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  1. Edre MA, Azmi MN, Hayati KS, Salmiah MS, Sharifah Norkhadijah SI
    IIUM Medical Journal Malaysia, 2019;18(102):68-0.
    MyJurnal
    Many studies have shown the effectiveness of educational modules on increasing colorectal cancer screening uptake at individual level but not adjusted for potential clustering effect such as workplace. Longitudinal studies on workplace colorectal cancer screening require a series of analysis under different conditions due to heterogeneity of workplace population. To achieve this, a sensitivity analysis based on Generalized Estimating Equations was conducted to determine the robustness of the predictive performance of health education module in increasing screening uptake. Materials and Method: A parallel, single blind, cluster randomized trial was conducted among 15 organizations in Kuantan, Pahang. Intervention group received a complex Health Education Module comprising of group education, practical session on fecal occult blood test usage and WhatsApp group follow-up, while control group received standard colorectal cancer screening brochure. Sensitivity analyses using intention to treat analysis with interaction term, compatibility term, behavioral intention term and key assumption term were performed. Data were imputed and analysed using generalized estimating equation with IBM SPSS version 23. Pooled adjusted odds ratio was calculated using random effect model with inverse variance weighting using RevMan version 3.5. Results: A total of 166 participants from 15 organizations were recruited in the study. Intervention and control group were comparable at baseline (P>0.05). Health Education Module given in intervention group significantly increased the uptake of FOBT by nearly 5 times compared to control group in sensitivity analyses (pooled adjusted OR=4.60, 95% CI=2.65-7.99, I2=47%, P
  2. Ambayya A, Zainina S, Salmiah MS, Sabariah MN
    Med J Malaysia, 2014 Apr;69(2):64-9.
    PMID: 25241814 MyJurnal
    INTRODUCTION: Acute Promyelocytic Leukaemia (APL) is associated with devastating coagulopathy and life threatening condition which requires immediate medical attention. It is crucial to establish an expedited diagnosis as early therapeutic intervention has led to optimal patient management. In this study, we assessed the type and frequency of antigen expressions in APL and correlated these findings with genetic studies.

    METHODS: Multiparametric immunophenotyping was performed on 30 samples and findings were correlated with karyotypes, FISH for t(15;17) translocation and RT-PCR for PML-RARΑ for detection of breakpoint cluster regions (bcr1,bcr2 and bcr3).

    RESULTS: On SSC/CD45, APL cells displayed high to moderate SSC, with the expression of CD33 (100%), CD13 (96.8%), cMPO (71%) but lacked CD34 (3.2%) and HLA-DR (9.7%). Aberrant expression of CD4 was seen in 12.9% and CD56 in 6.5% of the cases. A significant association between cumulative aberrant antigen expression and bcr1 were observed bcr1 (X2(2) =6.833,p.05) and (X2(2)=4.599,p>.05) respectively.

    CONCLUSIONS: Flow cytometry is a rapid and effective tool in detecting APL. It is interesting to note that there is significant association between cumulative aberrant antigen expression and genotype analysis. Further validation is required to corroborate this relationship.
  3. Amplavanar NT, Gurpreet K, Salmiah MS, Odhayakumar N
    Med J Malaysia, 2010 Sep;65(3):173-9.
    PMID: 21939163 MyJurnal
    This study describes the prevalence of selected cardiovascular disease (CVD) risk factors screened in patients 30 years and above attending a health centre in Cheras, Selangor. The study involved 3772 patients screened from March 2002 to June 2008. Risk factors screened included blood pressure, height, weight, serum total cholesterol, random blood sugar levels and smoking status. Majority of respondents were between 40 and 49 years of age (58.1%), males (64.7%) and ethnic Malays (74.4%). About two thirds (62.6%) were found to be overweight or obese, two fifths (40.2%) had hypercholesterolemia, a third (34.2%) had hypertension and 31.6% were smokers at some time. Overall 87% and 60% had at least one and two CVD risk factors respectively. Prevalence of four of the five risk factors screened was highest among the Malay middle aged men and lowest among the Chinese. Thus a substantial proportion of middle aged men were at high risk of CVD. Our findings show the need for ongoing monitoring of CVD risk factors and implementation of effective preventive strategies.
  4. Hasneezah H, Rosliza AM, Salmiah MS, Appanah G
    Med J Malaysia, 2020 11;75(6):626-634.
    PMID: 33219169
    BACKGROUND: Anaemia in pregnancy is considered a public health problem throughout the world. The effects of the existing intervention in ensuring compliance to the subscribed regimen and the impact of nutrition education in enhancing dietary modification during pregnancy in Malaysia have been minimal. This study aims to develop, implement and evaluate the effects of the Health Belief Model educational intervention on haemoglobin level among anaemic pregnant women.

