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  1. Transcultural mental health nursing in Malaysia: perspectives and strategies
    Chang KH
    Contemp Nurse, 2010 8 10;34(2):134-5.
    PMID: 20690223
  2. Is there a place for ontological hermeneutics in mental-health nursing research? A review of a hermeneutic study
    Chang KH, Horrocks S
    Int J Nurs Pract, 2008 Oct;14(5):383-90.
    PMID: 18808539 DOI: 10.1111/j.1440-172X.2008.00702.x
    A lot of research carried out within the context of mental-health nursing using qualitative data collection tools claims that it is hermeneutical, with usually just a short section describing the hermeneutical methodology as though it is a very broad philosophical approach. Criticisms of the latter approach more often than not concentrate on the level of the data collection tools without getting to grips with the underlying hermeneutical philosophy. This paper examines the difference between methodological and ontological hermeneutics and then gives an example of a piece of research using the latter approach. It is then argued that criticisms of the hermeneutical approach usually only concentrate on methodological hermeneutics with the consequence that they seriously misapply their criticisms if the research is using ontological hermeneutics.
  3. Lived experiences of family caregivers of mentally ill relatives
    Chang KH, Horrocks S
    J Adv Nurs, 2006 Feb;53(4):435-43.
    PMID: 16448486 DOI: 10.1111/j.1365-2648.2006.03732.x
    AIM: The aim of this paper is to report a study conducted to explore the meanings of the lived experiences that Chinese family caregivers in Malaysia ascribed to the care they provided to relatives with severe and persistent mental illness.
    BACKGROUND: In the past, many researchers have used quantitative approaches to explore the experiences of family caregivers of relatives with severe and persistent mental illness. However, the results of these studies have been far from conclusive because of serious methodological flaws. In addition, a large majority of these studies were conducted in western cultures, and it has been difficult to transfer the results to family caregivers in oriental cultures.
    METHOD: The philosophy of Martin Heidegger underpinned the study. Qualitative data were collected mainly through in-depth interviews with 19 criterion-selected Chinese family caregivers of relatives with severe and persistent mental illness in 2002.
    FINDINGS: We present the emergent themes reflecting the meaning structures of managing, enduring, and surviving the day-to-day experiences of the Chinese family caregivers. The impact of the stigma of the relatives' mental illness on family caregivers and families is pervasive and strong. As a result, family caregivers tried to avoid talking about their relative's mental illness with extended family or friends in order to protect their families from 'losing face'. In addition, most family caregivers believed that adopting positive behaviours and attitudes helped them cope with caregiving.
    CONCLUSION: Mental health nurses need to help Chinese family caregivers to cope with the stresses and stigmas of their relatives' mental illnesses through psychosocial education or family intervention, and to provide them with culturally-congruent care. They should also educate the public about mental health and ill health through health promotion and education.
  4. Authors' Response
    Abdullah AF, Chang KH
    J Forensic Sci, 2016 09;61(5):1411-2.
    PMID: 27621078 DOI: 10.1111/1556-4029.13166
  5. Fulltext Adults' perceptions of being overweight or obese: a focus group study
    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.
  6. Fulltext The supportive care needs for prostate cancer patients in Sarawak
    Cheah WL, Ling NC, Chang KH
    Chin Clin Oncol, 2016 Feb;5(1):7.
    PMID: 26932431 DOI: 10.3978/j.issn.2304-3865.2016.02.01
    This cross-sectional study aimed to determine the prevalence of unmet supportive care needs among prostate cancer patients.
  7. Optimization of headspace solid-phase microextraction technique for extraction of volatile smokeless powder compounds in forensic applications
    Chang KH, Yew CH, Abdullah AF
    J Forensic Sci, 2014 Jul;59(4):1100-8.
    PMID: 24611488 DOI: 10.1111/1556-4029.12440
    Smokeless powders are low explosives and are potentially found in cases involving firearms and improvised explosive devices. Apart from inorganic compound analysis, forensic determination of organic components of these materials appears as a promising alternative, especially the chromatographic techniques. This work describes the optimization of a solid-phase microextraction technique using an 85 μm polyacrylate fiber followed by gas chromatography-flame ionization detection for smokeless powder. A multivariate experimental design was performed to optimize extraction-influencing parameters. A 2(4) factorial first-order design revealed that sample temperature and extraction time were the major influencing parameters. Doehlert matrix design has subsequently selected 66°C and 21 min as the compromised conditions for the two predetermined parameters. This extraction technique has successfully detected the headspace compounds of smokeless powders from different ammunition types and allowed for their differentiation. The novel technique allows more rapid sample preparation for chromatographic detection of smokeless powders.
