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  1. Syed Elias SM, Neville C, Scott T
    Geriatr Nurs, 2015 Sep-Oct;36(5):372-80.
    PMID: 26099638 DOI: 10.1016/j.gerinurse.2015.05.004
    Loneliness, anxiety and depression are common problems for older adults in long-term care. Reminiscence therapy is a non-pharmacological intervention that may be of some benefit. In comparison to individual reminiscence therapy, group reminiscence therapy is a preferred option when dealing with the resource constraints of long-term care. The aim of this paper was to systematically review the literature in order to explore the effectiveness of group reminiscence therapy for older adults with loneliness, anxiety and depression in long-term care. Results indicated that group reminiscence therapy is an effective treatment for depression in older adults, however to date, there is limited research support for its effectiveness to treat loneliness and anxiety. Further research and an improvement in methodological quality, such as using qualitative and mixed methods approaches, is recommended to help establish an evidence base and provide better understanding of the effectiveness of group reminiscence therapy.
  2. Makhtar A, Syed Elias SM, Azizi A
    Enferm Clin, 2021 04;31 Suppl 2:S130-S134.
    PMID: 33849146 DOI: 10.1016/j.enfcli.2020.12.007
    This study aimed to determine the relationship between painful diabetic peripheral neuropathy and functional status among older people in Kuantan, Pahang. A cross-sectional study was performed by using an interviewer-administered questionnaire among 300 participants recruited from selective Primary Health Centres and endocrine clinics, Hospital Tengku Ampuan Afzan in Kuantan, Pahang. The data were analyzed by using SPSS version 22. The findings indicated that most participants reported neuropathic pain experience. The severity of pain was found to be significantly related to patients who had been diagnosed over 10 years ago, Indians patients and those who were treating their diabetes with insulin alone. No significant relationship was found between pain severity and functional status. The severity of pain and the associated factors suggest the need for a multidisciplinary approach to provide effective treatment to patients with painful diabetic peripheral neuropathy.
  3. Alaini R, Rajikan R, Elias SM
    BMC Public Health, 2019 Jun 13;19(Suppl 4):546.
    PMID: 31196148 DOI: 10.1186/s12889-019-6872-4
    BACKGROUND: Poor dietary habits have been identified as one of the cancer risks factors in various epidemiological studies. Consumption of healthy and balance diet is crucial to reduce cancer risk. Cancer prevention food plan should consist of all the right amounts of macronutrients and micronutrients. Although dietary habits could be changed, affordability of healthy foods has been a major concern, as the price of healthy foods are more expensive the unhealthy counterparts.

    METHODS: Therefore, using linear programming, this study is aimed to develop a healthy and balanced menu with minimal cost in accordance to individual needs that could in return help to prevent cancer. A cross sectional study involving 100 adults from a local university in Kuala Lumpur was conducted in 3 phases. The first phase is the data collection for the subjects, which includes their socio demographic, anthropometry and diet recall. The second phase was the creation of a balanced diet model at a minimum cost. The third and final phase was the finalization of the cancer prevention menu. Optimal and balanced menus were produced based on respective guidelines of WCRF/AICR (World Cancer Research Fund/ American Institute for Cancer Research) 2007, MDG (Malaysian Dietary Guidelines) 2010 and RNI (Recommended Nutrient Intake) 2017, with minimum cost.

    RESULTS: Based on the diet recall, most of subjects did not achieve the recommended micronutrient intake for fiber, calcium, potassium, iron, B12, folate, vitamin A, vitamin E, vitamin K, and beta-carotene. While, the intake of sugar (51 ± 19.8 g), (13% ± 2%) and sodium (2585 ± 544 g) was more than recommended. From the optimization model, three menus, which met the dietary guidelines for cancer prevention by WCRF/AICR 2007, MDG 2010 and RNI 2017, with minimum cost of RM7.8, RM9.2 and RM9.7 per day were created.

    CONCLUSION: Linear programming can be used to translate nutritional requirements based on selected Dietary Guidelines to achieve a healthy, well-balanced menu for cancer prevention at minimal cost. Furthermore, the models could help to shape consumer food choice decision to prevent cancer especially for those in low income group where high cost for health food has been the main deterrent for healthy eating.

