Master of Science in Medical Statistics Programme at Universiti Sains Malaysia: 20 Years Ongoing.

Health and medical research are important parts of the curriculum of medical and health programmes in universities and play an important role in the functioning of organisations related to health care. There is a shortage of well-trained health and medical research statisticians. This article describes the courses and structure of the Master of Science in Medical Statistics programme at Universiti Sains Malaysia (USM), as well as the graduates' achievements. It is a 2-year programme that prepares qualified and competent graduates in statistical methods and data analysis for research in health and medical sciences. The Biostatistics and Research Methodology Unit, School of Medical Sciences, USM has been running the programme since 2003. It is currently the only medical statistics programme available in Malaysia. There have been 97 graduates since 2005, with an employment rate of 96.7% and a successful subsequent doctorate rate of 21.1%. Most of the students returned to their previous employments, mainly with the Ministry of Health of Malaysia and several others became lecturers, statisticians or research officers. The employability of graduates from this programme is very high and their professional future is bright. We hope our graduates will impart their knowledge and skills to the nation.

Knowledge, Awareness, Attitude and Preventive Behaviour on the Transmission of the Pandemic Novel Coronavirus Among Malaysians.

BACKGROUND: Restricted movement and preventive actions have been introduced to break the chain of transmission of a new coronavirus. This study was conducted to determine the level of knowledge, awareness, attitude and preventive behaviour regarding the transmission of the COVID-19. METHODS: A cross-sectional study was conducted among Malaysians aged 20 years old and over, who had accessed the internet and used the WhatsApp application. The sampling method was a convenient snowball from 14 Malaysian states. This study was conducted online using questionnaires during the Movement Control Order due to the pandemic. RESULTS: Approximately 40.0%, 46.1% and 47.4% of 1,290 participants had a score above the median (good score) for preventive behaviour, attitude and knowledge, respectively. Age was significantly associated with poor knowledge (adjusted odds ratio [AOR] 0.98; 95% confidence interval [CI]: 0.97, 0.99; P = 0.026). Males (AOR 1.35; 95% CI: 1.05, 1.74; P = 0.021), Malays (AOR 1.41; 95% CI: 1.01, 1.98; P = 0.043) and Chinese (AOR 2.19; 95% CI: 1.17, 4.13; P = 0.015) were the associated factors for poor attitude. Chinese ethnicity was significantly associated with poor preventive behaviour (AOR 2.80; 95% CI: 1.39, 5.61; P = 0.004). CONCLUSION: The level of knowledge, attitude and practices were high except for a few questions. The young, males and Malay and Chinese individuals need health education.

MR Volumetry of Hippocampus in Normal Adult Malay of Age 50 Years Old and Above.

BACKGROUND: Hippocampal volume is affected by several psychiatric illnesses of old age, as well as by normal aging. It is important to have a normal data in a population to assist in diagnosis. The aim of this study is to determine hippocampal volume in normal Malay people aged 50 years old and older. METHODS: This was a cross-sectional study of the normal Malay population aged 50 to 77 years. We included 43 participants, representing 19 men and 24 women. Magnetic resonance imaging (MRI) was performed using a GE Signa Horizon LX 1.0 Tesla. Oblique coronal images of temporal lobes were obtained and hippocampal volumetry was done manually and normalised with intracranial volume. RESULTS: Mean right and left hippocampal volumes (HCVs) were 3.43 cm³ (SD 0.32) and 3.26 cm³ (SD 0.34), with a significant difference between them (P < 0.001). Total mean HCVs exhibited no significant difference between men and women (P = 0.234). The means of the normalised right and left HCVs were 3.42 cm³ (SD 0.31) and 3.26 cm³ (SD 0.32). CONCLUSION: The mean right and left hippocampal volumes were significantly different in this study. Men had slightly larger mean HCVs but the difference was not statistically significant. It was found that normalisation further reduces the mean volume difference between the genders.

