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  1. Naing, L., Winn, T., Rusli, B.N.
    MyJurnal
    The sample size calculation for a prevalence only needs a simple formula. However, there are a number of practical issues in selecting values for the parameters required in the formula. Several practical issues are addressed and appropriate recommendations are given. The paper also suggests the application of a software calculator that checks the normal approximation assumption and incorporates finite population correction in the sample size calculation.
  2. Mohd Nazri, S., Tengku, M.A., Winn, T.
    MyJurnal
    There is concern that shift workers are at higher risk for metabolic syndrome (MS) . The syndrome is characterized by a constellation of metabolic risk factors in one individual. A cross-sectional study of 148 workers in one factory in Kota Bharu, Kelarttan was conducted to examine relationships between shift work and five of the MS rnk factors namely high blood pressure, hyperglycemia, hypertriglyceridaemia, hypo·I·IDL-cholesterolaemia and high body mass index (BMI) . Data was collected through a questionnaire on psychosocial and life-style factors, anthropometric and blood pressure measurements, fasting blood sugar and fasting lipid profile. The National Cholesterol Education Program’s Adult Treatment Panel III Report (NCEPATP III) with some modifications was used to determine the presence of risk factors for the metabolic syndrome, The prevalence of high blood pressure, hypertriglyceridaemia and high BMI were significantly higher among shift workers compared to day workers. There was no difference in the prevalence of hyperglycemia and hypo-HDL-cholesterolaemia. When the shift workers were compared with the
    day workers, the proportion of workers having three or more risk factors for the syndrome was higher among shift workers which were 15.8% and 5.6% respectively.
  3. Aziah, B.D., Rusli, B.N., Winn, T., Naing, L.
    MyJurnal
    A cross-sectional study of 71 laboratory technicians in Ministry of Health Malaysia (MOH) Hospitals (response rate 89.9%) was conducted from September ZOO1 till February 2002. Seven MOH Hospitals in Kelantan were chosen. Karase job Content — Questionnaire (Malay Version) was used as research instrument in this study. There were five scales in the questionnaire; two scales were used to dehne job strain - decision latitude and psychological demands. Results showed that the majority of laboratory technicians in MOH Hospitah were classified as passive. However, the proportion of high strain group was the second highest after passive group. The percentage of laboratory technicians in MOH Hospitals which was classified as having a high job strain was 26.8%. The “high strain" group scored significantly higher for hazardous conditions, toxic exposures, total psychological stressors, total physical hazard, and total physical stressors as compared to the “non»high strain” group. Laboratory technicians in “high strain" group had significantly younger in age (18-34 years) group (42.1%) compared to those in “non·high strain" group (7.7%) and shorter total duration of employment (yr) ( 15 .3 x 6.8) compared to those in “non»high strain" group (19.2 x 6.7). We therefore conclude that less experienced and higher psychosocial factors at work experiencing higher job strain compared to those who were more experienced and less psychosocial factors.
  4. Daher AM, AlMashoor SA, Winn T
    Qual Life Res, 2015 Apr;24(4):951-8.
    PMID: 25352036 DOI: 10.1007/s11136-014-0830-5
    PURPOSE: To assess the relationship between glycaemic control and quality of life (QoL) among a sample of Malaysians with type 2 diabetes mellitus.

    METHODS: This study is a cross-sectional hospital-based study involving 256 patients from three major ethnic groups in Malaysia. Data about QoL were collected with the 18-item Audit of Diabetes Dependent QoL questionnaire. Other data about putative predictors of QoL including personal characteristics and disease-related factors were also collected. Hierarchical multiple linear regression was used to determine factors associated with QoL and to control for confounding variables.

    RESULTS: The mean age of participants was 56.79 years. Participants were mostly women, employed and married and had attained secondary education. More than a third of the patients had a disease duration of more than 10 years, and about two-thirds had HbA1c ≥ 6.5 %. Those with desired glycaemic control had poorer QoL than those with less than desired glycaemic control moderated by the use of insulin. Hierarchical multiple linear regression showed that desired glycaemic control (HbA1c), diabetes worry, use of insulin, more than 10 years' duration of diabetes, neuropathy and retinopathy were associated with poor QoL, whereas being satisfied with waiting time for consultation was associated with better QoL.

