Malaysian Journal of Medicine and Health Sciences
The Malaysian Journal of Medicine and Health Sciences (MJMHS) diterbitkan oleh Fakulti Perubatan dan Sains Kesihatan Universiti Putra Malaysia. Matlamat utama MJMHS adalah menjadi jurnal utama mengenai semua aspek perubatan dan sains kesihatan di Malaysia dan di peringkat antarabangsa. Tumpuan MJMHS akan menjadi hasil penyelidikan dan pembangunan saintifik yang asal, isu-isu baru dan analisis dasar yang berkaitan dengan sains perubatan, bioperubatan dan klinikal. The Malaysian Journal of Medicine and Health Sciences kini diindeks dalam pangkalan data berikut: Scopus, EBSCOhost, ISC, dan Rubriq. pISSN: 1675-8544 eISSN: 2636-9346
Malaysian Occupational Therapy Students’ Knowledge and Attitudes Towards Urinary Incontinence
Introduction: Urinary incontinence (UI) is a common health issue that affects people throughout the world, but stigma and misunderstandings about it still exist. This study investigates the knowledge and attitudes of Malaysian undergraduate occupational therapy (OT) students toward UI. Materials and Method: Using a cross-sectional design, data were collected through an online structured questionnaire distributed among OT students in Malaysian universities. Sections measuring participant demographics, the Urinary Incontinence Knowledge Scale (UIKS), and the Urinary Incontinence Attitude Scale (UIAS) were all included in the questionnaire. Results: The survey was completed by 230 (n = 230) undergraduate OT students from five different institutions. Their ages ranged from 19 to 26 years old, with a mean age of 22.67 (SD = 1.93). The majority, 43.9% (n=101) of respondents, had low knowledge of UI but had a positive attitude towards UI with a mean of 45.66 (SD = 4.28). The results showed a significant relationship between knowledge of UI and factors like year of education (p = 0.00) and level of study (p = 0.00). Furthermore, there was a significant correlation between gender and attitudes towards people with UI (p = 0.00). Conclusion: In conclusion, although OT students showed positive attitudes towards urinary incontinence, their limited knowledge highlights the need for improved educational strategies that address identified gaps and demographic influences. Initiatives aimed at destigmatising UI and promoting awareness among healthcare professionals are essential to foster a more inclusive and supportive healthcare environment for individuals affected by this condition in Malaysia.
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Validation and Reliability of a Questionnaire for Evaluating the Performance of Hospital Food Service Operations
Introduction: This study aimed to identify standardized indicators for food service operations in Malaysian hospitals and to validate these indicators comprehensively. Methods: A new questionnaire was distributed to 160 government, private, and teaching hospital food service administrators. Construct validity and reliability were assessed using exploratory factor analysis (EFA), discriminant and convergent validity, composite reliability (CR), and internal consistency reliability. Results: The final Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy (MSA) of EFA was 0.869. A total of 69.9% of the variation was explained by the factors “Food Production and Distribution Management,” “Patient or Customer Service Management,” and “Operational Management”. Items correlation with factors grouping established internal consistency (Cronbach’s alpha = 0.891). The AVEs above 0.5 showed convergent validity and composite reliability above 0.80, indicating the internal consistency of scale items. There were significant correlations between “Operational Management” and “Patient or Customer Service Management” (r = 0.550, p < 0.01), “Food Production and Distribution Management” (r = 0.204, p < 0.01), and “Operational Management” and “Food Production and Distribution Management” (r = 0.156, p < 0.05). The significant difference in subscale means for “Patient or Customer Service Management” (in-house: 2.96, outsourced: 2.55, p < 0.05) and “Food Production and Distribution Management” (in-house: 2.83, outsourced: 3.25, p < 0.05) between food service operations indicate discriminant validity. Conclusion: The findings of this study revealed that this questionnaire is validated and reliable, and further research should be undertaken to identify specific indicators that can be used to evaluate hospital food service quality.
Correlation between Low Back Pain with Core Muscles Endurances Among Undergraduate Students: A Cross Sectional Study
Introduction: Low back pain (LBP) is a prevalent musculoskeletal complaint in Malaysian healthcare and is increasingly common among undergraduate students. This study aimed to examine the relationship between functional status related to LBP and core muscle endurance, as well as evaluate their levels among undergraduates. Materials and Methods: A total of 297 students from various academic disciplines participated in this cross-sectional study. They completed a self-administered questionnaire that included demographic information and the Back Pain Functional Scale (BPFS). Core muscle endurance was assessed using McGill’s Core Muscle Endurance Test. Spearman’s rank correlation was used to analyze the relationship between BPFS scores and endurance levels. Results: The majority of participants were aged 20–21 years, with a nearly equal gender distribution. Most students were from health sciences disciplines and were in their second or third year of study. The most challenging functional tasks reported were sleeping and putting on shoes or socks. Among endurance measures, trunk flexors showed the highest median endurance, followed by extensors, with lower values observed for lateral trunk muscles. Significant positive correlations were found between BPFS scores and trunk flexor endurance (ρ = 0.426, p < .001), extensor endurance (ρ = 0.394, p < .001), and lateral trunk endurance (ρ = 0.379–0.403, p < .001). Conclusion: Core muscle endurance is positively associated with functional ability among undergraduates with LBP. These findings support integrating core-strengthening exercises into student wellness initiatives to reduce LBP-related limitations and promote spinal health.
Enhancing Bovine Hydroxyapatite: The Role of Crosslinker and Secretome in Biomechanical Properties and Toxicity
Background: Advancements in biomaterials aid in hard tissue repair. Hydroxyapatite (HAP) similar to natural bone and used in bone grafts. Crosslinking agents like poly-vinyl alcohol (PVA) and glutaraldehyde (GTA), combined with bone marrow-derived mesenchymal stem cell (BM-MSC) secretome, are being explored for their potential to enhance HAP's biomechanical properties and minimize toxicity. This study investigates how crosslinkers and secretomes affect the toxicity and biomechanical characteristics of bovine hydroxyapatite (BHA). Methods: This in vitro laboratory study employed a comparative design. HAP was crosslinked with PVA at a 0.5% concentration and with GTA at 0.1% and 1% concentrations, both with and without BM-MSC secretome. Mechanical properties, including compressive and bending strength, were measured. Toxicity levels and water content were also analyzed using MTT Assay. Data were analyzed descriptively and statistically using ANOVA dan Tukey’s Method for Post Hoc Analysis. Results: Addition of crosslinker and secretome significantly impacted bending strength (p=0.004), but not compressive strength (p=0.648). The HAP + PVA 0.5% + secretome group had the highest compressive and bending strength compared to the control, HAP + GTA 0.1% + secretome, and HAP + GTA 1% + secretome groups. While addition crosslinker and secretome tended to reduce HAP toxicity and water content, differences were not statistically significant (p > 0.05 and p > 0.05, respectively). Conclusion: The biomechanical properties of HAP are improved by the addition of 0.5% PVA, to enhanced compressive and bending strengths. GTA's effectiveness is concentration-dependent, with higher concentrations causing toxicity. Determining optimal concentration is crucial for safe clinical application.
