Publications by authors named "Haridah Alias"

38 Publications

Psychological Consequences of the Delay in the Silent Mentor Programme During the COVID-19 Pandemic: Perspectives From Family Members of Silent Mentors.

Omega (Westport) 2021 Apr 4:302228211000952. Epub 2021 Apr 4.

Unit of Silent Mentor Program, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

The COVID-19 pandemic has put a hold on the Silent Mentor Programme (SMP); this pause has not only caused unprecedented challenges for the delivery of medical education but has forced changes in the programme ceremony sessions. We aimed to describe the psychological impact and experiences of family members of silent mentors during the COVID-19 pandemic using qualitative interviews. Many expressed feelings of remorse and unrest about the unprecedented delay of the SMP. The delay increased negative emotions particularly among some elderly family members; however, there was no prominent negative effect on their functional health and well-being. Several participants relayed the belief that the soul cannot rest until the body receives a proper burial while some worried about the deterioration of the physical condition of the mentors. In conclusion, findings provide insights into the importance of not overlooking the mental health implications of delaying the SMP in future outbreaks or crises.
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http://dx.doi.org/10.1177/00302228211000952DOI Listing
April 2021

Psychological distress among cancer survivors during implementation of a nationwide Movement Control Order over the COVID-19 pandemic.

Support Care Cancer 2021 Apr 1. Epub 2021 Apr 1.

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.

Objectives: This study aimed to investigate the psychological distress and its associated factors among cancer survivors in Malaysia during the COVID-19 pandemic.

Methods: An anonymous Internet-based study was conducted between 23 April and 26 June 2020. During the study period, the country underwent phase 3 and phase 4 of the Movement Control Order (MCO), Conditional Movement Control Order (CMCO), and Recovery Movement Control Order (RMCO). Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS), which is a 14-item self-assessment scale for measuring distress (total HADS score; HADS-T) with two subscales, namely, anxiety (HADS-A) and depression (HADS-D). Perceived threat of infection was measured based on the health belief model.

Results: From a total of 631 responses received, the proportion of participants with anxiety and depression symptoms (above threshold score of 8 on HADS-A and HADS-D) was 29.0 and 20.9%, respectively. Psychological distress (HADS-T > 16) was reported in 22.3% of the respondents. A total of 16.5% had combined anxiety and depression symptoms. The highest HADS-A (6.10; 95% CI 5.64-6.56), HADS-D (5.61; 95% CI 5.14-6.08), and HADS-T (11.71; 95% CI 10.84-12.58) scores were reported among respondents during phase 4 of the MCO. Partial least square-based structural equation modelling (PLS-SEM) revealed that self-perceived health status, perceived susceptibility, and severity of COVID-19 have the greatest effect, leading to higher HADS-A, HADS-D, and HADS-T scores.

Conclusion: Heightened psychological distress was evident in cancer survivors particularly during the enforcement of the MCO over COVID-19. Providing support to address cancer survivors' psychological and emotional needs during the COVID-19 pandemic is essential.
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http://dx.doi.org/10.1007/s00520-021-06182-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016501PMC
April 2021

Quarantine for the coronavirus disease (COVID-19) in Wuhan city: Support, understanding, compliance and psychological impact among lay public.

J Psychosom Res 2021 05 16;144:110420. Epub 2021 Mar 16.

Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, Fujian Province, China; Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya 50603, Kuala Lumpur, Malaysia. Electronic address:

Objective: Wuhan, the epicentre of the coronavirus diseases (COVID-19) outbreak, has been locked down on January 23, 2020. We conducted a study among the lay public in Wuhan to access their support, understanding of, compliance with, and the psychological impacts of the quarantine.

Methods: We conducted a cross-sectional, online-based survey study between January 28, 2020, and February 2, 2020 among the adult lay public in Wuhan to access their support, understanding of, compliance with, and the psychological impacts of the quarantine. Multivariable logistic analysis was used to identify factors associated with psychological impacts.

Results: Among the 4100 participants investigated, a total of 15.9% were compliant with all the five household prevention measures, whereas 74.4% were compliant with all the three community prevention measures investigated. By demographics, participants of younger age, higher income, residing in an urban area, knowing neighbors infected with COVID-19 reported significantly higher psychological impact score. Participants with a lower level of support for quarantine were more likely to have a higher psychological impact score (OR = 1.45, 95% CI 1.07-1.96). Participants with a lower level of compliance with preventive measures (score of 0-19) reported higher psychological impact (OR = 1.40, 95% CI 1.22-1.60 vs. score 20-24). Participants who had been out of house socializing and attended public events expressed higher psychological impact.

Conclusions: Support, understanding of the rationale for quarantine are essential in ensuring appropriate psychological well-being during the quarantine. Improvements in compliance with preventive measures are highly warranted and may bring about a reduction in psychological distress.
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http://dx.doi.org/10.1016/j.jpsychores.2021.110420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962979PMC
May 2021

Escalating progression of mental health disorders during the COVID-19 pandemic: Evidence from a nationwide survey.

PLoS One 2021 25;16(3):e0248916. Epub 2021 Mar 25.

Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Since the first nationwide movement control order was implemented on 18 March 2020 in Malaysia to contain the coronavirus disease 2019 (COVID-19) outbreak, to what extent the uncertainty and continuous containment measures have imposed psychological burdens on the population is unknown. This study aimed to measure the level of mental health of the Malaysian public approximately 2 months after the pandemic's onset. Between 12 May and 5 September 2020, an anonymous online survey was conducted. The target group included all members of the Malaysian population aged 18 years and above. The Depression Anxiety Stress Scale (DASS-21) was used to assess mental health. There were increased depressive, anxiety and stress symptoms throughout the study period, with the depression rates showing the greatest increase. During the end of the data collection period (4 August-5 September 2020), there were high percentages of reported depressive (59.2%) and anxiety (55.1%) symptoms compared with stress (30.6%) symptoms. Perceived health status was the strongest significant predictor for depressive and anxiety symptoms. Individuals with a poorer health perception had higher odds of developing depression (odds ratio [OR] = 5.68; 95% confidence interval [CI] 3.81-8.47) and anxiety (OR = 3.50; 95%CI 2.37-5.17) compared with those with a higher health perception. By demographics, young people-particularly students, females and people with poor financial conditions-were more vulnerable to mental health symptoms. These findings provide an urgent call for increased attention to detect and provide intervention strategies to combat the increasing rate of mental health problems in the ongoing COVID-19 pandemic.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248916PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993793PMC
April 2021

Behavioural responses and anxiety symptoms during the coronavirus disease 2019 (COVID-19) pandemic in Japan: A large scale cross-sectional study.

