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  1. Chang CT
    Rural Remote Health, 2007 Oct-Dec;7(4):864.
    PMID: 18076311
    INTRODUCTION: There is an increase in the prevalence of overweight and obesity in Malaysia. Besides prevalence studies, not much is known about either overweight or obese individuals. The objective of this study was to determine the stages of change in losing weight and the self-efficacy in eating control of three indigenous groups of overweight and obese adults in Sarawak, Malaysia.
    METHODS: A cross-sectional study was conducted in one rural region in Sarawak using a purposive sample. A structured questionnaire, which included two scales: (1) Weight: Stages of change (SOC) to assess readiness to change; and (2) Weight Efficacy Lifestyle Questionnaire (WEL) (both adopted from the transtheoretical model of change); and a set of pre-tested questionnaires on socio-demographic data, the presence of health problems and self-assessment of weight appropriateness, was used to interview respondents.
    RESULTS: The stage distribution for weight loss of these adults respondents (n = 271) showed that 60.5% (n = 164) were in the pre-contemplation stage, 20.7% (n = 56) were in the contemplation stage, 8.5% (n = 23) were in the preparation stage, and 8.9% (n = 24) were in the action stage, while only 1.5% (n = 4) were in the maintenance stage. Except for education, the stage differences were generally stable across age, sex, race, household income, presence or absence of health problem, self-perceived weight and presence of overweight or obesity. Respondents were least able to control their eating under social pressure and food availability, according to their WEL score.
    CONCLUSION: A large proportion of the overweight or obese adults was not intending to lose weight. The factor structure of the two WEL original subscales enabled partial differentiation between respondents who were able or unable to resist eating in situations where there were availability of food and experienced physical discomfort. The study results indicate the importance of assessing individuals' SOC score in order to implement stage-matched intervention strategies. More studies should be performed in order to validate the WEL questionnaire for use with a Malaysian sample.
  2. Cheah WL, Majorie Ensayan J, Helmy H, Chang CT
    Malays Fam Physician, 2018;13(1):2-9.
    PMID: 29796204 MyJurnal
    Introduction: The present study aimed to determine the prevalence of hypertension and its association with nutritional status (body mass index, body fat percentage, and visceral fat) among students in a public university in Sarawak, Malaysia.

    Methods: This was a cross-sectional study among undergraduate students aged 18 years old and above. Anthropometric measurements, such as weight, height, body composition, and blood pressure measurements, were collected. Hypertension was defined as equal or more than 140/90 mmHg. Statistical analyses were done using IBM SPSS version 20.

    Results: A total of 354 respondents participated in the study. Mean age for the respondents was 21 years (SD 1.18 years). About 40% of the respondents were overweight or obese. Prevalence of hypertension was 8.2%. Mean systolic blood pressure was 119.1mmHg (SD14.36mmHg), and the mean diastolic blood pressure was 72.6mmHg (SD 9.73mmHg). There is a significant association between male gender (odds ratio =3.519, 95% CI is 1.886-6.566), body fat percentage (odds ratio = 1.944, 95% CI is 1.050-3.601), visceral fat (odds ratio = 2.830, 95% CI is 1.346-5.951), and family history of hypertension (odds ratio= 2.366, 95% CI is 1.334-4.194) and hypertension.

    Conclusion: The prevalence of hypertension was less than 10% and is associated with male gender, body composition, and family history of hypertension.

  3. Lee PM, Chang CT, Yusoff ZM
    Int J Clin Pharm, 2021 Feb;43(1):46-54.
    PMID: 32524510 DOI: 10.1007/s11096-020-01070-9
    Background Tyrosine kinase inhibitors have been demonstrated to improve the survival of patients with chronic myeloid leukaemia. However, medication adherence is vital for patients on chronic treatment. Objective The objective of the current study was to evaluate response to treatment, adherence by patients to tyrosine kinase inhibitors and factors associated with adherence and response. Setting A haematology clinic in a regional referral hospital in Malaysia. Method Patients aged ≥ 13 years who had been on imatinib or nilotinib for ≥ 12 months were included in this cross-sectional study. An optimal response was defined as the achievement of major molecular response at 12 months of treatment. Patient medication adherence was determined using the average medication possession ratio based on the dispensing records. The patients were considered adherent if the medication possession ratio was > 90%. Multiple logistic regression was performed to evaluate the factors associated with adherence. The association of adherence with molecular response was analysed by univariate logistic regression. Main outcome measure The primary outcome measures were the proportion of patients who achieved optimal response and the medication possession ratio. Results A total of 151 patients were screened, and 71 patients were included. Twenty-eight patients (39%) achieved major molecular response at 12 months of treatment. The median time to achieve this was 15.5 months (an interquartile range of 15). The mean medication possession ratio for imatinib and nilotinib was 0.94 (± 0.14) and 0.96 (± 0.10), respectively, but this difference was without statistical significance (t  =  - 0.517, p  =  0.610). Nausea and vomiting (odds ratio [OR] of 0.25, 95% confidence interval [CI]: 0.07-0.83, p  =  0.023) and disease phase at diagnosis (OR of 0.20, 95% CI 0.04-1.06, p  =  0.059) were associated with patient adherence. An association was not found between patient adherence and molecular response (OR of 1.03, 95% CI 0.35-3.09, p  =  0.956). Conclusion The patients in this study demonstrated a relatively deep molecular response and optimal adherence. Nevertheless, one fourth of them were noncompliant with imatinib. Therefore, active interventions are warranted to prevent treatment-associated adverse events and improve adherence.
  4. Lee PY, Cheah Wl, Chang CT, Siti Raudzah G
    Malays J Nutr, 2012 Aug;18(2):207-19.
    PMID: 24575667 MyJurnal
    There is limited data on childhood obesity and its impact on children from diverse cultural backgrounds. This study is aimed at determining the association between obesity, self-esteem and health-related quality of life (HRQOL) among Malaysian urban primary school children of different ethnicity.
  5. Cheah WL, Chang CT, Helmy H, Wan Manan WM
    Malays Fam Physician, 2019;14(3):46-54.
    PMID: 32175040
    Introduction: Physical inactivity is the one of the leading causes of major non-communicable diseases in the world. The aim of this study is to assess the feasibility of an intervention program based on the stages of change, physical activity levels and health profiles of selected overweight and obese adults in Sarawak.