  4. Jailani M, Elias SM, Rajikan R
    Nutrients, 2021 Sep 30;13(10).
    PMID: 34684475 DOI: 10.3390/nu13103474
    Healthy Eating Index (HEI) is a diet quality measure that assesses the population's compliance towards dietary guidelines. In Malaysia, diet quality measure, though existing, has some limitations in terms of application and relevance. This study aims to develop a new standardized Malaysian Healthy Eating Index (S-MHEI) that can measure the diet quality of all Malaysians regardless of their energy requirement level. The Malaysian Dietary Guidelines (MDG) 2010 and MDG for Children and Adolescents (MDGCA) 2013 were used as main references in developing the index components. In addition, the latest Malaysian Adults Nutrition Survey (MANS) and Adolescent Nutrition Survey (ANS) were also referred to ensure the relevance of the components selected. For adequacy components, the least restrictive method was used in setting the standard for the scoring system. Meanwhile, the scoring system for moderation components was built based on the Recommended Nutrient Intake (RNI) 2017. The new S-MHEI comprises of 11 components with a maximum total score of 100. The least restrictive method allowed the index to be used across energy requirement levels. However, the index will not be sensitive towards adhering to the specific recommended amount of intake-which in effect, made the index focus on measuring diet quality rather than diet quantity.
  5. Syed Elias SM, Rohinmi NR
    J Educ Health Promot, 2022;11:298.
    PMID: 36439003 DOI: 10.4103/jehp.jehp_1637_21
    BACKGROUND: Although older people are at a higher risk of COVID-19 infection, there is a lack of research that focuses on COVID-19 in older people in Malaysia. Therefore, the aim of this study was to assess the level of knowledge and attitudes related to COVID-19, and to identify the association of sociodemographic background with knowledge and attitudes towards COVID-19 among older people.

    MATERIALS AND METHODS: This is a cross-sectional study involving 382 older people living in the community in Malaysia. Data was collected using convenience sampling through an online questionnaire that consisted of three parts: sociodemographic details, knowledge, and attitude related to COVID-19.

    RESULTS: The overall correct rate of knowledge was 77.3%, indicating that participants had slightly good knowledge related to COVID-19. The participants showed a positive attitude with a mean score of 26.0 (SD = 5.0). There were significant associations between knowledge and education level (P = 0.00) and marital status (P = 0.02). Marital status was significantly associated with attitude towards COVID-19 (P = 0.03). A weak positive correlation was found between knowledge and attitude (r = 0.17, P = 0.00) suggesting that an increase in knowledge will increase the positive attitude among older people.

    CONCLUSION: Older people reported good knowledge and positive attitudes towards COVID-19. The Malaysian government should provide relevant health education for those with lower education levels and divorced or widowed to improve knowledge and attitudes towards COVID-19.

  6. Elias SM, Hashim Z, Marjan ZM, Abdullah AS, Hashim JH
    Asia Pac J Public Health, 2007;19(3):29-37.
    PMID: 18330402
    A cross-sectional study was conducted to identify the relationship between blood lead concentration and nutritional status among primary school children in Kuala Lumpur. A total of 225 Malay students, 113 male and 112 female, aged 6.3 to 9.8 were selected through a stratified random sampling method. The random blood samples were collected and blood lead concentration was measured by a Graphite Furnace Atomic Absorption Spectrophotometer. The nutrient intake was determined by the 24-hour Dietary Recall method and Food Frequency Questionnaire. An anthropometric assessment was reported according to growth indices (z-scores of weight-for-age, height-for-age, and weight-for-height). The mean blood lead concentration was low (3.4 +/- 1.91 ug/dL) and was significantly different between gender. Only 14.7% of the respondents fulfilled the daily energy requirement. The protein and iron intakes were adequate for a majority of the children. However, 34.7% of the total children showed inadequate intake of calcium. The energy, protein, fat and carbohydrate intakes were significantly different by gender, that is, males had better intake than females. Majority of respondents had normal mean z-score of growth indices. Ten percent of the respondents were underweight, 2.8% wasted and 5.4% stunted. Multiple linear regression showed inverse significant relationships between blood lead concentration with children's age (beta = -0.647, p < 0.001) and per capita income (beta = -0.001, p = 0.018). There were inverse significant relationships between blood lead concentration with children's age (beta = -0.877, p = 0.001) and calcium intake (beta = -0.011, p = 0.014) and positive significant relationship with weight-for-height (beta = 0.326, p = 0.041) among those with inadequate calcium intake. Among children with inadequate energy intake, children's age (beta = -0.621, p < 0.001), per capita income (beta = -0.001, p = 0.025) and protein intake (beta = -0.019, p = 0.027) were inversely and significantly related with blood lead concentration. In conclusion, nutritional status might affect the children's absorption of lead and further investigation is required for confirmation.
  7. Syed Elias SM, Makhtar A, Ahmad Tarmidi NH
    Enferm Clin, 2021 04;31 Suppl 2:S356-S360.
    PMID: 33849199 DOI: 10.1016/j.enfcli.2020.09.026
    This study aimed to determine the prevalence of suicidal ideation and the associated factors with suicidal ideation among older people. This was a cross-sectional study. The present study was carried out from March 2018 to May 2018. In total, 200 older people aged 60 years and over were recruited from a medical outpatient clinic in Malaysia. The older people completed a self-administered questionnaire on sociodemographic background, depression, and suicidal ideation. The data analysis involved descriptive and inferential analysis using IBM SPSS Statistics version 23.0. The prevalence rate of suicidal ideation was 3%. There were significant associations between ethnicity (p<0.00), marital status (p=0.008), depression (p<0.00) and suicidal ideation. Risk factors for suicidal ideation in older people are ethnicity, marital status, and depression. Future studies should focus on these factors in any intervention aimed to reduce suicidal ideation among older people in Malaysia.
  8. Syed Elias SM, Petriwskyj A, Scott T, Neville C
    Australas J Ageing, 2019 Mar;38(1):E25-E30.
    PMID: 30426630 DOI: 10.1111/ajag.12598
    OBJECTIVE: To explore how older people with loneliness, anxiety and depression experience a spiritual reminiscence therapy (SRT) program and to explore its acceptability within the Malaysian population.

