UNMET SUPPORTIVE CARE NEEDS AMONG BONE SARCOMA PATIENT IN SARAWAK

Purpose: This study aimed to determine the prevalence of unmet supportive care needs among bone sarcoma patients in Kuching, Sarawak and explored the relationship between these needs with various associated factors.  Methods: It was a descriptive cross-sectional study conducted among all bone sarcoma patients recruited from Sarawak General Hospital in Kuching, Sarawak. Data collection was done using an adopted questionnaire via interview assisted survey. Unmet needs were assessed using the 59-item Supportive Care Needs Survey (SCNS-SF59). Data was entered and analyzed using SPSS version 20.    Results: A total of 75 respondents participated in the study. The patients were mainly above 36 years (56%), Sarawak natives (33.3%) and married (54.7%). Majority of patients were not undergoing any active treatment (52%). Nine out of 10 items with highest ‘moderate’ to ‘high’ level unmet needs were from the domain of Health system and information.  Needs from Physical and daily living, and sexuality domains were found to have statistically significant associations with ethnicity, age and marital status.  Conclusion: Patients who were diagnosed with bone sarcoma had substantive unmet supportive care needs in relation with their illness trajectory. It is important that such needs to be acknowledged in order to provide quality healthcare services to them.   Key words : bone sarcoma, unmet needs, Malaysia, SCNS-SF59,supportive care need

Predictors of Diabetes Self-Management among Type 2 Diabetes Patients

Diabetes mellitus is a public health concern in Malaysia. Treatment of diabetes is costly and can lead to complications if disease is poorly controlled. Diabetes self-management (DSM) is found to be essential for optimal glycemic control. This cross-sectional study was conducted among samples from four randomly selected diabetes clinics in Sarawak,Malaysia. The aim was to determine the predictors for DSM. Face-to-face interview using questionnaire was used to collect data. Four hundred respondents with type 2 diabetes mellitus (T2DM) were recruited. Majority of the respondents were Sarawak Bumiputra (Iban and Bidayuh, 48.6%) and female (68.6%). The mean age was 58.77 years (SD = 11.46) and approximately half of the respondents (50.6%) had T2DM for six years (SD = 4.46). The mean fasting blood glucose (FBG) was 8.06mmol/L (SD = 2.94), with majority (76.1%) having the level higher than 6.1mmol/L. Multiple logistic regression tests showed significant linear relationship between DSM and belief in treatment effectiveness

The prevalence of cardiovascular risk factors in the young and middle-aged rural population in Sarawak, Malaysia

Background: Coronary heart disease (CHD) was the second leading cause of death in Malaysia in 2006. CHD has known risk factors including hypertension, diabetes mellitus, and obesity. Methods: This cross-sectional study examined the prevalence of cardiovascular risk factors among 260 participants aged 20 to 65 years in a rural community in Sarawak. Results: The prevalences of overweight and obesity in this study were 39.6% and 11.9%, respectively. Approximately 13% of participants had hypertension, and 1.5% had a random blood sugar greater than 11.1 mmol/L. Chi-square tests showed significant associations between obesity and gender (P = 0.007), low high-density lipoprotein cholesterol and race (P = 0.05), high total cholesterol and age (P = 0.007), age and hypertension (P = 0.011), smoking and gender (P 45 years) were 0.395 times more likely to have high cholesterol and that those with a higher monthly household income (> RM830) were 2.471 times more likely to smoke. Conclusion: These findings indicate that we should be concerned about the high rates of overweight in this rural community to prevent obesity

Prevalence of ultrasound diagnosed non-alcoholic fatty liver disease among rural indigenous community of Sarawak and its association with biochemical and anthropometric measures

Although the association between non-alcoholic fatty liver disease(NAFLD) and metabolic syndrome has been previously firmly established, the prevalence of NAFLD and its risk factors in rural communities remains incompletely defined. This study aimed to determine the prevalence and factors associated with ultrasound-diagnosed NAFLD amongst a rural community in Sarawak. An indigenous village was randomly selected where all adults aged 21 years and above underwent an abdominal ultrasound, biochemical tests and an anthropometric assessment. Respondents with a score ≥ 8 on an alcohol-use disorders-identification test (AUDIT) indicating harmful or hazardous drinking were excluded. Seventy-seven respondents (46.8% male, mean age 48.4 SD 16.64), met inclusion criteria. The prevalence of ultrasound diagnosed NAFLD was 44.2% (n=34), among them 52.9% had moderate NAFLD. There were no significant age or gender differences between respondents with and without NAFLD, although those with NAFLD were older. Respondents with NAFLD had a significantly higher BMI than those without NAFLD (p<0.001). Both male and female respondents with NAFLD had a significantly higher waist circumference than those without NAFLD (p<0.001). Prevalence of diabetes, hypertension, hyperglycemia and hypertriglyceridemia were significantly higher among those with NAFLD. However, there were no significant differences in terms of percentage of unhealthy body fat and muscle, and serum HDL levels. Risk factors independently associated with NAFLD included male gender (odd ratio 0.06; 95% CI 0.008-0.523) and waist circumference (odd ratio 1.2; 95% CI 1.036-1.421). There was a high prevalence of NAFLD and the presence of more severe stages of disease in this indigenous population. Life-style related diseases, such as fatty liver disease, can occur in rural as well as urban populations

