Zaliha Ismail

Low serum high density lipoprotein cholesterol concentration is an independent predictor for enhanced inflammation and endothelial activation.

Background Inflammation, endothelial activation and oxidative stress have been established as key events in the initiation and progression of atherosclerosis. High-density lipoprotein cholesterol (HDL-c) is protective against atherosclerosis and coronary heart disease, but its association with inflammation, endothelial activation and oxidative stress is not well established. Objectives (1) To compare the concentrations of biomarkers of inflammation, endothelial activation and oxidative stress in subjects with low HDL-c compared to normal HDL-c; (2) To examine the association and correlation between HDL-c and these biomarkers and (3) To determine whether HDL-c is an independent predictor of these biomarkers. Methods 422 subjects (mean age±SD = 43.2±11.9years) of whom 207 had low HDL-c concentrations (HDL-c <1.0mmol/L and <1.3mmol/L for males and females respectively) and 215 normal controls (HDL-c ≥1.0 and ≥1.3mmol/L for males and females respectively) were recruited in this study. The groups were matched for age, gender, ethnicity, smoking status, diabetes mellitus and hypertension. Fasting blood samples were collected for analysis of biomarkers of inflammation [high-sensitivity C-reactive protein (hsCRP) and Interleukin-6 (IL-6)], endothelial activation [soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1), soluble Intercellular Adhesion Molecule-1 (sICAM-1) and E-selectin)] and oxidative stress [F2-Isoprostanes, oxidized Low Density Lipoprotein (ox-LDL) and Malondialdehyde (MDA)]. Results Subjects with low HDL-c had greater concentrations of inflammation, endothelial activation and oxidative stress biomarkers compared to controls. There were negative correlations between HDL-c concentration and biomarkers of inflammation (IL-6, p = 0.02), endothelial activation (sVCAM-1 and E-selectin, p = 0.029 and 0.002, respectively), and oxidative stress (MDA and F2-isoprostane, p = 0.036 and <0.0001, respectively). Multiple linear regression analysis showed HDL-c as an independent predictor of IL-6 (p = 0.02) and sVCAM-1 (p<0.03) after correcting for various confounding factors. Conclusion Low serum HDL-c concentration is strongly correlated with enhanced status of inflammation, endothelial activation and oxidative stress. It is also an independent predictor for enhanced inflammation and endothelial activation, which are pivotal in the pathogenesis of atherosclerosis and atherosclerosis-related complications.

Public stigma towards patients with schizophrenia of ethnic Malay: a comparison between the general public and patients’ relatives

Abstract Background: The stigma attached to mental disorders has been recognized as a major concern in healthcare services across societies. Aims: To compare the stigmatizing attitude towards patients with schizophrenia between the general public, relatives of patient with schizophrenia and relatives of patient with neurotic illnesses. Method: The study sample of 600 subjects of Malay families was equally divided into three groups. The sample was selected using convenience sampling. Each subject completed a seven-item Social Distance Scale (SDS) and a six-item stereotypical beliefs (SB) scale of people with schizophrenia. Appropriate statistical analysis was then conducted to compare the differences in SDS and SB scores between the groups. Results: The scores of both SD and SB were consistent with each other, which reflected that far social distance and more negative attitudes were strongly adopted by the general public. There were significant differences in the total and most of the individual item scores of the SDS and the SB between the general public and the two relatives groups. However, the difference in the SDS scores between the relatives of patient with schizophrenia and neurotic illnesses was not significant. Among the socio-demographic factors, educational status had a stronger influenced on stigma than age and sex. Conclusions: The stigma towards patients with schizophrenia among the Malay community was strong. Individuals who had been exposed to patient with schizophrenia or neurotic illnesses tended to have better perceptions towards schizophrenia than the general public. The contact that promotes familiarity with mental illness, which may diminish prejudicial attitudes, attributed to the improvement.

Factors associated with larval control practices in a dengue outbreak prone area.

