SUMMARY Introduction: This study aims for construct validation using two approaches, i.e., exploratory factor analysis and Rasch Model. Methods: A cross sectional of 313 male workers from multiple worksites had completed self-administered Malay translated version of Three-Factor Eating QuestionnaireR21. Data quality was assessed by misfit person criteria, dimensionality, summary statistic, item measure and rating (partial credit) scale followed by exploratory factor analysis and internal consistency reliability assessment. Results: The dual approaches of construct validation analysis were complement to each other. Rasch analysis supported the theoretical constructs of three eating behaviour dimensions among respondents. In contrary to exploratory factor analysis, it did show presence of a newfound factor (α=0.04) came up from the separation of the cognitive restrain and uncontrolled eating however, the correlation between the two respective sub-factors were fair (r=0.39) and weak (r= -0.08). Both analyses had detected three problematic items but those items were psychometrically fit for used for current study setting. The data had adequate psychometric properties. Cronbach’s alpha for cognitive restraint, uncontrolled eating and emotional eating were 0.66, 0.79 and 0.87 respectively. Rating scale quality was conformed to standard criteria. Conclusion: Malay version TFEQ-R21 with promising psychometric properties and valid measures for eating behaviour dimensions among male workers aged between 20 to 60 years old is now available. Further development should focus on the items in relation to Malaysian cultural adaptation before its use for daily practice in future setting.
Psychometrics

Occupational stress is a modern epidemic. Prevalence and predictors of occupational stress in specific workforce are critical in management of occupational stress. The aim of this review is to explore the current prevalence of occupational stress and its predictors among selected Malaysian working population based on published articles between years 2008 to 2017. A systematic search of articles published between 2008 and 2017 was conducted in several databases (ISI Web of Knowledge, PubMed, Scopus, Google scholar). A total of eleven articles met the inclusion criteria, included in the review. The current prevalence of occupational stress was between 6.0% till 71.7%. Mean prevalence of stress was 29.9%. From eight job categories, most stressful job was primary teachers and least stressful job was academician in private university. Predictors of occupational stress were: 1) organizational factors: high job demand, poor workplace condition, lack of organization support, job insecurity, long working hours, burden of career development and interpersonal conflicts 2) individual (extra-organization) factors: gender, age, marital status, number of children, coping strategies. Although the predictors of occupational stress varies among different job categories, most job categories present similar risk factors such as high job demand, poor workplace condition, lack of organization support, job insecurity, long working hours, burden of career development and interpersonal conflicts. Dual approaches involving organization and individual level pertaining towards each stressor are recommended in alleviating occupational stress among those selected workforces.

Objective: To summarise the published research on teenage pregnancy in Malaysia, discuss the impact of the findings on clinical practice, and identify gaps in teenage pregnancy research in Malaysia. Methods: There were 31 articles related to teen pregnancy found after searching a database dedicated to indexing all original clinical research data published in Malaysia from year 2000 to 2014. Twenty-seven articles (including reports from the National Obstetrics Registry) were selected and reviewed on the basis of clinical relevance and future research implications. This literature review has been divided into eight sections: epidemiology, age at first marriage, adolescent fertility rate, unmarried childbearing, risk factors, maternal risks and neonatal outcome, future plan after delivery, and contraceptive use. Results: More than 19,000 births to teenage mothers were recorded each year between 2009 and 2011. Adolescent fertility rates were recorded at 6 births per 1000 women ages 15–19 years in 2013. Many of these births were from unwed pregnancies, which accounted for 1.99% of total deliveries. A majority of young mothers were willing to take care of their baby, although some of them planned to put their baby up for adoption. Risk factors for teenage pregnancy were found to be similar to those published in studies worldwide. Conclusion: More research is needed to better understand the issue of teen pregnancy. For the best results, collaborative studies among nationwide hospitals and institutions should be the way forward.
Pregnancy in Adolescence

