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
Development and Validation of an Educational Booklet on Nutrition and Physical Activity for Postpartum Mothers
An educational booklet may guide mothers in maintaining healthy lifestyle through proper maternal nutrition and physical activity, improving their well-being. This study aims to develop and validate an educational booklet on nutritional and physical activity for postpartum mothers. Materials and methods: This validation study comprises two phases: Phase I involved the booklet’s development, and Phase II focused on content and face validation. Content validation was performed by 10 expert panels, while face validation involved both experts and postpartum mothers (n= 21). The content validity index and face validity were assessed descriptively. Results: The booklet, consisting of 42 pages, includes five key messages focused on healthy eating, increasing iron and folic acid intake, omega-3 foods, physical activity, and enhancing flexibility and strength. The Content Validity Index (CVI) analysis yields an excellent value of more than 0.8 for each item (I-CVI), score of S-CVI/AVE of 0.97 and 0.98 for key message 1 and 5, and the rest is score 1, whereas score of S-CVI/UA 0.83 to 1.00 for all key messages. Face validation showed a 97.6% positive response rate, above the 75% threshold. Conclusion: The findings suggest that this validated booklet can effectively guide postpartum mothers in maintaining optimal health through proper nutrition and physical activity. Future research may consider intervention studies to assess its impact on improving health outcomes for postpartum mothers.
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Validation of Indonesian Version of the Pregnancy-related Empowerment Scale Questionnaire: A Cross-cultural Adaptation Study
Women’s empowerment promotes better health decision-making ability and seeking health services during pregnancy and childbirth, including seeking skilled birth attendants and birthing facilities. Nonetheless, adequate instruments to evaluate women’s empowerment related to pregnancy in the Indonesian version are currently lacking. Therefore, this study aimed to cross-culturally adapt the Pregnancy-Related Empowerment Scale (PRES) to the Indonesian version and test its validity and reliability. Materials and methods: The original English version of the PRES which consists of four domains with 16 items underwent a translation into the Indonesian language via a forward and backward translation process conducted by qualified and certified translators, with the outcomes reviewed by an expert committee. Ten experts conducted content validation. Content validity was achieved using the Davis technique. Furthermore, a pilot project for the scale reliability test was conducted on 30 pregnant women using Cronbach Alpha analysis. Results: The Indonesian version of the questionnaire showed satisfactory content evidence which overall validity index achieved acceptable value of more than 0.80. The scale-level content validity index with average method (S-CVI/Ave) and universal agreement index (S-CVI/UA) showed 0.99 and 0.88 respectively, indicating that the items of the Indonesian version of PRES are relevant and comprehensible. The questionnaire also showed high internal consistency with Cronbach's alpha value of 0.94, which indicates that all items are reliable. Conclusion: The Indonesian version of the PRES is a valid and reliable instrument to measure women’s empowerment during pregnancy. This study recommends for future research on construct validity and test-retest reliability of the instrument.
Factors Associated with Dietary Diversity Among Preschool Children Aged Two to Six From Low-income Households in Seremban, Malaysia
Dietary diversity is crucial for children’s growth, development, and overall health status, particularly for those aged two to six. However, studies on dietary diversity among young children in Malaysia are limited. This cross-sectional study aimed to determine the factors associated with dietary diversity among preschool children aged two to six years old from low-income households in Seremban. Materials and methods: A total of 245 children from 10 randomly selected Taska KEMAS and 30 randomly selected Tabika KEMAS in Seremban were participated in this study. Mothers completed a questionnaire on socio-demographic background and food security status. Anthropometric measurements, including weight and height, were taken following standardized procedures. A 3-day 24-hour dietary recall of the children was conducted through online interviews with their mothers to assess dietary diversity and nutrient intake. Results: Food insecurity was experienced by 53.9% of the households. The prevalence of underweight, stunting, and wasting among children were 23.3%, 29.4%, and 23.7%, respectively. The mean Dietary Diversity Score (DDS) was 6.34±0.64, with 20.0% were in the lowest DDS tertile. Multiple linear regression analysis showed that mother’s age (β=-0.019, 95% CI=-0.035, -0.002, p<0.05), protein intake (β=0.023, 95% CI=0.012, 0.033, p<0.001), and fat intake (β=-0.023, 95% CI=-0.032, -0.013, p<0.001) were significantly associated with dietary diversity among preschool children. Conclusion: These findings highlight the importance of targeted interventions to address food insecurity, promote balanced diets, and educate mothers to include a variety of nutrient-rich foods to improve dietary diversity of preschool children in low-income households.
