Publications by authors named "Li Ping Wong"

118 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

Virtual Group Exercises and Psychological Status among Community-Dwelling Older Adults during the COVID-19 Pandemic-A Feasibility Study.

Geriatrics (Basel) 2021 Mar 22;6(1). Epub 2021 Mar 22.

Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur 50603, Malaysia.

Social isolation, magnified by the restriction of movement order during the COVID-19 pandemic, may lead to negative psychosocial health impacts among community-dwelling older adults. We, therefore, aimed to evaluate recruitment rates, data collection, and group exercises conducted through virtual technology among individuals aged 60 years and over in Malaysia. Participants were recruited from the Promoting Independence in Seniors with Arthritis (PISA) pilot cohort through social media messaging. A four-week course of virtual group exercise was offered. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS) during the last attended follow-up of the cohort study (pre-pandemic), pre-intervention, and post-intervention. Exercise adherence was recorded using diaries with daily entries and attendance to the virtual group exercise sessions were also captured electronically daily. The outcomes of interest were changes in anxiety and depression scores from baseline to pre-intervention (pandemic-related) and post-intervention (virtual exercise related). Forty-three individuals were recruited. A significant increase in anxiety scores from baseline to pre-intervention was observed. Comparisons using repeated-measures analysis of variance between those who attendance ≥14 and <14 group exercise sessions revealed no between-within subject differences in depression scores. There was a 23% dropout rate in the post intervention survey and 60.5% of diaries were returned. Virtual group exercises could be conducted among older adults residing in a middle-income country, though recruitment would have been limited to those with internet access.
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http://dx.doi.org/10.3390/geriatrics6010031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005958PMC
March 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

Insights on emotional distress following cancer, sources of support and the unmet needs in a setting with limited supportive care services for people living with cancer.

Support Care Cancer 2021 Mar 19. Epub 2021 Mar 19.

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

Introduction: Delivery of supportive cancer care is often deemed a low priority in resource-limited settings. We aimed to explore the sources of emotional distress, the related support and the unmet needs of cancer survivors in Malaysia, where cancer survivorship services are presently limited.

Method: Twenty focus group discussions were conducted with 102 cancer patients from diverse ethnic and socioeconomic backgrounds. Thematic analyses were performed.

Results: Patient narratives suggested that emotional distress arose from direct and indirect stressors. Direct stressors comprised physical and cognitive side effects of cancer surgery and therapies, and fear of recurrence. Indirect stressors included worry over dependent family members, financial distress following cancer, working with cancer and lack of practical support at home. Distress from altered physical appearances, fear of recurrence and lack of practical support were mainly raised by women, implying that men and women may have disproportionate emotional needs. Emotional support largely came from informal sources including self, family, friends and religion. While formal emotional support from professional counsellors and cancer support groups was acknowledged as important, it appeared to be largely lacking. Unmet needs in coping with fear of recurrence, financial distress, workplace discrimination and household chores were particularly highlighted.

Conclusion: The unmet needs revealed in this study provide insights to initiate actionable changes to improve the emotional wellbeing of people living with cancer in settings where cancer survivorship services are still in its infancy.
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http://dx.doi.org/10.1007/s00520-021-06148-2DOI Listing
March 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

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

Meta-synthesis of Qualitative Research of Pre-exposure Prophylaxis (PrEP) Adherence Among Men Who Have Sex With Men (MSM).

AIDS Educ Prev 2020 10;32(5):416-431

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

The aim of the study was to consolidate evidence on barriers and facilitators to PrEP adherence among men who have sex with men. PubMed, Science Direct, and EBSCO host were utilized to search for relevant articles. Six articles from PubMed, published between 2010 and 2018, were reviewed. Thematic analysis was employed to synthesize findings. At the individual level, HIV susceptibility, knowledge of PrEP, and individual lifestyle affected PrEP adherence. At the organizational level, cost of PrEP and quality of PrEP services influenced adherence to PrEP. At the societal level, social stigma, financial assistance or medical insurance, and family and peer support were determinants of PrEP adherence. Facilitators included perceived high risk of HIV infection and payment assistance, while barriers included social stigma and high cost of PrEP. Social stigma and structural level factors such as payment assistance and cost of PrEP need to be examined to ensure optimal adherence to PrEP.
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http://dx.doi.org/10.1521/aeap.2020.32.5.416DOI Listing
October 2020

Working after cancer: in-depth perspectives from a setting with limited employment protection policies.

