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  1. Nur Farhanie Mahadi, Chin, Ri Wei Andrew, Chua, Yun Yuan, Chu, Min Ning, Wong, Mung Seong, Muhamad Saiful Bahri Yusof, et al.
    MyJurnal
    This study aimed to translate Oldenburg Burnout Inventory (OLBI) into Malay language, and test its
    response process (face validity) and internal structure (factor structure and internal consistency). To
    the author’s knowledge, OLBI is not yet validated in Malay language, thus this study aimed to produce
    a validated Malay version of OLBI (OLBI-M) in order to measure burnout among the healthcare
    learner population in Malaysia. OLBI has great potentials mainly due to its accessibility and free of
    any cost to use it, thus might promote more researchers to conduct burnout research in Malaysia. The
    forward-backward translation was performed as per standard guideline. The OLBI-M was distributed
    to 32 medical students to assess face validity and later to 452 medical students to assess construct
    validity. Data analysis was performed by Microsoft Excel, Statistical Package for the Social Sciences
    (SPSS), and Analysis of Moment Structures (AMOS). The face validity index of OLBI-M was more
    than 0.70. The two factors of CBI-M achieved good level of goodness of fit indices (Cmin/df = 3.585,
    RMSEA = 0.076, GFI = 0.958, CFI = 0.934, NFI = 0.912, TLI = 0.905) after removal of several
    items. The composite reliability values of the two factors ranged from 0.71 to 0.73. The Cronbach’s
    alpha values of the three factors ranged from 0.70 to 0.74. This study shows OLBI-M is a reliable
    and valid tool to measure burnout in medical students. Future burnout studies in Malaysia are highly
    recommended to utilise OLBI-M. However, it is crucial for further validity to be carried out to verify
    the credential of OLBI-M.
  2. Abdullah N, Kueh YC, Kuan G, Wong MS, Yahaya FH, Lee YY
    PMID: 32316495 DOI: 10.3390/ijerph17082773
    Abdominal bloating (AB), a common complaint that affects quality of life and disturbs psychological well-being, is largely a behavioral-driven disorder. We aimed to develop and validate a new health belief of bloating (HB-Bloat) scale in the Malay language. The initial item pool was developed based on the theory of planned behavior, empirical literatures, expert review and in-depth interviews. Using the population with bloating (diagnosed based on the Rome IV criteria and pictogram), exploratory and confirmatory factor analytical approaches (EFA and CFA, respectively) were utilized to explore and confirm the domains in the new scale. There were 150 and 323 respondents in the EFA and CFA, respectively. There were 45 items in the initial scale, but it was reduced to 32 items after content validity and pre-testing. In EFA, 17 items with three (3) structure factors (attitude 4 items, subjective norm 7 items, and perceived behavior control 6 items) were identified. Total variance explained by the EFA model was 40.92%. The Cronbach alpha of the three (3) factors ranged from 0.61 to 0.79. With CFA, the three factors model was further tested. Five problematic items were identified and removed. The final measurement model fit the data well (root mean square error of approximation (RMSEA (90% CI) = 0.054 (0.038, 0.070), Comparative Fit Index (CFI) = 0.941, Tucker-Lewis Fit Index (TLI) = 0.924, and standardized root mean squared residual (SRMR) = 0.044). The construct reliability of the final measurement model ranged from 0.76 to 0.84. As a conclusion, the new HB-Bloat scale is a valid and reliable tool for assessment of health beliefs in bloating.
  3. Deraman MA, Abdul Hafidz MI, Lawenko RM, Ma ZF, Wong MS, Coyle C, et al.
    Aliment Pharmacol Ther, 2020 06;51(11):1014-1021.
    PMID: 32343001 DOI: 10.1111/apt.15746
    BACKGROUND: Late-night supper increases the risk of postprandial reflux from the acid pocket especially in obesity. An alginate-based, raft-forming medication may be useful for obese patients with GERD.

    AIMS: To compare the efficacy of Gaviscon Advance (Reckitt Benckiser, UK) and a non-alginate antacid in post-supper suppression of the acid pocket and post-prandial reflux among obese participants.