The Influence of Physical Exercise on Peak Nasal Inspiratory Flow Results in Young Adults Population
Introduction: Exercise has a significant impact on health, and there is increasing evidence suggesting that exercise affects immunological function, contributing to its positive benefits on well-being. Physical exercise can help decrease nasal mucosal congestion through sympathetic reflex and strengthen respiratory muscle. Exercise also helps enhance the respiratory function and nasal patency, allowing individual to optimize their performance and overall health. Peak Nasal Inspiratory Flow (PNIF) examination is the objective method used to determine nasal patency. This study aims to analyze the influence of physical exercise on nasal patency using peak nasal inspiratory flow. Materials and Methods: A cross-sectional study was conducted at the Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, involving 82 healthy adult volunteers selected through consecutive sampling from January to March 2024. Data were collected using exercise questionnaires, NOSE questionnaire to assess nasal obstruction symptom, and the PNIF examination. Data was collected and analyzed using Spearman bivariate correlation and ANOVA. Results: The mean total nasal inspiratory flow (PNIF) in this study was 99.55 ± 27.11 and not correlated with the NOSE score (r= -0.081, p=0.469). Variance analysis factors showed a significant influence of the frequency of exercise (p=0.030) and gender (p=0.001) on PNIF score measurement. Post hoc test showed exercise frequency impact to PNIF score particularly for groups 3 times compared to groups none and one time a week. Conclusion: The frequency of physical exercise (three times a week) was the stronger influenced for nasal patency using PNIF examination in young adults.
Evaluating the REST Scoring Method (Radiological Evaluation Score for Bone Tumors) as a Novel Radiological Tool in Distinguishing Benign and Malignant Bone Tumors: Accuracy Study at a Tertiary Referral Hospital
Introduction: The misdiagnosis due to high mimicking of bone tumor malignancy and uneven access to advanced examinations in rural areas are yet several problems in bone tumor examinations. Not to mention, the high morbidity and mortality rates indicate obstacles to these cases. This study analyses the accuracy of X-rays processed using a new modality, Radiological Evaluation Score for Bone Tumors (REST) in primary bone tumor patients at Dr. Soetomo Regional Hospital Surabaya. Methods: This study was an analytical observational study that analyzed the correlation between each scoring criterion and its total score with histopathology (biopsy) results, calculated the cut-off value for benign and malignant type scoring, and diagnosis accuracy. The sample totaled 142 samples by a total sampling technique. Analysis calculation and variables were explained in the chapter. Discussion: Based upon the obtained p values, it showed that 1) there was no correlation between age, cortical erosion, and pathological fractures with histopathological results (p ≥ 0.05); 2) there were correlation between gender, characteristic, tumor content, lesion boundaries, transition zone, periosteal reaction, connective tissue mass, and the total scoring with histopathological results (p < 0.05); 3) the cut-off value was 3.5; 4) the diagnostic accuracy was 85.3%. The kappa value for interobserver reliability was 0.764. Conclusion: The correlation of REST scoring with the histopathology results has shown dominantly significant with considered good diagnostic accuracy. These results have demonstrated a promising future development for the utilization of X-ray as bone tumour diagnosis modality.
Cross-cultural Adaptation and Psychometric Testing of the Malay Version of Patient Education Materials Assessment Tool
Introduction: The Patient Education Materials Assessment Tool (PEMAT) evaluates the understandability and actionability of patient education materials. There are PEMAT-P and PEMAT-A/V for printable and audio-visual materials respectively. This study cross-culturally adapted these versions of PEMAT into Malay and determine their psychometric properties. Materials and methods: The study proceeded in four stages: 1) translation and cross-cultural adaptation of PEMAT-P(M) and PEMAT-A/V(M) (four translators, five healthcare workers [HCWs]), followed by cross-sectional studies to 2) determine the internal consistency, inter-rater and test-retest reliabilities (nine HCWs), 3) determine the validity by correlation with the Suitability Assessment of Materials (SAM) (20 HCWs) and 4) determine the validity by correlation with the Consumer Testing Questionnaire (16 adult patients). These stages involved HCWs from different healthcare disciplines. Results: Cross-culturally adapted PEMAT-P(M) and PEMAT-A/V(M) were produced. The median Cronbach’s alpha for understandability and actionability domains ranged between 0.78 and 0.90. The domain-level inter-rater reliability showed ICCs ranging from 0.72 to 0.81, and test-retest reliability showed ICCs ranging from 0.82 to 0.90. The item-level inter-rater and test-retest reliability showed Gwet’s AC1 values above 0.60 for most items. Significant positive correlations were found between all PEMAT-P(M) and PEMAT-A/V(M) scores with the SAM score. Most domain scores were significantly correlated with the consumer testing comprehension score, while only one domain score was significantly correlated with consumer testing numerical score. Conclusion: The cross-culturally adapted PEMAT-P(M) and PEMAT-A/V(M) were found to be valid and reliable. PEMAT(M) can be used by raters from diverse backgrounds to evaluate printable and audiovisual patient education materials.
A Partial Least Squares-Structural Equation Modelling (PLS-SEM) Analysis of Health Information Usage Among Patients with Non-Communicable Diseases in Sarawak, Malaysia
Introduction: Non-communicable diseases (NCDs), including diabetes, hypertension, and heart disease, remain the leading causes of morbidity and mortality in Malaysia, highlighting the growing importance of effective health information usage (HIU) for self-management and prevention. Although access to health information has expanded, disparities persist in how individuals particularly in rural areas such as Sarawak utilise this information in everyday health decisions. This study, guided by Longo’s Expanded Model of Health Information-Seeking Behaviour (EM-HISB), examines how the type (THI), sources (SHI), and access (AHI) to health information collectively predict HIU among adults with NCDs. Materials and Methods: This cross-sectional study formed part of a larger investigation on health information-seeking behaviour in Sarawak. Data were collected from May to December 2023 using multi-stage random sampling in Kuching (urban) and Lubok Antu (rural). Of the 782 participants surveyed, 217 self-reported having at least one NCD. Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to analyse the measurement and structural models. Results: Hypertension was the most commonly reported condition, particularly among participants aged 41–60. All three predictors: THI (β = 0.200, p < 0.05), SHI (β = 0.476, p < 0.05), and AHI (β = 0.178, p < 0.05) were significantly associated with HIU. The model demonstrated strong predictive validity (R² = 0.612), with SHI emerging as the most influential predictor, exhibiting the highest standardised beta coefficient and a moderate effect size (f² = 0.138). Discussion and Conclusion: The strong influence of SHI reflects Sarawak’s unique socio-cultural context, particularly in rural areas. These findings highlight the importance of developing multifaceted health promotion strategies that cater to the varied informational needs and preferences of NCD patients in Sarawak.
Prevalence of Pre-eruptive Intracoronal Resorption in Yemeni Children and Adolescents: A Cross-sectional Study
Introduction: Early detection of pre-eruptive intracoronal resorption/radiolucency(PEIR) helps in early management and treatment before and during tooth eruption. Therefore, this study aimed to assess the prevalence of PEIR and coexisting dental factors using archived digitalized panoramic radiographs of unerupted permanent teeth in Yemeni children and adolescents. Materials and methods: A cross-sectional study of 4927 unerupted teeth from 487 archived digitalized panoramic radiographs (males 243 and females 244) of children aged 6–15 years old were examined to assess the presence of PEIR. The prevalence of PEIR and associated factors as ectopic position, supernumerary teeth or fused teeth, hyperdontia or hypodontia, impaction, dense in dente, and taurodontism, the presence of dental caries, root canal treatment, restoration and/or periapical infection in the predecessor primary teeth were checked by two independent calibrated examiners. Results: After examination, 14 /4927 teeth and 14/487 patients had PEIR defects, which accounted for 2.9% of overall subject prevalence and 0.28% of overall tooth prevalence. A statistically significant difference was noted in PEIR defects with regard to age, dental arch type, arch side, and dentation stage. The second premolar was the most affected tooth in the maxillary and mandibular arches. Most lesions were located in less than 1/3 of the dentin thickness(50%). Most of the lesions were located on the mesial aspect of the crown(35.7%). The ectopic position was the most coexisting factor with PEIR(41.18%). Conclusion: Although PEIR is one of the detected lesions in the unerupted teeth of Yemeni children and adolescents with low prevalence, its early detection helps dentists to be aware of this hidden lesion and allows them to have an early treatment plan with few complications.
