Displaying publications 1 - 20 of 51 in total

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  1. Ramadas, A., Kandiah, M., Jabbar, F., Zarida, H.
    MyJurnal
    At least 6 million deaths occurred worldwide are due to cancer and this figure is expected to rise to
    15 millions by the year 2020. Colorectal cancer is among the most commonly occurring cancers
    both globally and in Malaysia. Numerous studies have shown significant relationships between
    various dietary components and the risks for colorectal cancer. Meanwhile, several theories have
    been suggested as etiological explanations, one of which is the influence of dietary factors on the
    cell proliferation rate. A higher cell proliferation rate is statistically associated with increased risk
    of colorectal cancer. However, evidence of a significant relationship between diet and colorectal
    adenomas, a potential precursor for colorectal cancer, remains insufficient. Colorectal adenomas or
    polyps are vital in their relationship with colorectal cancers as almost 70% of all colorectal cancers
    are developed from these polyps. Studying the modifiable risk factors related to polyps will provide
    an opportunity for the prevention of colorectal cancer even before it develops. This paper reviews
    the available evidence linking dietary factors with the risk for colorectal adenomas. As the numbers
    of published studies are limited, of which most are concentrated in Western countries, there is a
    need for epidemiological studies in Malaysia to strengthen the evidence of a relationship between
    diet and colorectal adenomas.
  2. Ramadas A, Kandiah M
    Asian Pac J Cancer Prev, 2009;10(5):925-32.
    PMID: 20104992
    It is well established that almost all colorectal cancers arise from benign, neoplastic adenomatous polyps. In previous studies, intake of fruits, vegetables and legumes were found to decrease the risk for colorectal adenomas (CRA) and colorectal cancer. This case-control study aimed to evaluate the roles of a variety of foods in contributing to the risk of CRA in Malaysian subjects. One hundred and eighteen subjects were recruited into case (n=59) and control (n=59) groups at Hospital Kuala Lumpur (HKL). A pre-tested quantitative food frequency questionnaire (FFQ) was used to record the types of food items and frequency consumed. Logistic regression was used to determine the crude and adjusted odds ratios of the independent variables. Soy bean and soy products were associated with a reduced risk for CRA (OR = 0.38, 95% CI = 0.15-0.98), while tubers were associated with increase in risk four-fold (OR = 4.14, 95% CI = 1.60-10.70) and red meat intake was found to increase the risk two and a half-fold (OR = 2.51, 95% CI = 1.02-6.28). Higher servings of fruits and vegetables were found to significantly decrease the risk (OR fruits = 0.47, 95% CI = 0.30-0.74; OR vegetables = 0.49, 95% = 0.29-0.80). In conclusion, our data support protective roles for soy, fruits and vegetables in the aetiology of colorectal adenomas and increase in risk in those with high intakes of red meat and tubers. Food intake of an individual may have an influence on one's risk for developing CRA. This finding warrants further investigation before the protective effect of these food items is to be accepted. New studies should explore the possibility of these associations among individuals in the general population especially with regard to different ethnic or other groups in Malaysia with low fruit and vegetable consumption.
  3. Balaravi, B., Chin, M.Q., Samantha Quah, L.W., Ramadas, A., Karppaya, H., Chai, W.J.
    Malays J Nutr, 2017;23(3):409-423.
    MyJurnal
    Introduction: Often considered a legitimate strategy to enhance health and
    performance, the consumption of nutritional supplements (NS) has become
    a common practice which frequently results in unintentional doping among
    athletes. Despite a probable association between NS and doping, there are limited
    studies on this topic in developing countries such as Malaysia. Thus, this study
    aimed to identify the prevalence of NS usage among national elite athletes and
    assess their knowledge and attitude regarding its use and doping.

    Methods:
    This was a cross-sectional study conducted at the Malaysian National Sports
    Institute among national elite athletes (n=50) recruited via convenience sampling.
    The athletes completed a self-administered questionnaire documenting their
    demographic characteristics, training information, NS consumption, knowledge
    and attitude related to supplement-doping. The total knowledge and attitude
    scores were compared according to demography, training information, and NS
    consumption.

