Interdisciplinary Rehabilitation to Facilitate Recovery of People Living with Long-Term Schizophrenia in Developing Countries

Schizophrenia is characterized by irregular, alternating episodes of exacerbation and remission of psychotic symptoms. The occupational care for people living with long-term schizophrenia (PLWS) after medical treatment, for re-engagement into work, leisure, and daily-living activities, still needs attention. Personalizing follow-up care of PLWS can improve the medical-psychosocial level of patient with differing medical, physical, and psychosocial effects from their treatment exposures. This chapter highlights the call for an individual care approach that is often lacking in resource-limited countries with additional burden from entrenched stigma. Patient categorization for PLWS may be a cost-effective step forward to overcome the less effective, one-size-fits-all approach. The need to address personalized assessment of risk exposure and to remediate its consequences on function, recovery, and quality of life calls for a better interdisciplinary-care approach, and a renewed investment to ensure occupational performance after recovery. Medicine is initial, but personalized rehabilitation is warranted for much improved functioning and better quality of life. Research is also needed to evaluate and document the effectiveness of various models of interdisciplinary care for PLWS that have been developed but may not be tested/evaluated and also on models tested effective but on other long-term nonphysical conditions

Occupational Participation of Persons with Schizophrenia: Exploring Issues of Job-Termination in Supported-Employment

Occupational participation in a supported-employment is a rehabilitation strategy to improve both vocational and non-vocational domains of people with psychiatric disabilities, enabling them to access and/or re-enter employment. This study aims to identify the factors associated with unsatisfactory job-termination among the participants of supported-employment to inform future intervention. A cross-sectional survey was conducted on a group (with a diagnosis of schizophrenia) who participated in a supported-employment program in a large psychiatry institution in Malaysia. Within the first week of job termination, interviews were conducted with three subgroups independently - the participants, the employers and the hospital employment specialists, using the Job-Termination Interview. Factors linked to job-termination and job-accommodation were analysed using univariate and multivariate logistic regression.Key reasons for job termination were- poor job performance (n = 32; 47.1%), interpersonal issue (n = 31; 45.6%), medical illnesses (n = 30, 44.1%), incompatibilities between work-schedule and environment (n = 30; 44.1%), and job-dissatisfaction (n = 29, 42.6%). Key factor for sustaining job/ job-accommodation was “higher pay” (n = 4; 33.3%). Overall, an unsatisfactory trend of job terminations was observed where many (n = 53; 77.9%) quit their job without a ready job at hand. Unsatisfactory job-terminations were associated with three factors -(i). Enrolment in the Individual Placement-Support (IPS) (Adj. OR = 10.70, 95% CI 1.32-86.98, p = 0.012), (ii). Unstable medical issues (Adj. OR = 22.51, 95% CI 1.74-291.08, p = 0.003), (iii). Interpersonal issues (OR = 18.26, 95% CI: 2.24-149.15, p < 0.001).Most participants terminated their jobs in an unsatisfactory manner (77.9%). A high 63.2 percent quit their job without another ready-job at hand, while 14.7 percent were fired. Unsatisfactory job-endings were correlated to, poor job-performance, interpersonal problems and medical illnesses. Occupational re-entry intervention program must be tailored to the individual levels and needs, and be fully integrated within the clinical system to ensure job-person-environment fit, in order to improve job-experience and to lower unfavourable job terminations

DNA methylation analysis of AKT1 promoter and HTR2A exon-I of Malaysian schizophrenia multiplex families with lower cognitive performance