Hypertension and its association with Anthropometric indices among students in a public university

Introduction: The present study aimed to determine the prevalence of hypertension and its association with nutritional status (body mass index, body fat percentage, and visceral fat) among students in a public university in Sarawak, Malaysia. Methods: This was a cross-sectional study among undergraduate students aged 18 years old and above. Anthropometric measurements, such as weight, height, body composition, and blood pressure measurements, were collected. Hypertension was defined as equal or more than 140/90 mmHg. Statistical analyses were done using IBM SPSS version 20. Results: A total of 354 respondents participated in the study. Mean age for the respondents was 21 years (SD 1.18 years). About 40% of the respondents were overweight or obese. Prevalence of hypertension was 8.2%. Mean systolic blood pressure was 119.1mmHg (SD14.36mmHg), and the mean diastolic blood pressure was 72.6mmHg (SD 9.73mmHg). There is a significant association between male gender (odds ratio =3.519, 95% CI is 1.886-6.566), body fat percentage (odds ratio =1.944, 95% CI is 1.050-3.601), visceral fat (odds ratio = 2.830, 95% CI is 1.346-5.951), and family history of hypertension (odds ratio= 2.366, 95% CI is 1.334-4.194) and hypertension. Conclusion: The prevalence of hypertension was less than 10% and is associated with male gender, body composition, and family history of hypertensi

Gender and Racial Differences in the Cardiovascular Risk Factors among Overweight and Obese Rural Adults, Kuching and Samarahan Division, Sarawak, Malaysia

Objective. This study aimed to determine whether gender and ethnic differences had an effect on cardiovascular risk factors in overweight and obese rural adults in Sarawak. Design and Setting. This was a cross-sectional study conducted in rural communities in Kuching and Samarahan division, Malaysia. Data was obtained using a set of questionnaire (sociodemographic data and physical activity), measurement of blood pressure, height, weight (body mass index, BMI), body fat percentage, fasting blood sugar, and lipid profile from three ethnic groups—Iban, Malay, and Bidayuh. Analysis of data was done using SPSS version 23.0. Results. A total of 155 respondents participated in the study (81.6% response rate). The levels of physical activity, BMI status, body fat, hypercholesterolemia, and hyperglycemia were similar across the three ethnic groups and both females and males. Iban and Bidayuh had significant higher Atherogenic Index of Plasma (AIP) when compared to the Malay (Bidayuh OR = 0.30, 95% CI 0.12, 0.78; Iban OR = 0.29, 95% CI 0.12, 0.69). Conclusions. The relationship between cardiovascular risk factors varied according to ethnic groups and gender. A better understanding of these differences would help in the design and implementation of intervention programme for the prevention of cardiovascular disease

Gender and Racial Differences in the Cardiovascular Risk Factors among Overweight and Obese Rural Adults, Kuching and Samarahan Division, Sarawak, Malaysia

This study aimed to determine whether gender and ethnic differences had an effect on cardiovascular risk factors in overweight and obese rural adults in Sarawak. Design and Setting.This was a cross-sectional study conducted in rural communities in Kuching and Samarahan division,Malaysia. Data was obtained using a set of questionnaire (sociodemographic data and physical activity), measurement of blood pressure, height, weight (body mass index, BMI), body fat percentage, fasting blood sugar, and lipid profile from three ethnic groups—Iban, Malay, and Bidayuh. Analysis of data was done using SPSS version 23.0. Results. A total of 155 respondents participated in the study (81.6% response rate). The levels of physical activity, BMI status, body fat, hypercholesterolemia, and hyperglycemiawere similar across the three ethnic groups and both females andmales. Iban and Bidayuh had significant higher Atherogenic Index of Plasma (AIP) when compared to theMalay (BidayuhOR = 0.30, 95%CI 0.12, 0.78; Iban OR = 0.29, 95% CI 0.12, 0.69). Conclusions. The relationship between cardiovascular risk factors varied according to ethnic groups and gender. A better understanding of these differences would help in the design and implementation of intervention programme for the prevention of cardiovascular disease

An intervention based on the stages of change, health profiles and physical activity levels of overweight and obese adults in Sarawak, Malaysia – a feasibility study

