Malaysian Journal of Medical Sciences最新文献

Background: The main aim of the study was to determine the relationships between components of physical activity level with quality of life (QoL) and cancer-related fatigue (CRF) among breast cancer survivors in Malaysia.

Methods: Eighty-three female breast cancer survivors with mean age 52.8 (8.7) years old participated in this study. The participants were asked to answer Short Form International Physical Activity Questionnaire (SF IPAQ) to identify physical activity level, Breast Cancer Functional Assessment of Cancer Therapy (FACT-B) questionnaire to determine the QoL, and Brief Fatigue Inventory (BFI) scale questionnaire to assess CRF. Descriptive statistic and Pearson correlation were performed for statistical analysis.

Results: There was a significant positive correlation between time spent for moderate to vigorous physical activity (mins/week MVPA) and functional well-being, a component of QoL (r = 0.217, P = 0.049). There was a significant negative correlation between the days spent for moderate physical activity (days/week MPA) and the severity of fatigue, a component of CRF (r = -0.234, P = 0.033). A negative correlation between total CRF score and total QoL score (r = -0.298, P = 0.01) was also observed.

Conclusion: Participation in physical activity might improve QoL and reduce the severity of CRF in Malaysian breast cancer survivors.

Background: Although stunting continues to decline, it remains a problem in Indonesia, particularly in underdeveloped areas such as the Papua region. This study determined policy targets for reducing the number of stunted Papuan children under five years old in Indonesia.

Methods: This secondary analysis focused on the 2022 Indonesian National Nutritional Status Survey data. A total of 13,268 individuals under five years old were studied. Eleven independent variables were examined: province, domicile, mother's age, education, marital status, work, wealth, antenatal care (ANC), children's age, sex, early initiation of breastfeeding (EIBF), and nutritional status. A binary logistic regression test was employed for all examinations.

Results: The prevalence of Papuan toddler stunting was 29.8%. Two factors related to residence were classified into five types: province and residence. Four maternal demographic characteristics were associated with stunting in Papua under five years old: age, education, marital status, and employment status. All wealth statuses were more likely than the richest to be stunted under five years old. Papuan mothers without ANC were 1.150 times more likely to have stunted children under five years old (95% CI: 1.116-1.185). All children were more likely to be stunted than those aged 0-1 months. Boys were 1.318 times more likely to be stunted than girls (95% CI: 1.297-1.340). Five patients without EIBF were 1.092 times more likely to be stunted than those with EIBF (95% CI: 1.060-1.124).

Conclusion: Eleven factors were related to stunting in Papuan children: province, residence, maternal age, education, marital status, employment, wealth, ANC, age, sex, and EIBF.

Background: Heart failure (HF) is a common comorbidity in the adult population and a common cause of recurrent readmissions. This study aimed to determine the proportion of readmissions, the median time to readmission and its prognostic factors among hospitalised HF patients.

Methods: This is a retrospective cohort study that involved patients admitted for HF at a tertiary hospital in Kelantan, Malaysia from October 2021 to December 2022. Adult patients who underwent a formal echocardiogram within one year of the index hospitalisation were included. Patients were excluded if they had inpatient mortality or an active malignancy, if they were transferred to another facility, or if they were discharged against medical advice. They had an additional follow-up period of one year to assess the event of interest (readmission). Patients who did not experience a readmission were censored. Prognostic factors for the time to readmission were identified using multiple Cox regression analysis.

Results: A total of 276 patients were included in the analysis, with a mean age of 60.64 years. The proportions of readmissions at six months and one year after discharge were 51.8% and 63.4%, respectively. The median time to readmission for the cohort was 118 days. Prognostic factors for the time to readmission included atrial fibrillation (AF) (adjusted hazard ratio [AHR] = 2.06; 95% confidence interval [CI] : 1.42, 2.99), chronic kidney disease (CKD) (AHR = 1.53; 95% CI: 1.14, 2.04), a low albumin level (AHR = 0.96; 95% CI: 0.94, 0.99), a high aspartate aminotransferase (AST) level (AHR = 1.003; 95% CI: 1.001, 1.006) and ejection fraction (EF) ≤ 40% (AHR = 1.37; 95% CI: 1.03, 1.84).