The Effect of Antimicrobial Resistance (AMR) Educational Module on Knowledge and Attitude Among Primary School Students in Kota Belud, Sabah, Malaysia
Introduction: Antimicrobial resistance (AMR) is a burgeoning problem worldwide. The trend of AMR has increased over the past decade. Health education and interventions with the goal of raising awareness and knowledge about AMR should be conducted to create a community that uses antimicrobial prudently and to slowdown the spread of resistance. Methods: This study used a quasi-experimental research design with pre-test and post-test. Primary school students (standard 4-6) in Kota Belud, Sabah were divided into control and intervention group. Paired t-test was used to compare knowledge and attitude level between pre-test and post-test scores in each group. Independent sample t-test was used to compare two groups and to assess the effect of the AMR Module. Results: After AMR education, the intervention group showed a significant increase in knowledge level from the pre-test (mean=17.48, SD=3.73) to post-test (mean=21.71, SD=4.50) compared to control group’s pre-test (mean=13.76, SD=5.66) to post-test (mean=14.33, SD=4.75). Significant increase in attitude level was also reported from the pre-test (mean=27.90, SD=5.25) to post-test (mean=32.13, SD=5.16) compared to control group’s pre-test (mean=27.73, SD=5.31) to post-test (mean=27.75, SD=4.19). A significant difference was also recorded in the intervention and control group’s knowledge level (p<0.001) and attitude level (p<0.001) in pre-test and post-test respectively. Conclusion: Improvements in primary school students' knowledge and attitude on AMR demonstrate that AMR Module was an effective tool for teaching AMR topic. Adopting AMR education interventions as part of public health school intervention can build positive knowledge and attitudes on AMR among primary school students.
Eating Disorder Among Adult Malaysian Attending Urban and Rural Primary Health Clinics in Malaysia and Its Associated Factors - A Cross Sectional Study (EDAM)
Introduction: Our survey showed that fifty per cent of adult Malaysians have symptoms of eating disorders. The burden of eating disorders showed that individuals with current or former eating disorders are at risk of increased mortality, high years lived with disability (YLD) rates, poorer quality of life, increased costs, and problems with childbearing. Methodology: We determined the factors associated with eating disorders among adults attending 11 health clinics between August to November 2022 using the Eating Disorder Examination Questionnaire (EDE-Q). Results: The response rate was 83% (n=829). Logistic regression was done to analyse the association between sociodemographic characteristics, depression, and anxiety scores, body mass index, with eating disorder score. Higher score in females; rural 0.40 (95% CI: 0.15,40.66; p-value = 0.002) urban 0.25 (95% CI: 0.02, 0.48; p-value = 0.037), obese participants 0.90 (95% CI: 0.38, 1.43; p-value = 0.0010), anxiety and depression increase scores rural 0.32 (95% CI: 0.04, 0.59; p-value = 0.023) and 0.54 (95% CI: 0.22, 0.87; p-value <0.001)urban; depression 0.31 (95% CI: 0.10, 0.52; p-value = 0.004) and anxiety 0.67 (95% CI: 0.41, 0.93; p-value <0.001). Conclusion: Screening of females, the obese and those with mental health issues should be considered.
Mind the Gap: A Clinical Audit of Asthma and COPD Documentation Practices at a University Primary Care Clinic in Selangor, Malaysia
Introduction: Clinicians are responsible for meticulous documentation and maintaining a systematic record-keeping system. Good documentation practices improve patient care and uphold quality assurance. This audit assessed documentation practices during asthma and COPD clinic consultations. Methods: This retrospective descriptive audit examined electronic medical records (EMRs) for documentation completeness of asthma and COPD patients attending a university primary healthcare clinic in Selangor, Malaysia, from January 1, 2020, to December 31, 2020. Patients’ EMRs meeting the inclusion/exclusion criteria were evaluated using standardised checklists to collect sociodemographic and clinical data, including selected asthma and COPD indicators across three domains: clinical assessment, disease control assessment, and disease management. Documentation completeness for each indicator was recorded and marked as “Yes” for documented or “No” for undocumented. Data were analysed using IBM SPSS V26.0. Results: 180 asthma and 15 COPD patients’ EMRs were analysed. The asthma cohort had a mean age of 54.46 (SD:18.99), were predominantly female (61.7%), Malay (92.8%) and obese (54.9%). The COPD cohort had a mean age of 73.67 (SD: 7.61), were mostly male (80.0%), Malay (73.3%) and overweight (54.5%). In asthma documentation, four indicators achieved > 50%, while the remaining four indicators achieved <50% completion rates. In COPD documentation, four indicators achieved >50%, while seven indicators achieved <50% completion rates. Conclusions: Documentation completion for asthma and COPD care indicators fell below targets. Regular training, feedback and audits are crucial for enhancing documentation, improving care and minimising medicolegal risks. Study limitations include variability in documentation practices and the generalizability of findings to a single setting.
Comparison of Environmental Health of Fishermen's Settlements on Islands and Mainland: Case Study of Muara Siberut and Pasie Nan Tigo, Indonesia
Introduction: In coastal settlements, especially among family fishermen, environmental health is crucial because their lives are closely tied to the condition of nature and local resources. This study compares the environmental health aspects of fishing communities on islands and the mainland, focusing on Muara Siberut, Mentawai Islands, and Pasie Nan Tigo, Padang. Materials and Methods: Environmental health is assessed through housing conditions, sanitation facilities, and pro-environmental behavior. The study involved 198 participants, 98 from the Island and 100 from the mainland, selected based on the inclusion criteria of working as fishermen for at least one year in their respective areas. Data were collected through interviews and observations using a validated questionnaire, capturing sociodemographic information and environmental health factors. The analysis was conducted using SPSS version 26. Results: The results reveal significant disparities in environmental health influenced by geographical factors, infrastructure accessibility, and local community awareness. Island communities face more significant challenges than mainland settlements, emphasizing the impact of limited resources on health outcomes. Conclusion: This research underscores the importance of targeted policies and interventions to improve environmental health in fishing settlements, especially in isolated coastal regions. The findings contribute to the field by highlighting the role of geography in shaping health disparities and offering actionable insights for policymakers to enhance sustainability and well-being in coastal communities.
Determination of Paediatric Diagnostic Reference Levels (DRLS) in Computed Tomography Scanners in Two Public Hospitals in Klang Valley
Introduction: Computed Tomography (CT) scanners have made significant contributions in health facilities around the world. However, CT scan examinations produce relatively higher radiation doses compared to other X-ray-based imaging modalities especially in paediatric. The International Commission on Radiological Protection (ICRP) have recommended Diagnostic Reference Levels (DRLs) to optimize dose received in paediatric patients. This study aims to determine paediatric CT DRLs values for four age groups in two Public Hospitals. Materials and Methods: A total of 958 CT scan examinations were conducted at were conducted at two public hospitals over a 12-month period. The retrospective analysis was divided into head, chest and abdominal examinations and categorized into four age groups: <1, 1-5, 6-10 and 11-15 years old. CTDIvol, DLP, and ED values were analysed. Results: The study found that the value of CTDIvol and DLP in Hospital A gave the lowest value for all age groups at head examination. The highest DLP were estimated in Hospital B for the group <1y and 5-10 y in head examination, and the 10-15 y group in abdomen examination. The estimated ED values were consistent with those reported in other studies which were 2.30 mSv (Hospital A) and 4.08 mSv (Hospital B). Conclusion: The CTDIvol, DLP and ED values in this study are in the optimal except for DLP values for the abdomen examinations in oldest group which gives the impression that there is room for an improvement.