Dysfunction of cognitive performance in schizophrenia has been associated with aberrant alteration of DNA methylation of several schizophrenia-risk genes. AKT1 and HTR2A are among the candidate genes for schizophrenia. Their expressions were found reduced in schizophrenia patients. Thus, we aimed to study the methylation status of AKT1 promoter and HTR2A exon-I in Malaysian schizophrenia patients and their affected family members. In this study, each participant was required to perform Trail Making Test (TMT) part A and B to measure their cognitive performance. Genomic DNA extracted from the peripheral blood of 12 Malaysian schizophrenia families and 12 controls families, was subjected to bisulfite conversion. The methylation status of CpG sites of AKT1 promoter at Chr14: 104796054 and HTR2A exon-I at Chr13: 46896918 were identified using methylation-specific polymerase chain reaction (MSP). Our results showed that schizophrenia patients performed worse in both TMT-A and B (p<0.0001) than healthy controls. The patients also displayed significantly (p=0.023) high level of methylation in AKT1 promoter compared to controls. Meanwhile, no significant difference (p=0.248) in methylation status was observed in HTR2A exon-I between schizophrenia and control groups. Therefore, methylation of AKT1 promoter in peripheral bloods of patients may involve in cognitive impairment and schizophrenia pathology. In addition, we were able to demonstrate the heritability of DNA methylation status across family members

Self management intervention for Malaysian women with breast cancer : enabling quality of life and participation

Study on self-management intervention has shown enhanced quality of life in the chronic 'non-oncology‘ population, but has yet to make an impact in the field of oncology. The aim of this study was to explore, develop and evaluate the 4-week self-management intervention for women with breast cancer. The study, based on robust phased-model of a complex intervention, demonstrated an increasing research evidence from a qualitative need-assessment to a pilot study and finally to a definitive Clinical Controlled Trial. Insights and findings from the preclinical phase aided the development of the 4-week “Staying Abreast, Moving Ahead” (SAMA) program which was piloted, refined and tested using a CCT on Malaysian women (n=147) with breast cancer. The results from the robust intent-to-treat multivariate analyses of co-variances and the univariate repeated measure analyses of variances supported the efficacy of the 4-week self-management intervention. There were significant between-group differences on Quality of life (p=0.005), Social Relationship (0.015), Psychological symptoms (p=0.001) at post test, and self-efficacy and proactive coping for both Post-test and Follow-up (p<0.001).There were significant differences over time within the experimental group for Quality of life (p<0.001), Participation, (p=0.04), Psychological outcomes (p<0.001), as well as the Cancer self-efficacy scales (p<0.001 to p=0.02) and Proactive coping (p<0.001). A key implication of this study is that the theory-led SAMA program (which was developed based on the perspectives from the fields of Psychosocial oncology and Patient self-management for chronic conditions) can be disseminated to enable better Quality of life. SAMA is a potential blueprint for a feasible, timely and effective self management program for women diagnosed with breast cancer

Reliability and validity of international physical activity questionnaire, Bahasa Malaysia version: a preliminary study

The International Physical Activity Questionnaire (IPAQ), a standardised method for assessing physical activity, has been tested at 14 centres in 12 countries on adults aged 18 to 65 years. However, there is no standardised instrument to determine levels of physical activity amongst Malay-speaking adults in Malaysia. The aim of this study was to develop the IPAQ Bahasa Malaysia version (IPAQ-BM), test its psychometric values and determine the gap (under or over estimation) in levels of physical activity in a pilot study involving multi-ethnic Malaysians. The IPAQ (long form) was translated into Bahasa Malaysia (IPAQ-BM), culturally adapted and content validated. The correlation between the IPAQ-BM and the accelerometer were low to moderate (r=0.13-0.41). The IPAQ-BM overestimated the accelerometer by 416% for vigorous intensity activity and only 1.6% for moderate intensity activity in this group. Future studies involving stratified sampling for several age groups and larger samples are warranted.Keywords: Validity; Reliability; Physical activity; Accelerometer; Estimations; IPA

Chemobrain experienced by breast cancer survivors: a meta-ethnography study investigating research and care implications.