J Cancer Surviv 2020 Oct 22. Epub 2020 Oct 22.

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

Purpose: A considerable proportion of individuals who are diagnosed with cancer are at a working age. We aimed to gain an in-depth understanding of the challenges, and arising needs related to working after cancer in a setting with limited employment protection policies.

Methods: Focus group discussions were conducted with cancer patients who were diagnosed at least 1 year prior to recruitment, and either had paid work, were self-employed, currently unemployed, or currently retired (N = 66).

Results: Three main themes were identified: (1) loss of income: While some participants were entitled for a 1-year cancer-specific sick leave, many other participants recounted having insufficient paid sick leave, forcing them to take prolonged unpaid leave to complete treatment; (2) dealing with side effects of cancer and its treatment: The need for workplace accommodations was highlighted including flexible working hours, lighter workloads, and dedicated rest areas to enable patients to cope better; (3) Discrimination and stigma at workplace: Some participants mentioned being passed over on a promotion, getting demoted, or being forced to resign once their cancer diagnosis was disclosed, highlighting an urgent need to destigmatize cancer in the workplace.

Conclusion: In settings with limited employment protection policies, a cancer diagnosis severely impacts the working experiences of patients, leading to financial loss. Urgent interventions and legislative reforms are needed in these settings to address the unmet employment needs of cancer survivors.

Implications For Cancer Survivors: This study may facilitate planning of local solutions to fulfill the unmet employment needs following cancer, such as return-to-work navigation services.
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http://dx.doi.org/10.1007/s11764-020-00962-zDOI Listing
October 2020

Breaking News of Cancer Diagnosis: A Qualitative Study on the Experiences and Emotional Needs of Patients With Cancer in a Multiethnic Asian Setting.

JCO Oncol Pract 2021 Apr 28;17(4):e548-e555. Epub 2020 Sep 28.

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

Purpose: The breaking of news of a cancer diagnosis is an important milestone in a patient's cancer journey. We explored the emotional experiences of patients with cancer during the breaking of news of a cancer diagnosis and the arising needs in a multiethnic Asian setting with limited supportive cancer care services.

Methods: Twenty focus group discussions were conducted with 102 Asian patients with cancer from diverse sociodemographic backgrounds. Thematic analysis was performed.

Results: While most participants, especially younger patients with young children, experienced intense emotional distress upon receiving a cancer diagnosis, those with a family history of cancer were relatively calm and resigned. Nonetheless, the prior negative experience with cancer in the family made affected participants with a family history less eager to seek cancer treatment and less hopeful for a cure. Although a majority viewed the presence of family members during the breaking of bad news as important, a minority opted to face it alone to lessen the emotional impact on their family members. Difficulties disclosing the news of a cancer diagnosis to loved ones also emerged as an important need. Sensitive and empathetic patient-physician communication during the breaking of news of a cancer diagnosis was stressed as paramount.

Conclusion: A patient-centered communication approach needs to be developed to reduce the emotional distress to patients and their families after the breaking of bad news of a cancer diagnosis. This is expected to positively affect the patients' subsequent coping skills and attitudes toward cancer, which may improve adherence to cancer therapy.
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http://dx.doi.org/10.1200/JOP.20.00002DOI Listing
April 2021

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

Comparing a Social and Communication App, Telephone Intervention, and Usual Care for Diabetes Self-Management: 3-Arm Quasiexperimental Evaluation Study.

JMIR Mhealth Uhealth 2020 06 2;8(6):e14024. Epub 2020 Jun 2.

Faculty of Public Health, Mahidol University, Bangkok, Thailand.

Background: Many technology-assisted innovations have been used to manage disease. However, most of these innovations are not broadly used by older adults due to their cost. Additionally, disease management through technology-assisted innovations has not been compared with other interventions.

Objective: In this study, we tested the employment of a free and widely used social and communication app to help older adults with diabetes manage their distress and glycemic control. We also compared the effectiveness of the app with 2 other methods, namely telephone and conventional health education, and determined which subgroup experiences the most effects within each intervention.

Methods: Adults aged ≥50 years with type 2 diabetes were recruited from Southern Taiwan (N=231) and were allocated to different 3-month interventions. Informed consent was obtained at the Ministry of Science and Technology and approved by the National Cheng Kung University Hospital Institutional Review Board (No. A-ER-102-425).