    CONCLUSIONS: The results of this study show that diabetes was associated with negative impact on quality of life. The use of insulin to achieve desired glycaemic control was particularly associated with negative impact on QoL.
  5. Nazri SM, Tengku MA, Winn T
    Med J Malaysia, 2007 Jun;62(2):134-8.
    PMID: 18705446 MyJurnal
    Shift work is associated with various health problems and there is concern that shift workers are at higher risk to develop dyslipidaemia. A cross-sectional study was conducted from December 2003 to May 2004 to compare the prevalence of dyslipidaemia (hypercholesterolaemia, hypertriglyceridaemia, hyper-LDL and hypo-HDL-cholesterolaemia) and to examine the relationship between shift work and dyslipidaemia among 148 randomly selected male workers from one of the factories in Kota Bharu, Kelantan. Information on psychosocial and life-style factors, anthropometric and blood pressure measurement, fasting blood sugar and lipid profiles analyses were obtained. In multiple variable analysis, the presence of any abnormalities in the lipid profiles was regarded as having dyslipidaemia. The prevalence of hypercholesterolaemia (47.4%) and hypertriglyceridaemia (42.1%) were significantly higher among shift workers compared to day workers with p-value of 0.014 and 0.044 respectively. There was no significant different in the prevalence of hyper-LDL and hypo-HDL-cholesterolaemia and shift work was not significantly associated with dyslipidaemia, OR(adj) = 1.27; 95% CI 0.63-2.57.
  6. Nazri SM, Tengku MA, Winn T
    PMID: 18567459
    Shift work associated with various health problems and there is concern that shift workers are at higher risk to develop hypertension. A cross-sectional study was conducted from December 2003 to May 2004 to compare the prevalence of hypertension and to examine the relationship between shift work and hypertension among 148 randomly selected male workers from one of the factories in Kota Bharu, Kelantan. Information on psychosocial and life-style factors, anthropometric and blood pressure measurements, and fasting blood sugar and lipid profiles analyses were obtained. The prevalence of hypertension was significantly higher among shift workers (22.4%) compared to day workers (4.2%), with p-value of 0.001. Shift work was significantly associated with hypertension (adjusted odds ratio 9.1; 95% CI 1.4-56.7).
  7. Daher AM, AlMashoor SH, Winn T
    PLoS One, 2016;11(10):e0163701.
    PMID: 27695086 DOI: 10.1371/journal.pone.0163701
    INTRODUCTION: Diabetes Mellitus (DM) is notorious for its metabolic effect, acute and chronic complications and impact on Quality of Life (QoL). Successful intervention to improve QoL necessitates a valid and reliable measurement tool to identify areas of concern to patients with diabetes.
    OBJECTIVES: To (1) assess the factor structure of the Malay Audit of Diabetes Dependent Quality of Life-18 (ADDQoL-18) questionnaire; (2) determine the impact of DM on QoL; and (3) identify areas of concern to patients with type 2 DM from three major ethnic groups in Malaysia.
    METHODS: Data was obtained from a cross sectional study involving 256 patients with type 2 DM attending the diabetes clinic of the National University of Malaysia Medical Centre. The Malay version of ADDQoL-18 survey was translated from its English version according to standard guidelines and administered by a trained research assistant. Exploratory Factor Analysis (EFA) with oblimin rotation was used to determine factor structure of the data. Confirmatory Factor Analysis (CFA) was used to confirm the factor structure. Hierarchical liner regression was used to determine factors associated with QoL.
    RESULTS: Unforced factor solution yielded two factors for the whole sample. Forced one factor solution was ascertained for the whole sample and for each ethnic group. Loadings ranged between 0.588 and 0.949. Reliability coefficients were all higher than 0.955. CFA showed that the two factor model had better fit statistics. QoL was associated with the use of insulin and desired glycaemic control, longer diabetes duration, worry about diabetes, and diabetes complications.
    CONCLUSIONS: The Malay ADDQoL-18 is a valid tool to be used among patients with diabetes from different ethnic groups in Malaysia. The use of insulin to achieve desired glycaemic control had more negative impact on QoL than the use of tablets and/or dietary changes.
  8. Robert SD, Ismail AA, Winn T, Wolever TM
    Asia Pac J Clin Nutr, 2008;17(1):35-9.