J Psychiatr Res 2021 04 13;136:296-305. Epub 2021 Feb 13.

Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China; Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. Electronic address:

Background: This study explored the behavioural responses and anxiety symptoms of the general adult population in Japan during the ongoing coronavirus disease 2019 (COVID-19) outbreak.

Methods: A web-based cross-sectional survey was conducted between 12th and May 13, 2020. Quota sampling was used to attain equal gender and age distributions representative of the Japanese population.

Results: A total of 4127 complete responses were analysed. Higher educational level (B = 0.045, p = 0.002) and household income (B = 0.04, p = 0.009) were associated with a higher increase in preventive measures when comparing before and after the state of emergency was declared. The highest reported social anxiety was a feeling of fear (65.6%), followed by embarrassment (43.8%), keeping infection a secret (41.3%), avoidance (41.3%), and stigma (25.5%). A total of 86.1% of the respondents reported moderate to severe anxiety. The partial least square-based structural equation modelling (PLS-SEM) revealed that being female has the greatest effect (B = 0.246, p < 0.0001) on higher current preventive measures, followed by social anxiety (B = 0.119; p = 0.001) and State-Trait Anxiety Inventory scores (B = 0.153; p < 0.001). Perceived susceptibility (B = 0.033, p = 0.020), knowing someone who have been diagnosed with COVID-19 (B = 0.097, p < 0.001), higher income (B = 0.079, p < 0.001) and educational level (B = 0.045; p = 0.004) all had a small but significant effect on influencing levels of preventive measures.

Conclusions: A moderate level of preventive practices found in this study indicates the need to encourage behavioural change to limit the spread of the coronavirus. The provision of mental health services is warranted as anxiety symptoms are prevalent.
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http://dx.doi.org/10.1016/j.jpsychires.2021.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880847PMC
April 2021

Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China.

PLoS Negl Trop Dis 2020 12 17;14(12):e0008961. Epub 2020 Dec 17.

Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China.

Background: This study attempts to understand coronavirus disease 2019 (COVID-19) vaccine demand and hesitancy by assessing the public's vaccination intention and willingness-to-pay (WTP). Confidence in COVID-19 vaccines produced in China and preference for domestically-made or foreign-made vaccines was also investigated.

Methods: A nationwide cross-sectional, self-administered online survey was conducted on 1-19 May 2020. The health belief model (HBM) was used as a theoretical framework for understanding COVID-19 vaccination intent and WTP.

Results: A total of 3,541 complete responses were received. The majority reported a probably yes intent (54.6%), followed by a definite yes intent (28.7%). The perception that vaccination decreases the chances of getting COVID-19 under the perceived benefit construct (OR = 3.14, 95% CI 2.05-4.83) and not being concerned about the efficacy of new COVID-19 vaccines under the perceived barriers construct (OR = 1.65, 95% CI 1.31-2.09) were found to have the highest significant odds of a definite intention to take the COVID-19 vaccine. The median (interquartile range [IQR]) of WTP for COVID-19 vaccine was CNY¥200/US$28 (IQR CNY¥100-500/USD$14-72). The highest marginal WTP for the vaccine was influenced by socio-economic factors. The majority were confident (48.7%) and completely confident (46.1%) in domestically-made COVID-19 vaccine. 64.2% reported a preference for a domestically-made over foreign-made COVID-19 vaccine.

Conclusions: The findings demonstrate the utility of HBM constructs in understanding COVID-19 vaccination intent and WTP. It is important to improve health promotion and reduce the barriers to COVID-19 vaccination.
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http://dx.doi.org/10.1371/journal.pntd.0008961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775119PMC
December 2020

Using individual stated-preferences to optimize HIV self-testing service delivery among men who have sex with men (MSM) in Malaysia: results from a conjoint-based analysis.

BMC Public Health 2020 Nov 25;20(1):1777. Epub 2020 Nov 25.

Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Background: HIV self-testing (HIVST) has the potential to improve HIV testing uptake and frequency for key populations like MSM who experience multiple barriers accessing clinic-based HIV testing. In the absence of HIVST in Malaysia, there is no guidance to inform HIVST delivery. This study investigated the acceptability of HIVST and preferences about the HIVST service delivery approaches using a standardized stated preference method.

Methods: A cross-sectional online survey conducted between January and April 2019 assessed the interest in HIVST in 544 MSM in Malaysia. Participants ranked eight hypothetical HIVST service delivery program elements with varied combinations of six, two-level HIVST service delivery program attributes (cost, privacy, accuracy, kit collection site, kit type, and testing support). SPSS conjoint procedure was used to estimate the relative importance of each attribute and preference across eight possible HIVST service delivery programs.

Results: Overall, 70.4% had previously tested for HIV, and of those, 64.0% had done so in the past 6 months (45.0% of all participants). Of all the participants, 25.2% reported having used HIVST previously. The acceptability for HIVST service delivery models ranged from 44.9 to 77.1%, with mean acceptability of 56.2% across the eight hypothetical HIVST distribution scenarios. The HIVST service delivery scenario with the highest acceptability had the following attributes: no cost (free), anonymity (name not required), 99-100% accuracy, home-delivered, fingerstick, and testing support using telephone hotline or texting. HIVST cost was the most important attribute (relative importance score: RIS = 19.30) associated with acceptability, followed by anonymity (RIS = 18.41), accuracy (RIS = 17.33), kit delivery (RIS = 16.99), fingerstick kit (RIS = 15.86), and support (RIS = 12.08).

Conclusions: Acceptability for HIVST in Malaysian MSM was high but differed markedly by a number of HIVST delivery scenarios and attributes. These findings could be relevant as the Malaysian Ministry of Health is in the process of developing a regulatory framework for ensuring the quality of kits, as well as policies supporting safe use while broader implementation under national AIDS programs.
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http://dx.doi.org/10.1186/s12889-020-09832-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687720PMC
November 2020

Uncovering Physical and Attitudinal Barriers to Adherence to Precautions for Preventing the Transmission of COVID-19 and Anxiety Level of People in Wuhan: 2 Months After the Lockdown.

