PMID: 18582430 DOI: 10.1016/j.actatropica.2008.05.022
    Data on soil-transmitted helminth (STH) infections and reinfection among Orang Asli (aborigine) schoolchildren and their nutritional and socioeconomic status were analyzed to investigate the pattern and the possible predictors of STH reinfection. In this longitudinal study, 120 (60 males and 60 females) Orang Asli primary schoolchildren aged 7-12 years and living in remote areas in Pos Betau, Kuala Lipis, Pahang were screened for the presence of STH using modified cellophane thick smear and Harada Mori techniques. The overall prevalence of ascariasis, trichuriasis and hookworm infections were 65.8, 97.5 and 10.8%, respectively. After complete deworming with a 3-day course of 400mg/daily of albendazole tablets, children were re-examined at 3 and 6 months from baseline. The reinfection rate, by one or more of STH species, at 3 months after deworming was high (49.5%) while 79.6% of the children were reinfected at 6 months after deworming. Logistic regression analyses showed that females, stunted children and those living in houses without toilets had significantly higher reinfection rates than others at 3 months (P<0.05). At 6 months, maternal employment status emerged as another predictor where children of working mothers had significantly higher reinfection rates (P=0.026). In conclusion, reinfection rate of STH is high and thus necessitates frequent and periodic deworming among children. Public health personnel need to re-look at the current control measures and identify innovative and integrated ways in order to reduce STH significantly in the rural communities.
  13. Al-Mekhlafi MH, Surin J, Atiya AS, Ariffin WA, Mahdy AK, Abdullah HC
    Trans R Soc Trop Med Hyg, 2008 Oct;102(10):1046-52.
    PMID: 18617209 DOI: 10.1016/j.trstmh.2008.05.012
    A cross-sectional study to determine the current prevalence of anaemia and iron deficiency anaemia (IDA) and to investigate the possible risk factors for IDA was carried out on 241 aboriginal schoolchildren (120 boys, 121 girls) aged 7-12 years and living in remote areas in Pos Betau, Pahang, Malaysia. Haemoglobin (Hb) level was measured and serum iron status was assessed by serum ferritin (SF), serum iron (SI) and total iron binding capacity measurements. Socioeconomic data were collected using pre-tested questionnaires. All children were screened for intestinal parasitic infections. Overall, 48.5% (95% CI 42.3-54.8) of children were anaemic (Hb<12 g/dl). The prevalence of IDA was 34% (95% CI 28.3-40.2), which accounted for 70.1% of the anaemia cases. The prevalence of IDA was significantly higher in females than males. Low levels of mothers' education and low household income were identified as risk factors for IDA. Severe trichuriasis also found to be associated with low SF and SI. Logistic regression confirmed low levels of mothers' education and gender as significant risk factors for IDA. Improvement of socioeconomic status and health education together with periodic mass deworming should be included in public health strategies for the control and prevention of anaemia and IDA in this population.
  14. Al-Mekhlafi MS, Surin J, Atiya AS, Ariffin WA, Mahdy AK, Abdullah HC
    PMID: 19058591
    A cross-sectional study was carried out to determine the current prevalence of protein-energy malnutrition (PEM) among Orang Asli schoolchildren and to investigate the potential predictors of malnutrition. A total of 241 (120 males and 121 females) Orang Asli schoolchildren age 7-12 years living in remote areas of Pos Betau, Pahang participated voluntarily in this study. Anthropometric and socioeconomic data were collected and the children were screened for intestinal parasitic infections. The overall prevalences of mild and significant underweight conditions were 52.3% and 37.3%, respectively, and the prevalences of mild stunting and wasting were 43.6% and 43.1%, respectively, while the prevalences of significant stunting and wasting were 43.6% and 5.6%, respectively. There was a significant association between gender (male) and malnutrition (p = 0.029). The results also showed a higher prevalence of stunting among children age < or = 10 years than in older children (p = 0.001). Other independent variables, including socioeconomic status and intestinal parasitic infections, had no significant associations with malnutrition indices. PEM is prevalent among schoolchildren in rural Malaysia and therefore of public health concern since PEM diminishes immune function and impairs cognitive function and educational performance. School-based programs of prevention through health education and interventions should be considered as an essential part of measures to improve the quality of life of schoolchildren in rural Malaysia.
