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Fulltext Human papillomavirus infection and its vaccines: knowledge and attitudes of primary health clinic nurses in Kelantan, Malaysia

Jeyachelvi K, Juwita S, Norwati D

Asian Pac J Cancer Prev, 2016;17(8):3983-8.
PMID: 27644649

BACKGROUND: Cervical cancer though preventable is still the leading cause of cancer death among women secondary to breast cancer. Persistent infection with HPV has been causally linked to the disease. A school based HPV vaccination program was introduced in late 2010 in Malaysia and nurse support is essential for its success.
OBJECTIVES: To determine nurses knowledge and attitudes about HPV infection and its vaccines, and factors associated with their knowledge.
MATERIALS AND METHODS: This cross-sectional study was conducted among nurses working at primary health clinics in Kelantan from mid-June till the end of July 2014. Its involved 330 nurses selected through multistage random sampling. A validated self-administered questionnaire consisting of 11 items for the knowledge domain and eight items for the attitude domain was used.
RESULTS: The response rate of the study was 93.7%. The mean knowledge and mean attitude (SD) scores were 5.37 (1.76) and 29.8 (3.51) respectively. Only 24% knew that HPV is the most common sexually transmitted infection and 67% correctly answered that Gardasil vaccine can protect against four types of HPV. Nearly 60% of participants wrongly answered that HPV vaccines cannot be offered to sexually active women. Likewise, 70.9% participants were not aware that HPV vaccine may be appropriate for females aged 9 through 26 years. Though 90% of participants believed that the vaccine is safe, nearly half of them were unsure about efficacy. From multiple linear regression analysis, among the factors tested only participant's level of education showed a statistically significant association with the HPV knowledge score (<0.001).
CONCLUSIONS: This study indicates nurses have favorable attitudes towards HPV vaccination; however they have significant knowledge deficit and major misunderstanding in critical knowledge items. Among the factors tested, nursing qualification is the only factor that is significantly associated with the nurses knowledge score.
Fulltext Proportion of dementia and its associated factors among elderly patients attending outpatient clinics of Universiti Sains Malaysia Hospital

Norlaily H, Azidah AK, Asrenee AR, Rohayah H, Juwita S

Med J Malaysia, 2009 Jun;64(2):140-5.
PMID: 20058574 MyJurnal

The increase in life expectancy observed over the last decade has particular relevance for conditions such as cognitive decline and dementia. This is a cross sectional study to determine the rate of dementia and to identify its associated factors among 399 elderly patients attending outpatient clinics of Universiti Sains Malaysia Hospital. This study was conducted in 2 phases. In the first phase, the literate subjects were screened using validated Malay version of Mini Mental State Examination (MMSE) and the illiterate subjects with Malay version of Elderly Cognitive Assessment Questionnaire (ECAQ). All subjects suspected to have dementia were selected for further evaluation in phase 2 of this study. The second phase involved full clinical examination in order to establish clinical diagnosis of dementia. The proportion of dementia in this study was 2.5% (10). Although history of exposure to pesticide (p < 0.05) and history of stroke (p < 0.05) were significant, they were not significant factors. These were because vast discrepancy in number between those exposed to pesticide and having stroke between dementia and non dementia.

Study site: Outpatient clinics, Hospital Universiti Sains Malaysia (HUSM)
Fulltext Circadian blood pressure profile and associated cardiovascular risk factors in non-dippers

Siti Suhaila MY, Juwita S, Harmy MY, Tengku Alina TI

International Medical Journal Malaysia, 2013;12(2):23-31.
MyJurnal

Introduction: Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers.
Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12.
Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic.
Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.
Study site: Family Medicine Clinic, Hospital Universiti Sains Malysia (HUSM), Kelantan, Malaysia
Fulltext Microalbuminuria prevalence study in hypertensive type 2 diabetic patients in Malaysia

Kong NC, Chia YC, Khalid BA, Juwita S, Samiah Yasmin AK, Yap LY, et al.

Med J Malaysia, 2006 Oct;61(4):457-65.
PMID: 17243524 MyJurnal

Microalbuminuria is the earliest indicator of diabetic kidney disease and generalised vascular endothelial dysfunction. The Microalbuminuria Prevalence (MAP) Study was carried out to assess the prevalence of macroalbuminuria, microalbuminuria and normoalbuminuria in Asian hypertensive patients with type 2 diabetes on usual care. This paper presents a subanalysis of data from patients in Malaysia. In 733 analysed patients, the prevalence of macroalbuminuria and microalbuminuria was 15.7% and 39.7%, respectively. The high prevalence of diabetic nephropathy in these high-risk patients is a cause for concern, and the Malaysian Health Care system should be prepared for a pandemic of end-stage renal disease due to diabetic nephropathy.

Study site: six medical centres in Kuala Lumpur, Kota Bharu,
Kuching and Kota Kinabalu
Fulltext Metabolic, inflammatory, and oxidative stress markers in women exposed to secondhand smoke

Siti Hajar MH, Zulkefli S, Juwita S, Norhayati MN, Siti Suhaila MY, Rasool AHG, et al.

PeerJ, 2018;6:e5758.
PMID: 30356972 DOI: 10.7717/peerj.5758

Background: Secondhand smoke (SHS) exposure has adverse effects on the cardiovascular system. This study aimed to determine the effects of SHS on the cardiovascular disease biomarkers, namely the metabolic, inflammatory, and oxidative stress markers in healthy adult women.
Methods: This comparative cross-sectional study was conducted among healthy women. The cases included those women exposed to SHS, and the controls included those women not exposed to SHS. SHS exposure was defined as being exposed to SHS for at least 15 min for 2 days per week. Venous blood was taken to measure the metabolic markers (high molecular weight adiponectin, insulin level, insulin resistance, and nonesterified fatty acids), oxidative stress markers (oxidized low density lipoprotein cholesterol and 8-isoprostane), and inflammatory markers (high-sensitivity C-reactive protein and interleukin-6). A hair nicotine analysis was also performed. An analysis of covariance and a simple linear regression analysis were conducted.
Results: There were 101 women in the SHS exposure group and 91 women in the non-SHS exposure group. The mean (with standard deviation) of the hair nicotine levels was significantly higher in the SHS exposure group when compared to the non-SHS exposure group [0.22 (0.62) vs. 0.04 (0.11) ng/mg; P = 0.009]. No significant differences were observed in the high molecular weight adiponectin, insulin and insulin resistance, nonesterified fatty acids, 8-isoprostane, oxidized low density lipoprotein cholesterol, interleukin-6, and high-sensitivity C-reactive protein between the two groups. The serum high molecular weight adiponectin was negatively associated with the insulin level and insulin resistance in the women exposed to SHS. However, no significant relationships were seen between the high molecular weight adiponectin and nonesterified fatty acids, 8-isoprostane, oxidized low density lipoprotein cholesterol, high-sensitivity C-reactive protein in the SHS group.
Discussion: There were no significant differences in the metabolic, oxidative stress, and inflammatory markers between the SHS exposure and non-SHS exposure healthy women. A low serum level of high molecular weight adiponectin was associated with an increased insulin level and resistance in the women exposed to SHS.