Measurements of Peripheral Refraction in Malay and Chinese Myopic Children in Kuala Lumpur: A Pilot Study
Introduction: Retinal shape varies between ethnicities and may contribute to myopia development. This study investigated the peripheral refraction (PR) in Malay and Chinese myopic children living in Kuala Lumpur. Materials and Methods: This is a retrospective study involving data from 96 participants (40 Malays, 56 Chinese). Subjects were myopes from -0.50D to -5.00D, with visual acuity (VA) of 0.00 log MAR in each eye. Cycloplegic refraction was conducted using an autorefractometer across the horizontal meridian, out to 30° at 10° intervals in the nasal (N) and temporal (T) of the retina. Axial length (AL) measurements were taken using A-scan and optical biometry. The results were analysed using SPSS. Results: The mean age of subjects was 9.55 ± 1.51 years (Malays) and 8.34 ± 0.48 years (Chinese) (p<0.05). Mean SER and AL for the Malays and Chinese were -2.97±1.26D and -3.06 ± 1.10D (p>0.05) and 24.74± 0.90mm and 24.50 ± 0.86mm (p<0.05) respectively. Higher hyperopic shift was observed in the Chinese than Malays but was only significant at 300 N (p=0.003). Greater RPR was noted at all eccentricities in the Chinese than the Malays (p<0.0001). No significant differences were noted in J0 and J45 between both ethnicities (p>0.05) and AL was shown to have significant influence in the changes of PR for both groups (p<0.05). Conclusion: Chinese children have greater horizontal hyperopic PR and RPR than the Malays of similar refractive error, indicating a more prolate ocular shape. Nevertheless, more data is needed to confirm these findings.
Understanding Malaria Prevention Behaviors Among Pregnant Women in the Gambia: Insights From the Health Belief Model
Introduction: Malaria poses a significant threat to pregnant women, increasing the risk of fetal infection and severe health complications. First-time pregnant women are especially vulnerable due to their lower immunity levels. Methods: Using a cross-sectional design and multiple linear regression test results, the study investigated the correlation between Health Belief Model components and malaria prevention behaviors among pregnant women in the Upper River Region, Gambia. Results: The findings revealed that perception of severity significantly influenced malaria prevention behaviors, with a coefficient of 0.238. T-test analyses revealed that only the perception of severity significantly and positively affected malaria preventive actions among pregnant women, with a t-value of 2.344 and a p-value of 0.025. In contrast, other components of the Health Belief Model (HBM), such as perceived vulnerability (t = 0.710, p = 0.482), perceived barriers (t = 1.006, p = 0.322), and self-efficacy (t = -1.260, p = 0.216) didn’t show significant impacts. The perceived benefits component also significantly affected preventive actions (t = -2.252, p = 0.031). The simultaneous f-test demonstrated that the collective influence of the five HBM components was not statistically significant, with an F-value of 2.376 and a p-value of 0.064. Conclusion: These results suggest that while the perception of malaria severity positively influences preventive behaviors, other HBM components do not significantly impact the adoption of malaria prevention measures among pregnant women. The study underscores the intricate nature of factors influencing malaria prevention behaviors in pregnant women, underscoring the need for customized interventions to enhance these practices.
Factors Influencing Exclusive Breastfeeding Intention Among Antenatal Mothers in Sarikei, Sarawak
Introduction: Exclusive breastfeeding (EBF) for six months is strongly recommended due to its health benefits, yet EBF rates remain suboptimal in Malaysia. Maternal intention is a strong predictor of breastfeeding behaviour. This study examines the factors influencing EBF intention among antenatal mothers in Sarikei, Sarawak. Materials and Methods: A cross-sectional study was conducted among pregnant women attending antenatal care at two systematically selected health clinics. Universal sampling was used. Data were collected via face-to-face interviews using validated tools: the Iowa Infant Feeding Attitude Scale (IIFAS), the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and a breastfeeding knowledge questionnaire. Binary logistic regression was used to identify significant predictors of EBF intention. Results: Among 137 participants, 81.0% intended to practise EBF. Binary logistic regression revealed that husband support (AOR = 7.949, 95% CI: 1.147–55.092, p = 0.036) and family support (AOR = 7.646, 95% CI: 1.899–30.785, p = 0.004) were significant predictors of EBF intention. Knowledge, attitudes, and self-efficacy were not independently associated with EBF intention. Conclusion: Husband and family support play crucial roles in shaping EBF intention. Future interventions should prioritise engaging family members in breastfeeding education and support programmes to improve EBF rates. This study may be subject to a few biases commonly associated with cross-sectional designs, including social desirability bias and recall bias. The use of a single question measure for breastfeeding intention may limit interpretation. Longitudinal studies are recommended to assess how intention translates into actual breastfeeding behaviour.
Analysis of Differentially Expressed Genes and Molecular Pathways in Spontaneous Preterm Birth: A Bioinformatics Approach
Introduction: Preterm birth (PTB) accounts for 35% of neonatal mortality worldwide within 28 days of life. Limited understanding of its molecular mechanisms hampers the development of effective preventive strategies. Thus, this study aims to investigate dysregulated genes in the maternal blood and placenta of PTB women to unveil potential underlying mechanisms. Materials and Methods: A meta-analysis of differentially expressed genes (DEGs) in PTB was conducted using the limma R package and p-value combination method. Seven maternal blood and four placenta studies was chosen for this analysis. Accordingly, protein-protein interaction networks were constructed using STRING and visualised in Cytoscape. Network centrality was assessed using cytoHubba and CytoNCA tools in Cytoscape to rank key genes. MCODE was then used to identify highly interconnected gene clusters. Functional enrichment analysis was performed to obtain significant ontologies and pathways. Results: This study discovered 20 blood and 18 placenta hub genes, with IKBKG, HSP90AA1, and EGR1 being the most significantly enriched and central in maternal blood, and IGF1, FN1, and LOX genes for placenta. These DEGs mainly involve cytokine-mediated signalling pathways (maternal blood) and extracellular matrix organisation (placenta) biological pathways. Comparably, KEGG revealed them to be enriched in pathways of IL-17 signalling and ECM-receptor interaction, respectively. Conclusion: These DEGs have the potential to precisely identify PTB-risk individuals by revealing the underlying pathophysiology, allowing for more targeted and effective interventions. Notably, maternal blood DEGs are of particular interest, as they may serve as early, non-invasive biomarkers for PTB risk, enabling earlier detection and preventive care during pregnancy.
Preventing Peritoneal Dialysis Catheter Exit Site Granuloma and Infection With Fixator Dressing: A Single-center Retrospective Analysis
Introduction: Peritoneal dialysis (PD)-related infection is associated with morbidity and mortality. Exit site care is important to prevent infection and the ensuing tunnel infection and peritonitis. The aim of this study is to compare the use of two different dressings on exit site and tunnel outcomes. Methods: A retrospective cohort study was conducted in a tertiary center from January 2023 to July 2024. All patients received either fixator or standard dressing, from immediately after PD catheter insertion up to 21 days. They are then followed up for 30 days. The primary outcomes for this study are exit site granuloma formation and exit site infection. The secondary outcomes are tunnel infection and catheter extrusion. Results: A total of 161 patients completed the study, with 111 patients in the fixator group, and 150 patients in the standard group. There were six cases of exit site infections, three in each group. This corresponds to 1 episode per 37 patient-months for fixator dressing, and 1 episode per 50 patient-months for standard dressing. There was no significant difference in exit site infection between the groups. Standard dressing group reported two cases of granuloma infection, and fixator group had none. There is no tunnel infection or catheter extrusion in both groups. Conclusion: There is no significant difference between the use of fixator or standard dressing in subsequent granuloma formation, exit site infection, tunnel infection or catheter extrusion. These two types of exit site dressings can be used interchangeably in the early post catheter insertion period.
