Normala Ibrahim

Risk Factors of Erectile Dysfunction in Patients Receiving Methadone Maintenance Therapy

INTRODUCTION While methadone effectively treats opiate dependence, the side effect of erectile dysfunction (ED) may interfere with treatment adherence and benefits. AIM To determine the rate of ED and the associated factors which predict ED in male patients on methadone maintenance therapy (MMT) in a Malaysian population. MAIN OUTCOME MEASURES The main outcome measures were the International Index of Erectile Function-15 (IIEF-15) and the Beck Depression Inventory (BDI). METHODS A total of 108 participants diagnosed with heroin dependence were assessed. We used the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I) on subjects who received MMT, and they were assessed using the IIEF-15, the BDI, and measures of other clinical and sociodemographic variables. RESULTS The rate of ED among men on MMT was 68.5% (mild ED, 36.1%; mild to moderate ED, 22.2%; severe ED, 3.7%). The mean age of the participants was 43.45 years. Older age (P = 0.002), concurrent illicit heroin use (P = 0.024), and having an older partner (P = 0.039) were significantly associated with ED. Following multivariate analysis, it was found that older age was the only significant predictor of ED, with an adjusted odds ratio of 1.07 (95% CI = 1.02-1.16). Methadone dose and duration of methadone treatment were not significantly associated with ED. CONCLUSION ED was highly prevalent among male patients on MMT. This suggests that there is a need for routine assessment of sexual function in patients on methadone. Among the risk factors, age was the only factor that was significantly associated with ED. The current use of MMT in Malaysia in terms of dosage and duration did not pose a significant risk for ED.

Effectiveness of peer-led education on knowledge, attitude and risk behavior practices related to HIV among students at a Malaysian public university--a randomized controlled trial.

OBJECTIVE Develop, implement and evaluate the effectiveness of a peer-led education program related to HIV/AIDS among university students. METHOD DESIGN randomized controlled trial with 276 university students at Faculty of Medicine and Health Sciences University Putra Malaysia (UPM), Serdang in 2011. INTERVENTION A peer-led education program on HIV prevention by university students. OUTCOME differences in knowledge, attitude and risk behavior practices related to HIV between baselines, immediate follow-up after intervention and after three months. RESULTS Significant improvement in sound knowledge in the intervention group as compared to the control group (Odds ratio, 1.75; 95% CI 1.01, 3.00; p=0.04) and improvement in good attitude related to HIV (Odds ratio 2.22; 95% CI 1.37, 3.61; p=0.01). The odds of high substance risk behavior was significantly reduced in the intervention group as compared to the control group (Odds ratio 0.07; 95% CI 0.02, 0.34; p=0.01). The association between good knowledge and intervention was modified by the different time points (baseline, immediately after intervention and 3 months after intervention), ethnicity and gender. CONCLUSION Peer-led education program in HIV prevention improves knowledge, attitude and substance risk behavior. Changes in sexual risk behavior may require a longer follow-up.

Religious commitment, attitudes toward suicide, and suicidal behaviors among college students of different ethnic and religious groups in Malaysia.

The variation in suicide patterns across ethnic groups with different religious background is a puzzling social phenomenon. This study sought to examine the impact of religious commitment and attitudes toward suicide on suicidal behaviors of college students across major ethnic and religious groups in a multicultural society of Malaysia. A total of 139 college students completed Religious Commitment Inventory-10, Attitudes Toward Suicide Scale, and Suicidal Behavior Questionnaire-Revised. Findings showed significant discrepancies in attitudes toward suicide, but not suicidal behaviors across ethnic and religious groups. Suicide acceptance significantly affected suicidal behaviors as well. Although religious commitment is not associated with suicidal behaviors, its deviation is reflected in students’ acceptance of suicide. Additionally, college students’ suicide risk, lifetime, and recent suicide ideation, as well as their likelihood of future suicide attempt can be associated with their acceptance of suicide. The influence of attitudes toward suicide and religion, therefore, should be taken into consideration while implementing suicide prevention programs as it helps shape the norms about suicide among youths.

Depression in male patients on methadone maintenance therapy

Depression is one of the most common psychiatric conditions in men. The aim of the study was to determine the depressive symptoms and associated factors among men on methadone maintenance therapy (MMT).