    METHODS: Unstructured observations and a focus-group discussion were carried out with 18 participants involved in a six-week SRT program in a residential care facility in Kuala Lumpur.

    RESULTS: Analysis revealed four themes: (i) Enthusiastic participation; (ii) Connections across boundaries; (iii) Expressing and reflecting; and (iv) Successful use of triggers.

    CONCLUSIONS: The findings suggest that the process of reminiscence, on which the program was based, was enjoyable for the participants and created opportunities to form connections with other members of the group. The use of relevant triggers in the SRT program that related to Malaysian cultures, ethnicities and religions was helpful to engage the participants and was acceptable across the different religions and ethnicities.

  9. Sawal Hamid ZB, Rajikan R, Elias SM, Jamil NA
    PMID: 31783474 DOI: 10.3390/ijerph16234720
    Achieving nutritional requirements for pregnant women in rural or suburban households while maintaining the intake of local and culture-specific foods can be difficult. Usage of a linear programming approach can effectively generate diet optimization models that incorporate local and culturally acceptable menus. This study aimed to determine whether a realistic and affordable diet that achieves recommended nutrient intakes for pregnant women could be formulated from locally available foods in Malaysia. A cross-sectional study was conducted to assess the dietary intake of 78 pregnant women using a 24-h dietary recall and a 3-day food record. A market survey was also carried out to estimate the cost of raw foods that are frequently consumed. All linear programming analyses were done using Excel Solver to generate optimal dietary patterns. Our findings showed that the menus designed from diet optimization models using locally available foods would improve dietary adequacy for the seven food groups based on the Malaysian Dietary Guidelines 2010 (MDG 2010) and the 14 nutrients based on Recommended Nutrient Intake 2017 (RNI 2017) in pregnant women. However, inadequacies remained for iron and niacin, indicating that these nutrients may require supplementation.
  10. Jeevanaraj P, Hashim Z, Elias SM, Aris AZ
    Environ Sci Pollut Res Int, 2016 Dec;23(23):23714-23729.
    PMID: 27619374
    We identified marine fish species most preferred by women at reproductive age in Selangor, Malaysia, mercury concentrations in the fish muscles, factors predicting mercury accumulation and the potential health risk. Nineteen most preferred marine fish species were purchased (n = 175) from selected fisherman's and wholesale market. Length, weight, habitat, feeding habit and trophic level were recognised. Edible muscles were filleted, dried at 80 °C, ground on an agate mortar and digested in Multiwave 3000 using HNO3 and H2O2. Total mercury was quantified using VP90 cold vapour system with N2 carrier gas. Certified reference material DORM-4 was used to validate the results. Fish species were classified as demersal (7) and pelagic (12) or predators (11), zoo benthos (6) and planktivorous (2). Length, weight and trophic level ranged from 10.5 to 75.0 cm, 0.01 to 2.50 kg and 2.5 to 4.5, respectively. Geometric mean of total mercury ranged from 0.21 to 0.50 mg/kg; maximum in golden snapper (0.90 mg/kg). Only 9 % of the samples exceeded the JECFA recommendation. Multiple linear regression found demersal, high trophic (≥4.0) and heavier fishes to accumulate more mercury in muscles (R (2) = 27.3 %), controlling for all other factors. About 47 % of the fish samples contributed to mercury intake above the provisional tolerable level (45 μg/day). While only a small portion exceeded the JECFA fish Hg guideline, the concentration reported may be alarming for heavy consumers. Attention should be given in risk management to avoid demersal and high trophic fish, predominantly heavier ones.
  11. Mohidem NA, Hashim Z, Osman M, Muharam FM, Elias SM, Shaharudin R
    Rev Environ Health, 2021 Dec 20;36(4):493-499.
    PMID: 34821116 DOI: 10.1515/reveh-2020-0096
    OBJECTIVE: To investigate the prevalence and incidence of TB by focusing on its environmental risk factor in Malaysia.