The Effectiveness of Art-based Psychoeducation Module in Improving Psychological Functioning Among Children with Dyslexia
Children with dyslexia are susceptible to emotional distress such as anxiety, due to delayed or limited overall academic achievement. This study aims to examine the effectiveness of art-based psychoeducation module in improving psychological functioning among children with dyslexia. Materials and methods: Children with dyslexia aged 7 to 12 years old were assigned into intervention (n=33) and control group (n=31). The former group was subjected to a newly validated art-based psychoeducation module which consists of psychoeducation, relaxation techniques, and art therapy activities. PedsQL Present Functioning Visual Analogue Scale (PedsQL-VAS) and State Trait Anxiety Inventory (STAI-C) were used to measure childrens’ psychological functioning at pre and post intervention. Results: The main effect comparing the intervention and control group over pre- and post- intervention was significant, suggesting the art-based psychoeducation intervention was effective in improving psychological functioning, [F (1,62) = 5.59, p<0.02]. There was a substantial major effect for time in the intervention group, [Wilks’ Lambda = 0.42, F (1,62) = 83.2, p<0.001] with a significant decrease in score post intervention. Conclusion: The effectiveness of art-based psychoeducation module found in the current study provides empirical support for it to be used as an intervention for children with dyslexia. Future studies can focus on a longitudinal approach to examine its long-term effectiveness.
Effectiveness of Finger Safety Intervention Module (FingSIM) in Increasing Finger Safety Knowledge Among Small and Medium Enterprise (SME) Manufacturing Industries in Selangor
Occupational finger accidents and injuries (OFAI) are prevalent among Malaysian employees. An analysis of accident statistics from the Department of Occupational Safety and Health (DOSH) Malaysia revealed that 26.25% of accidents between 2017 and 2019 involved finger injuries. This study aims to evaluate the effectiveness of the self-developed Finger Safety Intervention Module (FingSIM) in enhancing finger safety knowledge among manufacturing workers in small and medium enterprises (SMEs). Materials and methods: This quasi-experimental study, involving control and intervention groups from 14 manufacturing companies in Selangor, used G*Power v3.1 to determine sample sizes. Employing a pre-test, post-test, and second-post-test, data on finger safety knowledge were collected via the validated FingSTEv questionnaire. Mixed ANOVA compared mean differences within-subject (time and group) and between-subject (group) across three time intervals. Results: The results showed a significant increase in mean knowledge scores across all three time intervals (p<.05), with a very large effect size (partial eta squared = .549). The interaction between time and group on knowledge scores within subjects also demonstrated a very large effect (partial eta squared = .553, p<.05). Similarly, the interaction effect between time and group on knowledge scores between subjects was substantial (partial eta squared = .510, p<.05). Conclusion: The study found that implementing FingSIM significantly improved manufacturing workers' finger safety knowledge in SMEs, demonstrating its effectiveness and meeting the research objectives.
