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  1. LILY LIM, ZABIDAH PUTIT, CHANG CHING THON
    MyJurnal
    A qualitative study was conducted to assess the nursing students’ experiences of their clinical practice at one public university in Sarawak, Malaysia. Purposive sampling was used to recruit nine undergraduate nursing degree students at a medical faculty. An in-depth interview based on an open-ended questionnaire was used to collect data. The open-ended questionnaire was used to assess the students’ expectation, feelings, challenging experiences related to work culture, knowledge and skills in patient care, teaching learning supports, people interpersonal relationship, students’ role and their coping mechanism in clinical practice. Data were analysed using content analysis approach facilitated by Nvivo software (Version 8.) The themes emerged from the data analysis included (a) Gaining insight into the reality of clinical working environment and (b) challenges. The subthemes illustrated the students’ challenges were interpersonal relationship with people at the work place, different ward environment, theorypractice gap and insufficient clinical practice, and anxiety. The participants also reported experiencing anxiety due to challenges; however, after a period of time, they learnt to cope with them. The students were able to use different coping mechanism such as internal and external motivation, and this increased their confidence as they progressed in their learning. The learning difficulties faced by nursing students during clinical placement show that a supportive learning environment is important. This study proposed practical strategies to empower students in clinical learning and increase their self-esteem and confidence. In order to improve quality of students’ clinical education, adequate and effective work collaboration between nursing education and health care services are recommended. Future research should focus on how to create a supportive clinical learning environment in local setting
  2. Chang CT, Esterman A
    Rural Remote Health, 2007 Apr-Jun;7(2):667.
    PMID: 17511524
    Delayed diagnosis of tuberculosis (TB) can lead to an increased period of infectivity in the community, a delay in treatment and a severe form of the disease. The objective of this study was to determine the length of delay, and factors linking the delay from the onset of symptoms of pulmonary tuberculosis (PTB) until the commencement of treatment in Sarawak, Malaysia.
  3. Cheah, Whye Lian, Helmy Hazmi, Chang, Ching Thon, Wan Manan Wan Muda
    MyJurnal
    The objective of this study was to describe the differences in physical activity with socio-demographic factors and its association with cardiovascular risk factors. It was a cross-sectional study among selected urban and rural Malays communities in Kuching and Samarahan. Physical activity data was obtained using International Physical Activity Questionnaire (IPAQ) short version. Assessment of cardiovascular risk factors was based on blood pressure, fasting cholesterol and glucose and body mass index (BMI). Data was analysed using SPSS version 20. A total of 223 participated with higher response from rural areas (60.1%) and females (61.9%). More than half of the respondents (58.5%) were overweight and obese, with a mean BMI of 25.9 kg/m2 (SD=4.9). About 25% of the respondents were found to have blood pressure in the at-risk range. The prevalence of at-risk blood glucose was 52.3% with a mean value of 7.3mmol/L (SD=3.46). The prevalence of at-risk cholesterol were lower with 31.8%, mean value of 3.5 mmol/L (SD=2.94). There were more active respondents living in rural area (p=0.02). Logistics regression analysis showed that urban area (OR=1.988 95% CI 1.082 to 3.652), systolic blood pressure (OR1.020 95% CI 1.003 to 1.037) and blood cholesterol (OR0.884 95% CI 0.785 to 0.996) were associated with physical activity level. Change of physical activity due to urbanization can increase the risk of obesity and other chronic diseases. Efforts to include physical activity in intervention programme should be more intensified, with more provision of suitable built environment.
  4. Chang CT, Chang KH, Cheah WL
    Asia Pac J Clin Nutr, 2009;18(2):257-64.
    PMID: 19713186
    The objective of this study was to explore the perception of, feelings and attitudes toward overweight or obesity, and the perceived barriers to weight loss among native adults from lower socio-economic background. A total of six gender- and ethnic-specific focus groups consisted of 38 overweight and obese purposefully and criterion selected adults (21 women and 17 men), participated in this study. An unstructured discussion guide based on the study objectives were used for the focus groups. The results showed that some participants perceived themselves as ugly, felt ashamed of their body size and were frustrated because they did not desire to be overweight. Due to their excess weight, most also expressed they were less effective in their work performances. Although some participants had negative attitudes toward themselves because of excess weight, this appeared to link to self-stigmatization rather than anti-obesity discrimination. The participants remained in the Pre-contemplation stage of losing weight probably because of perceived barriers such as difficulty to resist eating, lack of know how and previous failed attempts to lose weight. Importantly, this study provided some evidence that individuals in the Pre-contemplation stage are unable to take action to lose weight, even if effective strategies are suggested.