    Methods: This intervention study was carried out using selected overweight and obese adults in Sarawak. A total of 75 participants were placed in the intervention group, and 80 respondents were placed in the control group participated. Respondent-determined weekly aerobic exercise sessions were conducted for six months. The Malay version of the long-form International Physical Activity Questionnaire (IPAQ) and Transtheoretical model of change (TTM) questionnaire were used, together with anthropometric measurements and the collection of venous fasting blood profiles. Data was entered and analyzed using SPSS Version 20.

    Results: The intervention group had significant better stage transitions compared to the control group (p<0.01). They also had significantly lower total cholesterol, although both groups showed significant results (difference= 0.53, p<0.01; difference= 0.38, p=0.01). The respondent-determined intervention program was effective in improving stage transition; however, an intervention of longer duration could provide more conclusive health outcomes.

    Conclusion: Physical activity plays a role in assisting overweight and obese adults to be more active and healthier.

  6. Tan PP, Mohamed Fauzi, H., Chang CT, Ahmad NH, Bahar B, Mangantig E, et al.
    MyJurnal
    ABSTRACTS FOR INTERNATIONAL HEALTH AND MEDICAL SCIENCES CONFERENCE 2019 (IHMSC 2019)
    Held at Taylor’s University Lakeside Campus, Subang Jaya, Selangor, Malaysia, 8-9th March, 2019
    Introduction: Unsafe blood products cause transfusion-transmissible infections among blood receivers. The knowledge and perception of blood donors is important as it is associated with their donation behaviour and hence the safety of blood products. There was no previous study that assessed the knowledge and perception on blood safety issues among blood donors to date. The objective of this study was to assess the knowledge and perception of blood
    donors on blood safety issues.
    Methods: This was a pilot study conducted to pilot test the self-developed questionnaire by the researchers. The questionnaire was available in the Malay language. One-hundred-thirty donors at the National Blood Centre were recruited to complete the self-administered questionnaire. Health sciences professionals, medical students and non-Malaysians were excluded in this study.
    Results: A total of 130 donors comprising of 70 males (53.8%) and 60 females (46.2%) responded. The mean age of the respondents is 32.48±8.86 years. Most of the respondents were Malay (55.4%), single (49.2%), working in private sector (46.9%) and regular donor (68.5%). More than half of the respondents did not know that dengue, Zika and mad-cow disease can be contracted through blood transfusion. Ten percent of the respondents answered that bisexual people are eligible to donate blood. 40.7% of the donors agreed to check their HIV status through blood donation. Majority of the donors (60.7%) agreed that the donors’ blood is safe if the screening test is negative. Whereas, 33.9% of the donors disagreed that they shall be responsible if their blood causes infection.
    Conclusion: Several knowledge gaps and inappropriate perception among the respondents were identified and these might affect the safety of the blood products. Targeted measures should be taken to rectify donors’ knowledge and perception in order to minimise inappropriate blood donor behaviours and reduce unsafe blood products.
  7. Tan KC, Chang CT, Cheah WK, Vinayak CR, Chan HK
    Med J Malaysia, 2019 Jun;74(3):215-218.
    PMID: 31256176
    INTRODUCTION: This study was designed to determine the influence of bariatric surgery on changes in the body mass index (BMI), and the control of diabetes, hypertension and dyslipidaemia among obese patients in Malaysia.

    MATERIALS AND METHODS: This was a retrospective cohort study undertaken at a public tertiary care centre in the state of Perak, Malaysia. Information of obese patients who underwent bariatric surgery was obtained from their medical records. The changes in the BMI, HbA1C, systolic and diastolic blood pressure (SBP and DBP), and lipid levels between three months before and after the surgery were assessed.