Results: Participants in the mobile-based group had significant reductions in hemoglobin A1c compared with the telephone-based and usual care groups (mean changes of -0.4%, 0.1%, and 0.03%, respectively; P=.02). Diabetes-specific distress decreased to a greater extent in the mobile-based group compared to the other 2 groups (mean changes of -5.16, -3.49, and -2.44, respectively, P=.02). Subgroup analyses further revealed that the effects on reducing blood glucose levels in the social and communication app groups were especially evident in patients with lower distress scores, and diabetes-related distress was especially evident in participants who were younger than 60 years or had higher educational levels.

Conclusions: The findings of this study inform more flexible use of social and communication apps with in-person diabetes education and counselling.
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http://dx.doi.org/10.2196/14024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298636PMC
June 2020

Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia.

Hum Vaccin Immunother 2020 07 19;16(7):1611-1622. Epub 2020 May 19.

Department of Pediatrics, School of Medicine, Indiana University , Indianapolis, IN, U.S.

HPV vaccine hesitancy in Asia is unique compared to Western countries due to multidimensional social-cultural norms that influence beliefs regarding vaccination. Reviews on HPV vaccine hesitancy in Asia lack of in-depth discussion regarding the traditional and social-cultural norms dimensions. This paper puts forward opinions in which culture, normative beliefs, and religion influence HPV vaccine hesitancy in Asian countries. Issues surrounding HPV hesitancy among parents, young adult women, adult women, men and the sexual and gender minority people in Asian countries were highlighted. The shortage of HPV vaccine supply would soon be reduced as some Asian countries are on the way to producing the HPV vaccine which production is currently dominated by Western European countries. The culture of favoring imported Western products among many in Asia and in addition to long-existing fake vaccine crisis pose a challenge for the newly emerging HPV vaccine produced in Asia. Some recommendations, research gaps, and future research needs were discussed.
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http://dx.doi.org/10.1080/21645515.2020.1756670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482900PMC
July 2020

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

Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study.

PLoS One 2020 22;15(4):e0231986. Epub 2020 Apr 22.

Sector of TB/Leprosy, Disease Control Division, Ministry of Health Malaysia, Federal Government Administration Centre, Putrajaya, Malaysia.

Introduction: The monitoring of tuberculosis (TB) treatment outcomes and examination of the factors affecting these outcomes are important for evaluation and feedback of the national TB control program. This study aims to assess the TB treatment outcomes among patients registered in the national TB surveillance database in Malaysia from 2014 until 2017 and identify factors associated with unsuccessful treatment outcomes and all-cause mortality.

Materials And Methods: Using registry-based secondary data, a retrospective cohort study was conducted. TB patients' sociodemographic characteristics, clinical disease data and treatment outcomes at one-year surveillance were extracted from the database and analyzed. Logistic regression analysis was used to determine factors associated with unsuccessful treatment outcomes and all-cause mortality.

Results: A total of 97,505 TB cases (64.3% males) were included in this study. TB treatment success (cases categorized as cured and completed treatment) was observed in 80.7% of the patients. Among the 19.3% patients with unsuccessful treatment outcomes, 10.2% died, 5.3% were lost to follow-up, 3.6% had outcomes not evaluated while the remaining failed treatment. Unsuccessful TB treatment outcomes were found to be associated with older age, males, foreign nationality, urban dwellers, lower education levels, passive detection of TB cases, absence of bacille Calmette-Guerin (BCG) scar, underlying diabetes mellitus, smoking, extrapulmonary TB, history of previous TB treatment, advanced chest radiography findings and human immunodeficiency virus (HIV) infection. Factors found associated with all-cause mortality were similar except for nationality (higher among Malaysians) and place of residence (higher among rural dwellers), while smoking and history of previous TB treatment were not found to be associated with all-cause mortality.

Conclusions: This study identified various sociodemographic characteristics and TB disease-related variables which were associated with unsuccessful TB treatment outcomes and mortality; these can be used to guide measures for risk assessment and stratification of TB patients in future.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231986PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176104PMC
July 2020

Quantitative Microbial Risk Assessment of Drinking Water Quality to Predict the Risk of Waterborne Diseases in Primary-School Children.

Int J Environ Res Public Health 2020 04 17;17(8). Epub 2020 Apr 17.

School of Community Health Sciences, University of Nevada, Reno, NV 89557, USA.