    Results: The prevalence of NS use among the athletes was 72%.
    NS usage was significantly associated with training duration (p=0.029), source of
    nutrition information (p=0.047) and self-exploration on supplements (p=0.045).
    Supplement-doping knowledge was significantly higher among athletes with
    tertiary level education (p=0.027), NS users (p=0.044), those obtaining information
    from nutritionists (p=0.048) and those who had attended nutrition workshops
    (p
  4. Liew JK, Cheong XP, Law L, Teo WH, Eng SS, Ngim CF, et al.
    MyJurnal
    Evidence has shown an increase in paediatric hypertension globally and this could give rise to increase prevalence of adult hypertension. The purpose of this paper was to determine the prevalence of hypertension among adolescents in Malaysia as well as the association between hypertension and lifestyle factors selected based on published literature. Methods:Adolescents aged 13-17 years old were selected randomly from two secondary schools to have their blood pressure measured. Their lifestyle information was obtained through completed bilingual questionnaires based on validated instruments, as well as anthropometry measurements. The relationship between hypertension and lifestyle factors was determined through statistical analysis. Results:A total of 273 students were included in the study with 120 (44%) males and 153 (56%) females. The prevalence of hypertension was 24.5% among the respondents with the highest being recorded among Malays (28.7%). Generally, hypertension was associated with an increased Body Mass Index (BMI) (AOR=4.053, 95%CI=1.677-9.795, p=0.002) and waist circumference (WC) (AOR=2.918, 95%CI=1.171-7.269, p=0.021) in all respondents. Similar associations were noted in females (BMI: AOR=7.707, 95%CI=2.043-29.072, p=0.003; WC: AOR=3.690, 95%CI=1.011-13.464, p=0.048) but not in males. Conclusion: Hypertension recorded high prevalence among Malaysian adolescents in our study. The strong association between elevated body weight, BMI and WC with hypertension may require further study to evaluate the need for screening.
  5. Ahmad B, Ramadas A, Quek KF
    Med J Malaysia, 2010 Dec;65(4):273-6.
    PMID: 21901944 MyJurnal
    The study's aim was to construct and validate a diabetes mellitus knowledge questionnaire in Bahasa Malaysia for Orang Asli (OA-DKQ). The questionnaire was administered to; case (Orang Asli) and control (administrative staff) groups at baseline and retested two weeks later. The Cronbach's Alpha was used to determine internal consistency and intraclass correlation coefficient (ICC) was used to determine test-retest reliability. The OA-DKQ has an internal consistency of 0.806. These findings suggest the OA-DKQ is an acceptable instrument to assess knowledge and preventive behaviour in Orang Asli (86 words).
  6. Dhillon H, Nordin RB, Ramadas A
    PMID: 31547629 DOI: 10.3390/ijerph16193561
    Diabetes complications, medication adherence, and psychosocial well-being have been associated with quality of life (QOL) among several Western and Asian populations with diabetes, however, there is little evidence substantiating these relationships among Malaysia's unique and diverse population. Therefore, a cross-sectional study was conducted in a Malaysian public primary care clinic among 150 patients diagnosed with type 2 diabetes mellitus (T2DM). Structured and validated questionnaires were used to investigate the associations between demographic, clinical, and psychological factors with QOL of the study participants. Approximately three-quarters of patients had a good-excellent QOL. Diabetes-related variables that were significantly associated with poor QOL scores included insulin containing treatment regimens, poor glycemic control, inactive lifestyle, retinopathy, neuropathy, abnormal psychosocial well-being, higher diabetes complication severity, and nonadherence (p < 0.05). The main predictors of a good-excellent QOL were HbA1c ≤ 6.5% (aOR = 20.78, 95% CI = 2.5175.9, p = 0.005), normal anxiety levels (aOR = 5.73, 95% CI = 1.8-18.5, p = 0.004), medication adherence (aOR = 3.35, 95% CI = 1.3-8.7, p = 0.012), and an aDCSI score of one and two as compared to those greater than or equal to four (aOR = 7.78, 95% CI = 1.5-39.2, p = 0.013 and aOR = 8.23, 95% CI = 2.1-32.8, p = 0.003), respectively. Medication adherence has also been found to be an effect modifier of relationships between HbA1c, depression, anxiety, disease severity, and QOL. These predictors of QOL are important factors to consider when managing patients with T2DM.
  7. Yau JW, Thor SM, Ramadas A
    Nutrients, 2020 Sep 29;12(10).
    PMID: 33003593 DOI: 10.3390/nu12102990
    Nutritional therapy has been conventionally recommended for people with prediabetes as a method to delay or halt progression to type 2 diabetes. However, recommended nutritional strategies evolve over time. Hence, we performed a scoping review on recently reported nutritional interventions for individuals with prediabetes. Ovid MEDLINE, PubMed, Embase, Scopus, CINAHL and PsycINFO databases were searched to identify relevant research articles published within the past 10 years. Ninety-five articles involving a total of 11,211 participants were included in this review. Nutritional strategies were broadly classified into four groups: low calorie diet, low glycemic index diet, specific foods, and a combination of diet and exercise. The most frequently assessed outcomes were plasma glucose, serum insulin, serum lipid profile, body mass index and body weight. More than 50% of reported interventions resulted in significant improvements in these parameters. Nutritional interventions have demonstrated feasibility and practicality as an effective option for prediabetes management. However, the intervention variability demonstrates the challenges of a 'one-size-fits-all' approach. Investigations in genetically diverse populations and objective assessment of progression rate to diabetes are necessary to better comprehend the impact of these nutritional strategies in prediabetes.