Psychosomatics 2020 Sep 22. Epub 2020 Sep 22.

Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China; Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Background: Wuhan, the epicenter of the coronavirus diseases 2019 outbreak, was locked down on January 23, 2020. We aimed to investigate the barriers to the physical prevention, negative attitudes, and anxiety levels.

Methods: A online cross-sectional survey was conducted with the people living in Wuhan between March 12th and 23rd, 2020.

Results: Of a total of 2411 complete responses, the mean and standard deviation for the total physical prevention barriers score was 19.73 (standard deviation ± 5.3; range 12-45) out of a possible score of 48. Using a cut-off score of 44 for the State-Trait Inventory score, 79.9% (95% confidence interval [CI]: 78.2-81.5) of the participants reported moderate to severe anxiety during the early phase of the outbreak, and 51.3% (95% CI 49.2-53.3) reported moderate to severe anxiety after the peak of coronavirus diseases 2019 was over (during the study period). Comparing anxiety levels in the early phase of the outbreak and after the peak of the outbreak, 58.5% (95% CI 56.5-60.5) recorded a decreased anxiety. Females reported a higher likelihood of having decreased levels of anxiety than males (odds ratio = 1.78, 95% CI 1.48-2.14). Low negative attitudes score were associated with a higher decrease in anxiety (odds ratio = 1.59, 95% CI 1.33-1.89).

Conclusions: The attitudinal barriers to prevention of transmission of coronavirus diseases 2019 are more prominent than physical prevention barriers after the peak of coronavirus diseases 2019. High anxiety levels even after the peak warrant serious attention.
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http://dx.doi.org/10.1016/j.psym.2020.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506304PMC
September 2020

Correction to: Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia.

J Headache Pain 2020 Aug 18;21(1):104. Epub 2020 Aug 18.

Novartis Corporation (Malaysia) Sdn. Bhd., Plaza 33, Petaling Jaya, Malaysia.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s10194-020-01172-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433051PMC
August 2020

Temporal changes in psychobehavioural responses during the early phase of the COVID-19 pandemic in Malaysia.

J Behav Med 2021 02 5;44(1):18-28. Epub 2020 Aug 5.

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.

Monitoring public psychological and behavioural responses during the early phase of the coronavirus disease 2019 (COVID-19) outbreak is important for the management and control of infection. This study aims to investigate the temporal trend in (1) avoidance and protective behaviors, (2) fear, (3) socio-economic impact, and (4) anxiety levels during the early phase of the COVID-19 pandemic. As a high level of anxiety may have a detrimental impact during an infectious disease outbreak, factors associated with anxiety were also explored. The survey was carried out for 10 weeks and the responses were divided into three periods of around 3 weeks: 25 January-21 February, 22 February-17 March and 18 March-3 April (the period the Malaysian Government issued Movement Control Order). Findings revealed that most of the pyschobehavioural variables showed small increases during first (25 January-21 February) and second (22 February-17 March) periods, and high psychobehavioral responses were reported during the third period. A total of 72.1% (95%CI = 69.2-75.0) reported moderate to severe anxiety as measured by the State-Trait Anxiety Inventory. Factor influencing moderate to severe anxiety is a high perception of severity (OR = 2.09; 95%CI = 1.48-2.94), high perceived susceptibility (OR = 1.71; 95%CI = 1.17-2.50), high impact score (OR = 1.63; 95%CI = 1.17-2.26) and high fear score (OR = 1.47; 95%CI = 1.01-2.14). In conclusion, the psychological and behavioural responses were found to increase with the progression of the outbreak. High anxiety levels found in this study warrant provision of mental health intervention during the early phase of COVID-19 outbreak.
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http://dx.doi.org/10.1007/s10865-020-00172-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405711PMC
February 2021

The use of the health belief model to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay.

Hum Vaccin Immunother 2020 09 30;16(9):2204-2214. Epub 2020 Jul 30.

Tropical Infectious Diseases Research and Educational Centre (TIDREC), University of Malaya , Kuala Lumpur, Malaysia.

Background: The development of a vaccine against SARS-CoV-2 infection is on the way. To prepare for public availability, the acceptability of a hypothetical COVID-19 vaccine and willingness to pay (WTP) were assessed to provide insights into future demand forecasts and pricing considerations.

Methods: A cross-sectional survey was conducted from 3 to 12 April 2020. The health belief model (HBM) was used to assess predictors of the intent to receive the vaccine and the WTP.

Results: A total of 1,159 complete responses was received. The majority reported a definite intent to receive the vaccine (48.2%), followed by a probable intent (29.8%) and a possible intent (16.3%). Both items under the perceived benefits construct in the HBM, namely believe the vaccination decreases the chance of infection (OR = 2.51, 95% CI 1.19-5.26) and the vaccination makes them feel less worry (OR = 2.19, 95% CI 1.03-4.65), were found to have the highest significant odds of a definite intention to take the vaccine. The mean ± standard deviation (SD) for the amount that participants were willing to pay for a dose of COVID-19 vaccine was MYR$134.0 (SD±79.2) [US$30.66 ± 18.12]. Most of the participants were willing to pay an amount of MYR$100 [US$23] (28.9%) and MYR$50 [US$11.5] (27.2%) for the vaccine. The higher marginal WTP for the vaccine was influenced by no affordability barriers as well as by socio-economic factors, such as higher education levels, professional and managerial occupations and higher incomes.

Conclusions: The findings demonstrate the utility of HBM constructs in understanding COVID-19 vaccination intention and WTP.
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http://dx.doi.org/10.1080/21645515.2020.1790279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553708PMC
September 2020

Anxiety symptoms and preventive measures during the COVID-19 outbreak in Taiwan.

BMC Psychiatry 2020 07 16;20(1):376. Epub 2020 Jul 16.

Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.

Background: It is hypothesized that anxiety and behavioral responses are intense at the beginning of an epidemic. The objective of this study was to investigate anxiety symptoms and use of preventive measures against COVID-19. The study also compared the association between preventive measures and anxiety symptoms during the week immediately preceding the study and those symptoms and measures at the beginning of the outbreak.