Conclusion: Most patients experienced a readmission within six months of discharge. Several factors were identified as prognostic factors for readmission. Therefore, clinicians must optimise patient care before discharge, paying special attention to these factors.

Background: PET/CT using ¹⁸F-FDG has been increasingly used for diagnostic imaging. Thus, dosimetry evaluation is crucial to minimise unnecessary radiation exposure to other organs. This study aimed to evaluate the absorbed dose to patients undergoing ¹⁸F-FDG sequential PET/CT imaging in the Institut Kanser Negara (IKN), Putrajaya, Malaysia using OLINDA/EXM and Geant4 MC simulation, focusing on identifying the most suitable method for clinical application and analysing whether the absorbed dose complies with the safety standard set by ICRP 128.

Methods: OLINDA/EXM (version 1.1) and Geant4 MC (version 10.6.0) software were used to evaluate the absorbed doses to the liver, kidneys, and urinary bladder. MIRD-5 mathematical phantom was used in Geant4 MC simulation, whereas in OLINDA/EXM, adult male and female models with organ masses normalised to the Japanese reference model were applied.

Results: The mean absorbed doses to the liver, kidneys, and urinary bladder were 0.010 ± 0.006 mGy/MBq, 0.011 ± 0.004 mGy/MBq, and 0.025 ± 0.047 mGy/MBq, respectively, for OLINDA/EXM, and 0.009 ± 0.004 mGy/MBq, 0.011 ± 0.003 mGy/MBq, and 0.073 ± 0.086 mGy/MBq, respectively, for Geant4 MC. The corresponding differences between these two methods were 10.526%, 0%, and 97.959%, respectively for the liver, kidneys, and urinary bladder. The results comply with the ICRP-128 limits, indicating the safe use of ¹⁸F-FDG for diagnostic purposes in IKN.

Conclusion: Both methods were shown to be reliable in estimating the absorbed dose for ¹⁸F-FDG. The selection of the methods for absorbed dose estimation depends on the capacity of the clinics (i.e., in terms of time and computational capability [power and literacy]).

Background: Naltrexone/bupropion is a recently approved antiobesity medication in Malaysia. We aimed to determine the 12-week outcomes of naltrexone/bupropion as an antiobesity medication at our centre.

Methods: This was a single-centre, prospective, pilot, observational study. All patients prescribed naltrexone/bupropion at Metabolic and Obesity Clinic, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, between July 2023 and January 2024 were identified. The collected data included demographics, comorbidities, baseline weight, and body mass index. At the 12-week follow-up, data on weight, body mass index, side effects, and anti-craving effects were documented. Data are presented as mean ± standard deviation (SD) for continuous variables and as count and frequency for categorical variables.

Results: Eighteen patients were treated with naltrexone/bupropion during the study. The majority were female (n = 13, 72%) and Malay (n = 13, 72%), with a mean age of 45 years (SD = 10). The mean body mass index was 38 kg/m² (SD = 8). Comorbidities included diabetes (n = 9, 50%), hypertension (n = 7, 39%), and dyslipidaemia (n = 11, 61%). Of the 14 patients (78%) who completed 12 weeks of follow-up, the mean weight loss was 2.11 kg (SD = 2.61, P = 0.01), and the percentage of total body weight loss was 2%. The main side effects were giddiness (50%), nausea (44%), and headaches (38%). Naltrexone/bupropion was effective in reducing cravings in 75% of the patients. 63% of patients experienced side effects, which slowed escalation.

Conclusion: Our early experience with naltrexone/bupropion as an antiobesity medication suggests that it is effective in managing obesity with craving symptoms. A longer follow-up with a larger group of patients is necessary before a definitive conclusion can be made.

Background: Limited scales exist for assessing adherence among inhaler users, and information on validity and diagnostic characteristics is lacking. This study aimed to develop a Medication Adherence Measure for Inhaler Users (MAM-I) and assess its reliability, validity, and cutoff score for determining nonadherence in patients with asthma.

