There is a large volume of published studies describing the adverse relationship between treatment non-adherence with tuberculosis treatment outcome. Non-adherence could result in increased risks of prolonged infectiousness, drug resistance, relapse cases and poor survival among tuberculosis patients. Nevertheless, few studies are to be found providing detailed on the reason of defaulting treatment among tuberculosis patients in Malaysia. Hence the goal of this paper is to find out the barriers and motivations factors that affect patients’ treatment compliance among our local tuberculosis patients. This is a qualitative study which included 12 in-depth interviews with tuberculosis non-compliance patients who were treated at Institute of Respiratory Medicine, Kuala Lumpur. All the conversations were recorded, transcribed and analysed by using thematic analysis. It was found that low knowledge, self-negative attitudes, traditional believes, negative perceptions towards health caregiver, drug side effects, stigma, financial problems, less family support and work commitments are the barriers that prevent the patients from religiously taking their anti-tuberculosis treatment. Meanwhile, factors that encourage them to continue their treatment were the believes of bad effects of the disease onto their lives and health, good relationship between patient and health caregiver and social support from people around them. In conclusion, non-adherence involved a dynamic influence of individual, socio-economic and treatment-related factors on the patients. The results presented here may facilitate improvement in the activities in promoting compliance among tuberculosis patients in the future which tailored to the patients’ specific needs.
Tuberculosis

Infant feeding is thought to modulate cardiovascular risk factors such as obesity, hypertension, hyperglycemia, and dyslipidemia. This possible association between patterns of feeding with development of cardiovascular disease later in life provides the opportunity for early intervention and prevention strategies. Among all the feeding methods applied, breastfeeding is thought to be the best method and is said to be attributable to future health benefits. However, current evidence from the literature is weak and inconsistent to advocate risk factors management. Therefore, this narrative review aims to provide current findings in assessing the association of breastfeeding pattern and risk of developing cardiovascular diseases later in life. We searched three databases (MEDLINE, PubMed and Google Scholar) from year 2000 to 11 July 2018. Findings on the association between breastfeeding and cardiovascular risk factors are equivocal, although positive trend of beneficial effects of breastfeeding in reducing risk of cardiovascular diseases in adulthood was reported in majority of the studies. Future research should address all limitations that were identified by previous studies such as bias of study design and heterogeneity of samples to establish the association between breastfeeding pattern and cardiovascular disease in later life.
Breastfeeding ; Cardiovascular diseases

Introduction: Posttraumatic growth (PTG) is a positive psychological change in life that occurs as a result of struggle with highly challenging life crises. There is a growing need to explore posttraumatic growth (PTG) in cancer patients, as higher PTG may enhance well-being of patients. Objectives: The aim of this study was to translate the Posttraumatic Growth Inventory-Short Form (PTGISF) into the Malay language and evaluate its psychometric properties for assessing Malaysian cancer patients in future studies. Methods: Two parallels forward and backward translations of the PTGI-SF into the Malay language were conducted. The test was administered to 195 cancer patients. Reliability was evaluated by testing internal consistency (Cronbach’s α) and calculating the test-retest intra-class correlation coefficient, and validity was examined by determining face, convergent, and discriminant validities and using confirmatory factor analysis (CFA). Results: The Malay version of the PTGI-SF and its five domains demonstrated good internal consistencies and acceptable test-retest reliability. All 10 items of this version were highly correlated with their own domains and thus exhibited convergent validity. Discriminant validity was achieved, as all domains of the Malay PTGI-SF was not highly correlated with the domains of the Source of Social Support Scale. CFA resulted in a bestfitting 5-factor model. Conclusion: The Malay version of the PTGI-SF is a suitable tool for measuring PTG in Malaysian cancer patients.

Objective: It is important to investigate the association between spousal support and psychology of cancer patients, thus a validated instrument to measure the degree of perceived spousal support is required. We translated and evaluated the psychometric properties of the Sources of Social Support Scale-Malay version (SSSS-Malay) among Malaysian cancer patients. Methods: In this study, the SSSS-Malay and Hope Scale-Malay [used to compare with the SSSS-Malay to assess discriminant validity] were administered to 195 Malaysian cancer patients during baseline assessment. The SSSS-Malay was re-administered 2 months after the baseline assessment during follow-up. Results: The SSSS-Malay total score (Cronbach’s α = 0.70, intraclass correlation coefficient (ICC) = 0.72) and its domains (Cronbach’s α ranging from 0.70 to 0.83, intraclass correlation coefficient ranging from 0.6 to 0.76) exhibited good internal consistencies and good test-retest reliability. The SSSS-Malay also demonstrated good convergent and discriminant validities. However, confirmatory factor analysis of the SSSSMalay showed that it was best fit into a 3-factor model instead of the 4-factor model of the original English version. Conclusion: The SSSS-Malay demonstrated good psychometric properties for use in Malaysian cancer patients.