Methods: A cross-sectional population survey using an online questionnaire commenced on 14 February 2020. The study participants were residents of Taiwan ages 20 to 70 years. The 6-item state version of the State-Trait Anxiety Inventory (STAI-6) was used to assess anxiety symptoms. The questions about preventive measures asked participants about their personal protection, cough etiquette, contact precautions, voluntary quarantine, and prompt reporting. Multivariable logistic regression was used to determine the factors influencing an increase in the preventive measures scores.

Results: Of a total of 3555 completed responses, a total of 52.1% (95% confidence interval [CI] 50.4-53.7) of the respondents reported moderate to severe levels of anxiety symptoms in the past week, whereas 48.8% (95%CI 47.2-50.5) reported moderate to severe anxiety symptoms at the beginning of the outbreak. With a higher score indicating greater anxiety, the median scores for anxiety symptoms in the past week and at the beginning of the outbreak were 46.7 (IQR [interquartile range] 36.7-53.3) and 43.3 (IQR 36.7-53.3), respectively. The median scores for the preventive measures taken in the past week and at the beginning of the outbreak were 26.0 (IQR 21.0-30.0) and 24.0 (IQR 19.0-28.0), respectively, out of a maximum score of 36. In the multivariable analysis, an increased anxiety symptom score from the beginning of the outbreak to the past week (adjusted OR = 7.38, 95%CI 6.28-8.66) was a strongly significant determinant of an increased preventive measures score in the past week compared with the score at the beginning of the outbreak.

Conclusions: Anxiety and preventive measures scores were high and increased with the epidemic rate. Higher anxiety was associated with an increased use of preventive measures against COVID-19.
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http://dx.doi.org/10.1186/s12888-020-02786-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364127PMC
July 2020

Influence of Mass and Social Media on Psychobehavioral Responses Among Medical Students During the Downward Trend of COVID-19 in Fujian, China: Cross-Sectional Study.

J Med Internet Res 2020 07 20;22(7):e19982. Epub 2020 Jul 20.

Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China.

Background: An extensive amount of information related to the novel coronavirus (COVID-19) pandemic was disseminated by mass and social media in China. To date, there is limited evidence on how this infodemic may influence psychobehavioral responses to the crisis.

Objective: The aim of this study is to assess the psychobehavioral responses to the COVID-19 outbreak and examine their associations with mass and social media exposure.

Methods: A cross-sectional study among medical and health sciences students from the Fujian Medical University in Fuzhou, China, was conducted between April 6-22, 2020.

Results: A total of 2086 completed responses were received. Multivariable analyses demonstrated that four constructs of the Health Belief Model (HBM)-higher perception of susceptibility (odds ratio [OR] 1.44; 95% CI 1.07-1.94), severity (OR 1.32; 95% CI 1.10-1.59), self-efficacy (OR 1.61; 95% CI 1.21-2.15), and perceived control or intention to carry out prevention measures (OR 1.32; 95% CI 1.09-1.59)-were significantly associated with a higher mass media exposure score, whereas only three constructs-higher perception of severity (OR 1.43; 95% CI 1.19-1.72), self-efficacy (OR 1.85; 95% CI 1.38-2.48), and perceived control or intention to carry out prevention measures (OR 1.32; 95% CI 1.08-1.58)-were significantly associated with a higher social media exposure score. Lower emotional consequences and barriers to carry out prevention measures were also significantly associated with greater mass and social media exposure. Our findings on anxiety levels revealed that 38.1% (n=795; 95% CI 36.0-40.2) of respondents reported moderate-to-severe anxiety. A lower anxiety level was significantly associated with higher mass and social media exposure in the univariable analyses; however, the associations were not significant in the multivariable analyses.

Conclusions: In essence, both mass and social media are useful means of disseminating health messages and contribute to the betterment of psychobehavioral responses to COVID-19. Our findings stress the importance of the credibility of information shared through mass and social media outlets and viable strategies to counter misinformation during a pandemic.
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http://dx.doi.org/10.2196/19982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373377PMC
July 2020

Knowledge, Attitudes, Impact, and Anxiety Regarding COVID-19 Infection Among the Public in China.

Front Public Health 2020 27;8:236. Epub 2020 May 27.

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Sufficient knowledge and positive attitudes are crucial to the prevention of COVID-19. However, little is known about public awareness and attitudes regarding COVID-19 in China. The impact of COVID-19 on the societal well-being and anxiety levels of the public has never been documented. The aim of this study was to survey the knowledge, attitudes, impact, and anxiety levels of the people of China in relation to the COVID-19 outbreak. A cross-sectional population survey using an online questionnaire was undertaken between Jan 24 and Feb 24, 2020. The study participants were residents of mainland China over the age of 18 years. The attitude items in this study measured the perceived threat of COVID-19 based on the Health Belief Model. Anxiety was measured with the State-Trait Anxiety Inventory (STAI), a self-reported questionnaire that measure both state (STAI-S), and trait anxiety (STAI-T) A total of 2,446 completed responses were received. The mean and standard deviation (SD) for the total knowledge score was 20.3 ( ± 2.9) out of a possible score of 23. The social disruption and household economic impact were notable, particularly in provinces with higher cumulative confirmed cases. The majority of responses indicated a low perceived susceptibility of being infected (86.7% [95%CI 85.4-88.1]), with a fair proportion of respondents perceiving a higher severity (62.9% [95% CI 61.0-64.8]). The mean total impact score was 9.9 ( ± 3.8) out of a possible score of 15. The mean score for STAI-S was 48.7 ( ± 10.8), whereas the mean STAI-T score was 45.7 ( ± 8.5). By demographics, women reported significantly higher odds for higher levels of both STAI-S ( = 1.67) and STAI-T ( = 1.30) compared to men. People of a younger age were also more likely to experience higher STAI-S and STAI-T. Higher perceived susceptibility and severity and impact were strong predictors of higher levels of STAI-S and STAI-T. Our findings can assist in tailoring public communication to change people's knowledge and attitudes. The present study also underlined the importance of the promotion of mental health during infectious disease outbreaks to help in moderating the perceived threat, social and household economic impact, targeting the vulnerable segment of the population.
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http://dx.doi.org/10.3389/fpubh.2020.00236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266871PMC
January 2021

Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia.