    METHODS: This is a quasi-experimental research with prepost test design with control group involving 81 participants per group from two health clinics in Sepang. The primary outcome was a change in the haemoglobin levels following educational intervention. Secondary outcomes include knowledge on anaemia, Health Belief Model (HBM) constructs, dietary iron intake and compliance towards iron supplementation. The intervention group received a HBMbased education intervention programme.

    RESULTS: The response rate in the intervention and control group were 83.9% and 82.7% respectively. Generalised estimating equations analysis showed that the intervention was effective in improving the mean haemoglobin level (β=0.75, 95%CI=0.52, 0.99, p<0.001), the knowledge score (β=1.42, 95%CI=0.36, 2.49, p=0.009), perceived severity score (β=2.2, 95%CI= 1.02, 3.39, p<0.001) and increased proportion of high compliance level (AOR=4.59, 95%CI=1.58, 13.35, p=0.005).

    CONCLUSION: HBM-based health education programme has proven to be effective in improving the haemoglobin levels, knowledge scores, perceived severity scores and compliance level of participants. The study results emphasized on the effectiveness of such an approach, therefore it is recommended that future educational interventions which aim at increasing preventive healthy behaviours in pregnant women may benefit from the application of this model in primary health care settings.

  5. Saparwan N, Tohit NM, Salmiah MS
    Med J Malaysia, 2023 Sep;78(5):627-634.
    PMID: 37775490
    INTRODUCTION: Poor sleep quality is common among patients with type 2 diabetes mellitus (T2DM). It has detrimental effects on physical and psychological health, as well as on quality of life. This study aimed to determine the prevalence of poor sleep quality among T2DM patients and to investigate the factors associated with this disorder.

    MATERIALS AND METHODS: A cross-sectional study was conducted at Klinik Kesihatan Seremban in Seremban district, Negeri Sembilan. Data were collected using the Malay version of the Pittsburgh Sleep Quality Index (PSQI-M) with a cut-off point of >5 as poor sleep quality. The Depression Anxiety Stress Scale-21 (DASS-21) was used to measure level of psychological distress. Data were collected between July 2022 until January 2023.

    RESULTS: A total of 319 patients with T2DM participated. Their mean age was 63 (11) years, 58% were women and 42.9% were of Indian ethnicity. The mean total score of PSQI was 4.04 (2.21) and 23% of the participants had poor sleep quality. Multivariate logistic regression analysis revealed that poor sleep quality was significantly associated with Indian ethnicity (Adj. OR = 2.25; 95%CI: 1.05, 4.82; p = 0.037), separated or widowed (Adj. OR = 2.16; 95%CI = 1.15, 4.05; p = 0.016), having nocturia (Adj. OR = 2.13; 95%CI = 1.18, 3.84; p = 0.012) and depressive symptoms (Adj. OR = 3.41; 95%CI: 1.01, 11.48; p = 0.048).

    CONCLUSION: Poor sleep quality was prevalent in almost a quarter of T2DM patients studied. Indian ethnicity, separated or widowed, having nocturia, and depressive symptoms were independently associated with poor sleep quality. Despite lower prevalence of poor sleep quality compared to other studies, identification of those at higher risk warrants further exploration in lifestyle management of patients with T2DM.