  8. Mahadzir MDA, Quek KF, Ramadas A
    PMID: 32290570 DOI: 10.3390/ijerph17082641
    Metabolic Syndrome (MetS) is a cluster of risk factors that increases the risk for diabetes and cardiovascular diseases. Lifestyle intervention is the gold standard of MetS management and prevention. Despite the growing positive influence of peer support-based interventions on management of various chronic diseases, its potential among adults with MetS has not been elucidated. We describe the development and process evaluation of a nutrition and lifestyle behavior "PEeR SUpport program for ADults with mEtabolic syndrome" (PERSUADE) using a systematic five-step approach-(i) review of evidence; (ii) focus group discussions; (iii) behavioral matrix development; (iv) module development; and (v) feasibility and process evaluation. High program adherence was recorded with 81.3% of participants attending all peer sessions. Participants' content satisfaction score was high (93.3%) while peer leadership score was satisfactory (70.0%). There were significant reductions in all anthropometric and metabolic parameters assessed post intervention, except for diastolic blood pressure. Significant correlations were found between reductions in body fat and triglyceride, and content satisfaction. Peer leadership was only significantly correlated with reduction in triglyceride. Future studies can explore aspects of module interactivity, use of social media, and other means to stimulate consistent engagement of participants, as well as extending the implementations to other lifestyle-related diseases.
  9. Ramadas A, Quek KF, Chan CK, Oldenburg B
    Int J Med Inform, 2011 Jun;80(6):389-405.
    PMID: 21481632 DOI: 10.1016/j.ijmedinf.2011.02.002
    Introduction: The Internet has emerged as a potentially effective medium for information exchange. The Internet's potential has been recognised and web-based education programmes have been steadily adopted in recent years in preventing and managing chronic diseases such as diabetes mellitus. This review provides a descriptive discussion of web-based behavioural interventions for the management of type 2 diabetes mellitus.
    Method: Systematic literature searches were performed using MEDLINE, EMBASE, PUBMED, PsycINFO, Web of Science and Cochrane Library to retrieve articles published between 2000 and June 2010 which fulfilled all inclusion criteria. Methodological quality assessment and data synthesis were then performed.
    Results: Twenty articles representing 13 different studies were reviewed. None of the studies were ranked as low in the methodological quality. Goal-setting, personalised coaching, interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage type 2 diabetes mellitus. Strong theoretical background, use of other technologies and longer duration of intervention were proven to be successful strategies as well.
    Conclusion: The web-based interventions have demonstrated some level of favourable outcomes, provided they are further enhanced with proper e-research strategies.
  10. Thor SM, Yau JW, Ramadas A
    PLoS One, 2021;16(9):e0257433.
    PMID: 34520483 DOI: 10.1371/journal.pone.0257433
    Metabolic syndrome (MetS) is frequently associated with various health issues and is a major contributor to morbidity and mortality worldwide, particularly with its recent relevance to coronavirus disease 2019 (COVID-19). To combat its increasing prevalence in Southeast Asia, numerous intervention programs have been implemented. We conducted a scoping review on recent interventions to manage MetS among Southeast Asians using standard methodologies. Cochrane, Embase, Ovid MEDLINE, PubMed, and Scopus databases were systematically searched to yield peer-reviewed articles published between 2010-2020. We included 13 articles describing 11 unique interventions in four Southeast Asian countries: Malaysia, Thailand, Indonesia, and Vietnam. These interventions were broadly categorized into four groups: (i) nutrition (n = 4); (ii) physical activity (n = 2); (iii) nutrition and physical activity (n = 2); and (iv) multi-intervention (n = 3). Most studies investigated the effects of an intervention on components of MetS, which are anthropometry, blood pressure, glucose-related parameters, and lipid profile. Significant improvements ranged from 50% of studies reporting serum triglyceride and HDL-cholesterol levels to 100% for waist circumference. Evidence on interventions for individuals with MetS remains limited in Southeast Asia. More studies from other countries in this region are needed, especially on the effects of dietary interventions, to effectively address gaps in knowledge and provide sufficient data to design the ideal intervention for Southeast Asian populations.
  11. Lee KX, Quek KF, Ramadas A
    Curr Nutr Rep, 2023 Dec;12(4):733-743.
    PMID: 38038894 DOI: 10.1007/s13668-023-00513-9
    PURPOSE OF REVIEW: Obesity is a growing public health concern worldwide, especially among young adults. This scoping review aims to identify and summarize the current evidence on dietary and lifestyle risk factors associated with obesity among young adults.