In order to reduce the risk of dengue outbreak recurrence in a dengue outbreak prone area, the members of the community need to sustain certain behavior to prevent mosquito from breeding. Our study aims to identify the factors associated with larval control practices in this particular community. A cross-sectional study involves 322 respondents living in a dengue outbreak prone area who were interviewed using a pretested questionnaire. The level of knowledge about Aedes mosquitoes, dengue transmission, its symptoms, and personal preventive measures ranges from fair to good. The level of attitude towards preventive measures was high. However, reported level of personal larval control practices was low (33.2%). Our multiple logistic regression analysis showed that only those with a good level of attitude towards personal preventive measure and frequent attendance to health campaigns were significantly associated with the good larval control practices. We conclude that, in a dengue outbreak prone area, having a good attitude towards preventive measures and frequent participation in health campaigns are important factors to sustain practices on larval control.

Socio-demographic and psychosocial correlates of erectile dysfunction among hypertensive patients.

OBJECTIVE The main aim of the study was to estimate the prevalence of ED and the associated socio-demographic and psychological correlates among hypertensive patients from a rural multiethnic community in Malaysia. METHODS A cross-sectional study was conducted among hypertensive patients attending rural primary care clinics. The socio-demographic, health characteristics, erectile function and levels of depression, anxiety and stress were recorded and analysed. The International Index of ErectileFunction-5 (IIEF-5) questionnaire and the Depression, Anxiety and Stress Scale (DASS-21) were used to assess erectile function and the levels of depression, anxiety and stress, respectively. RESULTS A total of 253 hypertensive patients comprising 178 (70.4%) Malays, 56 (22.1%) Chinese and 18 (7.5%) Indians participated. The mean age of participants was 59.8 ± 10.62 years. Overall, the prevalence rate of ED was 62%: 90 (35%) with moderate and 69 (27%) with severe ED. The prevalence rate of ED among those aged 65 years or older (83.1%) was significantly higher than those less than 65 years (51.8%), (p<0.001). Higher prevalence rates were also noted among the Chinese (78.6%) compared to Malays (59.6%) and Indians (50%) (p=0.021); lower education level (69.1%) (p=0.026), among hypertensive patients with concomitant diabetes mellitus (70.6%) (p=0.026) and WHR ≥ 0.9 (31.3%) (p=0.021). However, no significant association was found between depression, anxiety and stress scores with IIEF-5 score. CONCLUSION The prevalence rate of ED among Malaysian hypertensive patients is high. The rate increases significantly with age, Chinese ethnicity, concomitant diabetes mellitus, lower education level, WHR and the number of pack years of smoking. ED should be properly recognized and managed in hypertensive patients.

Comparable Enhanced Prothrombogenesis in Simple Central Obesity and Metabolic Syndrome

Objective There is limited data comparing prothrombogenic or fibrinolysis biomarkers (tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1)) simultaneously in subjects with Metabolic Syndrome (MS), simple central obesity without MS (COB) and normal controls (NC). We investigated the concentrations of fibrinolysis biomarkers in subjects with MS, COB and NC. Methods A cross-sectional study involving 503 drug naive subjects (163 males, aged 30–65 years old (mean age ± SD = 47.4 ± 8.3 years)) divided into MS, COB and NC groups. COB was defined as central obesity (waist circumference (WC) males ≥90 cm, females ≥80 cm) in the absence of MS according to the International Diabetes Federation 2006. Fasting blood levels of tPA and PAI-1were analyzed. Results MS and COB had significantly higher concentration of all biomarkers compared to NC. The MS group had significantly higher concentration of tPA and PAI-1 compared to COB. WC and HDL-c had significant correlation with all biomarkers (tPA p < 0.001, PAI-1 p < 0.001). Fasting plasma glucose and diastolic blood pressure were independent predictors after correcting for confounding factors. Conclusion Central obesity with or without MS both demonstrated enhanced prothrombogenesis. This suggests that simple obesity possibly increases the risk of coronary artery disease in part, via increased susceptibility to thrombogenesis.

Knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia: The importance of professional training

BACKGROUND AND AIMS This study aimed to determine knowledge, awareness and practice (KAP) regarding familial hypercholesterolaemia (FH) among Malaysian primary care physicians (PCP), and to compare KAP between PCP with postgraduate qualification (PCP-PG-Qual) and PCP without PG qualification (PCP-noPG-Qual). METHODS This was a cross-sectional study involving PCP with ≥1-year working experience in Malaysian primary care settings. An adapted and validated 25-item FH-KAP questionnaire was disseminated during primary care courses. Total score for each domain was calculated by summing-up the correct responses, converted into percentage scores. Normality distribution was examined and comparisons of mean/median percentage scores were made between the two groups of PCP. RESULTS A total of 372 PCP completed the questionnaire. Regarding knowledge, 77.7% correctly defined FH. However, only 8.3% correctly identified coronary artery disease risk in untreated FH. The mean percentage knowledge score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (48.9, SD ± 13.92 vs. 35.2, SD ± 14.13), t(370) = 8.66, p < 0.001. Regarding awareness, 39% were aware of the NICE FH guideline and only 27.2% were aware of FH diagnostic criteria. The median percentage awareness score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 11.54), p = 0.013. Regarding practice, only 19.1% stratified FH patients as high risk irrespective of other risk factors. The mean percentage practice score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (52.4, SD ± 12.92 vs. 42.7, SD ± 16.63), t(370) = 9.65, p < 0.001. CONCLUSIONS Substantial gaps in FH-KAP among Malaysian PCP were identified, with PCP-PG-Qual having better knowledge, awareness and practice than PCP-noPG-Qual, emphasising the importance of professional training and certification.

Motivating Reasons for Performing Physical Exercise in Relation to Socio-demographic Factors

Despite all the well-documented physical, psychological and social benefits of regular physical exercise, it has been reported that two-thirds of the industrialised world does not perform exercise regularly. One important factor that may contribute to exercising regularly is the motivation to exercise. Different socio-demographic factors may motivate people differently to exercise regularly. Identifying these factors may help in the implementation of interventions aimed at promoting physical exercise. This study was conducted to investigate the relationship between socio-demographic characteristics and the motivating reasons for performing physical exercise. Five recreational areas/parks in Shah Alam were chosen at random. Cross-sectional study was conducted, whereby 501 adults aged 18 and above who were performing exercise were interviewed using a questionnaire. In addition to socio-demographic information, this questionnaire includes 21 items referring to the motivation for getting involved in regular physical exercise. Each item was measured on a five-point scale, from (1) strongly disagree to (5) strongly agree. The mean score of the 21 reasons was then used as the dependent variable versus the socio-demographic characteristics. We found that the motivating reasons’ score significantly correlated with age (r = −0.122, p = 0.007), BMI (r = −0.091, p = 0.042) and household income (r = −0.095, p = 0.036). Significantly higher mean scores were detected: non-Malay (p = 0.001), unmarried (p = 0.032), unemployed (p = 0.01) and free of chronic disease (p = 0.010). However, difference in gender, educational level and smoking showed no significant difference. Therefore, we concluded that non-Malay, unemployed, young, unmarried, lower income, lower BMI and no chronic illness have higher motivating reasons in doing physical exercise.

Support for a Campus Tobacco-Free Policy among Non-Smokers: Findings from a Developing Country