Methods: A cross-sectional study, which included 145 patients with asthma, was conducted. The participants completed the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the Marlowe-Crowne Social Desirability Scale (MCSDS), and the 7-item MAM-I. The reliability of the scale was determined using Cronbach's alpha, and its validity was examined in terms of criterion, concurrent, predictive, and construct validity. The diagnostic characteristics and cutoff point for nonadherence to inhaler use were also evaluated using the receiver operating characteristic (ROC) curve, with asthma control at month 6 as the gold standard.

Results: The MAM-I showed a Cronbach's alpha value of 0.784 at baseline and 0.749 at month 6. Significant correlations were found between the MAM-I scores and adherence scores (P < 0.001), asthma control levels (P < 0.001), and quality of life scores (P < 0.001). The cutoff point for nonadherence was < 15, with a sensitivity of 78.95%, specificity of 98.13%, positive predictive value (PPV) of 93.75%, negative predictive value (NPV) of 92.92%, and accuracy of 93.10%.

Conclusion: The MAM-I shows satisfactory reliability and validity, with good diagnostic properties and a cutoff score of less than 15. This scale can be a helpful tool for identifying inhaler nonadherence in asthma management.

Background: This study explores the integration of halal ethnomedicine (HE) into health tourism within Bayan Village, North Lombok, Indonesia. HE combines traditional medical practices with Islamic principles, offering a culturally resonant health care option. This research aims to assess the potential benefits and challenges of developing HE as a health tourism initiative.

Methods: Utilising a qualitative case study approach, this research was conducted in Bayan Village, North Lombok Regency, West Nusa Tenggara Province, Indonesia. Data were collected through interviews with local stakeholders, including policy-makers, residents, and health tourists, from November 2023 to January 2024.

Results: The findings indicate that the Bayan community strongly supports the development of HE-based health tourism, primarily because of its economic potential and cultural preservation. The financial impact of HE was highlighted as the most significant, with the community recognising its capacity to generate income and attract investment. However, the health benefits, while acknowledged, were not as strongly prioritised. This study also identifies several challenges, including low local interest, a financial focus that may hinder long-term development, the spread of misinformation, and the limited quality of local human resources. To address these challenges, this research proposes a collaborative model involving public and private sector partnerships. This includes strategies for community engagement, capacity building, and marketing, emphasising the importance of aligning HE with broader tourism and health care infrastructure.

Conclusion: This study concludes that while HE holds promise as a health tourism product, its successful implementation requires overcoming significant sociocultural and operational barriers. This research contributes to the understanding of how traditional medicine can be integrated into modern health tourism, offering insights for policy-makers and stakeholders in similar contexts.

Background: There is an increasing global trend of child abuse, and research into knowledge, attitudes, and intentions towards reporting child abuse among early childcare providers (ECPs) in Malaysia has been limited. There is no existing questionnaire in the Malay language that measures these aspects. Therefore, this study cross-culturally adapted and validated the Early Childhood Educators Child Abuse Questionnaire (ECECAQ) from English into Malay to assess knowledge and attitude towards child abuse and its reporting, as well as intentions to report child abuse among ECPs.

Methods: This study comprises two phases. The first phase involved the cross-cultural adaptation of the original ECECAQ into Malay. The second phase, which involved 218 ECPs working in registered preschools in Kelantan, Malaysia, was conducted to validate the Malay version of ECECAQ. Five-point Likert-scaled attitude items were analysed using confirmatory factor analysis (CFA), while dichotomous-scaled knowledge items were analysed using 2-parameter logistic item response theory analysis.

Results: The four-factor model for the attitude had a good fit [χ² = 58.7 (48), P = 0.138; standardised root mean square (SRMR) = 0.044; root mean square error of approximation (RMSEA) = 0.033; comparative fit index (CFI) = 0.986; Tucker-Lewis index (TLI) = 0.981], with factor loadings (FLs) ranging from 0.414 to 0.869 and good reliability (Raykov's rho = 0.672 to 0.878). The knowledge had a good range of difficulty and discrimination values, with acceptable reliability (Cronbach's alpha = 0.66).

Conclusion: The Malay version of ECECAQ demonstrated good validity and reliability among ECPs in Malaysia.