Hope leads to lower depression and anxiety and is associated with improved quality of life of cancer patients. In thisstudy, Hope Scale (HS) was translated into Malay, and the psychometric properties of the Malay version of the HopeScale were investigated among Malaysian cancer patients. Concurrent translation and back translation of the originalEnglish version of the Hope Scale were performed, and the Malay version was administered to 195 cancer patientswith different cancer diagnoses at baseline assessment and 2 months later at follow-up. The Hope Scale (Malay) totalscore (Cronbach’s α = 0.72; intraclass correlation coefficient (ICC) = 0.67) and its domains (Cronbach’s α [pathway] =0.7; Cronbach’s α [agency] = 0.7; ICC[Pathway] = 0.64; ICC[Agency] = 0.70) demonstrated acceptable internal consistencies andtest-retest reliability. Convergent and discriminant validities were also achieved by the Hope Scale (Malay). The HopeScale (Malay) demonstrated construct validity, as confirmatory factor analysis demonstrated that the items in the HopeScale (Malay) best fit into two domains, which was true for the original English version. The Hope Scale (Malay) hadacceptable psychometric properties and thus is suitable for assessing hope in Malaysian cancer patients.

The primary objective of this study was to determine the factors influencing TB literacy among smear-positive pulmonary TB patients at the second month of treatment. The secondary objective was to investigate the difference in TB knowledge between patients with persistent sputum smear-positive and smear converted patients.The study was conducted as a cross-sectional study which involved 150 smear positive PTB patients. Patients’ knowledge of TB was assessed using a set of a pre-tested standardized questionnaire. Data were entered and analyzed using SPSS software version 24.0 for Windows (IBM Corporation, New York, United States). Descriptive data for continuous variables are presented as mean and standard deviation. Meanwhile, descriptive data for categorical variables are presented as frequencies and percentages. Data were analyzed by using binary logistic regression analysis. Overall, 26.0% (n= 39) of the patients had an unsatisfactory knowledge of Tuberculosis. Although the majority of the patients were aware that TB is infectious, many scored low for three critical aspects of stopping TB which were poor knowledge on the source of TB infection, the mode of transmission, and the correct preventive measures. Two factors which were gender (male: adj OR= 3.91, 95% CI= 1.09-14.00) and ethnicity (Chinese: adj OR= 10.24, 95% CI= 3.03-34.63; Immigrants: adj OR= 4.59, 95% CI= 1.10-19.12) were independently associated with unsatisfactory TB knowledge after controlling the age, gender, ethnicity, job and level of education. No significant difference was observed between the mean knowledge of patients with persistent sputum positivity (5.35±1.40) and those sputum converted TB patients (5.47±1.64) (crude OR= 0.95, 95% CI= 0.77-1.17, p=0.628). Gender and ethnicity were the independent factors that affected TB literacy. However, the TB literacy does not significantly associated with patients’ smear positivity at second month of intensive anti-TB treatment.
Tuberculosis, Pulmonary

Introduction: Acute transfusion reactions (ATR) are commonly reported in clinical transfusion practice, which may result in significant morbidity and mortality. This study aims to explore the impact of transfusion practice on the prevalence, characteristics, and associated factors of ATR at Hospital Sultanah Bahiyah, Kedah, Malaysia. Methods: This was a retrospective study using records from haemovigilance forms of reported transfusion reactions, E-Delphyn (blood bank system), and E-His (hospital information system). A total of 118 cases of ATR from January 1, 2015 until December 31, 2017 were selected and analysed. For each case, a control was selected from a patient who did not develop ATR. Results: A total of 122,215 units of whole blood and blood component transfusions have been performed and 415 ATR were reported. The prevalence of ATR was 0.34% or one in 294 units transfused. There was a significant association between ATR and red cell concentrate (RCC) stored for more than 14 days (adj OR = 65.29, 95% CI 9.29-458.85). The most common ATR were allergic reactions with 63 cases (53.4%), followed by febrile non-haemolytic transfusion reactions (FNHTR) with 45 cases (38.1%). Allergic reactions were significantly associated with female patients (p = 0.038) and the paediatrics age group (p = 0.038). Multivariate analysis revealed a significant association between FNHTR and RCC stored more than 14 days (p = 0.002). Conclusion: The prevalence of ATR in this hospital was low and associated with RCC stored for more than 14 days. Implementation of pre-storage leucoreduction is recommended.