    RECENT FINDINGS: A scoping review was performed using the PRISMA-ScR guidelines. A systematic search of five electronic databases published from inception to October 2023 was conducted. A total of 46 observational studies met the inclusion criteria and were included in the review. The findings suggest that high intake of energy-dense foods, unhealthy eating habits, poor sleep quality, and increased screen time were significant risk factors for obesity among young adults. In contrast, the association between obesity and sedentary behavior, low physical activity levels, alcohol consumption, and smoking habits was inconclusive. The reviewed evidence suggests that unhealthy dietary habits and lifestyle behaviors are associated with an increased risk of obesity among young adults. The findings highlight the need for further research on these modifiable risk factors to prevent and manage obesity among young adults.

  12. Mahadzir MDA, Quek KF, Ramadas A
    Nutrients, 2020 Apr 15;12(4).
    PMID: 32326541 DOI: 10.3390/nu12041091
    BACKGROUND: While peer support interventions have shown to benefit adults with certain chronic conditions, there is limited evidence on its feasibility and effectiveness among people with metabolic syndrome (MetS). This paper describes the outcomes of a pre-post feasibility trial of "PEeR SUpport program for ADults with mEtabolic syndrome" (PERSUADE), an evidence-based and community-specific nutrition and lifestyle behavior peer support program for Malaysian adults with MetS.

