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  1. Zulkiply SH, Rosliza AM
    Med J Malaysia, 2022 Nov;77(6):755-763.
    PMID: 36448396
    INTRODUCTION: Suicide is recognized as an important public health concern, as it is the second leading cause of death among young people. About 80% of all suicide cases occur in low- and middle-income countries (LMICs). Understanding the risk factors for suicidal behaviours among young people in LMIC is important in developing preventive strategies; however, evidence on this is still lacking. Socio-ecological model (SEM) is a suitable framework in explaining the factors of suicidal behaviour. The aim of this review is to identify the factors associated with suicidal ideation and suicidal attempt among young people in LMIC, guided by the SEM model, and eventually develop its preventive strategies.

    MATERIALS AND METHODS: This review has two parts. The first part is a scoping review of the factors associated with suicidal ideation and attempt among young people. The search was conducted in Pubmed, Scopus, and PsycInfo. The second part is the development of preventive strategies according to the identified factors. Both parts will be guided by the SEM model.

    RESULTS: A total of ten studies with 45,278 participants that matched the criteria are included in this review. The review found that the risk factors for suicidal ideation among young people in LMIC are being female, psychiatric illness, psychology problem, smoking, alcohol intake, victim of abuse, bullied, and food insecurity. The preventive strategies include policy, mental healthcare services, awareness programme, and coping strategies.

    CONCLUSION: More epidemiological studies are needed to evaluate the risk factors of suicide that are unique in LMIC, such as help-seeking behaviour and available mental healthcare services. Suicide prevention requires concerted effort of policymakers, healthcare services, community and individual; thus, SEM framework is suitable as a guidance for suicide prevention.

  2. Zulkiply SH, Abdul Manaf R, Dahlan R, Dapari R
    PLoS One, 2023;18(3):e0283747.
    PMID: 37000802 DOI: 10.1371/journal.pone.0283747
    BACKGROUND: Mental health problems, particularly depression and anxiety disorders are the leading causes of disease burden. Despite the effectiveness of mental healthcare services and the impairing effects of untreated mental health problems, the rate of help-seeking is low among young people. In addition, the mental health burden gap is high in low- and middle-income countries. Good mental health literacy has been associated with better help-seeking.

    AIMS: This study aims to evaluate the effect of theory- and web-based health education intervention on mental health literacy among foundation students at a public university in Malaysia.

    METHODS: A randomised controlled trial study will be conducted among foundation students. Participants will be recruited and randomly assigned to either the intervention or control group. The intervention will be conducted for two weeks with a one-month follow-up. The health education intervention will be developed according to the Information, Motivation, and Behavioural Skill Theory, and will be delivered via a website. The outcome will be measured using validated, self-administered questionnaires. at baseline, post-intervention, and one-month follow up. The data will be analysed using Generalised Estimating Equation (GEE). This study is registered to the Thai Clinical Trial Registry (TCTR) (reference number: TCTR20210705006), dated 4th July 2021.

    CONCLUSIONS: The results from this study will be useful for relevant authorities to take further efforts in mental health promotion among young people.

  3. Zulkiply SH, Balasubramaniam V, Abu Bakar NA, Abd Rashed A, Ismail SR
    PLoS One, 2019;14(8):e0220877.
    PMID: 31415611 DOI: 10.1371/journal.pone.0220877
    INTRODUCTION: Vegetable oil is an important source of fatty acids, and as palm oil being the highest consumed vegetable oil in many countries, its high saturated fatty acid content has led many concerns on cardiometabolic health. Dietary fatty acids has also been linked to affect glucose metabolism and insulin sensitivity. This systematic review is aimed at critically evaluating the available evidence on the association of palm oil with the biomarkers of glucose metabolism as compared to other vegetable oils.

    METHODS: We systemically searched PubMed, CENTRAL and Scopus up to June 2018. We searched for published interventional studies on biomarkers of glucose metabolism (defined as fasting glucose, fasting insulin, HOMA, 2-hour post prandial glucose and HbA1C) that compared palm oil- or palm olein-rich diets with other edible vegetable oils (such as olive oil, canola oil and soybean oil). Two reviewers independently extracted data and assessed study risks of bias. Mean differences of outcomes were pooled for the meta-analysis.