    METHODS: Participants underwent 48 h wireless and probe-based pH-metry recording of the acid pocket and lower oesophagus, respectively, and were randomised to single post-supper (10 pm) dose of either Gaviscon Advance or a non-alginate antacid on the second night. Primary outcomes were suppression of median pH of acid pocket and lower oesophagus, measured every 10-minutes post-supper for 1 h. Secondary outcomes were suppression of % time pH 

  4. Abdullah N, Kueh YC, Kuan G, Wong MS, Lee YY
    Malays J Med Sci, 2024 Aug;31(4):138-148.
    PMID: 39247105 DOI: 10.21315/mjms2024.31.4.11
    BACKGROUND: Abdominal bloating (AB) is a common, bothersome symptom that negatively affects most adults. Although social support may help people suffering from AB, limited validated questionnaire is available. This study aimed to validate the newly developed Abdominal Bloating Social Support (SS-Bloat) scale for the Malaysian context.

    METHOD: We conducted a cross-sectional study in which we used purposive sampling and a self-administered questionnaire. Based on the literature review, experts' input and in-depth interviews, new items were generated for SS-Bloat scale. Content validity was assessed by experts and pre-tested with 30 individuals with AB. Construct validity was determined based on exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was determined based on Cronbach's alpha and composite reliability (CR).

    RESULTS: During the development stage, eight items were generated for SS-Bloat scale and remained the same after content validity and pre-testing. A total of 152 participants with a mean age of 31.27 years old (68.3% female, 32.7% male) completed the questionnaire. Based on the EFA, three problematic items were removed. The total variance explained was 35.6% with acceptable reliability (α = 0.66). The model was then tested using CFA. The initial model did not fit the data well. After several model re-specifications, the final measurement model of SS-Bloat scale fit the data well with acceptable fit indices (comparative fit index [CFI] = 0.994 and Tucker-Lewis index [TLI] = 0.984). The CR was satisfactory with value of 0.84.

    CONCLUSION: SS-Bloat scale was deemed valid and reliable for assessing the level of social support among AB patients. The questionnaire can be useful for both research studies and clinical purposes, as it is easy to use.

  5. Chin ARW, Chua YY, Chu MN, Mahadi NF, Yusof MSB, Wong MS, et al.
    MyJurnal
    Introduction: The academic life of medical students can be considered as psychological toxic. About half of United States medical students experience burnout and more than 25% experience depression. This study aimed to determine the prevalence of burnout among medical students in a Malaysian medical school and its associated factors.
    Methods: This is a cross sectional study of 452 medical students from Universiti Sains Malaysia (USM). Copenhagen Burnout Inventory was distributed via Google Forms through Facebook Messenger. Ethical approval was obtained from the Human Research Ethics Committee USM. Data were collected via Google Sheets. Each respondent only submitted one Google Form as no resubmission link was provided once completed Google Form was submitted.
    Result: The prevalence of burnout among USM medical students was 67.9%. Personal burnout was the highest (81.6%), followed by work-related burnout (73.7%) and client-related burnout (68.6%). The analysis showed that regardless of year of study, gender and ethnicity (all P > 0.05), USM medical students were vulnerable to burnout.
    Conclusion: The prevalence of burnout among USM medical students was high and the most prevalent type of burnout was personal burnout. Therefore, burnout among medical students should be a concern and must be addressed to prevent subsequent unwanted consequences.
  6. Khine WWT, Zhang Y, Goie GJY, Wong MS, Liong M, Lee YY, et al.
    Sci Rep, 2019 05 24;9(1):7831.
    PMID: 31127186 DOI: 10.1038/s41598-019-44369-y
    Recent studies have realized the link between gut microbiota and human health and diseases. The question of diet, environment or gene is the determining factor for dominant microbiota and microbiota profile has not been fully resolved, for these comparative studies have been performed on populations of different ethnicities and in short-term intervention studies. Here, the Southern Chinese populations are compared, specifically the children of Guangzhou City (China), Penang City (west coast Malaysia) and Kelantan City (east coast Malaysia). These Chinese people have similar ancestry thus it would allow us to delineate the effect of diet and ethnicity on gut microbiota composition. For comparison, the Penang and Kelantan Malay children were also included. The results revealed that differences in microbiota genera within an ethnicity in different cities was due to differences in food type. Sharing the similar diet but different ethnicity in a city or different cities and living environment showed similar gut microbiota. The major gut microbiota (more than 1% total Operational Taxonomy Units, OTUs) of the children population are largely determined by diet but not ethnicity, environment, and lifestyle. Elucidating the link between diet and microbiota would facilitate the development of strategies to improve human health at a younger age.
  7. Mat Nawi N, Tagiling N, Mohd Rohani MF, Wan Zainon WMN, Zanial MS, Wong MS, et al.
    BMC Gastroenterol, 2020 Aug 31;20(1):293.
    PMID: 32867699 DOI: 10.1186/s12876-020-01426-5
    BACKGROUND: It is unclear if the 99mTc-sodium phytate (99mTc-SP) is as reliable as the gold-standard 99mTc-sulfur colloid (99mTc-SC) for gastric emptying scintigraphy (GES). This study is aimed to compare the emptying rates of both radiotracers in a prospective, randomized cross-over trial and to determine the normative data of a healthy multi-ethnic Asian population.