Testing comparison models of DASS-12 and its reliability among adolescents in Malaysia

OBJECTIVE The 21-item Depression, Anxiety and Stress Scale (DASS-21) is frequently used in non-clinical research to measure mental health factors among adults. However, previous studies have concluded that the 21 items are not stable for utilization among the adolescent population. Thus, the aims of this study are to examine the structure of the factors and to report on the reliability of the refined version of the DASS that consists of 12 items. METHOD A total of 2850 students (aged 13 to 17 years old) from three major ethnic in Malaysia completed the DASS-21. The study was conducted at 10 randomly selected secondary schools in the northern state of Peninsular Malaysia. The study population comprised secondary school students (Forms 1, 2 and 4) from the selected schools. RESULTS Based on the results of the EFA stage, 12 items were included in a final CFA to test the fit of the model. Using maximum likelihood procedures to estimate the model, the selected fit indices indicated a close model fit (χ(2)=132.94, df=57, p=.000; CFI=.96; RMR=.02; RMSEA=.04). Moreover, significant loadings of all the unstandardized regression weights implied an acceptable convergent validity. Besides the convergent validity of the item, a discriminant validity of the subscales was also evident from the moderate latent factor inter-correlations, which ranged from .62 to .75. The subscale reliability was further estimated using Cronbachs alpha and the adequate reliability of the subscales was obtained (Total=76; Depression=.68; Anxiety=.53; Stress=.52). CONCLUSION The new version of the 12-item DASS for adolescents in Malaysia (DASS-12) is reliable and has a stable factor structure, and thus it is a useful instrument for distinguishing between depression, anxiety and stress.

Prevalence and risk factors associated with suicidal ideation among adolescents in Malaysia

Abstract Background: Suicidal ideation, defined as thoughts, ideas and the desire to commit suicide, is becoming a major public health problem among adolescents. Indeed, suicidal ideation is known as a key predictor of future suicide risk. Objective: This study aims to determine the prevalence and risk factors associated with suicidal ideation among adolescents in Malaysia. Methods: This study used data from the 2013 Malaysian adolescent health risk behavior (MyAHRB) study, a cross-sectional school survey conducted in Peninsular Malaysia among school-going adolescents aged 16–17 years (n=2789). Logistic regression analysis was used to determine the risk factors associated with suicidal ideation among Malaysian adolescents. Results: The overall prevalence of suicidal ideation among the adolescents was 6.2%. The prevalence was significantly higher among females than males (7.6% vs. 4.7%; p=0.002). Multivariate regression analysis revealed that adolescents who were females [odds ratio (OR)=2.02; 95% confidence interval (CI): 1.40–2.92] or of Indian ethnicity (OR=2.32; 95% CI: 1.35–3.98) were more likely to report suicidal ideation. Loneliness (OR=2.54; 95% CI: 1.57–4.11), anxiety or worry (OR=2.70; 95% CI: 1.70–4.31), no close friends (OR=2.71; 95% CI: 1.43–5.14), and lack of supportive peers (OR=1.69; 95% CI: 1.15–2.47) were identified as risk factors for adolescents’ suicidal ideation. Adolescents who ever had sexual intercourse (OR=2.70; 95% CI: 1.48–4.92) and had been in a physical fight (OR=2.45; 95% CI: 1.62–3.70) were also reported to have higher risks of suicidal ideation. Conclusion: This study provides evidence on risk factors associated with suicidal ideation among Malaysian adolescents. Targeted mental health and health risk behavioral interventions for high-risk adolescents are recommended.

Recent Updates on Treatment of Ocular Microbial Infections by Stem Cell Therapy: A Review

Ocular microbial infection has emerged as a major public health crisis during the past two decades. A variety of causative agents can cause ocular microbial infections; which are characterized by persistent and destructive inflammation of the ocular tissue; progressive visual disturbance; and may result in loss of visual function in patients if early and effective treatments are not received. The conventional therapeutic approaches to treat vision impairment and blindness resulting from microbial infections involve antimicrobial therapy to eliminate the offending pathogens or in severe cases; by surgical methods and retinal prosthesis replacing of the infected area. In cases where there is concurrent inflammation, once infection is controlled, anti-inflammatory agents are indicated to reduce ocular damage from inflammation which ensues. Despite advances in medical research; progress in the control of ocular microbial infections remains slow. The varying level of ocular tissue recovery in individuals and the incomplete visual functional restoration indicate the chief limitations of current strategies. The development of a more extensive therapy is needed to help in healing to regain vision in patients. Stem cells are multipotent stromal cells that can give rise to a vast variety of cell types following proper differentiation protocol. Stem cell therapy shows promise in reducing inflammation and repairing tissue damage on the eye caused by microbial infections by its ability to modulate immune response and promote tissue regeneration. This article reviews a selected list of common infectious agents affecting the eye; which include fungi; viruses; parasites and bacteria with the aim of discussing the current antimicrobial treatments and the associated therapeutic challenges. We also provide recent updates of the advances in stem cells studies on sepsis therapy as a suggestion of optimum treatment regime for ocular microbial infections.