J Headache Pain 2020 Jun 8;21(1):68. Epub 2020 Jun 8.

Novartis Corporation (Malaysia) Sdn. Bhd., Plaza 33, Petaling Jaya, Malaysia.

Background/objective: Productivity and monetary loss due to migraine in the workplace may be substantial. This study aimed to determine the impact of migraine on productivity and monetary lost among employees in the banking sectors, in a multiethnic middle income country.

Methods: A cross-sectional online survey was conducted among employees in two multinational banks in Malaysia between April and July 2019. Screening for migraine was conducted using the self-administered ID-Migraine™ questionnaire. Migraine-related disability (MIDAS) and headache frequency were recorded. Impact of migraine on work productivity and activities were evaluated using the Work Productivity and Activity Impairment (WPAI) questionnaire.

Results: Of the 1268 employees who submitted complete responses, 47.2% (n = 598) were screened positive for migraine. Strikingly, the mean percent productivity loss at work (presenteeism) was almost 20-fold higher than the mean percent work time missed due to migraine (absenteeism) (39.1% versus 1.9%). The mean percent productivity loss in regular activity (activity impairment) and overall work productivity loss (work impairment) was 38.4% and 39.9%, respectively. It was also found that the costs related to presenteeism (MYR 5392.6) (US$1296) was 3.5-fold higher than absenteeism (MYR1,548.3) (US$370). Highest monetary loss related to presenteeism was reported in migraineurs with frequency of headache of above 3 days (MYR 25,691.2) (US$6176), whereas highest monetary loss related to absenteeism was reported in migraineurs with MIDAS grade IV (MYR 12,369.1) (US$2973). Only 30% of migraineurs of MIDAS grade IV reported taking prescribed medication. Notably, a vast majority (96%) of migraineurs who had three or lower episodes of migraine per month did not seek treatment.

Conclusion: The significant impact of migraine on work productivity and regular activity, appears to lead to substantial monetary loss attributed to not only absenteeism, but more importantly to presenteeism. This study also highlights the unmet needs in migraine management among employees in the banking sector.
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http://dx.doi.org/10.1186/s10194-020-01144-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282083PMC
June 2020

Uncovering psychobehavioural implications of SARS-CoV-2 infection in Iran.

Transbound Emerg Dis 2020 Nov 10;67(6):2892-2900. Epub 2020 Jul 10.

Department of Medical Surgical Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

Iran is the country in Western Asia most impacted by the COVID-19 outbreak. A survey was conducted among the general public in Iran aimed at investigating psychobehavioural issues related to the COVID-19 outbreak, namely (a) barriers to preventive measures against SARS-CoV-2 infection; (b) negative emotions towards SARS-CoV-2 infection; and (c) anxiety levels among the general public in Iran. A cross-sectional, web-based survey using an online questionnaire was carried out between 16 March and 1 April 2020. The six-item version of the State-Trait Anxiety Inventory (STAI-6) was used to assess anxiety levels. A total of 1,789 complete responses were received. Nearly 60% reported having difficulty in wearing a face mask to protect against SARS-CoV-2 infection. The mean and standard deviation (SD) for the total prevention barrier score was 35.8 (SD ± 7.1; range 18-68) out of a possible score of 72. Male respondents [odds ratio (OR) = 1.25; 95% confidence interval (CI) 1.03-1.51] and respondents who perceived their health status as poor/fair (OR = 1.49; 95% CI 1.31-1.82) were predictors of high prevention barriers. Negative emotions such as fear (74.6%) followed by depression (43.4%) and stigma (23.0%) associated with SARS-CoV-2 infection were reported. Respondents who perceived their health as poor/fair (OR = 2.19; 95% CI 1.57-3.04) reported a higher likelihood of having higher negative emotions. Findings on anxiety level revealed 68.0% (95% CI 65.8-70.1) reported moderate to severe anxiety. Respondents who perceived their health as poor/fair (OR = 3.46; 95% CI 12.22-5.40) and who were females (OR = 1.91; 95% CI 1.55-2.36) were predictors of moderate to severe anxiety. In conclusion, psychobehavioural interventions are needed to facilitate management and control of the COVID-19 outbreak.
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http://dx.doi.org/10.1111/tbed.13662DOI Listing
November 2020

Self-perceived burden and its associations with health-related quality of life among urologic cancer patients.

Eur J Cancer Care (Engl) 2020 Jul 3;29(4):e13248. Epub 2020 Jun 3.

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Objective: This study examined the prevalence of self-perceived burden (SPB) and its association with health-related quality of life (HRQoL) among urologic cancer patients.

Methods: This was a prospective, cross-sectional study. A total of 429 respondents diagnosed with urologic cancers (prostate, bladder and renal cancer) from Sarawak General Hospital and Subang Jaya Medical Centre in Malaysia were interviewed by using a structured questionnaire. SPB and HRQoL were measured by the Self-perceived Burden Scale and the Functional Assessment of Cancer Therapy-General 7 Item Scale respectively.

Results And Conclusion: Self-perceived burden was experienced by 73.2% of the respondents. Respondents who had a lower education level, a monthly household income
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http://dx.doi.org/10.1111/ecc.13248DOI Listing
July 2020

The Association Between E-Cigarette Use Behaviors and Saliva Cotinine Concentration Among Healthy E-Cigarette Users in Malaysia.

J Addict Nurs 2020 Apr/Jun;31(2):102-109

Li Ping Wong, and Haridah Alias, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Li Ping Wong, Siti Norfitrah Mohd Salim, Nasrin Aghamohammadi, Victor Hoe Chee Wai, and Marzuki Isahak, Centre for Occupational and Environmental Health, Faculty of Medicine, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia. Mustafa Ali Mohd, Faculty of Medicine, Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia.