  6. Balami AD, Salmiah MS, Nor Afiah MZ
    MyJurnal
    Pre-hypertension increased the risk of morbidity and mortality from non-communicable diseases. Whereas, psychological factors such as depression, anxiety and stress have been associated with increased in blood pressure. However, previous studies more focuses on psychological determinants of hypertension than prehypertension. Thus, this study aims to determine the association between these psychological factors with pre-hypertension. A cross-sectional study was conducted in 2012 among first year students of a public Malaysian university. A random cluster sampling was used to select 5 out of 15 faculties and a total of 495 students participated in this study. The Malay version of DASS-21 was used to elicit their levels of depression, anxiety and stress. Blood pressures were measured twice using sphygmomanometer and the averages were taken. Data analyses used chi-square test and binary multiple logistic regression. The prevalence of pre-hypertension was 30.1%. The percentage of severe and extremely severe depression was 3.8% and 1.2%; both severe and extremely severe anxiety was 16.4%; and severe and extremely severe stress was 4.2% and 0.2% respectively. Severe/extremely severe depression had more than 3 times higher in getting pre-hypertension than no depression. In conclusions, almost one third of respondents had pre-hypertension and only severe/extremely depression was associated with pre-hypertension.
  7. Norain M, Norliza A, Salmiah MS, Tan KA, Sutan R
    Med J Malaysia, 2023 Sep;78(5):646-652.
    PMID: 37775493
    INTRODUCTION: Sexting refers to the act of sending and receiving sexually explicit content in the form of in the form of texts, photos, or videos via the Internet and mobile phones. This behaviour is associated with many negative health consequences among young people. However, there is a lack of intervention studies to curb this behaviour. We have developed a new sexting prevention module and tested it using a randomised controlled field trial. This paper reported the phase one of the study i.e., the development of an animated sexting prevention module using the prototype willingness model (PWM) to reduce the intention and willingness to sext amongst diploma students in Malaysia.

    MATERIALS AND METHOD: The initial phase involved a review of previous interventions, validation from field experts, and the process of developing video. Then the module pilot was tested among 30 diploma students from a public university. They were given access to the newly developed videos posted on a private YouTube channel and asked to evaluate the videos quantitatively and qualitatively by using the acceptability of the intervention module (AIM), intervention appropriateness measure (IAM) and feasibility of the intervention measure (FIM). The minimum and maximum scores of each measure were 12 and 24 respectively whereby a higher score indicated greater acceptability, appropriateness and feasibility.

    RESULTS: The intervention consisted of five sections addressing the constructs of PWM, namely attitude, perceived norm, prototype perception, as well as intention and willingness of sexting. The contents were then converted into five videos with a total duration of 23 minutes. Based on the pilot test, the scores of AIM, IAM and FIM were not normally distributed and their median and the interquartile range values were 20 (4), 21 (4) and 22 (4) respectively. Most of the respondents gave favourable opinions on the intervention besides providing some input for improvement.

    CONCLUSION: This animated sexting intervention module based on PWM to reduce the intention and willingness was novel. The module was acceptable, appropriate and feasible to be implemented among undergraduate students. Further evaluation of this intervention module can be performed to provide more comprehensive evidence of its effectiveness.

