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The use of magnetic resonance phase-contrast cine in Chiari malformation with syringomyelia

Goh CH, Hamzah MR, Kandasamy R, Ghani ARI, Wong SH, Idris Z, et al.

Med J Malaysia, 2020 11;75(6):666-671.
PMID: 33219175

INTRODUCTION: Chiari malformation (CM) is a disorder of mesodermal origin and is commonly associated with syringomyelia. Foramen magnum decompression is the first-line of standard treatment in symptomatic patients with a confirmed radiographic diagnosis. Magnetic resonance (MR) cine allows accurate evaluation of cerebrospinal fluid (CSF) physiology at the craniovertebral junction but often this is under-utilised in Malaysia.
METHODS: In this series, we looked into nine cases of CM with syringomyelia from clinical and radiological perspective before and after surgery. The radiological parameters were herniated tonsillar length, syrinx: cord ratio, syrinx length and diameter. Flow velocity and morphologic changes in Chiari were illustrated.
RESULTS: Seven patients showed either reduction in syrinx length, syrinx: cord ratio or both postoperatively. Clinical recovery somewhat varied in motor and sensory symptoms. Four patients gained better functional grade in modified Rankin scale (MRS) while the rest remained similar. The study highlighted the advantage of CSF flow dynamics information over MR anatomical radiographic improvement in addressing the neurologic and functional recovery. We also discussed the practicality of cine sequence in preoperative patient selection, syrinx analysis and postoperative flow evaluation in anticipation of clinical outcome.
CONCLUSION: Phase-contrast cine MRI is a useful tool dictated by resource availability. We recommend its routine use in preoperative analysis and subsequent observational follow-up after surgery.
Fulltext Relationship Between COVID-19 Information Sources and Attitudes in Battling the Pandemic Among the Malaysian Public: Cross-Sectional Survey Study

Mohamad E, Tham JS, Ayub SH, Hamzah MR, Hashim H, Azlan AA

J Med Internet Res, 2020 11 12;22(11):e23922.
PMID: 33151897 DOI: 10.2196/23922

BACKGROUND: There are multiple media platforms and various resources available for information on COVID-19. Identifying people's preferences is key to building public confidence and planning for successful national health intervention strategies.
OBJECTIVE: This study examines the sources of information for COVID-19 used by the Malaysian public and identifies those that are associated with building public confidence and positive perceptions toward the Malaysian government.
METHODS: A cross-sectional online survey of 4850 Malaysian residents was conducted. Participant demographics, media use, information sources, and attitudes surrounding COVID-19 were assessed. Descriptive statistics and multiple logistic regression analyses were conducted to gauge the relationship between demographics, information sources, and attitudes toward COVID-19.
RESULTS: Malaysians primarily used television and internet news portals to access information on COVID-19. The Malaysian Ministry of Health was the most preferred source of COVID-19 information. Respondents who referred to the Ministry of Health, television, and the Malaysian National Security Council for information were more likely to believe that the country could win the battle against COVID-19 and that the government was handling the health crisis well compared to those who referred to other information sources. Those who used the World Health Organization, friends, YouTube, family, and radio as sources of information were less likely to harbor confidence and positive belief toward combating COVID-19.
CONCLUSIONS: Managing information and sustaining public confidence is important during a pandemic. Health authorities should pay considerable attention to the use of appropriate media channels and sources to allow for more effective dissemination of critical information to the public.
Fulltext Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia

Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E

PLoS One, 2020;15(5):e0233668.
PMID: 32437434 DOI: 10.1371/journal.pone.0233668

In an effort to mitigate the outbreak of COVID-19, many countries have imposed drastic lockdown, movement control or shelter in place orders on their residents. The effectiveness of these mitigation measures is highly dependent on cooperation and compliance of all members of society. The knowledge, attitudes and practices people hold toward the disease play an integral role in determining a society's readiness to accept behavioural change measures from health authorities. The aim of this study was to determine the knowledge levels, attitudes and practices toward COVID-19 among the Malaysian public. A cross-sectional online survey of 4,850 Malaysian residents was conducted between 27th March and 3rd April 2020. The survey instrument consisted of demographic characteristics, 13 items on knowledge, 3 items on attitudes and 3 items on practices, modified from a previously published questionnaire on COVID-19. Descriptive statistics, chi-square tests, t-tests and one-way analysis of variance (ANOVA) were conducted. The overall correct rate of the knowledge questionnaire was 80.5%. Most participants held positive attitudes toward the successful control of COVID-19 (83.1%), the ability of Malaysia to conquer the disease (95.9%) and the way the Malaysian government was handling the crisis (89.9%). Most participants were also taking precautions such as avoiding crowds (83.4%) and practising proper hand hygiene (87.8%) in the week before the movement control order started. However, the wearing of face masks was less common (51.2%). This survey is among the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Malaysia. The results highlight the importance of consistent messaging from health authorities and the government as well as the need for tailored health education programs to improve levels of knowledge, attitudes and practices.
Fulltext Associations between health literacy and sociodemographic factors: A cross-sectional study in Malaysia utilising the HLS-M-Q18

Azlan AA, Hamzah MR, Tham JS, Ayub SH, Ahmad AL, Mohamad E

Int J Environ Res Public Health, 2021 05 02;18(9).
PMID: 34063294 DOI: 10.3390/ijerph18094860