BACKGROUND A tobacco-free workplace policy is identified as an effective means to reduce tobacco use and protect people from second-hand smoke; however, the number of tobacco-free policies (TFP) remains very low in workplaces in Malaysia. This study explored the factors affecting support for a tobacco-free policy on two healthcare campuses in Malaysia, prior to the implementation of TFP. MATERIALS AND METHODS This cross- sectional study was conducted among 286 non-smokers from two healthcare training centres and two nearby colleges in Malaysia from January 2015 to April 2015. A standardized questionnaire was administered via staff and student emails. The questionnaire collected information on sociodemographic characteristics, support for a tobacco-free policy and perceived respiratory and sensory symptoms due to tobacco exposure. Bivariate and multivariate logistic regression analyses were performed to estimate the independent effects of supporting a tobacco-free campus. RESULTS The percentage of individuals supporting completely tobacco-free facilities was 83.2% (N=238), as opposed to 16.7% (N=48) in support of partially tobacco-free facilities. Compared to the supporters of partially tobacco-free facilities, non-smokers who supported completely tobacco-free health facilities were more likely to be female, have higher education levels, to be very concerned about the effects of other people smoking on their health and to perceive a tobacco-free policy as very important. In addition, they perceived that tobacco smoke bothered them at work by causing headaches and coughs and, in the past 4 weeks, had experienced difficulty breathing. In the multivariate model, after adjusting for sociodemographic characteristics and other factors, only experiencing coughs and headaches increased the odds of supporting a completely tobacco-free campus, up to 2.5- and 1.9-fold, respectively. CONCLUSIONS Coughs and headaches due to other people smoking at work enhances support for a completely tobacco-free campus among non-smokers.

Factors associated with anxiety among elderly hypertensive in primary care setting

Abstract Background: There is increasing evidence showing that anxiety is associated with morbidity in the older age group. Factors contributing to anxiety may vary among different diseases and settings. Aims: The aim of this study was to determine the factors associated with anxiety symptoms among elderly hypertensive at the primary care level. Methods: A cross-sectional study and face-to-face interviews using Hospital Anxiety and Depression Scale (HADS) were conducted among elderly hypertensive. Results: The mean (SD) age of subjects was 68.8 (6.76) years and comprised of 49.5% and 50.5% of males and females, respectively. The majority of respondents were Malays (76.1%), followed by Chinese (14.3%), and Indians (9.5%). The mean (SD) duration of hypertension was 8.44 (7.29) years and the prevalence of anxiety symptoms was 13.3% (95% CI: 9.9, 16.7). Multiple logistic regression analysis showed that elderly hypertensive with a past history of stroke (adjusted OR: 4.472; 95% CI: 1.754, 11.405; p = 0.002) and depression (adjusted OR: 3.715; 95% CI: 2.009, 6.872; p < 0.001) was significantly associated with the factors for anxiety. Conclusion: Elderly hypertensive with a history of stroke and having depressive symptoms are susceptible to get the anxiety. Therefore, screenings of risk factors and early intervention may improve the quality of life among elderly.

MOTIVATION TO PHYSICAL EXERCISE: IS IT DIVERSE WITH DIFFERENT SOCIODEMOGRAPHIC CHARACTERISTICS PARTICULARLY THE GENDER?