Introduction:The Vertigo symptom scale (VSS) is a well established tool for the evaluation of vestibular disorders and the associated symptoms of autonomic arousal and somatosensation. By using a validated Malay version of vertigo symptom scale (MVVSS) questionnaire, the severity of the vertigo from patients’ perspective can be determined and rated. Before MVVSS can be applied clinically among Malaysians, it was of interest to determine its clinical value in identifying vestibular disorders. Method: Forty normal and 65 PVD subjects participated in this cross-sectional study. Normal subjects were recruited amongst Universiti Sains Malaysia (USM) staff and students who had no history of ear and vestibular disorders. Results: Mean total score of MVVSS in normal and PVD subjects were 13.9 ± 11.1 and 30.1 ± 20.9, respectively. When the total scores of normal and PVD group were compared, the Mann-Whitney U test showed that there was a significant difference between the two groups (p<0.05). This is consistent with previous studies. It was also of interest to see if subtypes of PVD [benign paroxymal positional vertigo (BPPV), Meniere’s disease, labyrinthitis and unknown] have different MVVSS results. However, analysis of variance (ANOVA) found no significant difference in term of outcomes of MVVSS among the different PVD pathologies. Using receiver operating characteristic curve (ROC) method, the sensitivity and specificity of MVVSS were 71% and 60%, respectively. Conclusion: MVVSS is able to discriminate clinically among the normal and PVD subjects. However, it is not a good indicator for differential diagnosis of PVD subtypes, at least in this study. Its sensitivity and specificity in clinical diagnosis are reasonably high. Perhaps a bigger sample size would be useful to further study the clinical usefulness of MVVSS.

Increasing physical activity level during and after treatment is recommended by the American Cancer Society because of the many benefits namely reducing fatigue and improves psychological distress which leads to an improvement in the quality of life. This study is aimed to compare physical activity level and body composition between oncology patients who are still undergoing treatment and those on medical follow-up. Patients were recruited based on convenience sampling from the Oncology Outpatient Clinics of Universiti Kebangsaan Malaysia Medical Center (UKMMC). Anthropometric measurements and body compositions were measured using calibrated tools while physical activity level were assessed using Global Physical Activity Questionnaire (GPAQ). Medical treatment history was obtained from patients medical records. A total of 53 patients (n=38 were undergoing treatment and n=15 was on follow-up) consisting of Malays (54.7%) and Chinese (45.3%) and with mean age of 55.3 ± 9.3 years. Most patients were previously diagnosed with ovarian cancer (39.6%) and colon cancer (18.9%) patients and they were at cancer stage III (18.8%). Body mass index (BMI) and percent fat mass were significantly different (p<0.05) between patients undergoing treatment (22.8 ± 2.7 kg/m2, 28.7 ± 7.2%) and on follow-up (26.2 ± 5.5 kg/m2, 37.1 ± 11.9%). Majority of the patients undergoing treatment were categorized under low physical activity compared to those on follow-up (p<0.05). Physical activity level measured as METS-minutes/week is also found to be significantly different (p<0.05) between patients on treatment and follow-up. As a conclusion, cancer patients undergoing treatment have low physical activity, with lower BMI and fat mass compared to those on follow-up. This is consistent with their nature of living where during treatment the patients will resting while coping with side effects of treatments.

Background: Our objective was to investigate the association of CYP2D6 polymorphisms with symptoms and side-effects of patients with schizophrenia. Methods: The subjects were 156 patients with schizophrenia undergoing antipsychotic treatment at a psychiatric clinic. Patients with co-morbid diagnoses of substance abuse or mental retardation were excluded from the study. Psychopathology was evaluated using the Positive and Negative Symptoms Scale (PANSS). Extrapyramidal side-effects and akathisia were assessed with the Simpson Angus Scale (SAS) and the Barnes Akathisia Rating Scale (BARS), respectively. DNA was extracted from blood and subjected to PCR-genotyping. Results: We found that CYP2D6 polymorphisms were significantly associated with a subtotal negative PANSS score. In addition, CYP2D6 is not related to side-effects of antipsychotic therapy, or SAS and BARS scores. The results suggest that CYP2D6 polymorphisms may have implications in treatment response. Conclusions: Therefore, CYP2D6 may be a predictor for treatment outcomes of patients with schizophrenia. However, further investigation is required to confirm these findings in a larger sample.