    CONTENT: Databases search of Scopus, ScienceDirect, PubMed, Directory of Open Access Journals (DOAJ), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, MyJournal, Biblioteca Regional de Medicina (BIREME), BioMed Central (BMC) Public Health, Medline, Commonwealth Agricultural Bureaux (CAB), EMBASE (Excerpta Medica dataBASE) OVID, and Web of Science (WoS) was performed, which include the article from 1st January 2008 until 31st August 2018 using medical subject heading (MeSH). Articles initially identified were screened for relevance.

    SUMMARY: Out of 744 papers screened, nine eligible studies did meet our inclusion criteria. Prison and housing environments were evaluated for TB transmission in living environment, while the other factor was urbanization. However, not all association for these factors were statistically significant, thus assumed to be conflicting or weak to end up with a strong conclusion.

    OUTLOOK: Unsustainable indoor environment in high congregate setting and overcrowding remained as a challenge for TB infection in Malaysia. Risk factors for transmission of TB, specifically in high risk areas, should focus on the implementation of specialized program. Further research on health care environment, weather variability, and air pollution are urgently needed to improve the management of TB transmission.

  12. Mohidem NA, Osman M, Muharam FM, Elias SM, Shaharudin R, Hashim Z
    Int J Mycobacteriol, 2021 12 18;10(4):442-456.
    PMID: 34916466 DOI: 10.4103/ijmy.ijmy_182_21
    Background: Early prediction of tuberculosis (TB) cases is very crucial for its prevention and control. This study aims to predict the number of TB cases in Gombak based on sociodemographic and environmental factors.

    Methods: The sociodemographic data of 3325 TB cases from January 2013 to December 2017 in Gombak district were collected from the MyTB web and TB Information System database. Environmental data were obtained from the Department of Environment, Malaysia; Department of Irrigation and Drainage, Malaysia; and Malaysian Metrological Department from July 2012 to December 2017. Multiple linear regression (MLR) and artificial neural network (ANN) were used to develop the prediction model of TB cases. The models that used sociodemographic variables as the input datasets were referred as MLR1 and ANN1, whereas environmental variables were represented as MLR2 and ANN2 and both sociodemographic and environmental variables together were indicated as MLR3 and ANN3.

    Results: The ANN was found to be superior to MLR with higher adjusted coefficient of determination (R2) values in predicting TB cases; the ranges were from 0.35 to 0.47 compared to 0.07 to 0.14, respectively. The best TB prediction model, that is, ANN3 was derived from nationality, residency, income status, CO, NO2, SO2, PM10, rainfall, temperature, and atmospheric pressure, with the highest adjusted R2 value of 0.47, errors below 6, and accuracies above 96%.

    Conclusions: It is envisaged that the application of the ANN algorithm based on both sociodemographic and environmental factors may enable a more accurate modeling for predicting TB cases.

  13. Makhtar A, Ab Ghani NN, Syed Elias SM, Mohamed Ludin S
    Belitung Nurs J, 2023;9(1):69-78.
    PMID: 37469632 DOI: 10.33546/bnj.2334
    BACKGROUND: The negative health results associated with the family caregivers of older people can be alleviated with social support, which is considered a valuable resource. Hence, the factors contributing to social support need to be understood.

    OBJECTIVE: This study aimed to evaluate the social support associated with the family caregivers of older people.

    METHODS: A cross-sectional study was conducted among 231 family caregivers of older people conveniently selected from two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. Data were gathered between June to December 2021 using a Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire. Descriptive statistics were used to summarize the data in frequencies and percentages. Independent t-test and one-way analysis of variance were used to examine correlations among variables.