    PMID: 18364324
    The objective of the present study was to measure the glycemic index of durian, papaya, pineapple and water-melon grown in Malaysia. Ten (10) healthy volunteers (5 females, 5 males; body mass index 21.18+/-1.7 kg/m2) consumed 50 g of available carbohydrate portions of glucose (reference food) and four test foods (durian, papaya, pineapple and watermelon) in random order after an overnight fast. Glucose was tested on three separate occasions, and the test foods were each tested once. Postprandial plasma glucose was measured at intervals for two hours after intake of the test foods. Incremental areas under the curve were calculated, and the glycemic index was determined by expressing the area under the curve after the test foods as a percentage of the mean area under the curve after glucose. The results showed that the area under the curve after pineapple, 232+/-24 mmolxmin/L, was significantly greater than those after papaya, 147+/-14, watermelon, 139+/-8, and durian, 124+/-13 mmolxmin/L (p<0.05). Similarly, the glycemic index of pineapple, 82+/-4, was significantly greater than those of papaya, 58+/-6, watermelon, 55+/-3, and durian, 49+/-5 (p<0.05). The differences in area under the curve and glycemic index among papaya, watermelon and durian were not statistically significant. We conclude that pineapple has a high glycemic index, whereas papaya is intermediate and watermelon and durian are low glycemic index foods. The validity of these results depends on the accuracy of the data in the food tables upon which the portion sizes tested were based.
  9. Selasawati HG, Naing L, Wan Aasim WA, Winn T, Rusli BN
    Asia Pac J Public Health, 2007;19(2):29-36.
    PMID: 18050561 DOI: 10.1177/10105395070190020601
    This study was carried out to determine the associated factors and the reasons for inappropriate utilisation of Emergency Department (ED) services at Universiti Sains Malaysia Hospital. A case-control study was conducted with 170 cases from ED and 170 controls from the Outpatient Department (OPD). A self-administered questionnaire was designed and used to obtain sociodemographic data, knowledge on the functions of ED and OPD, health seeking attitude and behaviour, and reasons for seeking treatment at ED. The study found that gender, marital status, family size, shift work, perceived illness, and knowledge on the role and functions of ED and OPD were significant associated factors. The three most common reasons for inappropriate utilisation of ED were as follows: "due to severity of illness" (85%), "can't go to OPD during office hours" (42%), and "ED near my house" (27%).

    Study site: Emergency department, Hospital Universiti Sains Malaysia (HUSM)
  10. Aziah BD, Rusli BN, Winn T, Naing L, Tengku MA
    PMID: 15691158
    A cross-sectional study was conducted to determine the risk factors of job-related depression in laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) Hospitals in Kelantan, between September 2001 and February 2002. One hundred and two laboratory technicians from HUSM and 79 from KKM Hospitals were selected and 84 (82.4%) from HUSM and 71 (89.9%) from KKM Hospitals were recruited as study subjects. Data were collected by self-administered questionnaire using the validated Malay version of the Job Content Questionnaire (JCQ), originally developed by Robert Karasek. The results indicated significant associations between the risk factors of job-related depression, and low social support, and high psychological demands (OR 3.0, 95% CI 1.1-8.8) in laboratory technicians in HUSM. However, for laboratory technicians in KKM Hospitals, the significant association was between job-related depression, and low social support and low decision authority (OR 9.7, 95% CI 1.1-91.1). Low social support was highly associated with job-related depression in laboratory technicians in HUSM and KKM Hospitals. We, therefore, conclude that low social support positively predicted depression in laboratory technicians in HUSM and KKM Hospitals. In addition, high psychological demands also significantly predicted depression in laboratory technicians in HUSM; however, for laboratory technicians in KKM Hospitals, low decision authority was the significant predictor of depression.
  11. Aziah BD, Rusli BN, Winn T, Naing L, Tengku MA
    Med J Malaysia, 2004 Jun;59(2):268-78.