Depressive, Anxiety, and Stress Symptoms in Parents of Children Being Admitted for Febrile Seizures in a Tertiary Hospital in the East Coast of Malaysia.

Febrile seizures in children are an alarming experience for parents. This study aimed to assess the psychological functioning of parents of children when they were being admitted for treatment of febrile seizures in the hospital, the importance of which is clear, since parents are the primary custodian of their children. This is a cross-sectional study conducted on 110 participants whose child had been admitted for a febrile seizure to Hospital Universiti Sains Malaysia from September 2020 until June 2021. The depression, anxiety, and stress levels were determined based on a validated Bahasa Melayu questionnaire of the Depression Anxiety Stress Scale (DASS-21). In addition, multiple logistic regression was used to determine the associated factors related to the participants' psychological functioning. The mean age of children with febrile seizures were 21 months old, and most children showed features of simple febrile seizures (71.8%). The prevalence of anxiety, stress, and depression were 58.2%, 29%, and 23.6%, respectively. Using multiple logistic regression, child age, family history of febrile seizures, family history of epilepsy, and length of stay in the ward were found to be significantly associated with anxiety when adjusted for other variables. Otherwise, for depression and stress, no significant associated variables were found when adjusted for other variables. Anxiety was highly reported by participants when their children were admitted for febrile seizures. Several factors impacted their anxiety, including the lower the child's age was, participants with no family history of febrile seizures before, and the longer duration of hospital stay. Therefore, further study and intervention on reducing the parent's anxiety could be emphasized in the future.

Predictors of Mental Health Literacy among Parents, Guardians, and Teachers of Adolescents in West Malaysia.

Parents, guardians, and teachers are the informal sources of mental health support that adolescents rely on. Nevertheless, limited mental health knowledge limits their ability and confidence in providing appropriate assistance. This study aims to (1) evaluate the relationship between the roles of parents/guardians and teachers and their responses to discover the common misconceptions on mental health among those providing informal support to adolescents and (2) determine which demographic factors would act as the strongest predictor influencing their mental health literacy (MHL) status. The cross-sectional study recruited 867 parents, guardians, and teachers of adolescents from 24 government secondary schools' parent-teacher associations via multistage stratified random sampling. Parents, guardians, and teachers' MHL were evaluated using the Mental Health Knowledge Schedule-Malay Version (MAKS-M). The collected data were analyzed using Pearson's Chi-squared test to investigate the association between the respondents' roles and responses. Multiple Regression analysis was used to determine the predictors of MHL. The score of MAKS-M for the current study sample is 73.03% (M = 43.82, SD = 4.07). Most respondents responded incorrectly on Items 1 (employment), 6 (help-seeking), 8 (stress), and 12 (grief). Teachers provided more favorable responses on several items than parents and guardians. Finally, younger age, higher income, knowing someone with mental disorders, and having experience of attending formal training on mental health first aid were the significant predictors of MHL. MHL interventions in Malaysia should cater to older adults of lower socioeconomic status and lesser experience in mental health, specifically highlighting the stigmas on mental health help-seeking behaviors, treatment, and employment concerns, plus the recognition of various mental health diagnoses.

Factors Associated with Attitudes towards Rejecting Intimate Partner Violence among Young Adults in Malaysia.

Intimate partner violence (IPV) is a serious public health issue, which is health threatening across all age groups, including young adults, and makes them and vulnerable. The rejection of IPV and willingness to disclose IPV as part of the solution are important as they correlate to this concealed violent behavior. This study aimed to investigate determinants of attitudes towards rejecting IPV among young adults. A cross-sectional study was carried out on 405 young adults attending premarital courses who were selected using purposive sampling. A validated questionnaire (MYPAIPVQ) was used as the study instrument. Logistic regression analyses were performed to test for associations between sociodemographic characteristics and relationship status with attitudes towards IPV. Attitudes towards rejecting IPV included not accepting IPV and have the willing to disclose it. About half of the premarital young adults (50.4%) had attitudes towards rejecting IPV. In the regression analysis, age (AdjOR 1.12), female (AdjOR 2.49), self-employed (AdjOR 0.20), and drama as sources of information (AdjOR 3.66) were significantly associated with attitudes towards rejecting IPV. The findings have potentially important implications for interventions aimed at preventing violence among the young adult population as they are vulnerable to being involved in IPV in the future.