    METHODS: We recruited 48 peers (median age: 46 (IQR = 11) years old) into four peer groups, who underwent 3 months of PERSUADE, followed by 3 months of follow-up period. Statistical analyses were conducted at post-intervention and post-follow-up to assess the changes in nutrition intake, anthropometry, and metabolic parameters.

    RESULTS: Although there were significant overall increases in total carbohydrate intake and glycemic load (both p < 0.001), we noted significant reductions in the intakes of total energy and fat (both p < 0.001). Physical activity (total METS/week) also showed a significant improvement (p < 0.001). Overall, significant but marginal improvements in anthropometric and vital metabolic parameters were also observed.

    CONCLUSIONS: The feasibility trial supported the adoption of PERSUADE, though there is a need to assess the long-term impact of the peer support program in local community settings.

  13. Ramadas A, Tham SM, Lalani SA, Shyam S
    Nutrients, 2021 Apr 20;13(4).
    PMID: 33924050 DOI: 10.3390/nu13041380
    Malaysia is a rapidly developing economy experiencing a nutrition transition. It suffers from a double burden of over- and undernutrition, making it essential to understand diet quality in the population. In this scoping review, we have collated the existing literature on Malaysian diet quality, including factors that influence it, and the association between diet quality and health outcomes across the lifespan of Malaysians. Overall, diet quality was poor in all age groups studied. The Healthy Eating Index (HEI) and its iterations were predominantly used in urban and clinical settings to evaluate diet-chronic disease relationships. These indices were significantly associated with cardio-metabolic and disease risks in adults. The Diet Diversity Score (DDS) and Food Variety Score (FVS) were used to gauge diet quality in maternal and child nutrition studies and were associated with appropriate growth and caloric intake. Deficiencies were found in fruit, vegetable, legumes, and dairy intake. Meat, salt, and sugar intake were found to be excessive in many studies. The findings can inform policies to improve diet quality in this population. The review also identified knowledge gaps that require further investigation.
  14. Ramadas A, Kandiah M, Zarida H, Yunus Gul AG, Faizal JA
    Malays J Nutr, 2009 Mar;15(1):1-10.
    PMID: 22691799 MyJurnal
    Colorectal adenomas are precursor lesions of colorectal cancer. Several studies have proposed that obesity is a risk factor for colorectal adenoma. This case-control study examined the relationship between body mass index (BMI), waist circumference, waistto-hip ratio (WHR), body fat percentage and colorectal adenomatous polyps (CRA) in patients who have had a colonoscopy at the Hospital Kuala Lumpur (HKL). Fifty-nine patients (42 males and 17 females) positively identified as having CRA and 59 polypfree subjects were recruited as controls (33 males and 26 females). A pre-tested questionnaire was used to collect socio-economic information, while anthropometric measurements were determined directly by established methods. The mean BMI of female case subjects was significantly higher than control females (25.63 + 4.87 kg/m2 vs. 23.86 + 3.70 kg/m2, p<0.05) but the difference in BMI was not significant in men. The mean WHR of male subjects was significantly higher in the case group (0.92 + 0.07 vs. 0.90 + 0.06, p<0.05). After adjusting for confounders, waist circumference was the only indicator that was found to significantly increase the risk for CRA in women (OR = 6.349, 95% CI = 1.063 - 37.919). Higher BMI, WHR and body fat percentage showed a non-significant risk in female subjects. In men, none of the obesity indicators were found to be significant risk factors for CRA. These findings suggest that abdominal obesity may be a contributing factor to CRA risk particularly in women. A prospective study is needed to confirm the role of obesity in the development of CRA in Malaysians.
  15. Rehman IU, Munib S, Ramadas A, Khan TM
    PLoS One, 2018;13(11):e0207758.
    PMID: 30496235 DOI: 10.1371/journal.pone.0207758
    BACKGROUND: The prevalence of chronic kidney disease-associated pruritus (CKD-aP) varies from 22% to 84% among patients receiving hemodialysis. It occurs more frequently at night, and often affects patient's sleep quality. CKD-aP is often unreported by patients, and many do not receive effective treatment. There is, however, a paucity of available data on the prevalence and impact of CKD-aP on patients receiving hemodialysis in Pakistan.

