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Exploring the health information-seeking practices of breast cancer patients in a middle-income country with a diverse ethnic population: a cross-sectional investigation

Yip KC, Lai LL, Ngu ST, Chong RS, Yahya A, See MH

Support Care Cancer, 2023 Sep 27;31(10):593.
PMID: 37752312 DOI: 10.1007/s00520-023-08033-6

Seeking health information is an important step for cancer patients to understand their condition and facilitate treatment. It also helps them deal with the unknown and aid in recovery. Therefore, it is vital to understand the factors that drive health information-seeking behavior. This study aims to achieve that objective in a localized context by surveying 421 breast cancer patients in an urban teaching hospital. The patients were presented with a 5-point questionnaire that explored their demography, health status, information-seeking behavior, and literacy level. The prevalence of health information-seeking initiatives reported was 60%. Patients with higher education (OR 3.31; 95% CI (1.39-7.87), p = 0.01), having their own business or were self-employed (OR 4.68; 95% CI (1.03-21.24), p = 0.046), and in a Medium 40 (M40) income level (OR 2.31; 95% CI (1.09-4.88), p = 0.03) and Top 20 (T20) level were more likely to seek health information. The mean e-Health Literacy Score (eHEALS) was 28.01 ± 5.0, with healthcare professionals having the highest level of trust (mean 4.22 ± 0.79) and most useful resource score (mean 4.21 ± 0.78). Even though Google was the most popular online search tool used by respondents, most of them seldom (23.77%) or had never (34.34%) discussed the online information they found with healthcare professionals. In conclusion, it is still best for patients to appraise the sought-after information with experts to avoid misinformation and treatment delay.
Fulltext eHealth literacy of patients attending a primary care clinic in Malaysia and its associated factors: A cross-sectional study

Wong SS, Lim HM, Chin AJZ, Chang FWS, Yip KC, Teo CH, et al.

Digit Health, 2022;8:20552076221135392.
PMID: 36420318 DOI: 10.1177/20552076221135392

BACKGROUND: People are overloaded with online health information (OHI) of variable quality. eHealth literacy is important for people to acquire and appraise reliable information to make health-related decisions. While eHealth literacy is widely studied in developed countries, few studies have been conducted among patients in low- and middle-income countries (LMICs).
OBJECTIVE: We aimed to determine the level of eHealth literacy in patients attending a primary care clinic in Malaysia and its associated factors.
METHODS: A cross-sectional study using a self-administered questionnaire was conducted in an urban primary care clinic. We used a systematic random sampling method to select patients aged 18 years and above who attended the clinic. The eHealth literacy scale (eHEALS) was used to measure eHealth literacy.
RESULTS: A total of 381 participants were included. The mean eHEALS was 24.4 ± 7.6. The eHEALS statements related to skills in appraising OHI were scored lower than statements related to looking for online resources. Higher education level of attending upper secondary school (AOR 2.53, 95% CI 1.05-6.11), tertiary education (AOR 4.05, 95% CI 1.60-10.25), higher monthly household income of >US$470 (AOR 1.95, 95% CI 1.07-3.56), and those who had sought OHI in the past month (AOR 1.95, 95% CI 1.13-3.36) were associated with a higher eHealth literacy level.
CONCLUSIONS: This study found a low eHealth literacy level among primary care patients in Malaysia. While the patients were confident in searching for OHI, they lacked skills in appraising them. Our findings inform the interventions for improving eHealth literacy in LMICs, especially educating the public about OHI appraisal.
Online health information-seeking behaviour of patients attending a primary care clinic in Malaysia: a cross-sectional study

Lim HM, Wong SS, Yip KC, Chang FWS, Chin AJZ, Teo CH, et al.