Electronic cigarettes (e-cigarettes) have rapidly increased in popularity within the last 2 years in Malaysia. The study aims to understand the association between e-cigarette use behaviors and salivary cotinine (a CYP2AA metabolite of nicotine) concentration to inform the development of future e-cigarette control policies. A convenience sample of saliva from 144 e-cigarette users was obtained between November and December 2015. The study participants used refill liquid containing between 0 and 12 mg/ml of nicotine. The overall median cotinine concentration of the study participants was 81.1 ng/ml (interquartile range = 8.5-195.8). Among the zero-nicotine and single e-cigarette users, the median cotinine level was 51.1 (interquartile range = 8.20-125.35) ng/ml. Factors significantly associated with a higher salivary cotinine concentration were dual use of e-cigarettes and tobacco cigarettes, regular and daily e-cigarette use, a longer duration of e-cigarette use, using a higher amount of e-liquid, and a shorter duration to finish a refill. Multivariate analysis revealed that e-cigarette use of 1-6 and 6-12 months (but not 1 month and below) was significantly associated with a higher cotinine concentration. Cotinine found in zero-nicotine e-liquids implies the importance of stringent regulatory governance for the consistency of labeled nicotine content of e-cigarette liquid in the market. Zero-nicotine e-cigarette users should also be informed of the likelihood of environmental exposure to tobacco smoke. Future studies conducted on larger samples are warranted to validate the association between duration of e-cigarette use and salivary cotinine concentration as well as to investigate underlying mechanisms.
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http://dx.doi.org/10.1097/JAN.0000000000000335DOI Listing
March 2021

Chinese mothers' intention to vaccinate daughters against human papillomavirus (HPV), and their vaccine preferences: a study in Fujian Province.

Hum Vaccin Immunother 2021 Jan 13;17(1):304-315. Epub 2020 May 13.

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia.

Little is known regarding Chinese mothers' intention to vaccinate their daughters against human papillomavirus (HPV) since the HPV vaccine was approved for use in China in 2016. The aim was to explore maternal HPV vaccination acceptance, preference for 2-, 4- or 9-valent HPV vaccine and acceptance of domestically manufactured HPV vaccines. Study participants were mothers of primary school children in Southeastern region of Fujian. An online cross-sectional survey was undertaken between June and August 2019. Among the total of 3,586 completed responses (response rate 28.5%), the intention to vaccinate daughter against HPV was high (83.3%). Higher maternal education and perceived benefit and barriers were associated with greater intention to vaccinate. Among mothers who did not intend to vaccinate their daughters, the three most common reasons were daughter being too young to receive HPV vaccination (40.6%), fear of side effects (31.9%) and vaccine price is too high (16.0%). The largest proportion (41.4%) preferred their daughter to be vaccinated with the 9-valent HPV vaccine (9vHPV). Greater preference for 9vHPVwas strongly associated with higher maternal education level and annual household income. The majority of mothers expressed a preference for imported HPV vaccine (56.3%). Our result indicates that lower intentions to vaccinate daughters against HPV among less educated and lower-income mothers may lead to significant social inequalities in HPV vaccine uptake in the country.
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http://dx.doi.org/10.1080/21645515.2020.1756152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872083PMC
January 2021

HPV vaccination intent and willingness to pay for 2-,4-, and 9-valent HPV vaccines: A study of adult women aged 27-45 years in China.

Vaccine 2020 03 29;38(14):3021-3030. Epub 2020 Feb 29.

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Electronic address:

Objective: This study aims to investigate acceptance and willingness to pay for HPV vaccination among adult women in China.

Methods: An online survey was sent to mothers aged 27-45 years of primary school pupils in the Fujian province, China. Participants completed questions about HPV related knowledge and health beliefs, intention to take the HPV vaccine and the willingness to pay for bivalent vaccine (2vHPV), quadrivalent vaccine (4vHPV), and 9-valent HPV vaccine (9vHPV).

Results: Of a total of 2339 complete responses, 58.3% reported intent to obtain HPV vaccine. Mothers who were younger in age, residing in urban, working in managerial or professional occupations, who knew someone with cervical cancer and who were able to make independent decisions about the HPV vaccine (vs. joint decision with spouse) were more likely to express intent to have HPV vaccination. Perceived barriers, cues to action and self-efficacy were three of the constructs in the health belief model that significantly influenced HPV vaccination intent. A higher proportion of participants expressed willingness to pay for 2vHPV (81.2%) and 4vHPV (75.9%), as compared to 9vHPV (67.7%).

Conclusion: Adults women expressed moderate intention to receive the HPV vaccine. Intervention to address barriers to uptake of the HPV vaccine among adult women in China is warranted.
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http://dx.doi.org/10.1016/j.vaccine.2020.02.042DOI Listing
March 2020

Human Papillomavirus (HPV) Vaccine Uptake and the Willingness to Receive the HPV Vaccination among Female College Students in China: A Multicenter Study.

Vaccines (Basel) 2020 Jan 16;8(1). Epub 2020 Jan 16.

Department of Epidemiology, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo 315200, China.

Background: This study aimed to determine human papillomavirus (HPV) vaccine uptake and willingness to receive HPV vaccination among female college students, in China, and its associated factors.

Methods: An online cross-sectional survey of female college students across the eastern, central, and western regions of China was undertaken between April and September 2019. Partial least squares structural equation modeling (PLS-SEM) was used to examine factors associated with the HPV vaccine uptake and willingness to receive the HPV vaccine.

Results: Among the total 4220 students who participated in this study, 11.0% reported having been vaccinated against HPV. There are direct effects of indicators of higher socioeconomic status, older age (β = 0.084 and p = 0.006), and geographical region (residing in Eastern China, β = 0.033, and p = 0.024) on HPV vaccine uptake. Higher knowledge (β = 0.062 and p < 0.000) and perceived susceptibility (β = 0.043 and p = 0.002) were also predictors of HPV vaccine uptake. Of those who had not received the HPV vaccine, 53.5% expressed a willingness to do so. Likewise, social economic status indicators were associated with the willingness to receive the HPV vaccine. Total knowledge score (β = 0.138 and < 0.001), both perceived susceptibility (β = 0.092 and < 0.001) and perceived benefit (β = 0.088 and < 0.001), and sexual experience (β = 0.041 and = 0.007) had a positive and significant direct effect on the willingness to receive the HPV vaccine, while perceived barriers (β = -0.071 and < 0.001) had a negative effect on the willingness to receive the HPV vaccine.