  8. Ang KT, Ho BK, Mimi O, Salmah N, Salmiah MS, Noridah MS
    Malays Fam Physician, 2014;9(3):2-11.
    PMID: 26425299 MyJurnal
    Primary care providers play an important gatekeeping role in ensuring appropriate referrals to secondary care facilities. This cross-sectional study aimed to determine the level, pattern and rate of referrals from health clinics to hospitals in the public sector, and whether the placement of resident family medicine specialist (FMS) had made a significant difference. The study was carried out between March and April in 2012, involving 28 public primary care clinics. It showed that the average referral rate was 1.56% for clinics with resident FMS and 1.94% for those without resident FMS, but it was not statistically significant. Majority of referred cases were considered appropriate (96.1%). Results of the multivariate analysis showed that no prior consultation with senior healthcare provider and illnesses that were not severe and complex were independently associated with inappropriate referrals. Severity, complexity or uncertain diagnosis of patients' illness or injury significantly contributed to unavoidable referrals. Adequate facilities or having more experienced doctors could have avoided 14.5% of the referrals. The low referral rate and very high level of appropriate referrals could indicate that primary care providers in the public sector played an effective role as gatekeepers in the Malaysian public healthcare system.
  9. Cheong AT, Tong SF, Sazlina SG, Azah AS, Salmiah MS
    Asia Pac J Public Health, 2015 Mar;27(2):NP580-9.
    PMID: 23536235 DOI: 10.1177/1010539513480232
    Hypertension is a common comorbidity among diabetic patients. This study aimed to determine blood pressure (BP) control among hypertensive patients with and without diabetes. This was a cross-sectional study in 6 public primary care clinics in Wilayah Persekutuan, Malaysia. Hypertensive patients aged ≥18 years and attending the clinics were selected via systematic random sampling. The BP control target was defined as <130/80 mm Hg for diabetic patients and <140/90 mm Hg for nondiabetic patients. A total of 1107 hypertensive patients participated in this study and 540 (48.7%) had diabetes. About one fourth (24.3%) of the hypertensive patients with diabetes achieved BP control target, compared with 60.1% patients without diabetes (P < .001). Being diabetic and on ≥2 antihypertensive treatments were associated with poor BP control. Attention needs to be given to these groups of patients when managing patients with hypertension.
  10. Priscilla D, Hamidin A, Azhar MZ, Noorjan KO, Salmiah MS, Bahariah K
    East Asian Arch Psychiatry, 2011 Jun;21(2):44-51.
    PMID: 21838206
    Objectives: To determine the relationship between major depressive disorder, anxiety disorders and the quality of life of haematological cancer patients.
    Methods: This cross-sectional study was conducted at Ampang Hospital Kuala Lumpur, Malaysia, a tertiary referral centre hospital for haematological cancer. The Mini-International Neuropsychiatric Interview was used for the diagnosis of major depressive disorder and anxiety disorders. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was utilised to measure patients’ quality of life.
    Results: A total of 105 haematological cancer patients ere included in the study with response rate of 100%. Major depressive disorder correlated with almost all domains of the quality of life, except the pain scores. Logistic regression showed that insomnia and financial difficulties were related to major depressive disorder. Different anxiety disorders also correlated with quality of life in specific domains. The leading anxiety disorders that correlated mostly with quality﹣of life scales were generalised anxiety disorder, followed by obsessive-compulsive disorder, social anxiety disorder, as well as post-traumatic stress disorder and panic disorder with agoraphobia (p < 0.05).
    Conclusions: Psychological treatment along with medication and intervention should be implemented to improve the overall quality of life and psychiatric disorder symptoms among the haematological cancer patients.
    Key words: Anxiety; Depression; Hematologic neoplasms; Quality of life
  11. Priscilla D, Hamidin A, Azhar MZ, Noorjan KO, Salmiah MS, Bahariah K
    East Asian Arch Psychiatry, 2011 Sep;21(3):108-14.
    PMID: 21921304
    Objectives: To determine the relationship between major depressive disorder, anxiety disorders and the quality of life of haematological cancer patients.
    Methods: This cross-sectional study was conducted at Ampang Hospital Kuala Lumpur, Malaysia, a tertiary referral centre hospital for haematological cancer. The Mini-International Neuropsychiatric Interview was used for the diagnosis of major depressive disorder and anxiety disorders. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was utilised to measure patients’ quality of life.
    Results: A total of 105 haematological cancer patients were included in the study with response rate of 100%. Major depressive disorder correlated with almost all domains of the quality of life, except the pain scores. Logistic regression showed that insomnia and financial difficulties were related to major depressive disorder. Different anxiety disorders also correlated with quality of life in specific domains. The leading anxiety disorders that correlated mostly with quality of life scales were generalised anxiety disorder, followed by obsessive-compulsive disorder, social anxiety disorder, as well as post-traumatic stress disorder and panic disorder with agoraphobia (p < 0.05).
    Conclusions: Psychological treatment along with medication and intervention should be implemented to
    improve the overall quality of life and psychiatric disorder symptoms among the haematological cancer
    patients.
    Key words: Anxiety; Depression; Hematologic neoplasms; Quality of life
  12. Priscilla D, Hamidin A, Azhar MZ, Noorjan KO, Salmiah MS, Bahariah K
    Med J Malaysia, 2011 Jun;66(2):117-20.
    PMID: 22106690 MyJurnal
    The aim of this study was to determine the prevalence of symptoms and problems in hospitalized hematological cancer patients. A cross-sectional design was carried out with 105 respondents in Ampang hospital in Kuala Lumpur. The European Organization for Research and Treatment of Cancer Quality Of Life questionnaire (EORTC QLQ-C30) was used. Patients with a minimum response of "a little" were defined as having a symptom/problem while patients with a response of "quite a bit" were classified as having a "severe symptom/problem". The four most prevalent symptoms/problems identified were fatigue, financial difficulties, reduced role function and reduced social function. Multiple myeloma patients (MM) were identified as having the most symptoms/problems.
  13. Bolarinwa OA, Juni MH, Nor Afiah MZ, Salmiah MS, Akande TM
    Niger J Clin Pract, 2019 Jan;22(1):69-78.
    PMID: 30666023 DOI: 10.4103/njcp.njcp_246_17
    Background: Health-related quality of life (HRQoL) is an important clinical outcome assessment in hypertension management, given the lifelong (chronicity) nature and the need for daily self-management for hypertensive patents. Of some of the studies that implemented home-based interventions on hypertension globally, the HRQoL is rarely used as a primary outcome measure. This study developed, implemented, and assessed the impact of home-based follow-up care (HBFC) on HRQoL of hypertensive patients attending outpatients' clinics in Ilorin, Nigeria.