    METHODS: A multicenter cross-sectional study was undertaken from July 2016 to April 2017 at a tertiary care hospitals in Pakistan.

    RESULTS: 354 patients undergoing hemodialysis were studied. 35.6% had CKD for 1-2 years, and 42.4% were receiving hemodialysis for 1-2 years. The prevalence of pruritus was 74%. The median [interquartile range] score for pruritus was 10.0 (out of possible 25) [8.0-12.0]; while the median [interquartile range] Pittsburgh Sleep Quality Index (PSQI) score was 8.0 (out of possible 21) [7.0-10.0]'. Pruritus was significantly correlated with the sleep score (r = 0.423, p<0.001). The results of the multivariate linear regression revealed a positive association between pruritus and age of patients (β = 0.031; 95% CI = 0.002-0.061; p = 0.038) and duration of CKD (β = -0.013; 95% CI = -0.023 --0.003; p = 0.014). Similarly there was a positive association between sleep score and duration of CKD (β = 0.010; 95% CI = 0.002-0.019; p = 0.012) and pruritus (β = 0.143; 95% CI = 0.056-0.230; p = 0.001).

    CONCLUSIONS: Chronic kidney disease-associated pruritus is very common in patients receiving hemodialysis in Pakistan. Pruritus is significantly associated with poor sleep quality.

  16. Sidhu SRK, Kok CW, Kunasegaran T, Ramadas A
    Nutrients, 2023 Mar 21;15(6).
    PMID: 36986240 DOI: 10.3390/nu15061510
    Plant-based diets have grown increasingly popular across the globe, mainly for their health and environmental benefits. Several studies have identified a link between plant-based diets and the decreased risk of developing cardiovascular diseases, obesity, and other health issues. We systematically reviewed human interventions to identify the relationship between various plant-based food items and the gut microbiome, alongside the biochemical and anthropometric measurements as secondary findings. The study selection process was completed using the COVIDENCE platform. Overall, 203 studies were identified, of which 101 were chosen for title and abstract screening by two independent authors. Following this process, 78 studies were excluded, and the full texts and the reference lists of the remaining 23 records were reviewed using the review eligibility criteria. A manual search yielded five additional articles. In the end, 12 studies were included in the systematic review. We found evidence for short- to moderate-term beneficial effects of plant-based diets versus conventional diets (duration ≤ 13 months) on gut microbiome composition and biochemical and anthropometric measurements in healthy participants as well as obese, cardiovascular, and rheumatoid arthritis patients. However, contradictory results were observed for Enterobacteriaceae, at the family level, and for Faecalibacterium and Coprococcus, at the genus level, of gut microbiome composition. The relationship between plant-based diets and the gut microbiome, alongside their underlying metabolic and inflammatory effects, remains largely unexplored. Hence more interventional studies are needed to address these questions.
  17. Goh PH, Loh HY, Chung KR, Ramadas A
    J Health Psychol, 2024 Feb;29(2):137-155.
    PMID: 37493189 DOI: 10.1177/13591053231189413
    Engagement in health-promoting behaviors has been argued to be dependent on psychological factors in addition to simply having knowledge or access to resources. We systematically reviewed the evidence for the association between body (dis)satisfaction and health screening behaviors using six electronic databases and supplementary manual searches in the current study. To be included in the review, studies had to be empirical, in any language, and examined the potential link between body (dis)satisfaction and health screening. Findings from the final 16 quantitative and 12 qualitative studies generally suggest that people who were more satisfied or less dissatisfied with their bodies were more likely to engage in health screening. This review also highlighted key gaps in the literature such as the limited studies that included men as participants and the lack of examination of the underlying mechanisms and contingencies of the relationship between body (dis)satisfaction and health screening behaviors.
  18. Ahmad B, Ramadas A, Kia Fatt Q, Md Zain AZ
    BMC Endocr Disord, 2014 Apr 08;14:31.
    PMID: 24708715 DOI: 10.1186/1472-6823-14-31
    BACKGROUND: Diabetes education and self-care remains the cornerstone of diabetes management. There are many structured diabetes modules available in the United Kingdom, Europe and United States of America. Contrastingly, few structured and validated diabetes modules are available in Malaysia. This pilot study aims to develop and validate diabetes education material suitable and tailored for a multicultural society like Malaysia.