Fam Pract, 2022 01 19;39(1):38-45.
PMID: 34423368 DOI: 10.1093/fampra/cmab099

BACKGROUND: The internet has become a common source of health information; however, little is known about online health information-seeking behaviour (HISB) among patients in low- and middle-income countries (LMICs).
OBJECTIVES: This study aimed to determine the prevalence of online health information-seeking and its associated factors among patients in primary care in Malaysia. We also examined the reasons for, and the sources of, online health information-seeking, patients' level of trust in the information found and what the information was used for.
METHODS: A cross-sectional study using a self-administered questionnaire was conducted on patients who attended a primary care clinic. The questionnaire included the use of the internet to seek health information, sources and types of health information, eHealth literacy, patients' trust in online information, and how patients appraise and use online health information.
RESULTS: Out of 381 patients in this study, 54.7% (n = 208) used the internet to search for health information. Patients mainly sought information via Google (96.2%) and the most common websites that they visited were Wikipedia (45.2%) and MyHEALTH (37.5%). Higher levels of education, longer duration of internet use, and higher eHealth literacy were significantly associated with online HISB. Patients' trust in websites (45.6%) and social media (20.7%) was low when compared to trust in healthcare professionals (87.9%). Only 12.9% (n = 22) of patients had discussed online health information with their doctors.
CONCLUSION: Online HISB was common among primary care patients; however, their eHealth literacy was low, with suboptimal appraisal skills to evaluate the accuracy of online health information.
Regional comparison on ciguatoxicity, hemolytic activity, and toxin profile of the dinoflagellate Gambierdiscus from Kiribati and Malaysia

Zhu J, Lee WH, Yip KC, Wu Z, Wu J, Leaw CP, et al.

Sci Total Environ, 2023 May 10;872:162236.
PMID: 36791857 DOI: 10.1016/j.scitotenv.2023.162236

The dinoflagellates Gambierdiscus and Fukuyoa can produce Ciguatoxins (CTXs) and Maitotoxins (MTXs) that lead to ciguatera poisoning (CP). The CP hotspots, however, do not directly relate to the occurrence of the ciguatoxic Gambierdiscus and Fukuyoa. Species-wide investigations often showed no association between CTX level and the molecular identity of the dinoflagellates. In the Pacific region, Kiribati is known as a CP hotspot, while Malaysia has only three CP outbreaks reported thus far. Although ciguatoxic strains of Gambierdiscus were isolated from both Kiribati and Malaysia, no solid evidence on the contribution of ciguatoxic strains to the incidence of CP outbreak was recorded. The present study aims to investigate the regional differences in CP risks through region-specific toxicological assessment of Gambierdiscus and Fukuyoa. A total of 19 strains of Gambierdiscus and a strain of Fukuyoa were analyzed by cytotoxicity assay of the neuro-2a cell line, hemolytic assay of fish erythrocytes, and high-resolution mass spectrometry. Gambierdiscus from both Kiribati and Malaysia showed detectable ciguatoxicity; however, the Kiribati strains were more hemolytic. Putative 44-methylgambierone was identified as part of the contributors to the hemolytic activity, and other unknown hydrophilic toxins produced can be potentially linked to higher CP incidence in Kiribati.
Classification and assessment techniques of breast ptosis: A systematic review

See MH, Yip KC, Teh MS, Teoh LY, Lai LL, Wong LK, et al.

J Plast Reconstr Aesthet Surg, 2023 Aug;83:380-395.
PMID: 37302244 DOI: 10.1016/j.bjps.2023.04.003

BACKGROUND: Breast ptosis is characterized by the inferolateral descent of the glandular area and nipple-areola complex. A high degree of ptosis may negatively impact a woman's attractiveness and self-confidence. There are various classifications and measurement techniques for breast ptosis used as references in the medical and garment industry. A practical and comprehensive classification will provide accurate standardized definitions of the degrees of ptosis to facilitate the development of corrective surgeries and well-fitting undergarments for women in need.
METHODS: A systematic review on the classification and assessment techniques to measure breast ptosis was carried out based on the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the modified Newcastle-Ottawa scale for observational studies, whereas the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) was used to evaluate randomized studies.
RESULTS: Of 2550 articles identified in the literature search, 16 observational and 2 randomized studies describing the classification and assessment techniques of breast ptosis were included in the review. A total of 2033 subjects were involved. Half of the total observational studies had a Newcastle-Ottawa scale score of 5 and above. In addition, all randomized trials recorded a low overall bias.
CONCLUSION: A total of 7 classifications and 4 measurement techniques for breast ptosis were identified. However, most studies did not demonstrate a clear derivation of sample size beside lacking robust statistical analysis. Hence, further studies that apply the latest technology to combine the strength of previous assessment techniques are needed to develop better classification system that is applicable to all affected women.