Introduction: Physical inactivity is the one of the leading causes of major non-communicable diseases in the world. The aim of this study is to assess the feasibility of an intervention program based on the stages of change, physical activity levels and health profiles of selected overweight and obese adults in Sarawak. Methods: This intervention study was carried out using selected overweight and obese adults in Sarawak. A total of 75 participants were placed in the intervention group, and 80 respondents were placed in the control group participated. Respondent-determined weekly aerobic exercise sessions were conducted for six months. The Malay version of the long-form International Physical Activity Questionnaire (IPAQ) and Transtheoretical model of change (TTM) questionnaire were used, together with anthropometric measurements and the collection of venous fasting blood profiles. Data was entered and analyzed using SPSS Version 20. Results: The intervention group had significant better stage transitions compared to the control group (p<0.01). They also had significantly lower total cholesterol, although both groups showed significant results (difference= 0.53, p<0.01; difference= 0.38, p=0.01). The respondent-determined intervention program was effective in improving stage transition; however, an intervention of longer duration could provide more conclusive health outcomes. Conclusion: Physical activity plays a role in assisting overweight and obese adults to be more active and healthier

Factors associated with sexual engagement among schooling adolescents in Sarawak, East Malaysia

This study examined the factors of sexual behaviours among schooling adolescents in Sarawak. Respondents for the study were adolescents aged 13 to 19 years from 16 secondary schools in Sarawak using self-administered questionnaire. Information on socio-demographic characteristics, knowledge on and attitudes towards sexual and reproductive health, involvement in risky lifestyle and sexual activities, family relationships, school attachment and religious beliefs were obtained. Chi-square tests and logistic regression analysis were performed to examine factors associated with sexual intercourse. A total of 1,462 students participated in the study, with 60.1% female respondents, mean age 15.6 ± 1.72 years old. The prevalence of sex engagement was 3.6%, majority aged 16-17 years (58.5%). Mean age at first sexual intercourse was 16.8 ± 1.27 years, with a minimum age of 14 years. Age of respondents, knowledge on SRH, risky behaviours, peers’ risky behaviours, negative self-evaluation, cognitive inefficiency, perceived lack of motivation, religious belief and family support were significantly associated with sexual engagement. Logistic regression showed that age, respondents’ risky behaviour and peers’ involvement in sexual intercourse were significant risk factors of sexual engagement while a strong religious belief was a significant protective factor. Although the prevalence of sexual engagement was quite low compared to many other countries, there is a need to strengthen comprehensive sexual health education both at the school and community levels. It is important for adolescents to make informed decisions on their risky sexual behaviours as there are serious consequences of such behaviours on their current and future life

Transtheoretical model of change for weight control in Malaysian context

Obesity is a global problem, and the prevalence of obesity in Malaysia has increased four . folds during a 10 years period (1996 - 2006). Empirical support of the effectiveness of weight control using Transtheoretical Model of Change (TIM) as the framework have been demonstrated by some studies and clinical practice for weight control in developed countries. However, TIM's potentia1 in weight control has yet to be tested among the natives in Sarawak, Malaysia. This research study used focus groups and survey to evaluate the applicability of TTM for weight control in overweight and obese Bidayuh, Malay and Than adults in saraway Particularly, this study aimed to determine the applicability of the key constructs of TIM: Stages of Change, Self- Efficacy, Decisional Balance and Processes of Change in terms of stage distribution, factorial structure and the relationship between these constructs and the Stages of Change. A total of 271 respondents participated in the survey and 38 of these respondents joined the focus groups. The findings of this study indicated that the basic constructs of the TIM: the Stages of Change, the Decisional Balance, the Self-Efficacy, and the integration between the Stages of Change, and the Decisional Balance, Stages of Change and the SelfEfficacy variables were generalizable to the study population. The generalisability of Processes of Change was less clear. The Stages of Change algorithm was able to classify the respondents into different Stages of Change to lose weight. Although five items from the original Decisional Balance scale were deleted in the factor structure validation process, the remaining 15 pro and con items were able to discriminate the Decisional Balance variable of this study sample. Weight Efficacy Lifestyle Questionnaire (WELQ) was found to be applicable to measure Self-Efficacy construct of TIM. Scale validation obtained an I8-item, three subscales for WELQ. The generalisibility of Self- Efficacy to this population was also determined. Twenty-seven items of Processes of Change inventory were deleted during the factor structure validation process with many items of the original processes dispersed into different processes. As such, the relationship between Stages and Processes of Change in this study is less distinctive, making the generalisability of this construct less convincing. This research study found the focus groups and survey used in a concurrent mixed method approach was illuminating. The findings of the reasons for participants to remain in the Precontemplation Stage of losing weight were consistent with those proposed by the TIM