    Materials and Methods: A total of 149 and 150 patients were randomized to intervention and usual care (control) groups, respectively. A 12-month task-shifting (nurse-driven) HBFC intervention was administered to intervention group. The mid-term impact of intervention on HRQoL was assessed after 6 months intervention. Data were analyzed with intention-to-treat principle. Treatment effects were measured with the t-tests, analysis of covariance, and multivariate analysis of covariance analysis. Significant levels were set at P < 0.05 and 95% confidence interval.

    Results: The between-group treatment effect was not statistically significant (P > 0.05), whereas the within-group treatment effects were statistically significant for both the intervention and control arms (P < 0.05) at 6 months. After controlling for age and baseline HRQoL, the intervention group had an improved physical component of HRQoL than the control group. The intervention group also had statistically significant improvement in blood pressure control, medication adherence, and symptom counts (P < 0.05).

    Conclusion: The HBFC intervention for hypertensive patients impacted positively on physical component of HRQoL after controlling for baseline HRQoL and age of the patients at 6 months post-intervention.

  14. Azami G, Soh KL, Sazlina SG, Salmiah MS, Aazami S
    J Diabetes Metab Disord, 2018 Dec;17(2):365-380.
    PMID: 30918872 DOI: 10.1007/s40200-018-0376-0
    PURPOSE: The aim of this study was to systematically-review published experimental studies to determine the effectiveness of behavioral interventions on self-management in Iranian adults with type 2 diabetes.

    METHOD: Pub Med, Web of Science, Science Direct, Ovid Medline, EBSCO, ProQuest, Google Scholar, and the Scientific Information Database (SID) were searched for English and Persian language studies published between 2009 and 2017. The primary outcome of this review was to assess the effects of behavioral interventions on glycosylated hemoglobin. Changes in the blood pressure, Lipid profiles, BMI, Self-efficacy, knowledge, attitude, practice, Self-care behaviors, social support, anxiety, and depression were the secondary outcomes.

    RESULTS: Comprehensive search procedures resulted in twenty-three experimental studies with 2208 participants. Eleven studies were included in the Meta-analysis. Compared with the control group, behavioral interventions significantly lower glycosylated hemoglobin -0.61% (95% CI -0.80, -0.41). To explore the effects of the study intervention (regarding what aspects of the intervention are most effective), we then conducted a stratified analysis for HbA1c. Larger effects were found in interventions with a longer duration and higher intensity, delivered in the group format, interventions offered to individuals with higher baseline HbA1c, and interventions delivered by a multidisciplinary team. Moreover, behavioral interventions were effective in improving blood glucose, lipid profiles, knowledge, attitude, practice, self-efficacy, quality of life, and self-care.