Development and Evaluation of Animated Videos Promoting Healthy Diet During Pregnancy and Exclusive Breastfeeding for Healthy Child Growth
Introduction: Healthy and adequate maternal nutrition during pregnancy and exclusive breastfeeding are helpful for preventing child stunting, yet educational tools to promote this, particularly on digital platforms, are still lacking. Thus, this study aimed to develop and evaluate a series of animated videos for nutrition educational purpose. Methods: A design and developmental research method consisting of content analysis, video design and development, and video evaluation phases was utilised in this study. The video storyboards and scripts were created based on a review of literature and guidelines and evaluated by six field experts. The videos were created using Powtoon software and evaluated by multimedia experts to ensure technical quality. Fifty reproductive-aged women assessed the understandability, actionability, and suitability of the videos using the PEMAT-AV and SAM tools. Results: Four short, animated videos were developed regarding the recommended intakes of total calories, macronutrients, and micronutrients for pregnant and exclusively breastfeeding mothers. The storyboards and scripts were approved by content experts in terms of objectives, structure, presentation, and relevance. The videos also received favourable responses from the target viewers, with scores ranging from 96% to 100% for understandability, 95% to 99% for actionability, and 94% to 99% for suitability. Conclusion: The newly developed animated video series on healthy maternal nutrition during pregnancy and exclusive breastfeeding was approved by content and multimedia experts. They were also found to have desirable levels of suitability, understandability, and actionability. These indicate its acceptability as a nutrition education tool for promoting healthy child growth through maternal nutrition.
Developing a Real-Time Behavioural Safety Culture Framework (BOSCA) Using Progressive Web Applications (PWA)
Introduction: The oil and gas industry’s complex operations demand a proactive safety culture that addresses behavioural safety challenges. Traditional safety management systems often fall short in promptly identifying safety culture performance, risk and enabling timely interventions. This study introduces the Behavioural Occupational Safety Culture Application (BOSCA), a framework that leverages Progressive Web Application (PWA) technology to enhance safety culture through integrated behavioural elements. Methods: BOSCA was developed through a structured four-phase process: requirements gathering, design, implementation and testing. Key safety elements were identified through expert consultations with stakeholders, including safety practitioners, authorities, academicians, and management. These consultations prioritized eight behavioural sub-elements: management commitment, safety commitment, safety ownership, safety training, safety communication, reward recognition, safety investment and safety competency, which were then integrated into BOSCA’s multi-layered architecture. The application was designed for cross-platform functionality to ensure accessibility and usability. Results: The BOSCA framework successfully supports continuous monitoring of safety-related behaviours and provides timely feedback to management, enabling proactive interventions. The system integrates an intuitive interface that promotes active user engagement and seamless data processing to reinforce safe behaviours. Internal system testing confirmed that all feedback modules functioned as intended. Conclusion: BOSCA represents a significant advancement in safety management for high-risk industries. While potential challenges such as integration with legacy systems and data privacy need addressing, BOSCA’s framework sets a new standard for safety culture, fostering a safer, more engaged workforce within the oil and gas sector.
Mediating Role of Safety Climate in The Associations Between Safety Culture, Safety Education and Training, Reporting Attitudes with Medical Errors in Riyadh Hospitals
Introduction: Medical errors pose significant challenges to healthcare systems globally. In Saudi Arabia, the alarming rise in medical error incidents since 2016 has eroded trust in the healthcare system, highlighting inadequacies in current policies and practices. This study investigated how safety climate mediates the relationship between safety culture, safety education and training attitudes, and reporting attitudes on medical errors among healthcare professionals in Riyadh public hospitals. Materials and Methods: This cross-sectional study collected data from 403 healthcare professionals across four Riyadh public hospitals. Descriptive analysis was conducted using SPSS, while AMOS was used for structural equation modelling. Results: Healthcare professionals perceiving stronger safety culture (b=0.53, p<0.001) and reporting attitudes (b=0.44, p<0.001) were more likely to commit medical errors, while those with positive safety education and training attitudes (b=-0.21, p<0.001) recorded fewer errors. Safety climate partially mediated relationships between safety culture and medical errors (p<0.001) and between safety education/training attitudes and medical errors (p<0.001), but not between reporting attitudes and medical errors (p=0.068). Conclusion: Safety climate crucially mediates the translation of organizational safety factors into medical error outcomes. Healthcare organizations should simultaneously develop strong safety cultures, positive safety climates, effective training programs, and non-punitive reporting systems to enhance organizational learning and improve patient safety outcomes in Saudi Arabian healthcare settings.
Predictive Value of Postoperative Neutrophil-Lymphocyte Ratio for Major Adverse Cardiac Events Following Off-Pump CABG with Preoperative Dexamethasone: A Retrospective Analysis from a Randomized Controlled Trial
Introduction:The neutrophil-lymphocyte ratio (NLR) is a known predictor of major adverse cardiac events (MACE) after coronary artery bypass grafting (CABG). However, its prognostic value in patients receiving preoperative dexamethasone remains uncertain. This study aimed to determine the optimal cut-off value of 24-hour postoperative NLR for predicting MACE in off-pump CABG (OPCAB) patients who received preoperative dexamethasone. Methods: This study is a single-center retrospective secondary analysis of data derived from a previously conducted randomized controlled trial (RCT). For this current observational study, a specific cohort of 60 OPCAB patients was retrospectively selected from the parent RCT, focusing on those who had received preoperative dexamethasone. This cohort comprised 12 patients who developed MACE and 48 who did not. The primary outcome for this analysis was the occurrence of MACE postoperatively, and the NLR was measured within the first 24 hours after surgery. Results: Patients who developed MACE had significantly higher postoperative NLRs. Receiver operating characteristic analysis showed an area under the curve (AUC) of 72.9%. A cut-off value of 16.24 for NLR provided a sensitivity of 91.7%, specificity of 58%, positive predictive value of 35.5%, negative predictive value of 96.9%, and a risk ratio of 10.29 (95% CI: 1.42–74.79). No significant adverse effects related to dexamethasone were noted. Conclusion: An NLR cut-off of 16.24 may serve as a reliable early predictor of MACE in OPCAB patients receiving preoperative dexamethasone, indicating that NLR retains prognostic value even with anti-inflammatory premedication.
Barriers of Back-referral program Implementation for Diabetes Mellitus Care in Primary Health Care Settings: A Case Study in Surakarta City, Central Java Province, Indonesia
Introduction: Back-referral is a key component in the management of diabetes mellitus (DM) within Indonesia’s health system, aiming to strengthen continuity of care at the primary level. However, its implementation remains suboptimal in many areas. In response, the Indonesian government launched the Chronic Disease Management Program (Prolanis) in 2014 to promote integrated care in Primary Health Care (PHC) facilities, including back-referral mechanisms. Materials and Methods: This qualitative case study explored barriers to implementing the back-referral program for DM care among Prolanis patients in Surakarta City, Central Java Province, Indonesia. Results: Barriers were identified at multiple levels, including: limited hospital engagement in initiating referrals back to PHC, inefficiencies in the hospital–PHC referral process, technical issues with the digital referral system, and poor patient adherence to program protocols. Conclusions: Barriers to back-referral implementation were found at the patient level, provider level, and in inter-facility coordination. To improve program sustainability, clearer and more enforceable standard operating procedures (SOPs) are needed across stakeholders.
Physical Activity and BMI in Relation to Diabetic Neuropathy: Which Factor Plays a Greater Role?