Factors Influencing Visual Improvement after Phacoemulsification Surgery among Malaysian Cataract Patients.

Blindness and visual impairment are part of the global burden of eye disease, with cataract being one of the leading causes of blindness. This study aimed to determine the factors affecting visual acuity (VA) improvement among cataract patients after phacoemulsification surgery in Malaysia. Cataract patients aged over 18 who underwent phacoemulsification surgery between January 2014 and December 2018 were included in this retrospective cohort study. Patients' sociodemographic, comorbidities, surgical, and related complication factors were extracted from the National Eye Database. The outcome was measured by the difference in visual acuity before and after the operation and was categorized as "improved", "no change", and "worse". A total of 180,776 patients were included in the final analysis. Multinomial logistic regression analysis showed "no changes in VA" was significantly higher in patients aged less than 40 years old (OR: 1.66; 95% CI: 1.22, 2.26), patients with ocular comorbidities (OR: 1.65; 95% CI: 1.53, 1.77), patients who had undergone surgery lasting more than 60 min (OR: 1.39; 95% CI: 1.14, 1.69), patients who had surgery without an intraocular lens (IOL) (OR: 1.64; 95% CI: 1.20, 2.26), and patients with postoperative complications (OR: 8.76; 95% CI: 8.13, 9.45). Worsening VA was significantly higher among male patients (OR: 1.11; 95% CI: 1.01, 1.22), patients who had ocular comorbidities (OR: 1.76; 95% CI: 1.59, 1.96), patients who had undergone surgery lasting more than 60 min (OR: 1.94; 95% CI: 1.57, 2.41), patients who had surgery without an IOL (OR: 2.03; 95% CI: 1.48, 2.80), and patients with postoperative complications (OR: 21.46; 95% CI: 19.35, 23.80). The factors impacting "no changes" in and "worsening" of VA after cataract surgery were the following: older age, male gender, ethnicity, ocular comorbidities, surgeon grade, absence of IOL, intraoperative complication, and postoperative problems.

Lower Formalin-Induced Pain Responses in Painless Diabetic Neuropathy Rat Correlate with the Reduced Spinal Cord NR2B Subunit of N-Methyl-D-Aspartate Receptor Activation.

Diabetic neuropathy (DN) is a late complication of diabetic mellitus and may rise into painful and painless variants. Limited studies have looked at nociceptive mechanisms of painless DN variant. The study aimed to determine phosphorylation and total NR2B subunit of N-methyl-D-aspartate receptor in the spinal cord of painless DN rat during early phase following formalin injection. Thirty-six Sprague-Dawley male rats were randomly assigned into three groups: control, painful, and painless DN (n = 12). The rats were developed into the early phase of DN for 2 weeks following diabetic induction. Two weeks later, the rats were injected with 5% formalin solution and flinching and licking responses were recorded for 60 min. The rats were sacrificed 3 days later, and the spinal cord enlargement region was collected. Immunohistochemistry and Western blot procedures were conducted to determine the phosphorylated and total NR2B subunit expressions. The results showed reduced flinching and licking responses in painless DN rats compared to control and painful DN groups, followed by a significant reduction in phosphorylated and total NR2B expression at both ipsilateral and contralateral regions of the spinal cord. In conclusion, reduced pain behavior responses in painless DN rats following formalin injection is possibly contributed by the reduced expression of phosphorylated and total NR2B subunit in the spinal cord.

The Malay Literacy of Suicide Scale: A Rasch Model Validation and Its Correlation with Mental Health Literacy among Malaysian Parents, Caregivers and Teachers.