Primary-school children in low- and middle-income countries are often deprived of microbiologically safe water and sanitation, often resulting in a high prevalence of gastrointestinal diseases and poor school performance. We used Quantitative Microbial Risk Assessment (QMRA) to predict the probability of infection in schoolchildren due to consumption of unsafe school water. A multistage random-sampling technique was used to randomly select 425 primary schools from ten districts of Sindh, Pakistan, to produce a representative sample of the province. We characterized water supplies in selected schools. Microbiological testing of water resulted in inputs for the QMRA model, to estimate the risks of infections to schoolchildren. Groundwater (62%) and surface water (38%) were identified as two major sources of drinking water in the selected schools, presenting varying degrees of health risks. Around half of the drinking-water samples were contaminated with (49%), spp. (63%), spp. (53%), and (49%). Southern Sindh was found to have the highest risk of infection and illness from and . Central and Northern Sindh had a comparatively lower risk of waterborne diseases. Schoolchildren of Karachi were estimated to have the highest probability of illness per year, due to (70%) and (22.6%). Pearson correlation was run to assess the relationship between selected pathogens. was correlated with spp., , , and spp. Overall, the risk of illness due to the bacterial infection ( spp., , , and ) was high. There is a dire need for management plans in the schools of Sindh, to halt the progression of waterborne diseases in school-going children.
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http://dx.doi.org/10.3390/ijerph17082774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215448PMC
April 2020

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

A qualitative study to explore farmworkers' knowledge, beliefs and preventive practices toward ticks and tick-borne diseases.

J Infect Dev Ctries 2019 12 31;13(12):1117-1126. Epub 2019 Dec 31.

Department of Veterinary Services, Ministry of Agriculture and Agro-Based Industry Malaysia, Federal Government Administrative Centre, 62630 Putrajaya, Malaysia.

Introduction: Farmworkers are considered a high-risk group for tick-borne diseases (TBDs). This qualitative study aimed to gain an in-depth understanding of the farmworkers' experience, knowledge, health beliefs, information needs, and preventive practices of tick bites and TBDs.

Methodology: A total of nine focus group discussions with 56 farmworkers across eight animal farms in Peninsular Malaysia were conducted between August and October 2013.

Results: Farmworkers explained their experience of tick bites, but no one reported TBDs. Many farmworkers indicated that they did not seek any medical treatment. There was a misconception that ticks are solely pathogenic to farm animals. Farmworkers perceived low severity and susceptibility of tick bites, and low self-efficacy of tick bite prevention, however, a group also perceived susceptibility to getting tick bites due to the characteristics of their job. Barriers for prevention were related to the perception and knowledge towards ticks. Farmworkers requested information about TBDs.

Conclusions: This study of farmworkers identified gaps in the knowledge of TBDs, barriers of the tick bite preventive measures and information needs. These findings suggest a need for education programs to improve the knowledge of ticks and TBDs, change health beliefs and address the barriers of tick bite preventive measures.
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http://dx.doi.org/10.3855/jidc.11668DOI Listing
December 2019

Seroprevalence of Borrelia burgdorferi among the indigenous people (Orang Asli) of Peninsular Malaysia.

J Infect Dev Ctries 2019 05 31;13(5):449-454. Epub 2019 May 31.

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

Introduction: Lyme disease has been well-described in the North America and European countries. However, information is still very limited in the developing countries including Malaysia. The Orang Asli (OA), the indigenous people of Peninsular Malaysia reside mostly in the forest and forest fringe areas abundant with the vector for Lyme disease. Here, we described the seroprevalence of Borellia burgdorferi (B. burgdorferi) among the OA and demographic variables that could be associated with seroprevalence.

Methodology: A total of 16 OA villages distributed across 8 states in Peninsular Malaysia participated in this study. Sera obtained from 904 OA volunteers were screened for anti-B. burgdorferi IgG antibodies. ELISA results obtained and demographic information collected were analysed to identify possible variables associated with seroprevalence.

Results: A total of 73 (8.1%) OA tested positive for anti-B. burgdorferi IgG antibodies. Among all the variables examined, village of residence (p = 0.045) was the only significant predictor for seropositivity. High (> 10.0%) prevalence was associated with three OA villages. Those living in one particular village were 1.65 times more likely to be seropositive as compared to other OA villages. Age, gender, marital status, household size, level of education, monthly household income and occupation were not significant predictors for seropositivity.

Conclusion: Results of the present study support earlier findings that B. burgdorferi infection among Malaysians is currently under-recognized. Further studies will be needed at these locations to confirm the presence of Lyme disease among these populations.
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http://dx.doi.org/10.3855/jidc.11001DOI Listing
May 2019