    PMID: 15559179
    Karasek's job strain model postulates that workers chronically exposed to adverse psychosocial work environment (high strain job)--high psychological job demands and low job control, including poor social support, increased physical demand and hazardous work condition--will eventually develop both physical illnesses such as cardiovascular diseases and psychological disorders such as depression. In order to determine the prevalence and associated factors of job-related depression, a cross-sectional study was conducted among laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) Hospitals in Kelantan between September 2001 and February 2002. One hundred and two laboratory technicians in HUSM and 79 laboratory technicians in 7 KKM Hospitals were selected; 84/102 (82.4%) in HUSM and 71/79 (89.9%) in KKM Hospitals responded. Data was collected using self-administered questionnaires of the validated Malay version of the Job Content Questionnaire (JCQ) originally developed by Robert Karasek. Results indicated that the prevalence of high job strain in laboratory technicians in HUSM and KKM hospitals was 33.3% (28/84) and 26.8% (19/71), respectively (p>0.05). Significantly higher proportion (59.5%) (50/84) of laboratory technicians in HUSM compared to those in KKM Hospitals (39.4%) (28/71) (p = 0.016) experienced job-related depression. Significant associated factors of job-related depression were low social support (HUSM: adjusted OR 4.7, 95% CI 1.2-18.8; KKM: adjusted OR 14.8, 95%CI 2.4-89.3), high psychological demand (HUSM: adjusted OR 3.0, 95%CI 1.0-8.8), and low decision authority (KKM: adjusted OR 9.7, 95%CI 1.0-91.1). We conclude that strengthening the social support network (supervisors' and coworkers' support), reducing psychological job demand, and increasing decision-making authority of laboratory technicians may go a long way towards reducing job-related depression.
  12. Selasawati HG, Naing L, Wan Aasim WA, Winn T, Rusli BN
    Med J Malaysia, 2004 Mar;59(1):26-33.
    PMID: 15535332
    Inappropriate utilization of Emergency Departments (ED) services may result in compromised management of patients requiring true emergency treatment. Significant attendance of non-emergency cases in ED was found in several countries. A cross-sectional study was conducted in Universiti Sains Malaysia Hospital (HUSM) to determine the proportion of the inappropriate cases and the utilization pattern by time (over 24 hours and within a week) and by diagnoses. A sample of 350 cases was randomly selected from ED-HUSM register of the year 2000. A decision flowchart, which was adopted from 4 guidelines, was applied to classify appropriate and inappropriate cases. There were 55% inappropriate cases in this study. The inappropriate cases increased considerably in early morning, late evening, during the weekend and early part of the week. Most common diagnoses of inappropriate cases were upper respiratory tract infections, mild acute gastroenteritis and urinary tract infections. Considerable attendance of inappropriate cases calls for interventions.
  13. Aziah BD, Rusli BN, Winn T, Naing L, Tengku MA
    Singapore Med J, 2004 Apr;45(4):170-5.
    PMID: 15094986
    Several sources of job stress exist. Some of these stressors are intrinsic to the job, while some are related to psychosocial and other factors.
  14. Mohamed M, Winn T, Rampal GL, Abdul Rashid A, Mustaffa B
    Malays J Med Sci, 2005 Jan;12(1):20-5.
    PMID: 22605943
    Cardiovascular disease (CVD) has been the number one cause of death since the last three decades in Malaysia and diabetes mellitus and hypertension are considered as major risk factors. A study to reduce risk factors for cardiovascular diseases in the community (PIKOM) through education and lifestyle changes was undertaken. The study population was from four different areas in Peninsular Malaysia - Kota Bharu and Bachok in Kelantan ; Raub in Pahang; Gunung Besout in Perak and Felda Palong in Negri Sembilan. The subjects invited to participate in this study ware aged between 30 - 65 years, did not have any debilitating illnesses and no known history of diabetes mellitus, hypertension or cardiovascular disease. Subjects were asked to come to the local clinic in a fasting state and after physical examination, blood was taken for plasma glucose and lipids. Oral glucose tolerance test (OGTT) was then performed. A total of 4,121 subjects participated in the study. The proportion of subjects with diabetes mellitus was highest in Felda Palong area (20.3%) and lowest in Raub area (7.1%). The proportion of subjects with hypertension was also highest in Felda Palong area (38.6%) and lowest in Raub area (29.1%). This could be attributable to the subjects in Felda Palong having the highest mean Body Mass Index (BMI) and Waist-to-Hip Ratio (WHR). There were significant associations between diabetes and hypertension with age and obesity. Subjects with diabetes mellitus and hypertension also had the highest mean age, BMI, WHR and plasma cholesterol.In conclusion, the proportion of patients with risk factors for CVD was high and intervention studies through education and lifestyle changes were being carried out to see their effectiveness.