Promoting awareness of depression with a mobile application: A usability study and evaluation

This paper reports selected results from a study designed to understand the potential and limitations of a mobile application in promoting health awareness of depression to patients, their families and others. The mobile application was developed with a user-centered approach, which emphasized user preferences and opinions throughout an iterative process of development. It comprised medical information about depression, and causes, symptoms and methods of treatment. We conducted several design and evaluation sessions with a group of users (patients, their family, doctors, nurses and general users). Our findings demonstrate that the mobile medical application has the potential to improve and increase awareness among patients and their family members.

Mindful Attention Awareness Scale (MAAS): factorial validity and psychometric properties in a sample of medical students in Malaysia

Purpose The principles of mindfulness have been increasingly applied in medical education for stress reduction. One of the most often used measures for mindfulness research is the Mindful Attention Awareness Scale (MAAS). The purpose of this paper is to determine the factor structure, and investigate its reliability and validity in a sample of multi-ethnic medical students in Malaysia. Design/methodology/approach In total, 590 medical students were involved in the study. After minor modification of the MAAS, a test battery including sociodemographic information, the MAAS, Subjective Happiness Scale (SHS), Satisfaction with Life Scale (SWLS), Five-facet Mindfulness Questionnaire (FFMQ), Depression, Anxiety and Stress Scale (DASS), and Perceived Stress Scale (PSS) was administered to the participants. Findings Exploratory and confirmatory factor analyses supported a one-dimensional factor structure of the MAAS. Cronbach’s α coefficient of the scale was 0.92 and in a sub-sample (n=118), it showed satisfactory temporal stability in two weeks period. There were significant positive correlations with SHS, SWLS, and four subscales of FFMQ scores (convergent validity); and negative correlations (discriminant validity) with the DASS and PSS scores (p<0.05). In another sub-sample (n=52) who participated in a four-week mindfulness-based intervention, the scale showed significant change in scores (p=0.002). Originality/value The study provided preliminary results supporting the use of the MAAS as a valid, reliable and stable factor structure of mindfulness measure among medical students in Malaysia.

Effectiveness of health education intervention in improving knowledge, attitude, and practices regarding Tuberculosis among HIV patients in General Hospital Minna, Nigeria – A randomized control trial

Introduction The risk of development of active TB in HIV-infected individuals is 20–37 times higher than those that are HIV negative. Poor knowledge of TB amongst people living with HIV has been associated with high transmission. Objectives To determine the effectiveness of a new health education intervention module in improving knowledge, attitude, and practice (KAP) regarding tuberculosis among HIV patients in General Hospital Minna, Nigeria. Methods A randomized control trial was carried out from July 2015 to June 2017. A random number generating program was used to allocate 226 respondents into 2 groups. The intervention group received health education regarding tuberculosis using the developed module. The control group received the normal services provided for HIV patients. Data were collected from December 2015 to September 2016 at baseline, immediate post intervention, three, six and nine months. The outcome measures were knowledge, attitude, and practice. Results There was no significant difference with respect to socio-demographic characteristics, KAP of the respondents in the intervention and control group at baseline. However, there was significant improvement in knowledge in the intervention group compared to the control group, group main effect (F = (1,218) = 665.889, p = 0.001, partial ἠ2 = 0.753, d = 5.4); time (F = (3.605, 218) = 52.046, p = 0.001, partial ἠ2 = 0.193, d = 1.52) and interaction between group with time (F = (3.605, 218) = 34.028, p = 0.001, partial ἠ2 = 0.135, d = 1.23). Likewise, there was significant improvement in attitude, group main effect (p = 0.001, d = 1.26) and time (p = 0.001, p, d = 0.65). Similarly, there was improvement in practice, group main effect, time, and interaction of group with time (p < 0.05). Conclusion The health education intervention program was effective in improving KAP regarding tuberculosis among HIV patients.