    METHODS: Out of the 44 healthy individuals screened, 31 (14 females; mean age: 28.4 ± 7.0 years) were enrolled and underwent GES using the standardized egg-white meal. All participants were randomly assigned to either 99mTc-SP or 99mTc-SC on the first GES session before crossed over to the other formulation after 2 weeks.

    RESULTS: Both kits achieved the radiochemical purities of > 95%. The median rate (95th upper normative limit) of gastric emptying, reported as total gastric meal retention between 99mTc-SP and 99mTc-SC, was found to be comparable at all measured time points: 0.5 h [85.0% (96.6%) vs. 82.0% (94.0%)], 1 h [70.0% (86.4%) vs. 65.0% (86.6%)], 2 h [31.0% (55.8%) vs. 25.0% (64.4%)], 3 h [7.0% (26.3%) vs. 5.0% (29.9%)], and 4 h [3.0% (10.3%) vs. 2.0% (9.9%)]; P > 0.05. In addition, both radiotracers correlated well (Kendall's Tau (τ) coefficient = 0.498, P 

  8. Abdullah N, Kueh YC, Kuan G, Wong MS, Tee V, Tengku Alang TAI, et al.
    PeerJ, 2024;12:e17265.
    PMID: 38708340 DOI: 10.7717/peerj.17265
    BACKGROUND: The objective of this study was to investigate the inter-relationship between psychosocial variables and their impact on symptom severity and quality of life (QoL) concerning abdominal bloating.

    METHODS: The study adopted a cross-sectional design with purposive sampling. Participants who consented and met the criteria for bloating based on the Rome IV classification completed designated questionnaires. Independent variables comprised health beliefs, intentions, health-promoting behaviors, social support, depression, and anxiety, while dependent variables included bloating severity (general and within 24 h) and QoL. Structural Equation Modeling (SEM) was conducted utilizing Mplus 8.0 to analyze the relationships between these factors.

    RESULTS: A total of 323 participants, with a mean age of 27.69 years (SD = 11.50), predominantly females (64.7%), volunteered to participate in the study. The final SEM model exhibited good fit based on various indices (CFI = 0.922, SRMR = 0.064, RMSEA (95% CI) = 0.048 (0.041-0.054), p-value = 0.714), with 15 significant path relationships identified. The model explained 12.0% of the variance in severity within 24 h, 6% in general severity, and 53.8% in QoL.

    CONCLUSION: The findings underscore the significant influence of health beliefs, intentions, behaviors, social support, depression, and anxiety on symptom severity and QoL in individuals experiencing abdominal bloating.