    RESULTS: The mean scores of social support for family caregivers were significantly higher among their family (Mean ± SD; 5.44 ± 0.969) and other important people (5.25 ± 1.123) compared to their friends (4.84 ± 1.094). Caregivers' gender and duration of caregiving were significant factors associated with social support (p <0.05).

    CONCLUSIONS: The family caregivers received maximum support from their family and other important people, but they were less supported by their friends. This study also observed that the perceived social support of the caregivers of older people was affected by several factors, such as gender and duration of caregiving. This finding gives nurses and other healthcare workers the basic information they need to enhance nursing interventions and promote social support among those who care for older people, which can positively impact caregiving.

  14. Isa KNM, Jalaludin J, Elias SM, Than LTL, Jabbar MA, Saudi ASM, et al.
    Ecotoxicol Environ Saf, 2021 Sep 15;221:112430.
    PMID: 34147866 DOI: 10.1016/j.ecoenv.2021.112430
    The exposure of school children to indoor air pollutants has increased allergy and respiratory diseases. The objective of this study were to determine the toxicodynamic interaction of indoor pollutants exposure, biological and chemical with expression of adhesion molecules on eosinophil and neutrophil. A self-administered questionnaire, allergy skin test, and fractional exhaled nitric oxide (FeNO) analyser were used to collect information on health status, sensitization to allergens and respiratory inflammation, respectively among school children at age of 14 years. The sputum induced were analysed to determine the expression of CD11b, CD35, CD63 and CD66b on eosinophil and neutrophil by using flow cytometry technique. The particulate matter (PM2.5 and PM10), NO2, CO2, and formaldehyde, temperature, and relative humidity were measured inside the classrooms. The fungal DNA were extracted from settled dust collected from classrooms and evaluated using metagenomic techniques. We applied chemometric and regression in statistical analysis. A total of 1869 unique of operational taxonomic units (OTUs) of fungi were identified with dominated at genus level by Aspergillus (15.8%), Verrucoconiothyrium (5.5%), and Ganoderma (4.6%). Chemometric and regression results revealed that relative abundance of T. asahii were associated with down regulation of CD66b expressed on eosinophil, and elevation of FeNO levels in predicting asthmatic children with model accuracy of 63.6%. Meanwhile, upregulation of CD11b expressed on eosinophil were associated with relative abundance of A. clavatus and regulated by PM2.5. There were significant association of P. bandonii with upregulation of CD63 expressed on neutrophil and exposure to NO2. Our findings indicate that exposure to PM2.5, NO2, T. asahii, P.bandonii and A.clavatus are likely interrelated with upregulation of activation and degranulation markers on both eosinophil and neutrophil.
  15. Sincihu Y, Lusno MFD, Mulyasari TM, Elias SM, Sudiana IK, Kusumastuti K, et al.
    Neuropsychiatr Dis Treat, 2023;19:73-83.
    PMID: 36636141 DOI: 10.2147/NDT.S396556
    PURPOSE: Low-density polyethylene microplastics are ingested into the bloodstream and distributed to all the organ tissue, including the hippocampus, causing toxic effects. This research aimed to elucidate the responses of hippocampal neurons to microplastic in the blood based on the expressions of superoxide dismutase (SOD), catalase (CAT) enzymes, malondialdehyde (MDA), 8-oxo-7,8-dihydro-2-deoxyguanosine (8-OHdG) in hippocampal neurons, and blood serum amyloid beta 1-42 (Aβ42) levels using SMART PLS pathway analysis.

    METHODS: This was a pure experimental research on Wistar rats with a post-test control group design. Five experimental groups (X1, X2, X3, X4, X5) were given 0.0375 mg, 0.075 mg, 0.15 mg, 0.3 mg, and 0.6 mg of low-density polyethylene microplastics mixed in 2cc distilled water, respectively. Furthermore, except for control (C), the groups received microplastics an oral probe for 90 days.

    RESULTS: The molecular response of hippocampal neurons of Wistar rats to microplastics in the blood significantly decreased SOD enzyme expression, while CAT enzyme was unaffected. It considerably increased neuronal membrane damage (expression of MDA), increased considerably neuronal deoxyribonucleic acid damage (expression of 8-OHdG), and decreased blood serum Aβ42 levels (pathway analysis, all t-value >1.96).

    CONCLUSION: The pathway analysis showed that hippocampal neurons were significantly affected by microplastic particles in the blood.

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