Conclusions: Geographical region and socioeconomic disparities in the HPV vaccination uptake rate and willingness to receive the HPV vaccine provide valuable information for public health planning that aims to improve vaccination rates in underserved areas in China. The influence of knowledge and perceptions of HPV vaccination suggests the importance of communication for HPV immunization.
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http://dx.doi.org/10.3390/vaccines8010031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157221PMC
January 2020

The study of seroprevalence of hepatitis E virus and an investigation into the lifestyle behaviours of the aborigines in Malaysia.

Zoonoses Public Health 2020 05 12;67(3):263-270. Epub 2020 Jan 12.

State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, China.

Malaysia is a non-endemic country for hepatitis E virus (HEV) infection. However, seroprevalence as high as 50% among samples of aboriginal people were reported over two decades ago. A total of 207 samples collected from seven aboriginal villages in rural settlements across two states in Malaysia were analysed for anti-HEV IgG and IgM by an enzyme-linked immunoassay. Following the detection of anti-HEV seroprevalence, we organized health outreach to inform and educate the community. Qualitative interviews were conducted with individuals tested positive for anti-HEV antibodies. Data derived from interviews and observations were used to investigate possible lifestyle behaviours associated with HEV infection. Anti-HEV IgG was detected in six samples (5.9%) from the village of Dusun Kubur. Qualitative inquiry and observation study revealed poor dietary and household hygiene, contaminated food and water, contact with animal faeces, unsanitary and domestic waste disposal, and wildlife reservoirs could be the contributing factors for transmission and acquisition of HEV infection. Investigation during health outreach is important to provide insights for future empirical research and implementation for improvement of lifestyle behaviours among the aborigines. Managing the risk of HEV infection in the aborigines may reduce the risk of HEV transmission to the local communities.
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http://dx.doi.org/10.1111/zph.12681DOI Listing
May 2020

Factors influencing intention to obtain the HPV vaccine and acceptability of 2-, 4- and 9-valent HPV vaccines: A study of undergraduate female health sciences students in Fujian, China.

Vaccine 2019 10 20;37(44):6714-6723. Epub 2019 Sep 20.

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Electronic address:

Background: Little research has been conducted on the intention to obtain HPV vaccine now that the vaccine is approved for use in China. Acceptance of the three HPV vaccines, which differ in valency and price, has never been investigated.

Methods: An online cross-sectional survey assessing female undergraduate students' intention to obtain the HPV vaccine and their acceptability of 2-, 4- and 9-valent HPV vaccines (2vHPV, 4vHPV, and 9vHPV, respectively).

Results: Of a total of 997 complete responses, 55.2% reported intent to obtain the HPV vaccine. Some of the significant factors exerting influence on intent to obtain HPV vaccination were high knowledge score (OR = 1.469, 95% CI:1.087-1.987), perceived high risk of HPV infection (OR = 1.466, 95%CI:1.017-2.114), perception of no serious side effects (OR = 1.562, 95%CI:1.150-2.121), and mass media exposure to HPV vaccination information (OR = 2.196, 95%CI: 1.625-2.966). Socioeconomic status indicators did not significantly influence intent to obtain the HPV vaccine. A higher proportion of respondents were willing to pay for 2vHPV (78.6%) and 4vHPV (68.0%) compared with 9vHPV (49.3%). Socioeconomic status indicators were the strongest correlates of acceptability for all the three vaccines. Exposure to mass media reporting about HPV vaccination is the factor which exerts the most influence on acceptance of 9vHPV after socioeconomic status indicators.

Conclusions: It is important to improve knowledge and health beliefs, and to establish a mass media marketing strategy to promote HPV vaccination in order to enhance HPV vaccine uptake. Undergraduate female students should be provided with detailed information about the different valency vaccine choices to help them make informed decisions about immunization.
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http://dx.doi.org/10.1016/j.vaccine.2019.09.026DOI Listing
October 2019

Financial toxicity and its associations with health-related quality of life among urologic cancer patients in an upper middle-income country.

Support Care Cancer 2020 Apr 10;28(4):1703-1715. Epub 2019 Jul 10.

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Purpose: This study examined the prevalence of financial toxicity (FT) and associated factors among urologic cancer patients. The association between FT and health-related quality of life (HRQoL) was also investigated.

Methods: A total of 429 respondents diagnosed with urologic cancers (prostate cancer, bladder and renal cancer) from Sarawak General Hospital and Subang Jaya Medical Centre in Malaysia were interviewed using a structured questionnaire. Objective and subjective FT were measured by catastrophic health expenditure (healthcare-cost-to-income ratio greater than 40%) and the Personal Financial Well-being Scale, respectively. HRQoL was measured with the Functional Assessment of Cancer Therapy - General 7 Items scale.

Results: Objective and subjective FT were experienced by 16.1 and 47.3% of the respondents, respectively. Respondents who sought treatment at a private hospital and had out-of-pocket health expenditures were more likely to experience objective FT, after adjustment for covariates. Respondents who were female and had a monthly household income less than MYR 5000 were more likely to experience average to high subjective FT. Greater objective FT (OR = 2.75, 95% CI 1.09-6.95) and subjective FT (OR = 4.68, 95% CI 2.63-8.30) were associated with poor HRQoL.

Conclusions: The significant association between both objective and subjective FT and HRQoL highlights the importance of reducing FT among urologic cancer patients. Subjective FT was found to have a greater negative impact on HRQoL.
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http://dx.doi.org/10.1007/s00520-019-04975-yDOI Listing
April 2020

A Qualitative Study of HIV "Test-and-Treat" Experience Among Men Who Have Sex With Men in Malaysia.

AIDS Educ Prev 2019 06;31(3):193-205

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

This study aimed to examine the barriers and facilitators to HIV testing and treatment among Malaysian MSM. Between June 2014 and December 2015, in-depth interviews were conducted in 20 HIV-positive MSM recruited from a teaching hospital and NGO in Kuala Lumpur. Thematic analysis was used to identify, analyze, and report themes. Most participants investigated their HIV status after long period of sickness. Others sought testing upon partner's diagnosis and some were diagnosed via blood donation. Barriers to testing include personal (perceived good health, fear of positive result, denial); social and structural factors (stigmatization by health providers and family, lack of information about free HIV testing and long wait time). Barriers to treatment comprise personal factors (perceived HIV as incurable and treatment as complicated), social factors (HIV and homosexual stigma), and cost. Promoting benefits of regular testing and early treatment is needed to improve HIV care continuum among MSM in Malaysia.
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http://dx.doi.org/10.1521/aeap.2019.31.3.193DOI Listing
June 2019

A Nationwide Study Comparing Knowledge and Beliefs about HPV among Female Students before and after HPV Vaccination.