  9. Johari MI, Yusoff K, Haron J, Nadarajan C, Ibrahim KN, Wong MS, et al.
    Sci Rep, 2020 Jun 25;10(1):10599.
    PMID: 32587371 DOI: 10.1038/s41598-020-67806-9
    An amendment to this paper has been published and can be accessed via a link at the top of the paper.
  10. Johari MI, Yusoff K, Haron J, Nadarajan C, Ibrahim KN, Wong MS, et al.
    Sci Rep, 2019 08 02;9(1):11232.
    PMID: 31375753 DOI: 10.1038/s41598-019-47763-8
    Currently, there is no effective therapy for non-alcoholic fatty liver disease (NAFLD), although intensive calorie restriction is typically recommended but dietary adherence is an issue. The current study aimed to determine the effectiveness and adherence of eight weeks of modified alternate-day calorie restriction (MACR) in the control of NAFLD activity. This was a randomized controlled trial with MACR as the intervention and normal habitual diet as control. The outcome measures were body mass index (BMI), blood lipids, fasting blood sugar (FBS), liver enzymes (ALT and AST), and ultrasonographic measurements of liver steatosis and shear wave elastography (SWE). Per-protocol (PP) and intention-to-treat (ITT) analysis were performed within and between-groups with P  0.22). Both liver steatosis grades and fibrosis (SWE) scores were reduced in between-group analyses of MACR vs. controls (PP and ITT, all P 
  11. Hamid N, Muhamad R, Kueh YC, Zahari Z, Mohamad Nor N, Abdullah N, et al.
    J Pharm Bioallied Sci, 2020 10 08;12(4):444-448.
    PMID: 33679091 DOI: 10.4103/jpbs.JPBS_265_19
    Background: In Malaysia, the problem of marital distress is fast becoming an important public health concern. A major shortcoming is inadequate marital evaluation. There are, however, very few localized instruments for married women in Malaysia. The objective of this study was to translate the original version of the Revised Dyadic Adjustment Scale (RDAS) and to evaluate for its psychometric properties. Multiple aspects of validity and reliability were also assessed.

    Materials and Methods: The questionnaire was first translated into the Malay language (RDAS-M). In this cross-sectional study, healthy married Malay women in Kota Bharu, Kelantan, were recruited from January to April 2018. Participants were asked to complete the RDAS-M that consists of three domains, that is, dyadic consensus, dyadic satisfaction, and dyadic cohesion with a total of 14 items. The concept, content, and construct validity using exploratory factor analysis (EFA) and reliability of the RDAS-M were assessed.

    Results: Of the 164 recruited participants, 150 consented to participate. The mean age of the participants was 34.1 years (standard deviation [SD], 9.5 years), ranging from 20 to 57 years. All 14 items were considered comprehensible by more than 95% of the subjects. Based on EFA, total variance extracted was 69.08%, and the original three factors were retained. The Malay version of the RDAS was valid based on factor loadings for dyadic consensus, dyadic satisfaction, and dyadic cohesion, which ranged from 0.64 to 0.80, 0.79 to 0.98, and 0.37 to 0.78, respectively. The internal consistency was good with coefficient α of 0.87 for dyadic consensus, 0.93 for dyadic satisfaction, and 0.78 for dyadic cohesion.

    Conclusions: The Malay version of the RDAS is easy to understand, and is a reliable and valid instrument for married women. It is also comparable with the original version of the RDAS in terms of structure and psychometric properties.

  12. Chuah KH, Wong MS, Tan PO, Lim SZ, Beh KH, Chong SCS, et al.
    Dig Dis Sci, 2021 Aug 21.
    PMID: 34417923 DOI: 10.1007/s10620-021-07227-4
    INTRODUCTION: Small intestinal bacterial overgrowth (SIBO) is prevalent in irritable bowel syndrome (IBS), but its' association with other functional gastrointestinal disorders (FGIDs) is less certain. This study aimed to explore SIBO in a multi-racial Asian population with various FGIDs compared to non-FGID controls.

    METHODOLOGY: Consecutive Asian adults with Rome III diagnosed common FGIDs (functional dyspepsia/FD, IBS and functional constipation/FC) and non-FGID controls were subjected to glucose breath testing, with hydrogen (H2) and methane (CH4) levels determined.