    RESULTS: The patients (n=106) were mostly Malay (66.0%), had at least one comorbidity (61.3%), and had a mean age of 40.38±11.75 years. Following surgery, the BMI of the patients was found to reduce by 9.78±5.82kg/m2. For the patients who had diabetes (n=24) and hypertension (n=47), their mean HbA1C, SBP and DBP were also shown to reduce significantly by 2.02±2.13%, 17.19±16.97mmHg, and 11.45±12.63mmHg, respectively. Meanwhile, the mean total cholesterol, triglyceride and low-density lipoprotein levels of those who had dyslipidaemia (n=21) were, respectively, lowered by 0.91±1.18mmol/L, 0.69±1.11mmol/L and 0.47±0.52mmol/L.

    CONCLUSION: The findings suggest that in addition to weight reduction, bariatric surgery is helpful in improving the diabetes, hypertension and dyslipidaemia control among obese patients. However, a large-scale trial with a control group is required to verify our findings.

  8. Chang CT, Ang JY, Wong JM, Tan SS, Chin SK, Lim AB, et al.
    Med J Malaysia, 2020 05;75(3):286-291.
    PMID: 32467546
    AIM: This study is conducted to compare the pharmacokinetic profiles of two fixed dose combination of metformin/glibenclamide tablets (500mg/5 mg per tablet).

    MATERIALS AND METHODS: This is a single-center, single-dose, open-label, randomized, 2-treatment, 2-sequence and 2- period crossover study with a washout period of 7 days. All 28 adult male subjects were required to fast for at least 10 hours prior to drug administration and they were given access to water ad libitum during this period. Thirty minutes prior to dosing, all subjects were served with a standardized high-fat and high-calorie breakfast with a total calorie of 1000 kcal which was in accordance to the EMA Guideline on the Investigation of Bioequivalence. Subsequently, subjects were administered either the test or reference preparation with 240mL of plain water in the first trial period. During the second trial period, they received the alternate preparation. Plasma levels of glibenclamide and metformin were analysed separately using two different high performance liquid chromatography methods.

    RESULTS: The 90% confidence interval (CI) for the ratio of the AUC0-t, AUC0-∞, and Cmax of the test preparation over those of the reference preparation were 0.9693-1.0739, 0.9598- 1.0561 and 0.9220 - 1.0642 respectively. Throughout the study period, no serious drug reaction was observed. However, a total of 26 adverse events (AE)/side effects were reported, including 24 that were definitely related to the study drugs, namely giddiness (n=17), while diarrheoa (n=3), headache (n=2) and excessive hunger (n=2) were less commonly reported by the subjects.

    CONCLUSION: It can be concluded that the test preparation is bioequivalent to the reference preparation.

  9. Chew LS, Lim XJ, Chang CT, Kamaludin RS, Leow HL, Ong SY, et al.
    Med J Malaysia, 2023 Sep;78(5):602-608.
    PMID: 37775486
    INTRODUCTION: Previous trials and real-world studies have shown that nirmatrelvir/ritonavir (Paxlovid®) reduces hospitalisation and deaths in symptomatic, high-risk, nonsevere COVID-19 patients. However, there was a scarcity of data on its effectiveness in the local setting. This study aimed to determine the effectiveness of Paxlovid® in reducing hospitalisation and mortality among COVID-19 patients and to identify the types of adverse events that occur after taking Paxlovid®.

    MATERIALS AND METHODS: A two-arm prospective cohort study was conducted among adult patients with COVID-19 categories 2 and 3 treated with Paxlovid® and a matched control group. A standard risk-stratified scoring system was used to establish Paxlovid® eligibility. All patients who were prescribed Paxlovid® and took at least one dose of Paxlovid® were included in the study. The control patients were selected from a centralised COVID-19 patient registry and matched based on age, gender and COVID-19 stage severity.

    RESULTS: A total of 552 subjects were included in the study and evenly allocated to the treatment and control groups. There was no statistically significant difference in 28-day hospitalisation after diagnosis [Paxlovid®: 26 (9.4%), Control: 34 (12.3%), OR: 0.74; 95%CI, 0.43-1.27; p=0.274] or all-cause death [Paxlovid®: 2 (0.7%), Control: 3 (1.1%), OR 1.51; 95%CI, 0.25-9.09; p=0.999]. There was no significant reduction in hospitalisation duration, intensive care unit admission events or supplementary oxygen requirement in the treatment arm. Ethnicity, COVID-19 severity at diagnosis, comorbidities and vaccination status were predictors of hospitalisation events.

    CONCLUSION: In this two-arm study, Paxlovid® did not significantly lower the incidence of hospitalisation, all-cause death and the need for supplemental oxygen. Adverse effects were frequent but not severe. Paxlovid® efficacy varied across settings and populations, warranting further real-world investigations.

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