BACKGROUND: Cognitive impairment, colloquially termed "chemobrain", occurs in 10-40% of all cancer patients, and is an emerging target of cancer survivorship research. AIM: This study reviews published qualitative studies to explore cognitive impairments or chemobrain among breast cancer survivors, with particular attention given to the impact on quality of life. METHOD: Using keywords, we searched ten electronic databases (CINAHL, EMBASE, Proquest, OVID SP, MEDLINE, Oxford Journal, Science Direct, PubMED). FINDINGS: Of 457 papers, seven relevant papers were included. Data was extracted and concepts were analysed using a meta ethnography approach. Four second order intepretations were identified, on the basis of which, four third order intrepretations were constructed. Linked together in a line of argument, was a consistent account on their struggles to self-manage the chemobrain impairments that impact their daily lives. Five concepts emerged from the analysis of the primary findings: i) real experiences of cognitive changes, ii) calls for help, iii) impact of cognitive impairments, iv) coping and v) survivorship and meaning. Further synthesis resulted in four new order intepretations: i) The chemobrain struggle, ii) The substantial impact of chemobrain on life domains, iii) The struggle to readjust and to self manage, and iv) 'thankful yet fearful' representation. DISCUSSION: Awareness of cognitive changes were context-dependent on healthcare settings and cultural contexts as strong determinants. Subjects verified the existence of chemobrain but healthcare providers mis-recognised, under-recognised, and sometimes negated it perhaps due to its unknown aetiology. Asian breast cancer survivors appear less vocal than their western counterparts. CONCLUSION: The current literature on the lived experiences of how women experienced chemobrain provides a consistent report that chemobrain is real, persistent and with detrimental impacts on quality of life - manifested as a constant struggles. A greater awareness of the effects of chemobrain with improved functional assessment and interventions is warranted

Women's experiences of cognitive changes or 'chemobrain' following treatment for breast cancer: A role for occupational therapy?

Background/aim: Changes to functioning and cognition are commonly reported following chemotherapy. These changes are highly individual, and may not be fully recognised or understood. Breast cancer is the most common cancer diagnosed in women worldwide, yet little is known about the impact of cognitive changes for these women following treatment and many do not benefit from occupational therapy services. The aim was to describe changes in cognitive function experienced by women who had undergone chemotherapy, and the strategies used to overcome the associated challenges. Method: This was a qualitative phenomenological study conducted with nine women, aged between 39 and 67 years, from New South Wales. Participants were breast cancer survivors who had received chemotherapy treatment, and self‐reported chemobrain symptoms. Data were collected through semi‐structured in‐depth telephone and face‐to‐face interviews. Data were transcribed, coded and thematically analysed. Results: Six themes described the chemobrain experience for these women. They were: uncertainty about the origin of the chemobrain experience; persistent but inconsistent impacts on function; simple function turned complex; losing functional independence in family life; strategies to maintain function; and the need for recognition of the subjective experience of cancer treatment. Conclusion: The experiences of cognitive and functional changes following chemotherapy for those reporting chemobrain symptoms are highly individual, and include the need for adaptive strategies. Some similarities in the types of impairments were experienced. As breast cancer survivorship rates continue to rise, there is a need for occupational therapy services to assist women in returning to daily occupations during or following their cancer treatment

Breast cancer survivors: return to work and wage loss in selected hospitals in Malaysia

Purpose: This study aimed, firstly, to assess the determinants of return to work (RTW), secondly, to explore the amount of annual wage loss, and finally, to discover the determinants of wage loss among breast cancer (BC) survivors. Methods: A cross-sectional study design was used in this research. The data was collected via interview using a validated questionnaire. Logistic regression models were developed to discover the significant determinants of RTW and of wage loss among BC survivors. Results: A total of 256 BC survivors were included in this study. The analysis showed that there was a 21% loss of or reduction in mean income within 1 year after diagnosis. The significant predictors of RTW are being a government employee, having reduced wages or wage loss, and if the case had been diagnosed 1 year or more ago. Being a private sector employee and having a late stage of cancer was a barrier to RTW. The main risk factors for reduced wages or wage loss were belonging to the age group of 40–59 years, being of Chinese or Indian ethnicity, having low educational status, and not returning to work. However, belonging to the higher monthly income group (earning > RM 2000) is a protective factor against the risk of reduced wages or wage loss. Conclusions: Non-RTW and wage loss after diagnosis of BC may result in the survivors experiencing a significant financial burden. Assessment of these patients is becoming more crucial because more women participate in the workforce in Malaysia nowadays and because BC is managed using multiple treatment modalities with their consequences could lead to long absences from work