The 27-item Literacy of Suicide Scale (LOSS) is a test designed to measure the respondent's suicide knowledge. The purpose of this study is to examine the psychometric properties of the Malay-translated version of the LOSS (M-LOSS) and its association to sociodemographic factors and mental health literacy. The 27-item LOSS was forward-backward translated into Malay, and the content and face validities were assessed. The version was distributed to 750 respondents across West Malaysia. Rasch model analysis was then conducted to assess the scale's psychometric properties. The validated M-LOSS and the Malay version of the Mental Health Knowledge Schedule (MAKS-M) were then distributed to 867 respondents to evaluate their level of suicide literacy, mental health literacy, and their correlation. Upon Rasch analysis, 26 items were retained. The scale was found to be unidimensional, with generally satisfying separation and reliability indexes. Sex, socio-economic status, and experience in mental health were found to significantly impact the mean score for mental health literacy. This study also found a significant mean difference for suicide literacy across school types. Furthermore, while this study observed a weak but significant negative correlation between age and suicide literacy, no correlation was found between mental health and suicide literacy.

Spatial Variation of Survival for Colorectal Cancer in Malaysia.

A patient's survival may depend on several known and unknown factors and it may also vary spatially across a region. Socioeconomic status, accessibility to healthcare and other environmental factors are likely to contribute to survival rates. The aim of the study was to model the spatial variation in survival for colorectal cancer patients in Malaysia, accounting for individual and socioeconomic risk factors. We conducted a retrospective study of 4412 colorectal cancer (ICD-10, C18-C20) patients diagnosed from 2008 to 2013 to model survival in CRC patients. We used the data recorded in the database of the Malaysian National Cancer Patient Registry-Colorectal Cancer (NCPR-CRC). Spatial location was assigned based on the patients' central district location, which involves 144 administrative districts of Malaysia. We fitted a parametric proportional hazards model in which the spatially correlated frailties were modelled by a log-Gaussian stochastic process to analyse the spatially referenced survival data, which is also known as a spatial survival model. After controlling for individual and area level characteristics, our findings indicate wide spatial variation in colorectal cancer survival across Malaysia. Better healthcare provision and higher socioeconomic index in the districts where patients live decreased the risk of death from colorectal cancer, but these associations were not statistically significant. Reliable measurement of environmental factors is needed to provide good insight into the effects of potential risk factors for the disease. For example, a better metric is needed to measure socioeconomic status and accessibility to healthcare in the country. The findings provide new information that might be of use to the Ministry of Health in identifying populations with an increased risk of poor survival, and for planning and providing cancer control services.

Minocycline alleviates nociceptive response through modulating the expression of NR2B subunit of NMDA receptor in spinal cord of rat model of painful diabetic neuropathy.

BACKGROUND: It has been reported that neuropathic pain can be overcome by targeting the NR2B subunit of N-methyl-D-aspartate receptors (NR2B). This study aimed to investigate the effects of minocycline on phosphorylated and total expression of NR2B in the spinal cord of rats with diabetic neuropathic pain. METHODS: A total of 32 Sprague-Dawley male rats were randomly assigned into four groups (n = 8); control healthy, control diabetic (PDN), and PDN rats that received 80 µg or 160 µg intrathecal minocycline respectively. The rats were induced to develop diabetes and allowed to develop into the early phase of PDN for two weeks. Hot-plate and formalin tests were conducted. Intrathecal treatment of minocycline or normal saline was conducted for 7 days. The rats were sacrificed to obtain the lumbar enlargement region of the spinal cord (L4-L5) for immunohistochemistry and western blot analyses to determine the expression of phosphorylated (pNR2B) and total NR2B (NR2B). RESULTS: PDN rats showed enhanced flinching (phase 1: p < 0.001, early phase 2: p < 0.001, and late phase 2: p < 0.05) and licking responses (phase 1: p < 0.001 and early phase 2: p < 0.05). PDN rats were also associated with higher spinal expressions of pNR2B and NR2B (p < 0.001) but no significant effect on thermal hyperalgesia. Minocycline inhibited formalin-induced flinching and licking responses (phase 1: p < 0.001, early phase 2: p < 0.001, and late phase 2: p < 0.05) in PDN rats with lowered spinal expressions of pNR2B (p < 0.01) and NR2B (p < 0.001) in a dose-dependent manner. CONCLUSION: Minocycline alleviates nociceptive responses in PDN rats, possibly via suppression of NR2B activation. Therefore, minocycline could be one of the potential therapeutic antinociceptive drugs for the management of neuropathic pain.