  15. Daher AM, Ahmad SH, Winn T, Selamat MI
    Malays J Med Sci, 2015 May-Jun;22(3):48-55.
    PMID: 26715896 MyJurnal
    BACKGROUND: Few studies have employed the item response theory in examining reliability. We conducted this study to examine the effect of Rating Scale Categories (RSCs) on the reliability and fit statistics of the Malay Spiritual Well-Being Scale, employing the Rasch model.
    METHODS: The Malay Spiritual Well-Being Scale (SWBS) with the original six; three and four newly structured RSCs was distributed randomly among three different samples of 50 participants each.
    RESULTS: The mean age of respondents in the three samples ranged between 36 and 39 years old. The majority was female in all samples, and Islam was the most prevalent religion among the respondents. The predominating race was Malay, followed by Chinese and Indian. The original six RSCs indicated better targeting of 0.99 and smallest model error of 0.24. The Infit Mnsq (mean square) and Zstd (Z standard) of the six RSCs were "1.1"and "-0.1"respectively. The six RSCs achieved the highest person and item reliabilities of 0.86 and 0.85 respectively. These reliabilities yielded the highest person (2.46) and item (2.38) separation indices compared to other the RSCs.
    CONCLUSION: The person and item reliability and, to a lesser extent, the fit statistics, were better with the six RSCs compared to the four and three RSCs.
    KEYWORDS: analysis; rating scale; reliability; spirituality
  16. Edimansyah BA, Rusli BN, Naing L, Mohamed Rusli BA, Winn T, Tengku Mohamed Ariff BR
    Ind Health, 2008 Jan;46(1):90-100.
    PMID: 18270454
    Depression, anxiety and stress have been recognized as important mental outcome measures in stressful working settings. The present study explores the prevalence of self-perceived depression, anxiety and stress; and their relationships with psychosocial job factors. A cross-sectional study involving 728 male automotive assembly workers was conducted in two major automotive assembly plants in Malaysia using the validated Malay versions of the Depression Anxiety Stress Scales (DASS) and Job Content Questionnaire (JCQ). Based on the DASS cut-off of > or =78 percentile scores, the prevalence of self-perceived depression, anxiety and stress was 35.4%, 47.2% and 31.1%, respectively. Four (0.5%), 29 (4.0%) and 2 (0.3%) workers, respectively, reported extremely severe self-perceived depression, anxiety and stress. Multiple linear regression analyses, controlling for age, education, salary, duration of work and marital status, revealed that psychological job demand, job insecurity and hazardous condition were positively associated with DASS-Depression, DASS-Anxiety and DASS-Stress; supervisor support was inversely associated with DASS-Depression and DASS-Stress. We suggest that reducing psychological job demand, job insecurity and hazardous condition factors may improve the self-perceived depression, anxiety and stress in male automotive assembly workers. Supervisor support is protective for self-perceived depression and stress.
  17. Huda BZ, Rusli BN, Naing L, Winn T, Tengku MA, Rampal KG
    Asia Pac J Public Health, 2004;16(1):32-40.
    PMID: 18839865
    A cross-sectional study to assess job strain and its associated factors among lecturers of the School of Medical Sciences, Universiti Sains Malaysia (USM) and Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) was undertaken between August 2001 and May 2002. The original English version of the Job Content Questionnaire (JCQ) version 1.7 (revised 1997) by Robert Karasek based on the Job Strain Model was self-administered to 73 (response rate 58.4%) and 80 (response rate 41.7%) lecturers in the medical faculties of USM and UKM respectively. The prevalence of job strain (defined by low decision latitude and high psychological demand) in USM and UKM was 23.3% and 17.5%, respectively; the difference was not significant (p 2 0.05). Analysis showed that the associated factors of job strain in USM lecturers were psychological stressors (adjusted OR 1.2, 95% CI: 1.0, 1.4), created skill (adjusted OR 0.4, 95% CI: 0.2, 0.8), working in clinical-based departments (adjusted OR 18.9, 95% CI: 1.6, 22.7). The risk factors of job strain in UKM lecturers were created skill (adjusted OR 0.3, 95% CI: 0.1, 0.9), psychological stressors (adjusted OR 1.2, 95% CI: 1.0, 1.5) and co-worker support (adjusted OR 0.3, 95% CI: 0.1, 0.9). We conclude psychological stressors and created skill were nonprotective and protective, respectively, against job strain in both USM and UKM lecturers.