  8. Study of the Behaviors of Gunshot Residues from Spent Cartridges by Headspace Solid-Phase Microextraction-Gas Chromatographic Techniques
    Chang KH, Yew CH, Abdullah AF
    J Forensic Sci, 2015 Jul;60(4):869-77.
    PMID: 25771708 DOI: 10.1111/1556-4029.12745
    Gunshot residues, produced after shooting activity, have acquired their importance in analysis due to the notoriety of firearms-related crimes. In this study, solid-phase microextraction was performed to extract the headspace composition of spent cartridges using 85-μm polyacrylate fiber at 66°C for 21 min. Organic compounds, that is, naphthalene, 2,6-dinitrotoluene, 2,4-dinitrotoluene, diphenylamine, and dibutyl phthalate were detected and analyzed by gas chromatography-flame ionization detection technique. Evaluation of chromatograms for diphenylamine, dibutyl phthalate, and naphthalene indicates the period after a gunshot was discharged, whether it was 1 days, 2-4 days, <5 days, 10 days, 20 days, or more than 30 days ago. This study revealed the potential effects of environmental factors such as occasional wind blow and direct sunlight on the estimation of time after spent cartridges were discharged. In conclusion, we proposed reliable alternative in analyzing the headspace composition of spent cartridges in a simulated crime scene.
  9. Forensic Significance of Gunshot Impact Marks on Inanimate Objects: The Need for Translational Research
    Nordin FA, Bominathan UR, Abdullah AFL, Chang KH
    J Forensic Sci, 2020 Jan;65(1):11-25.
    PMID: 31373699 DOI: 10.1111/1556-4029.14142
    Wherever an impact mark is found, either on the surface or on the recovered projectile, it is important for forensic investigators to extract useful information in solving shooting-related cases. This article reviews a collection of works on examination of impact marks upon striking of projectiles on inanimate objects, emphasizing on the retrievable information from a shooting scene and their forensic significance in shooting event reconstruction. Literature suggested that impact marks on target surfaces and the degree of deformation on striking projectiles vary according to different combinations of ammunition and surface materials. It was noted that conditions in real-case scenarios further differed unpredictably in comparison with controlled studies, where forensic investigation should be treated as case-specific basis. Furthermore, the way forensic science is researched and applied operationally has to be reconsidered to reduce the gap via translational approach for more effective use of forensic evidence.
  10. Profiling of cured residue of solvent-based adhesives by attenuated total reflectance-Fourier transform infrared spectroscopy with chemometrics for forensic investigation
    Saman SA, Chang KH, Abdullah AFL
    J Forensic Sci, 2021 Mar;66(2):608-618.
    PMID: 33202056 DOI: 10.1111/1556-4029.14625
    Abuse of solvent-based adhesives jeopardizes world population, especially the young generation. Adhesive-related exhibits encountered in forensic cases might need to be determined if they could have come from a particular source or to establish link between cases or persons. This study was aimed to discriminate solvent-based adhesives, especially to aid forensic investigation of glue sniffing activities. In this study, thirteen brands with three samples each, totaling at 39 adhesive samples, were analyzed using attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy followed by chemometric methods. Experimental output showed that adhesive samples utilized in this study were less likely to change in their ATR-FTIR profiles over time, at least up to 2 months. No interference from plastic materials was noticed based on ATR-FTIR profile comparison. Physical examination could differentiate the samples into two groups, namely contact adhesives and cement adhesives. A principal component analysis-score linear discriminative analysis (PC-score LDA) model resulted in 100% and 98.6% correct classification in discriminating the two groups of adhesive samples, forming seven discriminative clusters. Test set with adhesive samples applied glass slide and plastic substrates also demonstrated a 100% correct classification into their respective groups. As a conclusion, the method allowed for discrimination of adhesive samples based on the spectral features, displaying relationship among samples. It is hoped that this comparative information is beneficial to trace the possible source of solvent-based adhesives, whenever they are recovered from a crime scene, for forensic investigation.
  11. Physical Activity Among Adolescents in an East Malaysian Rural Indigenous Community: Exploring the Influence of Neighborhood Environmental Factors
    Saimon R, Choo WY, Chang KH, Ng CJ, Bulgiba A
    Asia Pac J Public Health, 2015 Nov;27(8 Suppl):33S-40S.