Introduction: The rising prevalence of obesity indices, such as body mass index (BMI), alongside persistently low levels of physical activity, contributes significantly to the development of diabetic microvascular complications, including somatic and autonomic neuropathy. This study aims to analyse the relationship between body mass index (BMI) and physical activity with the incidence of diabetic neuropathy in patients with type 2 diabetes mellitus. Method: This study employed a cross-sectional design in 55 patients diagnosed with type 2 diabetes mellitus in 2024 who met the inclusion and exclusion criteria and were selected using consecutive random sampling. The research instruments used were weight and height scales, the Global Physical Activity Questionnaire (GPAQ), and the Michigan Neuropathy Screening Instrument (MNSI). Results: The neuropathy-positive group had higher BMI (27.78 ± 4.708 vs. 23.70 ± 3.444, p < 0.05) and lower physical activity (905.05 ± 911.871 vs. 2,537.11 ± 2,126.107, p < 0.05). BMI status (r=0.461, p<0.05) and physical activity level (r=0.450, p<0.05) had a positive and moderate association with the incidence of diabetic neuropathy. Logistic regression results showed that physical activity (Wald = 8.167) and BMI (Wald = 5.530) had a more significant influence than BMI on the incidence of diabetic neuropathy. Conclusion: A significant relationship was identified between Body Mass Index (BMI) and physical activity with the incidence of diabetic neuropathy in type 2 diabetes mellitus patients.
Correlation Between Screen Time and Speech and Language Skills Among Preschool-Aged Children
Introduction: The increasing prevalence of screen media usage among young children has raised concerns about its potential effects on various aspects of development, particularly speech and language development. Therefore, this study aims to examine the screen time of children aged 4 and 5 years old and its correlation with their speech and language scores. Materials and Methods: A total of 45 parents employed at a university took part in this cross-sectional study, which utilised an online self-administered Speech and Language Assessment Scale (SLAS) questionnaire to gather necessary data. Descriptive statistics were used to summarise sociodemographic characteristics and screen time patterns. The Spearman rank correlation was used to examine the correlation between screen time and speech and language scores. Results: On average, young children spent 1.96 hours per day engaged in screen time, with passive content being the most commonly watched, followed by interactive and educational content. Statistical analysis revealed a significant inverse correlation between total screen time and speech and language scores (p=0.001), suggesting that increased screen time is associated with lower speech and language skills. Notably, specific domains such as assertiveness, responsiveness, semantics, syntax, and articulation were adversely affected by higher levels of screen use. Conclusion: In conclusion, this study highlights the critical role of parental supervision in managing children's screen time and underscores the importance of promoting activities that foster face-to-face interaction and support speech and language development.
Knowledge, Attitudes, and Self-Efficacy of Towards Palliative Care in Indonesian Pre-Registration Nursing Students: A Cross-Sectional and Multicenter Study
Introduction: Palliative care education at the undergraduate level offers nursing students a solid foundation for clinical practice. Knowledge, support, and skilled nurses are essential when caring for patients with life-limiting conditions and their families. Current palliative care education focuses mainly on academic learning with limited clinical learning. This study aimed to identify knowledge, attitudes, and self-efficacy towards palliative and end-of-life care among nursing students who received palliative care education at three undergraduate nurse training institutions in Indonesia. Materials and Methods: This cross-sectional study utilized non-probability sampling to recruit 152 respondents from Bandung, Yogyakarta, and Jember nursing schools. Three instruments were used for data collection: the Palliative Care Quiz for Nursing (PCQN), the Frommelt Attitude Toward Care of the Dying (FATCOD-B), and the Self-Efficacy in Palliative Care (SPEC) scale. The data was analyzed using the Spearman correlation. Results: Findings suggest that all students have positive attitudes towards death and caring for dying patients. However, over half of the students demonstrated low knowledge and self-efficacy (52%). Such deficiencies can lead to suboptimal care for those at the end of life. Conclusion: Palliative care education should be taught theoretically in the classroom and incorporated into clinical internships to strengthen students' self-efficacy and clinical skills. The current palliative care nursing curriculum in Indonesia needs to be modified to address this gap.
Parental Impact on Socio-Emotional Development of Deaf and Hard-of-Hearing Children with Cochlear Implants: A Mixed-Methods Study
Introduction: This study explores the relationships between parenting styles, parenting stress, child-parent relationships, and the socio-emotional functioning of Deaf and Hard-of-Hearing (DHH) children with cochlear implants (CI) through a mixed-methods approach. Methods: In the quantitative phase, 36 parents of CI children aged four to six completed questionnaires via purposive sampling. Subsequently, in the qualitative phase, 12 parents participated in in-depth interviews. Results: The findings suggest that practicing authoritative parenting, which was the most common parenting style among the participants, was associated with higher socio-emotional skills in CI children. CI children might still exhibit undesirable behaviour, and this often stimulates parents to evaluate and enhance their parenting skills. Parenting stress was found to be higher among the participants, attributed to various challenges such as guilt, self-doubt, time management, and work-related stress. However, proactive strategies like positive self-talk and sharing success stories of cochlear implantation were identified as potential mitigating factors for parenting stress. Parental investment in building a close relationship and engaging in activities together, with the degree of closeness serving as a vital mediator, further enhances socio-emotional skills in CI children. Conclusion: This research provides valuable insights for future studies on the socio-emotional development of CI children and the role of parenting. The results suggest the need for early prevention programs tailored to the unique needs and challenges of parents with CI children. Additionally, clinicians in CI teams should be aware of the potential for high levels of parenting stress and strive to provide appropriate support for the socio-emotional functioning of CI children.
Oral Health Status and Function of Cancer Patients Undergoing Chemotherapy and/or Radiotherapy: Findings From Two Tertiary Hospitals in Malaysia
Introduction: Cancer treatments are commonly associated with painful oral complications that may influence patients’ prognosis. This study aimed to determine the oral health status and function of cancer patients undergoing chemotherapy (CTx) and/or head and neck radiotherapy (H&N RT) and factors associated with presence of oral mucositis (OM). Materials and method: This cross-sectional study included hospitalized cancer patient undergoing CTx and/or H&N RT at two tertiary hospitals in Malaysia, excluding those in isolation. Structured proforma and the Oral Assessment Guide (OAG) were used to determine patients’ oral health status and function. Factors associated with OM were determined using logistic regression analysis. Results: Out of 177 patients, 25.4% reported experiencing oral complications, with xerostomia being the most common (66.7%), followed by mouth ulcers (35.6%), dysgeusia (15.6%), and lip numbness (15.6%). The most affected component of the OAG was the teeth or dentures, with 71.8% of patients showing issues with localized (39.0%) and generalized (32.8%) plaque accumulation. Based on the OAG score, about half of patients (58.8%) had OM. Pediatric cancer patients were 5.60 times more likely to have OM than adult patients (p <0.001). Conclusion: OM affected approximately half of the cancer patients undergoing CTx and/or H&N RT, with pediatric patients being significantly more susceptible. Additionally, around 25% of patients reported experiencing at least one oral complication during the course of their treatment, with xerostomia being the most common. These findings highlight the importance of implementing oral care regimens throughout cancer therapy to help prevent or reduce the frequency and severity of oral complications.
The Perceptions of Nursing Students on Learning Practical Skills During Undergraduate Study
Introduction: Practical skills training is a crucial component of nursing education, linking theoretical knowledge with real-world clinical applications. With an emphasis on readiness, competency, and the efficacy of educational programmes, this study explores nursing students' opinions on acquiring practical skills during their undergraduate studies. Methods: Twelve final-year nursing students at the Kulliyyah of Nursing, IIUM, participated in semi-structured interviews as part of a qualitative study using a purposive sampling method. Key themes and sub-themes were identified through thematic analysis. Findings: The four themes that emerged were practical skills, preparedness, self-assessed competence, and educational programme. Students emphasised the value of practical experience, theoretical integration, and feedback in learning new skills. Recommendations include increasing simulation opportunities and improving the curriculum structure. Conclusion: A strong nursing education programme that prioritizes hands-on training, self-assessment, and feedback systems is essential for preparing students for clinical practice.