Development and validation of a new questionnaire to measure mistreatment of women during childbirth, satisfaction of care, and perceived quality of care.

OBJECTIVE: This study aims to develop and validate a new questionnaire to measure mistreatment of women during childbirth and its association with satisfaction and perceived quality of care among women in West Bank, Palestine. RESEARCH DESIGN /SETTING: A cross-sectional validation study was conducted in middle and south of West Bank from February 2019 to June 2020. Two-hundred postpartum women were given self-administered and online questionnaire. Content and face validity were assessed. The "satisfaction of care" and "perceived quality of care" domains were analyzed using exploratory factor analysis, while items in "experience of mistreatment" domain were evaluated descriptively. Cronbach's alpha was used to assess the reliability of the questionnaire items. FINDINGS: The new questionnaire consisted of three domains: "satisfaction of care", "perceived quality of care", and "experience of mistreatment" during childbirth. Five new items were added and two items were removed during content validation. Another two items were deleted through face validation. Exploratory factor analysis was conducted for the "satisfaction of care" and "perceived quality of care" domains. Two factors were identified for each domain, with a factor loading of more than 0.5. Twelve items were deleted from "satisfaction of care" domain and two items from "perceived quality of care" domain. The Cronbach's alpha values for the two factors in both domains were more than 0.87. The items in the "experience of mistreatment during childbirth" domain were evaluated descriptively. KEY CONCLUSIONS: The new questionnaire is valid and reliable. The final questionnaire consists of 11 items for "satisfaction of care", 16 items for "perceived quality of care" and 43 items for "experience of mistreatment of women during childbirth".

Impact of Extended and Restricted Antibiotic Deescalation on Mortality.

BACKGROUND: More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. This study aims to compare the survival curve of patient de-escalated (early or late) against those not de-escalated on antibiotics, to determine the association of patient related, clinical related, and pressure sore/device related characteristics on all-cause 30-day mortality and determine the impact of early and late antibiotic de-escalation on 30-day all-cause mortality. METHODS: This is a retrospective cohort study on patients in medical ward Hospital Kuala Lumpur, admitted between January 2016 and June 2019. A Kaplan-Meier survival curve and Fleming-Harrington test were used to compare the overall survival rates between early, late, and those not de-escalated on antibiotics while multivariable Cox proportional hazards regression was used to determine prognostic factors associated with mortality and the impact of de-escalation on 30-day all-cause mortality. RESULTS: Overall mortality rates were not significantly different when patients were not de-escalated on extended or restricted antibiotics, compared to those de-escalated early or later (p = 0.760). Variables associated with 30-day all-cause mortality were a Sequential Organ Function Assessment (SOFA) score on the day of antimicrobial stewardship (AMS) intervention and Charlson's comorbidity score (CCS). After controlling for confounders, early and late antibiotics were not associated with an increased risk of mortality. CONCLUSION: The results of this study reinforce that restricted or extended antibiotic de-escalation in patients does not significantly affect 30-day all-cause mortality compared to continuation with extended and restricted antibiotics.

Effects of different doses of complete Freund's adjuvant on nociceptive behaviour and inflammatory parameters in polyarthritic rat model mimicking rheumatoid arthritis.