    RESULTS: A total of 244 participants (FGIDs n = 186, controls n = 58, median age 45 years, males 36%, Malay ethnicity 76%) were recruited. FGIDs had a higher prevalence trend of SIBO compared to controls (16% FGIDs vs. 10% controls, p = 0.278) with 14% in FD, 18% in IBS and 17% in FC. Compared to controls, SIBO was associated with diarrhoea-predominant IBS (IBS-D) (24% vs. 10%, P = 0.050) but not with other types of FGIDs. IBS-D remained an independent predictor of SIBO (OR = 2.864, 95% CI 1.160-7.071, p = 0.023) but not PPI usage nor history of diabetes (both p > 0.050) at multivariate analysis. Compared to controls, SIBO in IBS-D was associated with an elevated H2 level (≥ 20 ppm from baseline) (18% vs. 3%, p = 0.017), but not CH4 levels (≥ 10 ppm) (9% vs. 7%, p = 0.493). In addition, no difference was found in the prevalence of methane-positive SIBO between chronic constipation (constipation-predominant IBS and FC) compared to controls (9% vs. 7%, P = 0.466).

    CONCLUSION: SIBO is prevalent amongst multi-ethnic Asian adults with and without FGIDs. Amongst various FGIDs, only IBS-D is significantly associated with SIBO.

  13. Lua BC, Md Hashim MN, Wong MS, Lee YY, Zakaria AD, Zakaria Z, et al.
    Sci Rep, 2022 Oct 17;12(1):17355.
    PMID: 36253448 DOI: 10.1038/s41598-022-22363-1
    Clinical benefits and safety of carbohydrate loading pre-gastroscopy remain unclear. We aimed to determine the effects of a commercial carbohydrate-rich whey protein beverage versus plain water given pre-gastroscopy on gastric residual volume and well-being, and to determine adverse events. This was a single centre, single-blinded, parallel-group, sex-stratified randomized controlled trial. Participants were randomized either to carbohydrate-rich whey protein beverage group (Resource®, Nestle Health Science) or control group (250 ml plain water) given pre-gastroscopy. Gastric contents were aspirated into a suction reservoir bottle to determine the gastric residual volume (GRV). Visual analogue scale (VAS) of well-being (anxiety, hunger, thirst, tiredness, and weakness) was compared before and after the intervention. Adverse events were also evaluated post-intervention. Of 369 screened, 78 participants (36 males, mean age 49 ± 14.3 years) were randomized. Compared with the control group, carbohydrate beverage was associated with significantly higher GRV (p 
  14. Mahd-Ab Lah N, Kueh YC, Kuan G, Yahaya FH, Wong MS, Abd Samat NA, et al.
    PMID: 33802426 DOI: 10.3390/ijerph18052487
    Abdominal bloating (AB) is a prevalent and bothersome symptom, but there are no specific measures for severity and quality of life (QoL) other than the Bloating Severity Questionnaire (BSQ) and Bloating Quality of Life (BLQoL). We aimed to translate the BSQ and BLQoL into the Malay language and to validate them using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) approaches. The 12-item BSQ has two components, seven-item severity in general (SevGen) and five-item severity in the past 24 h (Sev24), and BLQOL has five items. Translation to the Malay language (BSQ-M and BLQoL-M) was performed using standard forward and backward processes. EFA followed by CFA were performed in participants with AB due to functional bowel disorders, with the purpose of examining the validity and reliability of the questionnaires translated into Malay. After EFA with 152 participants, all the items of BSQ-M remained in the model. Total variance extracted was 53.26% for BSQ-M and 58.79% for BLQoL-M. The internal consistency based on Cronbach's alpha values was 0.52 for SevGen, 0.86 for Sev24, and 0.81 for BLQoL-M. After performing CFA with another 323 participants, the final measurement model for BSQ-M and BLQoL-M fit the data well in terms of several fit indices (BSQ-M: root mean square error of approximation (RMSEA) = 0.050, Comparative Fit Index (CFI) = 0.966, Tucker-Lewis Fit Index (TLI) = 0.956, and standardized root mean squared residual (SRMR) = 0.051; BLQoL-M: RMSEA = 0.071, CFI = 0.985, TLI = 0.962, SRMR = 0.021). The composite reliability for BSQ-M and BLQoL-M were satisfactory (SevGen = 0.83, Sev24 = 0.89, BLQoL = 0.80). The intraclass correlation (ICC) results showed excellent stability for BSQ-M and BLQoL-M, ranging from 0.74 to 0.93. The Malay language versions of BSQ-M and BLQoL-M are valid and reliable instruments for measuring the severity and QoL of AB for the Asian population with functional bowel disorders.
  15. Khoo XH, Chong CW, Talha AM, Philip K, Teh CS, Isa AM, et al.
    J Gastroenterol Hepatol, 2023 Aug;38(8):1259-1268.
    PMID: 36908030 DOI: 10.1111/jgh.16174
    BACKGROUND AND AIM: The gut microbiota in irritable bowel syndrome (IBS) is known to vary with diet. We aim to (i) analyze the gut microbiota composition of IBS patients from a multi-ethnic population and (ii) explore the impact of a low FODMAP diet on gastrointestinal symptoms and gut microbiota composition among IBS patients.