Discrepancies in Nicotine Content of E-Cigarette Liquids: A Systematic Review of High Performance Liquid Chromatography-Based Analyses
Introduction: E-cigarettes have emerged as a popular alternative to traditional tobacco products, largely driven by perceptions of reduced harm and customizable nicotine delivery. Accurately determining nicotine concentrations using high performance liquid chromatography is crucial for guiding public health policies and ensuring consumer safety. This assessment method is preferred due to its high sensitivity, precision and ability to reliably quantify nicotine in complex matrices especially the liquid in e-cigarettes. Methods: A systematic search using electronic databases was performed using PubMed, Science Direct, and Google Scholar with specific keywords to identify relevant studies to determine the findings. The articles that met the inclusion criteria were retrieved following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: The findings of this systematic review revealed that the nicotine concentration in e-liquid samples varies across multiple studies. The deviation of nicotine content in e-liquid samples found to be high as +451% and as low as −90.6%. The analyzed e-liquid samples with concentrations ranging from 0 to 50 mg/ml indicated that nicotine levels were more than 20% and at least 10% below the labelled concentrations in packaging. The analysis also exposed the existence of nicotine in e-liquid samples labelled as nicotine-free. Conclusion: This systematic review employing high performance liquid chromatography as primary analytical method to uncover inconsistencies between measured nicotine content of e-liquids and their labelled values. These findings underscore the urgent need for stricter regulatory oversight and standardized quality control measures for consumer safety and compliance with regulatory standards.
A Systematic Review of Potential Anticancer Activities of Muntingia Calabura L. With a Focus on Cellular and Molecular Mechanisms
Background: Medicinal plants have been extensively explored for their chemopreventive and antiproliferative properties. Muntingia calabura has emerged as a promising candidate due to its ability to modulate various signaling pathways involved in cancer progression and suppression. This includes interactions with multiple cell signaling molecules that regulate cancer formation and development. Purpose: This review aims to critically evaluate the anticancer properties of M. calabura across different cancer types. Methods: A systematic literature search was performed across major scientific databases, including ScienceDirect, PubMed, and Scopus. Studies were selected based on predefined inclusion criteria using the keywords "Muntingia calabura", “M. calabura”, “anticancer,” and "cancer." A total of 14 studies met the eligibility criteria and were analyzed for this review. Results: Evidence from the reviewed studies highlights the anticancer effects of M. calabura extracts, which include inhibition of inflammatory and apoptotic pathways. The modulation of dysregulated signaling cascades, such as the LOX, XO, and RAF1 pathways, was shown to contribute significantly to its anticancer activity. Conclusion: The findings support the potential application of M. calabura and its phytochemical constituents in cancer prevention and therapy. However, further in-depth studies are necessary to identify its bioactive compounds and elucidate the mechanisms underlying its anticancer effects for clinical translation.
Factors Of Compliance To Iron Supplementation On Adolescent Girls With Anemia In Asia: A Systematic Review
Introduction: Iron deficiency anemia (IDA) remains a critical global health challenge, particularly among adolescent girls, with a worldwide prevalence of 29.4%. While iron supplementation is a proven intervention, adherence rates remain suboptimal (32.7%-44.3%), undermining anemia control efforts. This systematic review synthesizes evidence on factors affecting adherence to iron supplementation in adolescent girls. Methods: This study followed the PRISMA guidelines, with searches conducted in five databases for studies published between 2020 and 2025. Of the 309 articles identified, 13 met the inclusion criteria and were analyzed thematically. Results: Key findings reveal that individual, social, and systemic factors influence adherence. Personal factors influencing adherence include low knowledge, negative attitudes, and low awareness of the consequences of anemia, which hinder adherence. Meanwhile, social factors include maternal support and peer influence, which significantly influence adherence behavior. Barriers related to supplements, such as unpleasant taste and gastrointestinal side effects, are often reported, along with forgetfulness as a major challenge. The systemic factors include school-based policies and the quality of program implementation, which also shape adherence. Context-specific interventions such as nutrition and monitoring can demonstrate improved adherence, highlighting the importance of locally tailored strategies. Conclusion: Adherence to iron supplementation is multifactorial, requiring integrated approaches. Recommendations include: (1) targeted education campaigns to enhance knowledge and attitudes, (2) optimizing supplement formulations to minimize side effects, (3) strengthening school and community-based distribution systems, and (4) engaging families and peers to foster supportive environments. Future programs should prioritize contextual adjustments to maximize compliance and reduce IDA among vulnerable groups.
Primary Fused Teeth: A Comprehensive Case Series with Clinical Insights
Introduction - Fusion occurs when two tooth germs that are normally separated join. Depending on the developmental stage of the tooth, it can either be complete or incomplete. Fusion can have an impact on a child's oral health. These abnormalities are associated with several clinical consequences, including dental caries, malocclusions, periodontal issues, and anomalies in the permanent dentition. Case Series - The current paper presents three paediatric patients with primary fused teeth (PFT) associated with missing permanent teeth. Clinical and radiographic follow-up was performed every 3 months to monitor the tooth development. No clinical or radiological symptoms were noted during the follow-up visits. Conclusion - This article discusses therapeutic care, consequences, and potential ramifications of PFT on permanent successors through three cases of fusion. PFT could necessitate interdisciplinary care to prevent and manage any potential issues in the primary teeth as well as their permanent successors. Hence, PFT should be detected at the earliest.
A Case Series of Atypical BCR:: ABL1 Signal Patterns in Chronic Myeloid Leukaemia (CML) Patients
Introduction: Chronic Myeloid Leukaemia (CML) is a myeloproliferative neoplasm defined by the BCR::ABL1 fusion gene resulting from the Philadelphia chromosome t(9;22)(q34.1;q11.2). Fluorescence in situ hybridization (FISH) is helpful in detecting both typical and atypical BCR::ABL1 rearrangement patterns. This case series highlights the clinical, cytogenetic and molecular implications of atypical signal patterns in CML patients. Methods: Four newly diagnosed CML patients exhibiting atypical BCR::ABL1 FISH signal patterns were included in this case series. Clinical features, cytogenetic findings, and molecular responses to frontline tyrosine kinase inhibitor (TKI) therapy were documented. Results: Each patient demonstrated distinct atypical signal patterns: Patient 1 had a deletion on derivative chromosome 9; Patients 2 and 3 showed deletions on derivative chromosome 22; Patient 4 exhibited BCR::ABL1 fusion with concurrent ABL1 and BCR deletions. Patients 1–3 failed to achieve major molecular remission during follow-up. Patient 4, although initially responsive, required a switch from imatinib to nilotinib due to loss of complete cytogenetic remission. Conclusion: Atypical BCR::ABL1 FISH signal patterns may correlate with suboptimal therapeutic responses to frontline TKIs. While their prognostic significance remains uncertain, these patterns offer valuable cytogenetic insights that may aid in early identification of patients at risk for treatment resistance or poor major cytogenetic response.