    PMID: 25900978 DOI: 10.1177/1010539515582220
    This study explores the rural environmental factors that influence adolescents' participation in physical activities (PA). Thirty-six indigenous adolescents, aged 13 to 17 years from rural communities of East Malaysia were involved in the photovoice procedures: photo-taking, selecting, contextualizing, and codifying themes. Despite being endowed with natural resources such as river, forest, hills, and so on, the adolescents and the community did not capitalize on these rich resources to promote and engage in PA. Poor maintenance of natural resources, the lack of pedestrian infrastructures and road safety, the lack of PA facilities, and negative perception of ancestors' agricultural activities were among factors that constrained adolescents' PA. Although basic amenities such as play spaces and pedestrian infrastructures are necessary to increase adolescents' PA, any intervention should make the most of the natural resources, which are cheaper, environment friendly, and sustainable.
  12. Quick determination and discrimination of commercial hand sanitisers using attenuated total reflectance-Fourier transform infrared spectroscopy and chemometrics
    Teoh WK, Md Muslim NZ, Ismail ML, Chang KH, Abdullah AFL
    Anal Methods, 2021 04 07;13(13):1601-1611.
    PMID: 33730137 DOI: 10.1039/d1ay00075f
    Due to the outbreak of the COVID-19 pandemic, practicing personal hygiene such as frequent hand sanitising has become a norm. The making of effective hand sanitiser products should follow the recommended formulations, but the high demand worldwide for such affordable products could have made them a candidate for counterfeiting, thus deserving forensic determination and profiling for source determination or supply chain tracing. In this study, determination and discrimination of hand sanitisers was carried out by employing attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy combined with chemometrics. Fifty commercially available hand sanitisers were obtained from the market and analysed. ATR-FTIR profiles of each sanitiser were compared and decomposed by principal component analysis (PCA) followed by linear discriminant analysis (LDA). Physical observation enabled the discrimination of seven samples based on their respective colours, the presence of beads and their colours, and the physical forms of formulations. Subsequently, eight distinct patterns were observed through visual comparison of ATR-FTIR profiles of the remaining 43 samples. An initial unsupervised exploratory PCA model indicated the separation of two main groups with ATR-FTIR profiles similar to those of ethanol and isopropanol, respectively. The PCA score-LDA model provided good predictions, with a 100% correct classification into eight different groups. In conclusion, this study demonstrated a quick determination and discrimination of hand sanitiser samples, allowing screening for any restricted components and sample-to-sample comparison.
  13. Fulltext A qualitative study on malnutrition in children from the perspectives of health workers in Tumpat, Kelantan
    Cheah WL, Wan Manan WM, Zabidi-Hussin ZM, Chang KH
    Malays J Nutr, 2007 Mar;13(1):19-28.
    PMID: 22692186 MyJurnal
    Underlying causes of most nutrition related problems are diverse, including biological, social, cultural, and economic factors. Qualitative approaches complement quantitative methods in identifying the underlying meanings and patterns of relationships involved in managing malnutrition. This study examined perceptions regarding malnutrition among health workers from 7 clinics (community and health clinics) in Tumpat, Kelantan. A total of 18 nurses and 2 doctors, who were involved in monitoring child health and nutrition, were included in the study. These health workers were interviewed using a semi-structured questionnaire adapted from Sastry's framework on malnutrition (Sastry, 1996). The questionnaire included biological, behavioral and environmental factors that influence child health and nutrition. All the health workers perceived that mothers/caregivers play the main role in improving the health of malnourished children. The quality of childcare was rated as moderately satisfactory by the health workers. Most of the affected families who were given the Food Baskets did not fully use all the items for the malnourished child. Child feeding practice was based on the needs of the whole family rather than according to the target child's needs. Most of the mothers preferred processed cereals than rice porridge because the former is easier to prepare for the child. Although they were from a low socioeconomic background, most of the mothers were not earning additional income for the family. The qualitative methodology provided information that can be used as a basis for the designing of quantitative questionnaires to assess malnutrition among children. The induction characteristic of qualitative methods was used to gain an understanding of the underlying reasons or phenomena such as behaviours that are directly observable.
    Study site: Klinik kesihatan, Tumpat, Kelantan, Malaysia
  14. Temporal association of maternal weight gain with early-term and preterm birth and low birth weight babies
    Jan Mohamed HJ, Lim PY, Loy SL, Chang KH, Abdullah AFL
    J Chin Med Assoc, 2021 07 01;84(7):722-727.