  5. Gunggu A, Chang CT, Cheah WL
    J Diabetes Res, 2016;2016:9158943.
    PMID: 27563681 DOI: 10.1155/2016/9158943
    Diabetes mellitus is a public health concern in Malaysia. Treatment of diabetes is costly and can lead to complications if disease is poorly controlled. Diabetes self-management (DSM) is found to be essential for optimal glycemic control. This cross-sectional study was conducted among samples from four randomly selected diabetes clinics in Sarawak, Malaysia. The aim was to determine the predictors for DSM. Face-to-face interview using questionnaire was used to collect data. Four hundred respondents with type 2 diabetes mellitus (T2DM) were recruited. Majority of the respondents were Sarawak Bumiputra (Iban and Bidayuh, 48.6%) and female (68.6%). The mean age was 58.77 years (SD = 11.46) and approximately half of the respondents (50.6%) had T2DM for six years (SD = 4.46). The mean fasting blood glucose (FBG) was 8.06 mmol/L (SD = 2.94), with majority (76.1%) having the level higher than 6.1 mmol/L. Multiple logistic regression tests showed significant linear relationship between DSM and belief in treatment effectiveness (p = 0.001), family support (p = 0.007), and self-efficacy (p = 0.027). Health care personnel must convince patients with T2DM of the effectiveness of the treatment, empower and enhance their self-efficacy, and enlist the family support so as to ensure patients sustain their DSM efforts.
    Study site: diabetes clinics in Kuching and Samarahan Division of Sarawak, Malaysia
  6. Chang CT, Lee PY, Cheah WL
    Malays J Med Sci, 2012 Apr;19(2):27-34.
    PMID: 22973135 MyJurnal
    Background: Coronary heart disease (CHD) was the second leading cause of death in Malaysia in 2006. CHD has known risk factors including hypertension, diabetes mellitus, and obesity.
    Methods: This cross-sectional study examined the prevalence of cardiovascular risk factors among 260 participants aged 20 to 65 years in a rural community in Sarawak.
    Results: The prevalences of overweight and obesity in this study were 39.6% and 11.9%, respectively. Approximately 13% of participants had hypertension, and 1.5% had a random blood sugar greater than 11.1 mmol/L. Chi-square tests showed significant associations between obesity and gender (P = 0.007), low high-density lipoprotein cholesterol and race (P = 0.05), high total cholesterol and age (P = 0.007), age and hypertension (P = 0.011), smoking and gender (P < 0.001), and smoking and income (P = 0.050). Age-adjusted logistic regression showed that women were 0.246 times more likely to be obese, that older participants (> 45 years) were 0.395 times more likely to have high cholesterol and that those with a higher monthly household income (> RM830) were 2.471 times more likely to smoke.
    Conclusion: These findings indicate that we should be concerned about the high rates of overweight in this rural community to prevent obesity.
    Study site: 8 villages, Serian district, Sarawak, Malaysia
    Keywords: adult; cardiovascular diseases; epidemiology; obesity; prevalence; risk factors.
  7. Cheah WL, Dollah NB, Chang CT
    Malays J Med Sci, 2012 Jul;19(3):36-42.
    PMID: 23610548 MyJurnal
    This study aimed to determine the perceptions and expectations of bone cancer patients with respect to their doctors and the breaking of bad news as well as the environment in which the news was delivered.
  8. Cheah WL, Chang CT, Hazmi H, Kho GWF
    Int J Hypertens, 2018;2018:6736251.
    PMID: 30155286 DOI: 10.1155/2018/6736251
    This cross-sectional study was conducted to determine the predictive power of anthropometric indicators and recommend cutoff points to discriminate hypertension among adolescents in Sarawak, Malaysia. A total of 2461 respondents aged 12-17 years participated in this study with mean age of 14.5±1.50 years. All anthropometric indicators had significant area under the ROC curve, with body mass index (BMI) and waist circumference (WC) ranging from 0.7 to 0.8. The best anthropometric indicators for predicting hypertension for boys were WC, BMI, and waist-to-height ratio (WHtR). For girls, BMI was the best indicators followed by WHtR and WC. The recommended BMI cutoff point for boys was 20 kg/m2 and 20.7 kg/m2 for girls. For WC, the recommended cutoff point was 67.1 cm for boys and 68.2 cm for girls. BMI and WC indicators were recommended to be used at the school setting where the measurement can easily be conducted.