Hypnotherapy on Positive Mental Health: A Case Series Study
Introduction: Hypnotherapy has gained recognition as a complementary treatment for mental health, particularly for addressing deep-seated emotional and psychological issues. This case series study investigated the effectiveness of hypnotherapy in promoting positive mental health among six patients with diverse mental health concerns, including unexpressed grief, psychosomatic symptoms, trauma-induced phobias, and suicidal ideation. The Positive Mental Health Scale (PMHS) and the Depression Anxiety Stress Scale (DASS 21) were used to measure mental health outcomes before and after hypnotherapy interventions. Case Series: Each case presented unique psychological challenges: Case 1, a 20-year-old female, alleviated her grief-related distress after expressing emotions surrounding her father’s death. Case 2, a 23-year old male with psychosomatic stomach pain triggered by association with a friend’s ulcer symptoms, achieved full recovery. Case 3, a 24-year-old female with stress-induced rashes, resolved her symptoms. Case 4, a 19-year-old male student struggling with suicidal ideation, showed significant reductions in depressive thoughts. Case 5, a 10-year-old female child who developed fear after hearing a violent story, overcame her anxiety. Case 6, a 35-year-old female with childhood-trauma-related agoraphobia, demonstrated marked reductions in anxiety and phobic responses. Conclusion: In all cases, hypnotherapy led to significant reductions in DASS 21 scores for depression, anxiety, and stress, along with improvements in PMHS scores, reflecting enhanced emotional psychological well-being. These findings support hypnotherapy as a promising intervention for unresolved trauma and emotional distress. Larger controlled trials are warranted to confirm effectiveness and long-term benefits.
Diagnostic relevance of ZnT8 autoantibodies in Type 1 Diabetes Mellitus: Insight from a Malaysian Cohort
Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disorder marked by the destruction of insulin-producing pancreatic beta cells. The presence of diabetes-associated autoantibodies (DAAs) supports diagnosis; however, the utility of zinc transporter 8 (ZnT8) autoantibodies in Malaysian patients remains understudied. This study aimed to screen ZnT8 autoantibodies in Malaysian T1DM patients using an enzyme-linked immunosorbent assay (ELISA). ZnT8 autoantibodies were detected in 17.3% of all patients, with a higher prevalence in paediatric cases (36.7%) compared to adults (11.3%). Further analysis revealed variations based on gender, ethnicity, and the presence of other DAAs across age groups. These findings suggest differing autoimmune responses and disease mechanisms between paediatric and adult T1DM patients in Malaysia, highlighting the potential role of ZnT8 autoantibodies as a complementary diagnostic marker and the need for age-specific diagnostic and therapeutic strategies
Perception of Continuous Assessment Anatomy OSPE Among First-Year Medical Students at Universiti Putra Malaysia
This study examines medical students’ perceptions of the Objective Structured Practical Examination (OSPE) as a continuous assessment tool and explores associations with gender, ethnicity, and repeater status. A total of 113 students participated, and their responses were analysed using descriptive statistics and non-parametric tests (Mann-Whitney U for gender and repeater status, Kruskal-Wallis for ethnicity). The results indicate that students generally found OSPE useful, effective in improving understanding, and preferable to written exams. However, confidence levels varied, with some students expressing low confidence in OSPE. No significant associations were found between students’ perceptions and demographic factors, suggesting that OSPE is an equitable assessment method. Despite positive perceptions, the findings highlight the need for additional support mechanisms to enhance student confidence. Overall, this study supports the continued use of OSPE in medical education and suggests further refinements to maximize its benefits in student learning and assessment.
Unveiling the Hidden Threat: Climatic, Environmental, and Socioeconomic Drivers of Dengue Transmission in the Middle East: A Systematic Review
Background: Dengue fever is an emerging public health concern in the Middle East, influenced by climatic, environmental, and socioeconomic factors. Traditionally linked to tropical regions, recent outbreaks in arid and semi-arid areas highlight increasing regional vulnerability. Methods: This systematic review (2000–2024) analyzed studies on climatic (temperature, humidity, rainfall), environmental (urbanization, land use), and socioeconomic (population density, household conditions) factors affecting dengue transmission. A total of seven studies were included in the final synthesis. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Data synthesis was performed through a narrative review, categorizing findings into positive, negative, and non-significant associations with dengue incidence. Results: The findings highlight a strong correlation between climatic factors and dengue transmission, with temperature, humidity, and rainfall being the most significant predictors. While moderate rainfall provided breeding sites for Aedes mosquitoes, excessive rainfall disrupted larval development. Urbanization and poor neighborhood conditions were also positively associated with dengue incidence, particularly in high-density, lower-income communities with inadequate sanitation and water storage practices. Socioeconomic determinants such as age, gender, and occupation influenced exposure risk, with younger populations and outdoor workers being more susceptible. Methodologically, cross-sectional studies (42.8%) dominated the literature, followed by geospatial risk modeling (28.6%) and longitudinal studies (28.6%). Conclusions: The study highlights the urgent need for climate-adaptive dengue early warning systems, improved urban planning to mitigate vector breeding, and targeted interventions for high-risk populations.
Factor Associated With Cervical Elongation in Women With Pelvic Organ Prolapse: A Systematic Review
Women with severe symptoms of pelvic organ prolapse may be able to benefit from surgery. Cervical elongation events may occur during or after this surgical operation, potentially interfering with the healing process. This study explores the cervical elongation risk factors in women with pelvic organ prolapse. A comprehensive analysis was carried out utilizing the PubMed, Google Scholar, and ScienceDirect databases during 2016-2021, employing a combination of the following Medical Subject Headings phrases and appropriate keywords. The inclusion criteria that were used to choose the articles were investigated using a prospective cohort and case-control study written in English. Data from 140 women without pelvic organ prolapse and 1205 women with pelvic organ prolapse were included in this study. According to these data, cervical elongation is not a common symptom of pelvic organ prolapse in women. Nonetheless, compared to women without pelvic organ prolapse, women with pelvic organ prolapse have an association and are more likely to experience cervical elongation. Maternal characteristics such as parity, age, BMI, and menopausal status, as well as measurements like vaginal length, uterine weight, POPDI-6, POP-Q point C, POP-Q cervical length, and anatomical cervical length, are associated with the risk of cervical elongation in women with pelvic organ prolapse. The occurrence of pelvic organ prolapse and cervical elongation is influenced by several factors, including the severity of the prolapse and maternal features. This factor requires further consideration, particularly when it comes to the proper care of women who have pelvic organ prolapse.
An Underrated Epidemic: Highlighting the Outbreak of HMPV in China as a Public Health Concern in the Region
Training and Development in Healthcare Institutions: Study Protocol of a Sequential Explanatory Mixed Methods Research Exploring Healthcare Professionals Perceptions
Introduction: The training and development (T&D) process is critical for enhancing healthcare professionals’ (HCPs’) competencies and performance. However, its effectiveness largely depends on how HCPs perceive it, as these perceptions shape their attitudes, behaviors, and workplace outcomes. This research aims to investigate and explain HCPs' perceptions of the T&D process and identify key factors influencing these perceptions in Jordanian public hospitals. Methods: An explanatory sequential mixed-methods design will be employed, integrating quantitative and qualitative methods in two distinct phases. In the quantitative phase, a cross-sectional survey will be administered to a stratified random sample of 402 HCPs from six public hospitals across three major geographic regions. The quantitative data will be analyzed using descriptive statistics, correlation, and multiple regression. In the qualitative phase, semi-structured interviews will be conducted with a purposive subsample of the survey participants to explore the contextual and experiential dimensions underlying observed perception patterns. Thematic analysis will guide qualitative interpretation. Findings will be integrated during interpretation to draw meta-inferences that connect statistical trends with lived experiences. Discussion: This research will offer evidence-based insights on how the T&D process is perceived by HCPs, filling a critical gap in T&D literature. Findings are expected to inform policymakers and healthcare administrators about critical areas for improvement, potentially enhancing the health workforce and hospitals' outcomes.