    CONCLUSION: In line with other behavioral studies, our study shows that behavioral interventions improve self-management in Iranian adults with type 2 diabetes.

  15. Azami G, Soh KL, Sazlina SG, Salmiah MS, Aazami S, Mozafari M, et al.
    J Diabetes Res, 2018;2018:4930157.
    PMID: 30225268 DOI: 10.1155/2018/4930157
    In recent years, great emphasis has been placed on the role of nonpharmacological self-management in the care of patients with diabetes. Studies have reported that nurses, compared to other healthcare professionals, are more likely to promote preventive healthcare seeking behaviors. The aim of this study was to investigate the effectiveness of a nurse-led diabetes self-management education on glycosylated hemoglobin. A two-arm parallel-group randomized controlled trial with the blinded outcome assessors was designed. One hundred forty-two adults with type 2 diabetes were randomized to receive either usual diabetes care (control group) or usual care plus a nurse-led diabetes self-management education (intervention group). Duration of the intervention was 12 weeks. The primary outcome was glycosylated hemoglobin (HbA1c values). Secondary outcomes were changes in blood pressure, body weight, lipid profiles, self-efficacy (efficacy expectation and outcome expectation), self-management behaviors, quality of life, social support, and depression. Outcome measures were assessed at baseline and at 12-week and 24-week postrandomizations. Patients in the intervention group showed significant improvement in HbA1c, blood pressure, body weight, efficacy expectation, outcome expectation, and diabetes self-management behaviors. The beneficial effect of a nurse-led intervention continued to accrue beyond the end of the trial resulting in sustained improvements in clinical, lifestyle, and psychosocial outcomes. This trial is registered with IRCT2016062528627N1.
  16. Priscilla D, Hamidin A, Azhar MZ, Noorjan K, Salmiah MS, Bahariah K
    Malays J Med Sci, 2011 Jul;18(3):49-56.
    PMID: 22135601 MyJurnal
    The paper examined the quality of life of haematological cancer patients according to their socio-demographic profiles and clinical diagnoses.

    Study site: Ampang Hospital, Kuala Lumpur
  17. Mohd Tariq MN, Shahar HK, Baharudin MR, Ismail SNS, Manaf RA, Salmiah MS, et al.
    BMC Public Health, 2021 09 24;21(1):1735.
    PMID: 34560858 DOI: 10.1186/s12889-021-11719-3
    BACKGROUND: Flood disaster preparedness among the community seldom received attention. Necessary intervention must be taken to prevent the problem. Health Education Based Intervention (HEBI) was developed following the Health Belief Model, particularly in improving flood disaster preparedness among the community. The main objective of this study is to assess the effect of HEBI on improving flood disaster preparedness among the community in Selangor. This study aims to develop, implement, and evaluate the impact of health education-based intervention (HEBI) based on knowledge, skills, and preparedness to improve flood disaster preparedness among the community in Selangor.

    METHOD: A single-blind cluster randomized controlled trial will conduct at six districts in Selangor. Randomly selected respondents who fulfilled the inclusion criteria will be invited to participate in the study. Health education module based on Health Believed Theory will be delivered via health talks and videos coordinated by liaison officers. Data at three-time points at baseline, immediate, and 3 months post-intervention will be collected. A validated questionnaire will assess participants' background characteristics, knowledge, skill, and preparedness on disaster preparedness and perception towards disaster. Descriptive and inferential statistics will be applied for data analysis using IBM Statistical Package for Social Sciences version 25. Longitudinal correlated data on knowledge, skills, preparedness, and perception score at baseline, immediate post-intervention, and 6 months post-intervention will be analyzed using Generalized Estimating Equations (GEE).

    DISCUSSION: It is expected that knowledge, skills, preparedness, and flood disaster perception score are more significant in the intervention group than the control group, indicating the Health Education Based Intervention (HEBI).

    TRIAL REGISTRATION: Thai Clinical Trial TCTR20200202002 .

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