Domestic violence in itself is one of the most difficult, specific and wide-spread social-legal problems containing the number of signs of violation. Conflict directly concerns people connected with coexistence; it has the local, exclusive character and the fight against it is less effective in accordance with common practice of fight against the crime. Specificity of the fight against the crime of this category is expressed in both complexity of its revealing and in effective and lawful choice of coercive measures against it. The issue of domestic violence has been tabooed in many countries for a long time, because the disclosure of such issues was considered as interference in people’s private life. Although the society has gradually realized that the problem of domestic violence must not be ignored as violence endangers people’s health and life. Domestic violence is not only the problem of separate individuals, it has negative effect on the other members of the family, especially on minors and leads to distortion of their psyche and consciousness which, in its turn, leads to the formation of an unhealthy situation in the society.The author analyzes the results of the four stages of victimization surveys and Unified Crime Reports prepared by the Ministry of Internal Affairs of Georgia in 2010-2013. The results of victimization surveys and statistics reports related to indexes and structure of crime became important after the parliamentary elections held in October 1, 2012, resulted by defeating of the ruling political party “National Movement” which was in power for the last 9 years. The new coalition “Georgian Dream”, headed by the billionaire B. Ivanishvili, radically changed political climate and announced the acceleration of democratization of the country and adopted the legislation decriminalization policy. According the new policy, the government of the country carried out the general amnesty, and released more than 60% of all prisoners from the custody. Such policy became the object of serious criticism from the part of the oppositions and some experts. They have expressed concerns about the criminal situation and decreasing level of security in the country predicted anarchy and disorganizations. This article is an attempt to assess the real situation in Georgia and the level of real threat to stability posed by criminality.Everything has his pros and cons. Debtor’s rights and obligations during court order enforcement, causes of problems that may arise. This problem is in the whole country, not just in one city or in one social class. A very large number of families from everywhere around Georgia have been affected. How and where it started will be discussed below in the text. Rights of creditors and debtors overlap in many aspects. We need to be very careful when sorting out this issue. We cannot under any circumstances make a decision with a benefit of one party while the other party will suffer losses. Georgian law on “Law Enforcement” does not support in any ways rights of debtors and all the procedures highlighted are towards forcing the debtor to pay off the debt. At this stage based on the current law, current socio-economic problems, statistics, ways on sorting out the problem, this object of studies is very important and has a very high intrinsic value in its theoretical part as well as in its practical part. If the right approach is taken it is possible to minimise the need to protect rights of creditors or debtors in the futures, because every party will be fully aware of their abilities and punishments for failures to fulfil their obligations, before signing the contractThe article includes detailed employment and uniploymant analysis in each municipality. In the analysis we use results from household survey conducted by the National Statistics Service. More specific information about the labour market at the municipal level was collected through cooperation with local municipalities. For the analysis we used information from municipalities’ web pages, telephone conversations with stakeholders, personal meetings with experts and so on. It should also be noted that a certain part of the data obtained from municipalities and from administrative territorial units have an approximate nature, but based on these information it is possible to gain some valuable conclusions and make assumptions. Terms and reality of employment analysis is carried out not only at the level of the municipality but on the country and regional ones as well.This project aims to apply learning of operations research and optimizing resources to practical cases. The aim of this problem is to maximize the the fairness of the schedule , while respecting all the constraints . In regards with the results obtained after some tests ILP has found a very good solution to our problem . Better values of the penalties associated to the shifts could be defined in order to represent the reality more accurately especially by taking into account the length of the shifts. The models can also be solved by means of optimization software. As shown in this paper, the current schedules can benefit from this work. My problem is NP-hard that it means unsolvable.My objective is to do the objective values ( diff =0.1) . The ideal must be 0 but it is impossible.there is shown in the table in 5 shifts , 20 nurses 10 weeks. We see that when we increase the number of shift the objective value is decreasing. It is fact that when we add a shift the software must do more iterations but the penalty is decreasing. We see that with the same number of iterations the penalty is smaller when we add a shift.For the welfare of modern society and any state`s correct function it is very important to have straightened working court system and to ensure every person`s court accessibility. Each step of court case management is detailed in civil procedure code. The legislation of civil procedure of Georgia foresees some mechanisms and opportunities of the restriction of court accessibility, which must be studied. The meaning of this study is stipulated by huge importance of court accessibility itself and by need of due caution during its restricting. The access to the court right is reserved not only by national, but also by international law, as evidenced by Article 42 of the Constitution [1], ``The UN Convention for Protection of Human Rights and Fundamental Freedoms`` Article 6 [3]. As any study issue, this one also needs scientific, systemic approach. For fully demonstrating the issue it is advised to classify and define court accessibility restriction mechanisms. Here presented work is about this matter.The Administrative Law is a part of public law, as it is depended on the subordinate principle. It aims to realize public interest. On the other hand, Enforcement Law is part of administrative space, which regulates the rules and procedures of the enforcement process for different court’s decisions as well as other acts. As administrating effects our everyday lives, it is a public interest that this process should be kept in the legal borders. This is exactly what the Administrative Law is all about. It regulates the social relations in which were government and other administrative bodies play a major role. It is true that Enforcement Law provides us with the norms, rules and procedures of the legal administration, but it is still court’s responsibility to assess the legal quality of it. This is why we need effective justice, to have the competent court ruling practice and to enforce them properly.Collision issues are discussed in family law such as conditions of marriage, results of marriage, annulment of marriage, duty of maintenance, relations between parents and children, relations related to child’s origin, conditions of adopting, guardianship and tuition. I discuss issues of guardianship and tuition in mentioned work, which I think is very interesting and actual.