Health literacy is progressively seen as an indicator to describe a nation's health status. To improve health literacy, countries need to address health inequalities by examining different social demographic factors across the population. This assessment is crucial to identify and evaluate the strengths and limitations of a country in addressing health issues. By addressing these health inequalities, a country would be better informed to take necessary steps to improve the nation's health literacy. This study examines health literacy levels in Malaysia and analyses socio-demographic factors that are associated with health literacy. A cross-sectional survey was carried out using the HLS-M-Q18 instrument, which was validated for the Malaysian population. Multi-stage random sampling strategy was used in this study, utilising several sampling techniques including quota sampling, cluster sampling, and simple random sampling to allow random data collection. A total of 855 respondents were sampled. Our results showed that there were significant associations between health literacy and age, health status, and health problems. Our findings also suggest that lower health literacy levels were associated with the younger generation. This study's findings have provided baseline data on Malaysians' health literacy and provide evidence showing potential areas of intervention.
Fulltext Establishing the HLS-M-Q18 short version of the European health literacy survey questionnaire for the Malaysian context

Mohamad EMW, Kaundan MK, Hamzah MR, Azlan AA, Ayub SH, Tham JS, et al.

BMC Public Health, 2020 Apr 28;20(1):580.
PMID: 32345285 DOI: 10.1186/s12889-020-08704-7

BACKGROUND: The European Health Literacy Survey Questionnaire (HLS-EU-Q47) is becoming a widely used tool to measure health literacy (HL), including in Malaysia. There are efforts to reduce the 47-item scale to parsimonious short item scales that still reflect the assumptions and requirements of the conceptual model. This study used confirmatory factor analysis to reduce the 47-item scale to a short scale that can offer a feasible HL screening tool with sufficient psychometric properties.

METHODS: A cross-sectional survey was conducted on the Malaysian population based on ethnic distribution to ensure that the short version instrument reflects the country's varied ethnicities. The survey was administered by well-trained interviewers working for the Ministry of Health Malaysia. A total of 866 responses were obtained. Data was analysed using multi-factorial confirmatory factor analysis (CFA) with categorical variables.

RESULTS: The analysis resulted in a satisfactory 18-item model. There were high correlations among the 18 items. The internal consistency reliability was robust, with no floor/ceiling effects. These results represented equivalence and consistency among the responses to items, suggesting that these items were homogenous in measuring Malaysian health literacy. The strong convergent and discriminant validity of the model makes the proposed 18 items a suitable short version of the health literacy instrument for Malaysia.

CONCLUSIONS: The researchers propose the 18-item instrument to be named HLS-M-Q18. This short version instrument may be used in measuring health literacy in Malaysia as it achieved robust reliability, structural validity and construct validity that fulfilled goodness-of-fit criteria.
Fulltext Exposure to Misinformation, Risk Perception, and Confidence towards the Government as Factors Influencing Negative Attitudes towards COVID-19 Vaccination in Malaysia

Mohamad E, Tham JS, Mohd Ajis SZ, Hamzah MR, Ayub SH, Tri Sakti AM, et al.

Int J Environ Res Public Health, 2022 Nov 08;19(22).
PMID: 36429342 DOI: 10.3390/ijerph192214623

INTRODUCTION: This study explored exposure to misinformation, COVID-19 risk perception, and confidence towards the government as predictors of negative attitudes toward the COVID-19 vaccine.
METHODS: A cross-sectional survey was carried out from 30 June to 30 August 2021 involving 775 respondents. The survey instrument for the questionnaire was an adaptation from various different studies consisting of five main variables: (1) misinformation about vaccination; (2) risk perception toward COVID-19; (3) attitudes toward the vaccination programme; (4) intention to get vaccinated; and (5) public confidence in the government in executing the vaccination programme.
RESULTS: The results of this study indicate that higher exposure to misinformation led to higher levels of negative attitudes toward the COVID-19 vaccine. When the perceived risk of COVID-19 infection was high, mistrust of vaccine benefits was low but there were also higher worries about the future effects of the vaccine. Confidence in the government was associated with lower negative attitudes toward the COVID-19 vaccine.
CONCLUSION: The results of this study may help develop an understanding of negative attitudes toward vaccinations in Malaysia and its contributing factors.
A Cross-Sectional Evaluation of Complementary and Alternative Medicine Use in a Non-urban Malaysian Population

Teow YEE, Ng SC, Azmi AHM, Hamzah MR, Kaur J, Mathiarasu DS, et al.

J Community Health, 2021 06;46(3):515-521.
PMID: 32710232 DOI: 10.1007/s10900-020-00891-z

Complementary and alternative medicine (CAM) therapies have been an integral part of Malaysia culture for many centuries. In recent years influences from other parts of the world have gained a foot-hold in Malaysian popular culture. We investigated the engagement with CAM in a non-urban, Malaysian population. We investigated the association of CAM use with cultural influence, perceived health status, gender and age. We recruited 700 adult participants to this study across three sites in central Malaysia. We found massage, Vitamin supplements, Herbal medicine and traditional Chinese medicine to be the most popular CAM modalities with participation at 67.7%, 55.7%, 55.5% and 26.3% respectively. CAM use was equally high at 67% among those people who claimed a predominantly Malay or Chinese cultural influence. The use of vitamins and participation in yoga were at higher prevalence among female participants compared to males. There was no gender difference for other CAM modalities. There were differences between age groups for most CAM modalities, and those over 50 years tended to be the highest frequency users for most modalities. There is a high rate of CAM use in non-urban Malaysia with younger people being more engaged with less traditional modalities such as aromatherapy, yoga and music therapy.