Introduction: Many countries struggle to supply enough blood while maintaining their quality and safety. Increasing the number of regular donors is expected to increase the donor pool and blood safety. Thus, this study describes lapsed and regular blood donors’ characteristics, knowledge, motivation, and barriers concerning blood donation. Methods: This observational cross-sectional study has adopted an assisted self-administered questionnaire, which was distributed to blood donors at the Department of Transfusion Medicine, Hospital Sultanah Bahiyah, Kedah. A total of 328 participants consisting of 164 lapsed and 164 regular donors were selected. Logistic regression tests were used to determine the factors that predict lapsed donors. Results: Out of the selected 328 respondents, 54.3% were in the 25–39 age group, 66.2% were males, and 85.1% were Malays. Most of the respondents (88.4%) showed adequate blood donation knowledge, and 99.7% cited altruism as a motivator for blood donation. About 47.0% of the respondents claimed they lack enough time as their donation barrier. Donors who were younger in age, had a moderate blood donation knowledge (adjusted OR, 3.60; 95% CI, 1.34-9.64), didn’t know where to donate (adjusted OR, 2.79; 95% CI, 1.47-5.29), lack enough time (adjusted OR, 1.83; 95% CI, 1.04-3.24), and insufficient information about blood donation campaigns (adjusted OR, 2.19; 95% CI, 1.23-3.91) were more likely to lapse. Conclusion: Donor education, convenient time and location, and sufficient information about blood donation campaigns targeted at young donors are critical for preventing lapsed donors, which could subsequently increase the regular donor pool.

ABO blood groups have been associated to increased susceptibility in allergic diseases, including asthma and atopic dermatitis. Although few studies demonstrated the association of ABO blood groups with allergic rhinitis, the evidences are still generally scarce and involved certain population. Therefore, this study aimed to investigate the association of ABO blood groups and allergic rhinitis in the Malaysian population. Further analysis was conducted to investigate the association between ABO blood groups and specific allergens, such as house dust mites, in patients with allergic rhinitis. A total of 163 patients with allergic rhinitis and 163 controls were recruited from AMDI, USM, Penang and HUSM, Kelantan. Blood samples were collected from both groups, and ABO phenotypes were identified using the tube method. The Pearson Chi-square test was employed to determine the association. Statistical significance was set for an alpha error of 5% (p-value < 0.05). O blood was identified as the most common blood group. However, no significant associations of ABO blood groups were observed in the allergic rhinitis patients. The result was also not significant with the O blood group being the highest prevalence and the AB blood group being the least prevalence to house dust mites allergy. This study provides beneficial information for future studies on the predictive role of blood groups in clinical practices. In our study, most of the participants recruited were Malays which might cause genetic bias. Therefore, employing a multi-centered and multiracial approach with larger sample size is recommended for future research.
Rhinitis, Allergic

Introduction: Non-communicable diseases (NCDs) are evolving as the leading cause of death worldwide, including in Malaysia. Changes in a socio-economic status have increased at-risk populations with NCDs. The objective of this study is to describe the prevalence of self-reported NCDs and its contributing factors in a selected low socio-economic status community in Kedah, Malaysia. Methods: A cross-sectional study with a self-administered questionnaire was done among convenience samples of 139 adults (age more than 18 years old) living in a selected low socio-economic status community in Kedah. Results: Among 139 respondents with a mean (SD) age 48.5 (13.1), there were 40.3% of respondents reported to have chronic illnesses with a prevalence of hypertension (25.9%), diabetes mellitus (21.6%), hypercholesterolemia (7.2%), chronic respiratory diseases (5.0%), heart disease (2.9%) and stroke (1.4%). The significant contributing factors of NCDs by multiple logistic regression were age, marital and working status. A person with an increase in 1 year of age has 1.05 times the odds to have NCDs (95% CI: 1.01 to 1.09, p-value=0.007). A divorcee has 3.55 times the odds compared to a married person to have NCDs (95% CI: 1.28 to 9.80, p-value=0.015). The non-working individual has 2.27 times the odds compared to working individuals to have NCDs (95% CI: 1.03 to 5.01, p-value=0.042). Conclusion: The prevalence of NCDs is high in this selected low socio-economic status community. The contributing factors are age, marital and working status.