    PMID: 34050107 DOI: 10.1097/JCMA.0000000000000557
    BACKGROUND: Low birth weight and preterm or early-term babies may have a higher risk of poor health. One of the main factors is the weight gain of a pregnant woman during gestational weeks in the second and third trimesters. Changes in weight over a month in a pregnant woman might also have an impact on infant outcomes. This study aimed to investigate the association between maternal weight at different time points and low birth weight and preterm or early-term babies (premature babies).

    METHODS: A total of 156 pregnant women were recruited. Maternal weight was collected at different gestational weeks. Maternal age, body mass index, delivery mode, delivery week, and infant weight were also recorded. Maternal data were restructured into a person-period format before mixed-effects multiple logistic regression was used. Various weight variables with either a fixed effect or time-varying effects were tested in the model.

    RESULTS: Thirty (19.23%) women had delivered low birth weight or premature babies. Multiple logistic regression model demonstrated that mothers with higher increases in weight at 32 weeks of gestation than that in the predelivery stage had a lower probability of having a low birth weight or premature baby (odds ratio [OR] = 0.64; 95% CI, 0.49-0.85; p < 0.001). Women with a weight increase of more than 2 kg in a 4-week gestation period had a higher probability of having a low birth weight or premature baby than those with an increment of <1 kg (OR = 8.43; 95% CI, 2.90-24.54; p < 0.001).

    CONCLUSION: An increase in weight gain after 32 weeks was shown to reduce the risk of low birth weight and premature babies. Maternal weight monitoring was suggested to be conducted every 4 weeks to minimize the chance of having a low birth weight and premature baby.

  15. Fulltext Emerging pathways to neurodegeneration: Dissecting the critical molecular mechanisms in Alzheimer's disease, Parkinson's disease
    Tan SH, Karri V, Tay NWR, Chang KH, Ah HY, Ng PQ, et al.
    Biomed Pharmacother, 2019 Mar;111:765-777.
    PMID: 30612001 DOI: 10.1016/j.biopha.2018.12.101
    Neurodegenerative diseases are usually sporadic in nature and commonly influenced by a wide range of genetic, life style and environmental factors. A unifying feature of Alzheimer's disease (AD) and Parkinson's disease (PD) is the abnormal accumulation and processing of mutant or damaged intra and extracellular proteins; this leads to neuronal vulnerability and dysfunction in the brain. Through a detailed review of ubiquitin proteasome, mRNA splicing, mitochondrial dysfunction, and oxidative stress pathway interrelation on neurodegeneration can improve the understanding of the disease mechanism. The identified pathways common to AD and PD nominate promising new targets for further studies, and as well as biomarkers. These insights suggested would likely provide major stimuli for developing unified treatment approaches to combat neurodegeneration. More broadly, pathways can serve as vehicles for integrating findings from diverse studies of neurodegeneration. The evidence examined in this review provides a brief overview of the current literature on significant pathways in promoting in AD, PD. Additionally, these insights suggest that biomarkers and treatment strategies may require simultaneous targeting of multiple components.
  16. A portable electrochemical sensor for detection of the veterinary drug xylazine in beverage samples
    Saisahas K, Soleh A, Promsuwan K, Phonchai A, Mohamed Sadiq NS, Teoh WK, et al.
    J Pharm Biomed Anal, 2021 Feb 08;198:113958.
    PMID: 33662759 DOI: 10.1016/j.jpba.2021.113958
    A portable electrochemical sensor was developed to determine xylazine in spiked beverages by adsorptive stripping voltammetry (AdSV). The sensor was based on a graphene nanoplatelets-modified screen-printed carbon electrode (GNPs/SPCE). The electrochemical behavior of xylazine at the GNPs/SPCE was an adsorption-controlled irreversible oxidation reaction. The loading of graphene nanoplatelets (GNPs) on the modified SPCE, electrolyte pH, and AdSV accumulation potential and time were optimized. Under optimal conditions, the GNPs/SPCE provided high sensitivity, linear ranges of 0.4-6.0 mg L-1 (r = 0.997) and 6.0-80.0 mg L-1 (r = 0.998) with a detection limit of 0.1 mg L-1 and a quantitation limit of 0.4 mg L-1. Repeatability was good. The accuracy of the proposed sensor was investigated by spiking six beverage samples at 1.0, 5.0, and 10.0 mg L-1. The recoveries from this method ranged from 80.8 ± 0.2-108.1 ± 0.3 %, indicating the good accuracy of the developed sensor. This portable electrochemical sensor can be used to screen for xylazine in beverage samples as evidence in cases of sexual assault or robbery.
  17. Detection and discrimination of sedative-hypnotics in spiked beverage dry residues using attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy combined with chemometrics
    Teoh WK, Mohamed Sadiq NS, Saisahas K, Phonchai A, Kunalan V, Md Muslim NZ, et al.