  15. Teng CL, Hanafi NS, Ng CJ, Chia YC, Atiya AS
    J Paediatr Child Health, 2006 Oct;42(10):612-7.
    PMID: 16972968 DOI: 10.1111/j.1440-1754.2006.00937.x
    AIM: Fever in children, a mostly benign and self-limiting illness, is often viewed with consternation by the care givers. It results in early consultation and excessive use of antipyretics and antibiotics. In this study, we document the prescribing practice of doctors from three primary care settings in Malaysia and identify the predictors of antibiotic prescription.
    METHODS: Interview of care givers bringing febrile children (age = 12 years) to three primary care settings: public primary care clinics, private general practice clinics and a university-based primary care clinic.
    RESULTS: Data from 649 children were analysed. Mean age of children 4.1 years and 55% were boys. One-third of the children had prior consultation for the same episode of fever. About 80% of the febrile children were diagnosed to have upper respiratory tract infection, viral fever and gastroenteritis. Overall antibiotic prescribing rate was 36.6% (public primary care clinic 26.8%, private general practice clinic 70.0% and university-based primary care clinic 32.2%). Independent predictors of antibiotic prescription were: clinic setting, longer duration of fever (>7 days), higher temperature (>38 degrees C) and the diagnosis of upper respiratory tract infections. After controlling for demographic and clinical factors, antibiotic prescription in private general practice clinic was seven times higher than public primary care clinic (odds ratio 7.1, 95% confidence interval 4.0-12.7), and 1.6 times higher than university-based primary care clinic (odds ratio 1.6, 95% confidence interval 1.0-2.5).
    CONCLUSION: Differences in the patients' demographic and clinical characteristics could not adequately explain the high antibiotic prescribing rate in private general practice clinics. This inappropriately high antibiotic prescribing for febrile children in private general practice clinics is a suitable target for future intervention.
  16. Al-Mekhlafi MS, Atiya AS, Lim YA, Mahdy AK, Ariffin WA, Abdullah HC, et al.
    PMID: 18613540
    Despite great development in socioeconomic status throughout 50 years of independence, Malaysia is still plagued with soil-transmitted helminthiases (STH). STH continue to have a significant impact on public health particularly in rural communities. In order to determine the prevalence of STH among rural Orang Asli children and to investigate the possible risk factors affecting the pattern of this prevalence, fecal samples were collected from 292 Orang Asli primary schoolchildren (145 males and 147 females) age 7-12 years, from Pos Betau, Kuala Lipis, Pahang. The samples were examined by Kato-Katz and Harada Mori techniques. Socioeconomic data were collected using pre-tested questionnaires. The overall prevalence of ascariasis, trichuriasis, and hookworm infections were 67.8, 95.5 and 13.4%, respectively. Twenty-nine point eight percent of the children had heavy trichuriasis, while 22.3% had heavy ascariasis. Sixty-seven point seven percent of the children had mixed infections. Age > 10 years (p = 0.016), no toilet in the house (p = 0.012), working mother (p = 0.040), low household income (p = 0.033), and large family size (p = 0.028) were identified as risk factors for ascariasis. Logistic regression confirmed low income, no toilet in the house and working mother as significant risk factors for ascariasis. The prevalence of STH is still very high in rural Malaysian communities. STH may also contribute to other health problems such as micronutrient deficiencies, protein-energy malnutrition and poor educational achievement. Public health personnel need to reassess current control measures and identify innovative and integrated ways in order to reduce STH significantly in rural communities.
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