Complete Freund's adjuvant (CFA) has been used to develop the arthritic or inflammatory condition in the animal, but there is a lack of information concerning high CFA doses on nociceptive behaviour and inflammatory parameters. This study aimed to compare the effects of different high doses of CFA in rat to closely mimic nociceptive and inflammatory parameters of rheumatoid arthritis (RA) in humans. Twenty-four male Sprague-Dawley rats were randomly divided into four groups (n = 6): Control (C), CFA-induced polyarthritic groups at 5.0 mg/mL (CFA 5.0), 7.5 mg/mL (CFA 7.5) and 10.0mg/mL (CFA 10.0). The rats' right hindpaw was inoculated with CFA intradermally and developed into a polyarthritic state within 20 days. Nociceptive behavioural assessments, including von Frey and hot plate tests and spontaneous activities, were conducted on day 0, 7, 15 and 20. Bilateral ankle joints diameter and circumference, full blood count, joints and paw histological examinations were also conducted throughout the study period. Based on the results, CFA 5.0 and CFA 7.5 groups showed a significant increase in spontaneous activities and development of thermal hyperalgesia but no change in body weight and food intake, no development of tactile allodynia and haematological indices, and no significant morphological changes of joints histology. Meanwhile, CFA 10.0 group demonstrated significant and constant changes in all nociceptive and inflammatory parameters investigated. In conclusion, CFA at the dose of 10mg/mL has the most potential and reliable dosage to develop polyarthritis in a rat model to mimic RA condition in humans.

Global Prevalence of Macroprolactinemia among Patients with Hyperprolactinemia: A Systematic Review and Meta-Analysis.

Hyperprolactinemia (hPRL) often poses a diagnostic dilemma due to the presence of macroprolactin. Understanding the prevalence of macroprolactinemia (mPRL) has an important implication in managing patients with hPRL. The primary aim of this study was to determine the prevalence of mPRL globally and to explore selected factors influencing the prevalence estimate. Studies with original data related to the prevalence of mPRL among patients with hPRL from inception to March 2020 were identified, and a random effects meta-analysis was performed. Of the 3770 records identified, 67 eligible studies from 27 countries were included. The overall global prevalence estimate was 18.9% (95% CI: 15.8%, 22.1%) with a substantial statistical heterogeneity (I2 = 95.7%). The highest random effects pooled prevalence was observed in the African region (30.3%), followed by Region of the Americas (29.1%), European (17.5%), Eastern Mediterranean (13.9%), South-East Asian (12.7%), and Western Pacific Region (12.6%). Lower prevalence was observed in studies involving both sexes as compared to studies involving only female participants (17.1% vs. 25.4%) and in more recent studies (16.4%, 20.4%, and 26.5% in studies conducted after 2009, between 2000 and 2009, and before 2000, respectively). The prevalence estimate does not vary according to the age group of study participants, sample size, and types of polyethylene glycol (PEG) used for detection of macroprolactin (PEG 6000 or PEG 8000). With macroprolactin causing nearly one-fifth of hPRL cases, screening for mPRL should be made a routine before an investigation of other causes of hPRL.

Prognostic factors in patients with colorectal cancer at Hospital Universiti Sains Malaysia.

OBJECTIVE: To determine the 5-year survival rate and prognostic factors for survival in patients with colorectal cancer treated at the Surgical Unit, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. METHODS: We retrospectively reviewed the records of 115 patients treated in HUSM from 1996 to 2005. Data of variables considered as prognostic factors were obtained from the records. Simple and multiple Cox proportional hazard regression using the stepwise method were used to model the prognostic factors for survival. RESULTS: We found that the significant prognostic factors were liver metastases [adjusted hazard ratio (HR): 3.75; 95% confidence interval (CI): 1.95-7.22], Dukes C stage (adjusted HR: 4.65; 95% CI: 2.37-9.11), Dukes D stage (adjusted HR: 6.71; 95% CI: 2.92-15.48) and non-surgical treatment (adjusted HR: 3.75; 95% CI: 1.26-11.21). CONCLUSION: Colorectal patients treated at HUSM with Dukes C staging, presence of liver metastases and received treatment with both chemotherapy and radiotherapy are at the greatest risk of death from colorectal cancer.