    J Forensic Sci, 2023 Jan;68(1):75-85.
    PMID: 36273275 DOI: 10.1111/1556-4029.15156
    Drugs-facilitated crimes (DFCs) involve the incapacitation of victims under the influence of drugs. Conventionally, a drug administration act is often determined through the examination of biological samples; however, dry residues from any surface, such as drinking glass if related to a DFC could be a potential source of evidence. This study was aimed to establish an attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy coupled with chemometrics for the determination of spiked sedative-hypnotics from dry residues of a drug-spiked beverage. In this study, four sedative-hypnotics, namely diazepam, ketamine, nimetazepam, and xylazine were examined using ATR-FTIR spectroscopy. Subsequently, the ATR-FTIR profiles were compared and decomposed by principal component analysis (PCA) followed by linear discriminant analysis (LDA) for their detection and discrimination. Visual comparison of ATR-FTIR profiles revealed distinct spectra among the tested drugs. An initial unsupervised exploratory PCA model indicated the separation of four main sedative-hypnotics clusters, and the proposed PCA score-LDA model had allowed for a 100% accurate classification. Discrimination of sedative-hypnotics from a dry beverage previously spiked with these drugs was also possible upon an additional extraction procedure. In conclusion, ATR-FTIR coupled with PCA score-LDA model was useful in detecting and discriminating sedative-hypnotics, including those that had been previously spiked into a beverage.
  18. Fulltext Electrochemical Sensor for Methamphetamine Detection Using Laser-Induced Porous Graphene Electrode
    Saisahas K, Soleh A, Somsiri S, Senglan P, Promsuwan K, Saichanapan J, et al.
    Nanomaterials (Basel), 2021 Dec 28;12(1).
    PMID: 35010025 DOI: 10.3390/nano12010073
    A 3D porous graphene structure was directly induced by CO2 laser from the surface of Kapton tape (carbon source) supported by polyethylene terephthalate (PET) laminating film. A highly flexible laser-induced porous graphene (LI-PGr) electrode was then fabricated via a facile one-step method without reagent and solvent in a procedure that required no stencil mask. The method makes pattern design easy, and production cost-effective and scalable. We investigated the performance of the LI-PGr electrode for the detection of methamphetamine (MA) on household surfaces and in biological fluids. The material properties and morphology of LI-PGr were analysed by scanning electron microscopy (SEM), energy dispersive x-ray (EDX) and Raman spectroscopy. The LI-PGr electrode was used as the detector in a portable electrochemical sensor, which exhibited a linear range from 1.00 to 30.0 µg mL-1 and a detection limit of 0.31 µg mL-1. Reproducibility was good (relative standard deviation of 2.50% at 10.0 µg mL-1; n = 10) and anti-interference was excellent. The sensor showed good precision and successfully determined MA on household surfaces and in saliva samples.
  19. Fulltext Inter-rater reliability of vehicle color perception for forensic intelligence
    Lee K, Abdul Fatah AA, Mohd Norizan N, Jefrey Z, Md Nawi FH, Wan Nor WFK, et al.
    PLoS One, 2019;14(6):e0218428.
    PMID: 31211821 DOI: 10.1371/journal.pone.0218428
    The topcoat color of motor vehicles offers vital information while investigating vehicular accidents, especially in instance of hit-and-run, since witnesses seldom perceive and retain the plate details. Differences in color perceptions among individuals with normal vision may lead to confusion in determining the color of the car involved. In this way, witnesses of crash accidents could potentially initiate flawed leads in forensic investigation, and thus affect the administration of justice. In this study, the inter-rater reliability of vehicle color determination by different volunteers was explored. Six individuals observed the topcoat colors of 500 stationary and 500 moving vehicles from five locations, employing a common system of color gradation. The outcome was binary: the vehicle color was either a "match" or "non-match". This was followed by statistical analysis in terms of the colors' frequencies and inter-rater reliability, based on which more suitable color descriptions were determined for subsequent comparisons of stationary and moving vehicles. Higher match frequencies and greater inter-rater reliability were observed when color gradations were disregarded. The frequency of correct matches could have been closely related to their relative on-the-road distribution, regardless of the statuses of observed vehicles. It was also found that black and white were associated with a greater number of matches than were intermediate colors, which should be carefully interpreted during forensic investigation to avoid wrong leads. In conclusion, the present study demonstrated the forensic significance of vehicle topcoat color determination, particularly in cases where witness statements are crucial.
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