    METHODS: The theoretical framework of this module was founded from the Health Belief Model (HBM). The participants were assessed using 6-item pre- and post-test questionnaires that measured some of the known HBM constructs namely cues to action, perceived severity and perceived benefit. Data was analysed using PASW Statistics 18.0.

    RESULTS: The pre- and post-test questionnaires were administered to 88 participants (31 males). In general, there was a significant increase in the total score in post-test (97.34 ± 6.13%) compared to pre-test (92.80 ± 12.83%) (p 85%) at post-test (84.1%) compared to pre-test (70.5%) (p 

  19. Ramadas A, Qureshi AM, Dominic NA, Botross NP, Riad A, Thirunavuk Arasoo VJ, et al.
    Asian Pac J Cancer Prev, 2015;16(4):1479-85.
    PMID: 25743818
    BACKGROUND: Even after completion of conventional treatment, breast cancer survivors continue to exhibit a variety of psychological and physical symptoms, affecting their quality of life. The study aimed to investigate the relationship between socio-demography, medical characteristics and health-related quality of life (HR-QOL) of a sample of breast cancer survivors in Malaysia.

    MATERIALS AND METHODS: This pilot cross-sectional survey was conducted among breast cancer survivors (n=40) who were members of Breast Cancer Support Group Centre Johor Bahru. A validated self-administered questionnaire was used to identify the relationships between socio-demography, medical characteristics and HR-QOL of the participants.

    RESULTS: Living with family and completion of treatment were significant predictive factors of self-rated QOL, while living with family and ever giving birth significantly predicted satisfaction with health and physical health. Psychological health had moderate correlations with number of children and early cancer stage. Survivors' higher personal income (>MYR4,500) was the only significant predictor of social relationship, while age, income more than MYR4,500 and giving birth significantly predicted environment domain score.

    CONCLUSIONS: The findings suggested the survivors coped better in all four HR-QOL domains if they were married, lived with family, had children and were employed.

  20. Ramadas A, Chan CK, Oldenburg B, Hussien Z, Quek KF
    Int J Behav Med, 2015 Jun;22(3):365-73.
    PMID: 25274015 DOI: 10.1007/s12529-014-9445-z
    BACKGROUND: Diabetes is becoming a very important health issue in rapidly developing nations and there is an urgent need to improve overall diabetes self-management education in these countries. Although e-health is an emerging theme, only a few successful web-based studies on diabetes self-management have been reported.
    PURPOSE: We describe the development, implementation, and process evaluation of an Internet-delivered dietary intervention program (myDIDeA) for diabetic patients in a developing country.
    METHOD: Specific dietary components to be included in the intervention module were first identified through a comprehensive review of literature and guidelines. The lesson plans and the study website were then developed based on the evidence, Transtheoretical Model's Stages of Change and user-centered design approach. Finally, the effectiveness of the website was tested through a randomized-controlled trial to promote dietary change in patients with type 2 diabetes. The participants in the intervention group (n = 66) were given access to myDIDeA for 6 months. Process evaluation in form of intervention adherence and program reception were conducted at post intervention.
    RESULTS: The response rate for the process evaluation was 89%. On average, each participant logged in at least once for each lesson plan and spent almost 12 min on the site. The participants' content satisfaction, acceptability, and usability scores were satisfactory. The primary outcome of the trial, Dietary Knowledge, Attitude, and Behavior score was strongly correlated with content satisfaction (r = 0.826, p 
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