  9. Cheah WL, Giloi N, Chang CT, Lim JF
    Malays J Med Sci, 2012 Jul;19(3):57-63.
    PMID: 23610550
    This study aimed to determine the perception and level of safety satisfaction of staff nurses with regards to Occupational Safety and Health (OSH) management practice in the Sabah Health Department, and to associate the OSH management dimensions, to Safety Satisfaction and Safety Feedback.
  10. Cheah WL, Lee PY, Chang CT, Mohamed HJ, Wong SL
    PMID: 23691641
    Although the association between non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome has been previously firmly established, the prevalence of NAFLD and its risk factors in rural communities remains incompletely defined. This study aimed to determine the prevalence and factors associated with ultrasound-diagnosed NAFLD amongst a rural community in Sarawak. An indigenous village was randomly selected where all adults aged 21 years and above underwent an abdominal ultrasound, biochemical tests and an anthropometric assessment. Respondents with a score > or =8 on an alcohol-use disorders-identification test (AUDIT) indicating harmful or hazardous drinking were excluded. Seventy-seven respondents (46.8% male, mean age 48.4 SD 16.64), met inclusion criteria. The prevalence of ultrasound diagnosed NAFLD was 44.2% (n=34), among them 52.9% had moderate NAFLD. There were no significant age or gender differences between respondents with and without NAFLD, although those with NAFLD were older. Respondents with NAFLD had a significantly higher BMI t,han those without NAFLD (p<0.001). Both male and female respondents with NAFLD had a significantly higher waist circumference than those without NAFLD (p<0.001). Prevalence of diabetes, hypertension, hyperglycemia and hypertriglyceridemia were significantly higher among those with NAFLD. However, there were no significant differences in terms of percentage of unhealthy body fat and muscle, and serum HDL levels. Risk factors independently associated with NAFLD included male gender (odd ratio 0.06; 95% CI 0.008-0.523) and waist circumference (odd ratio 1.2; 95% CI 1.036-1.421). There was a high prevalence of NAFLD and the presence of more severe stages of disease in this indigenous population. Life-style related diseases, such as fatty liver disease, can occur in rural as well as urban populations.
  11. Cheah WL, Chang CT, Rosalia S, Charles LD, Yii SL, Tiong PH, et al.
    Malays J Med Sci, 2011 Jul;18(3):33-42.
    PMID: 22135599 MyJurnal
    BACKGROUND: Overweight and obesity rates among adolescents have increased substantially over the years. This study aimed to determine the body mass index (BMI) of students and parents and the relationship among media use, BMI, socio-demographic profiles, and snacking behaviour during television watching of secondary school students in Kuching South City.
    METHODS: In accordance with the two-stage sampling method, a total of 316 adolescents aged 13-17 years from 7 secondary schools participated. Data were collected using questionnaire and anthropometric measurement. Independent t test, one-way ANOVA, Mann-Whitney U test, and chi-square test were performed.
    RESULTS: The mean BMI was 20.56 kg/m(2) (SD 4.33) for boys and 20.15 kg/m(2) (SD 3.91) for girls. No significant difference in terms of z score for BMI-for-age or socio-demographic factors was found. The mean duration of time devoted to media use was 4.69 hours (SD 2.93) on weekdays and 5.69 hours (SD 2.87) on weekends. Boys were found to spend more hours on media use than did the girls (t = 4.293, P < 0.01). Respondents were reported to consume more cereal compared with soft drinks and junk foods. Respondents whose fathers worked in the private sector devoted the fewest hours to media use, whereas those with self-employed fathers devoted the most time to media use. Respondents with mothers who were employed spent more time on media use than did respondents whose mothers were housewives (F = 4.067, P < 0.01). No significant difference was found between BMI and media time or snacking habits.
    CONCLUSION: This finding indicated that media time has no effect on body weight, because respondents were found to have normal weight and to consume less unhealthy food.
    KEYWORDS: adolescent; behaviour; body mass index; public health; urban population
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