J Pediatr Adolesc Gynecol 2019 Apr 3;32(2):158-164. Epub 2018 Nov 3.

Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana.

Study Objective: To assess the knowledge and beliefs regarding human papillomavirus (HPV) and the HPV vaccine among girls before and after vaccination in the Malaysian HPV Immunisation Programme.

Design: A nationwide longitudinal survey.

Setting: Thirty-two randomly selected schools from 13 states and 3 federal territories in Malaysia from February to March 2013, and October to November 2013.

Participants: Form One female students (13 years old).

Interventions: None.

Main Outcome Measures: Mean knowledge score of HPV infection.

Results: A total of 2644 students responded to the prevaccination survey, of whom 2005 (70%) completed the postvaccination survey. The mean knowledge score was 2.72 (SD ± 2.20) of a maximum score of 10 in the prevaccination survey, which increased significantly to 3.33 (SD ± 1.73) after the 3 doses of HPV vaccine (P = .001). Many answered incorrectly that, "Only girls can get HPV infection" (91.5%, n = 1841 prevaccination vs 96.1%, n = 1927 postvaccination), and only a few were aware that, "Vaccinating boys helps to protect girls against HPV infection" (11.4%, n = 229 for prevaccination vs 10.2%, n = 206 for postvaccination). The mean knowledge score was significantly higher postvaccination among higher-income families and those with parents of a higher occupational status. Regarding beliefs about the HPV vaccine, 89.4% in the prevaccination survey held the view that they would not get a HPV infection, and the percentage remained similar in the postvaccination survey. Perceived severity of HPV infection also remained low in the pre- and postintervention groups. Only 21.5% reported receiving health information about HPV along with the provision of the HPV vaccine; those who received health information showed higher levels of knowledge.

Conclusion: Findings revealed a general lack of knowledge and erroneous beliefs about HPV and the HPV vaccine even after receiving vaccination. This suggests that imparting accurate knowledge about HPV along with vaccine administration is essential. Specifically, girls from lower socioeconomic groups should be a target of educational intervention.
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http://dx.doi.org/10.1016/j.jpag.2018.10.010DOI Listing
April 2019

Community Needs Assessment in Relation to Urban Heat Effects: A Study in Greater Kuala Lumpur, Malaysia.

Biomed Environ Sci 2018 09;31(9):705-711

Department of Chemical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.

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http://dx.doi.org/10.3967/bes2018.095DOI Listing
September 2018

Physical, Psychological, and Social Health Impact of Temperature Rise Due to Urban Heat Island Phenomenon and Its Associated Factors.

Biomed Environ Sci 2018 Jul;31(7):545-550

Department of Chemical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.

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http://dx.doi.org/10.3967/bes2018.074DOI Listing
July 2018

Awareness, perception and barriers to seeking information from online academic databases and medical journals as sources of information.

Inform Health Soc Care 2018 Dec 16;43(4):335-347. Epub 2017 Oct 16.

b University of Malaya , Medical Education and Research Development Unit, Faculty of Medicine , Kuala Lumpur , Malaysia.

Medical students' use of online medical journals as a source of information is crucial in the learning pathway to become medical doctors. We conducted a cross-sectional survey study among University medical students between December 2012 and March 2013 to assess their awareness, perceived usefulness, practices, and barriers to seeking information from online academic databases and medical journals. The response rate was 67.53%. The majority of the students knew of the availability of online academic databases and medical journals. The mean score for awareness (4.25 of possible 11.0), perceived usefulness (13.95 of possible 33.0), and practice (10.67 of possible 33.0) were low. The mean barrier score toward using online academic databases and medical journals was 25.41 (of possible 45.0). Multivariate findings showed that significant barriers associated with overall usage of online databases and medical journals were 1) not knowing where or how to locate databases and 2) unsureness of using the Boolean operators. Availability of full text subscriptions was found to be an important factor in using online databases. Study findings highlighted the need to increase awareness of academic databases' availability and increase training on ways to search online academic databases and medical journals.
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http://dx.doi.org/10.1080/17538157.2017.1364248DOI Listing
December 2018

Attitudes towards Zika screening and vaccination acceptability among pregnant women in Malaysia.

Vaccine 2017 10 5;35(43):5912-5917. Epub 2017 Sep 5.

Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Tropical Infectious Diseases Research and Educational Centre (TIDREC), University of Malaya, 50603 Kuala Lumpur, Malaysia. Electronic address:

The aim of this study was to examine the willingness of pregnant women to have prenatal screening for the Zika virus (ZIKV). Secondly, the study also assessed the acceptability of a hypothetical Zika vaccination and its association with the health belief model (HBM) constructs. A cross-sectional study was conducted from 4th October to 11th November 2016, among pregnant women who attended antenatal care at the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. The majority (81.8%) was willing to be tested for ZIKV and 78% felt that their spouse would be willing to be tested for ZIKV. A total of 94% expressed a willingness to receive a Zika vaccination if available. The participants expressed high perceived benefits of a ZIKV vaccination. Although many have a high perception of the severity of ZIKV, the proportion with a strong perception of their susceptibility to ZIKV was low. In the multivariate analysis of all the HBM constructs, cue-to-action, namely physician recommendation (odds ratio [OR]=2.288; 95% confidence interval [CI] 1.093-4.793) and recommendation from friends or relatives (OR=4.030; 95% CI 1.694-9.587), were significantly associated with a willingness to be vaccinated against ZIKV. The favourable response to a Zika vaccination implies that more research attention has to be given to develop a vaccine against ZIKV. Should the vaccine be available in the future, publicity and healthcare providers would play a vital role in ensuring vaccine uptake among pregnant women.
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http://dx.doi.org/10.1016/j.vaccine.2017.08.074DOI Listing
October 2017