  18. Edimansyah BA, Rusli BN, Naing L, Mohamed Rusli BA, Winn T
    Ind Health, 2007 Jun;45(3):437-48.
    PMID: 17634693
    The present study investigates the relationship between psychosocial work factors and health-related quality of life (HRQOL) in male automotive assembly plant workers in Malaysia.

    MATERIALS AND METHODS: A total of 728 male workers were recruited in March-July 2005 from 2 major automotive assembly plants in Selangor and Pahang. In this cross-sectional study, information on socio-demography, psychosocial work factors using the 97-item Job Content Questionnaire (JCQ) and an abbreviated 26-item version of the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) questionnaire containing 4 domains (physical health, psychological, social relationship, and environment) was self-administered to all workers involved.

    RESULTS AND CONCLUSION: The prevalence of reported good or very good overall HRQOL and general health was 64.9% and 53.7%, respectively. Multiple linear regression analysis indicated that created skill was positively associated with physical health and psychological domains; whilst, skill discretion was positively associated with social relationship and environment domains. Social support was positively associated with physical health and environment domains; whilst, co-worker support was positively associated with psychological and social relationship domains. Job insecurity and hazardous condition were negatively associated with all domains, whilst psychological job demands was negatively associated with the environment domain of HRQOL.

  19. Huda BZ, Rusli BN, Naing L, Tengku MA, Winn T, Rampal KG
    Med J Malaysia, 2004 Jun;59(2):242-51.
    PMID: 15559176 MyJurnal
    Job dissatisfaction in doctors and teachers is known to have direct consequences on the quality of service and teaching for patients and students respectively. A cross-sectional study to assess dissatisfaction in lecturers of School of Medical Sciences, Universiti Sains Malaysia (USM) and Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) was undertaken between August 2001 and May 2002. The original English version of the Job Content Questionnaire (CQ) version 1.7 (revised 1997) by Robert Karasek was self-administered to 73 (response rate 58.4%) and 80 (response rate 41.7%) lecturers in the medical faculties of USM and UKM, respectively. The prevalence of job dissatisfaction in USM and UKM lecturers were 42.6% and 42.9%, respectively; the difference was not significant (p>0.05). Risk factors of job dissatisfaction in USM lecturers were decision authority (p<0.001) and psychological job demand (p<0.001). Significant risk factors of job dissatisfaction in UKM lecturers were skill discretion (p<0.01) and psychological job demand (p<0.001). We conclude that psychological job demand was a risk factor of job dissatisfaction in both USM and UKM lecturers; in USM, decision authority was protective, while in UKM, skill discretion was protective against job dissatisfaction.
  20. Huda BZ, Rusli BN, Naing L, Tengku MA, Winn T, Rampal KG
    PMID: 15272771
    Job stress has now become one of the most significant health and safety issues in the workplace and one of the least understood areas of organizational cost. A cross-sectional study to assess job strain and dissatisfaction in lecturers of the School of Medical Sciences, Universiti Sains Malaysia (USM) was undertaken between August 2001 and May 2002. The original English version of the Job Content Questionnaire (JCQ) version 1.7 (revised 1997) by Robert Karasek was self-administered to 73 (response rate 58.4%) lecturers in School of Medical Sciences USM. The prevalence of job strain (defined by low decision latitude and high psychological demands) in USM was 23.3%. The risk factors of job strain in the lecturers were psychological stressors (adjusted OR 1.2, 95% CI 1.0, 1.4), created skill (adjusted OR 0.4, 95% CI 0.2, 0.8) and working in clinical-based departments (adjusted OR 18.7, 95% CI 1.6, 22.7). The prevalence of job dissatisfaction was 42.6%. Associated factors of job dissatisfaction in USM lecturers were decision authority (p < 0.001) and psychological job demand (p < 0.001). We conclude that psychological stressors and created skill were non-protective and protective, respectively, against job strain in USM lecturers. Clinical-based lecturers experienced higher job strain compared to non-clinical-based lecturers. Psychological job demand was strongly associated with job dissatisfaction, and decision authority was protective against job dissatisfaction.
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