Objectives: The study aimed to determine current status of Knowledge, practices and attitudes towards adverse drug reaction (ADR) reporting among private practitioners in Klang region of Malaysia. Methods: A total of 238 private practitioners in Klang valley were distributed a questionnaire consisting of seven questions, two knowledge-related, two practice-related and three attitude-related. Each favourable and unfavourable response was given a score of 1 and 0 respectively. Total score of 70% or more for each domain was considered “satisfactory” whereas less than 70% as “unsatisfactory”. Results: One hundred forty-five participants completed questionnaire. Knowledge assessment showed 83.4% responses stating that ADR reporting helps to identify safe drugs and 91.7% responded that it measures ADR incidence. Regarding practices, 76.6% respondents were willing to report only if confident that reaction is an ADR. Regarding attitudes, 81.9%, 66.9% and 23.5% participants showed complacency, ignorance, and indifference respectively. Unsatisfactory knowledge, practices, and attitudes were observed in 57.2%, 56.6%, and 73.1% respondents respectively. Satisfactory knowledge was significantly higher in respondent with higher qualification with odds ratio of 2.96 with 95% confidence interval of 1.48–5.93. Conclusion: The study showed unsatisfactory level of knowledge, practices and attitudes towards ADR reporting among high proportion of private practitioners in Klang valley, Malaysia.

Background: The objectives of this study were to investigate whether severity of clubfoot, age, and weight of the patients at initial manipulation and casting influence the total number of castings required. Methods: This prospective study was conducted on 38 idiopathic clubfoot patients undergoing weekly manipulation and casting using the method recommended by Ponseti. The patients’ age, weight, and foot Pirani score at the start of manipulation and casting were analysed against the total number of castings required to achieve correction to 60° abduction. Results: Simple linear regression analysis on the influence of weight, age, and Pirani score at the time of cast initiation showed that the Pirani score was the only significant predictor for the total number of castings required. Conclusion: The total number of castings required to treat clubfoot was determined by the severity of clubfoot but not by the weight and age of patients.

Peripheral vestibular disorder (PVD) is serious and common. Clinically, giving an accurate diagnosis of PVD can be challenging. Vestibular evoked myogenic potential (VEMP) is an objective test to evaluate the integrity of vestibular organs, particularly saccule and/or inferior vestibular nerve. This study was performed to determine the sensitivity and specificity of VEMP using different stimuli. Fourty normal and 65 PVD subjects who fulfilled the inclusion criteria were recruited. While sitting comfortably, VEMP waveforms were recorded with active electrode on sternocleidomastoid muscle and negative electrode on upper forehead. Tone bursts (500, 750 and 1000 Hz) were delivered via headphones at 90 dBnHL and 5/s presentation rate. VEMP parameters for each stimulus (amplitude and latency of P1 and N1 peak) were analyzed accordingly. Receiver operating characteristic (ROC) was performed to determine the sensitivity and specificity of VEMP at different test frequencies. N1 amplitude of 750 Hz stimulus produced the most ideal sensitivity (65% on right and 63% on left) and specificity (83% on right and 78% on left). The importance of using a few tone bursts in VEMP test in order to minimize the false negative in cases might be encountered in clinics as the certain tone burst had inadequate sensitivity in detecting PVD cases. The 750 Hz stimulus produced the most ideal VEMP with adequate values of sensitivity and specificity, at least in this study.
Vestibulocochlear Nerve Diseases

Various proportions of chitosan/collagen films (70/30% to 95/05%) w/w were prepared and evaluated for its suitability as skin regenerating scaffold. Interactions between chitosan and collagen were studied using Fourier Transform Infrared spectroscopy (FTIR) and Differential Scanning Colorimetry (DSC). Scanning Electron Microscope (SEM) was used to investigate the morphology of the blend. Mechanical properties were evaluated using a Universal Testing Machine (UTM). The chitosan/collagen films were found to swell proportionally with time until it reaches equilibrium. FTIR spectroscopy indicated no chemical interaction between the components of the blends. DSC data indicated only one peak proving that these two materials are compatible at all proportions investigated. SEM micrographs also indicated good homogeneity between these two materials.
Biocompatible Materials/*analysis ; Burns/physiopathology ; Burns/*therapy ; Chitosan/*analysis ; Collagen Type I/*analysis ; *Materials Testing ; Microscopy, Electron, Scanning ; *Occlusive Dressings ; Regeneration/*physiology ; Skin/*physiopathology ; Spectroscopy, Fourier Transform Infrared ; Tensile Strength