    RESULTS: We identified 1921 potentially eligible articles with only eight included studies. Seven randomised cross-over trials and one parallel trial were included. Study population were among young to middle-aged, healthy, non-diabetic, and normal weight participants. Intervention duration ranged from three to seven weeks, and fat substitution ranged from 15% to 20% energy. There were insignificant differences in fasting glucose when compared to partially hydrogenated soybean oil [-0.15mmol/L (-0.46,0.16) P = 0.33, I2 = 48%], soybean oil [0.05mmol/L (-0.09,0.18) P = 0.49, I2 = 0%] and olive oil [0.04mmol/L (-0.09,0.17) P = 0.76, I2 = 0%]. Insignificant effects were also seen on fasting insulin when compared to partially hydrogenated soybean oil [1.72pmol/L (-11.39,14.84) P = 0.80, I2 = 12%] and olive oil diet [-0.14pmol/L (-4.87,4.59) P = 0.95, I2 = 0%].

    CONCLUSION: Current evidence on the effects of palm oil consumption on biomarkers of glucose metabolism is poor and limited to only healthy participants. We conclude that little or no additional benefit will be obtained by replacing palm oil with other oils rich in mono or polyunsaturated fatty acids for changes in glucose metabolism.

  4. Zulkiply SH, Ramli LF, Fisal ZAM, Tabassum B, Abdul Manaf R
    PLoS One, 2020;15(11):e0242691.
    PMID: 33211779 DOI: 10.1371/journal.pone.0242691
    BACKGROUND: Sustainable Development Goals (SDG) has set the target to reduce premature mortalities from non-communicable diseases (NCDs) by one-third. One of the ways to achieve this is through strengthening the countries' implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Community health workers (CHWs) involvement has shown promising results in the prevention of NCDs. This systematic review is aimed at critically evaluating the available evidence on the effectiveness of involving CHWs in smoking cessation.

    MATERIALS AND METHODS: We systemically searched PubMed and CENTRAL up to September 2019. We searched for published interventional studies on smoking cessation interventions using the usual care that complemented with CHWs as compared to the usual or standard care alone. Our primary outcome was abstinence of smoking. Two reviewers independently extracted data and assessed study risks of bias.

    RESULT: We identified 2794 articles, of which only five studies were included. A total of 3513 smokers with 41 CHWs were included in the studies. The intervention duration range from 6 weeks to 30 months. The studies used behavioral intervention or a combination of behavioral intervention and pharmacological treatment. Overall, the smoking cessation intervention that incorporated involvement of CHWs had higher smoking cessation rates [OR 1.95, 95% CI (1.35, 2.83)]. Significant smoking cessation rates were seen in two studies.

    CONCLUSION: Higher smoking cessation rates were seen in the interventions that combined the usual care with interventions by CHWs as compared to the usual care alone. However, there were insufficient studies to prove the effectiveness. In addition, there was high heterogeneity in terms of interventions and participants in the current studies.

  5. Chowdhury R, Noh MFM, Ismail SR, van Daalen KR, Kamaruddin PSNM, Zulkiply SH, et al.
    JMIR Res Protoc, 2022 Feb 10;11(2):e31885.
    PMID: 35142634 DOI: 10.2196/31885
    BACKGROUND: Although the burden of premature myocardial infarction (MI) is high in Malaysia, direct evidence on the determinants of MI in this multi-ethnic population remains sparse.

    OBJECTIVE: The Malaysian Acute Vascular Events Risk (MAVERIK) study is a retrospective case-control study established to investigate the genomic, lipid-related, and other determinants of acute MI in Malaysia. In this paper, we report the study protocol and early results.

    METHODS: By June 2019, we had enrolled approximately 2500 patients with their first MI and 2500 controls without cardiovascular disease, who were frequency-matched by age, sex, and ethnicity, from 17 hospitals in Malaysia. For each participant, serum and whole blood have been collected and stored. Clinical, demographic, and behavioral information has been obtained using a 200-item questionnaire.

    RESULTS: Tobacco consumption, a history of diabetes, hypertension, markers of visceral adiposity, indicators of lower socioeconomic status, and a family history of coronary disease were more prevalent in cases than in controls. Adjusted (age and sex) logistic regression models for traditional risk factors indicated that current smoking (odds ratio [OR] 4.11, 95% CI 3.56-4.75; P30 kg/m2; OR 1.19, 95% CI 1.05-1.34; P=.009) were associated with MI in age- and sex-adjusted models.

    CONCLUSIONS: The MAVERIK study can serve as a useful platform to investigate genetic and other risk factors for MI in an understudied Southeast Asian population. It should help to hasten the discovery of disease-causing pathways and inform regionally appropriate strategies that optimize public health action.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/31885.

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