    METHODS: A multi-center study of multi-ethnic Asian patients with IBS was conducted in two phases: (i) an initial cross-sectional gut microbiota composition study of IBS patients and healthy controls, followed by (ii) a single-arm 6-week dietary interventional study of the IBS patients alone, exploring clinical and gut microbiota changes.

    RESULTS: A total of 34 adult IBS patients (IBS sub-types of IBS-D 44.1%, IBS-C 32.4%, and IBS-M 23.5%) and 15 healthy controls were recruited. A greater abundance of Parabacteroides species with lower levels of bacterial fermenters and short-chain fatty acids producers were found among IBS patients compared with healthy controls. Age and ethnicity were found to be associated with gut microbiota composition. Following a low FODMAP dietary intervention, symptom and quality of life improvement were observed in 24 (70.6%) IBS patients. Symptom improvement was associated with adherence to the low FODMAP diet (46.7% poor adherence vs 92.9% good adherence, P = 0.014), and gut microbiota patterns, particularly with a greater abundance of Bifidobacterium longum, Anaerotignum propionicum, and Blautia species post-intervention.

    CONCLUSION: Gut microbiota variation in multi-ethnic IBS patients may be related to dietary intake and may be helpful to identify patients who are likely to respond to a low FODMAP diet.

  16. Verma N, Duseja A, Mehta M, De A, Lin H, Wong VW, et al.
    Aliment Pharmacol Ther, 2024 Mar;59(6):774-788.
    PMID: 38303507 DOI: 10.1111/apt.17891
    BACKGROUND: The precise estimation of cases with significant fibrosis (SF) is an unmet goal in non-alcoholic fatty liver disease (NAFLD/MASLD).

    AIMS: We evaluated the performance of machine learning (ML) and non-patented scores for ruling out SF among NAFLD/MASLD patients.

    METHODS: Twenty-one ML models were trained (N = 1153), tested (N = 283), and validated (N = 220) on clinical and biochemical parameters of histologically-proven NAFLD/MASLD patients (N = 1656) collected across 14 centres in 8 Asian countries. Their performance for detecting histological-SF (≥F2fibrosis) were evaluated with APRI, FIB4, NFS, BARD, and SAFE (NPV/F1-score as model-selection criteria).

    RESULTS: Patients aged 47 years (median), 54.6% males, 73.7% with metabolic syndrome, and 32.9% with histological-SF were included in the study. Patients with SFvs.no-SF had higher age, aminotransferases, fasting plasma glucose, metabolic syndrome, uncontrolled diabetes, and NAFLD activity score (p  140) was next best in ruling out SF (NPV of 0.757, 0.724 and 0.827 in overall, test and validation set).

    CONCLUSIONS: ML with clinical, anthropometric data and simple blood investigations perform better than FIB-4 for ruling out SF in biopsy-proven Asian NAFLD/MASLD patients.

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