Validity and Reliability of Finger Safety Training Evaluation (FingSTEv) to Measure Finger Safety Knowledge Among Manufacturing Industries Workers at Small and Medium Enterprise in Selangor
Finger injuries are prevalent in manufacturing, particularly in SMEs, leading to significant physical and financial consequences, highlighting the urgent need for effective intervention to mitigate these risks. Intervention on finger safety helps employees perform their tasks safely and effectively, thereby enhancing their competencies. The Finger Safety Intervention Modules (FingSIM) comprehensively address the critical aspects of occupational finger accidents and injuries (OFAI). However, a validated instrument to assess its efficacy for future improvement and sustainability has been lacking. This research aims to validate the Finger Safety Training Evaluation (FingSTEv), designed to measure the knowledge of workers in Selangor's small and medium enterprise (SME) manufacturing industries. Materials and methods: The FingSTEv was developed utilizing occupational accident and injury data, a literature review, and an expert evaluation. FingSTEv's Internal Consistency Reliability (ICR) was determined via Kuder-Richardson 20 (KR-20). Results: The analysis of the Itemized Content Validity (I-CVI) and Scale Content Validity (S-CVI) validated its validity. The S-CVI for relevance, clarity, simplicity, and ambiguity ranged from 0.9899 to 0.9966. The S-CVI of FingSTEv is 0.9924. With a KR-20 value of 0.84, the ICR of FingSTEv revealed a significant link between the questions. Conclusion: FingSTEv exhibited excellent content and face validity, along with a high ICR, making it an effective, reliable, and valid tool for assessing finger safety knowledge. Its robust validation ensures that it effectively measures the intended knowledge areas, supporting the ongoing enhancement and sustainability of occupational finger safety initiatives.
Assessment of Knowledge on Osteoporosis and Prevention Among Caregivers in Institutions for The Elderly
Osteoporosis, a disease characterized by reduced bone mass and increased fracture risk, significantly affects millions worldwide and is notably underdiagnosed, particularly among the ageing population. Caregivers, including nurses and therapists, play a vital role in the care and education of osteoporosis prevention among the elderly. Nevertheless, the knowledge gap in osteoporosis and its prevention among healthcare providers globally remains. In response to the escalating global health concern posed by osteoporosis, this study aimed to assess the knowledge of osteoporosis and its prevention among caregivers in the institutions for the elderly in Selangor, Malaysia, and examine how this knowledge correlates with their educational background and work experience. Materials and methods: This study employed convenience sampling to survey caregivers from 26 registered institutions for the elderly using the Osteoporosis Prevention and Awareness Tool (OPAAT). Chi-square test was used to test the association of the variables. Results: Approximately 136 participants were recruited in this study. The findings revealed that caregivers' overall knowledge was moderate, with higher educational qualifications linked to better understanding, while work experience showed no significant impact. Meanwhile caregivers with fewer years of experience demonstrated better knowledge. Conclusion: This study found that while osteoporosis knowledge among caregivers in institutions for the elderly in Selangor was moderate, those with higher educational achievements had better awareness. It emphasizes the need for continuous education and targeted training to address knowledge gaps, particularly in osteoporosis prevention and management.
Safety of Face Masks and Hygiene Precautions in MRI During Covid-19 Pandemic
During the Covid-19 pandemic, questions have been raised among medical imaging practitioners on the safety and practicality of wearing face masks while undergoing magnetic resonance imaging (MRI). Although asking patients to wear face masks during such procedure is sometimes not feasible, mitigating steps to minimise exposure to Covid-19 infection in an MRI environment is important. An online survey was conducted to find out the practice at government and private institutions in Malaysia. Materials and methods: This survey was distributed to MRI radiographers from government and private institutions in Malaysia. Questions were about types of face masks, metal strip removal, the reasons for not using face masks on patients, and procedures for sanitising the MRI machine. Results: A total of 61 institutions required patients to wear face masks when undergoing MRI, and 79 offered standard surgical masks for patients. Only two institutions provided the more efficient but costly N95 respirator. However, 61 respondents only said their institutions removed the metallic nose clip before starting the procedure. Most respondents in institutions that did not provide face masks to patients said they did so because it was unsafe. It was also found that the bed and radiofrequency(RF) coils are the most sanitised parts of the MRI machine, while the gantry is the least cleaned. Conclusion: MRI administrators should modify their standard operating procedure and workflow to fulfil safety requirements during the pandemic. Other strategies to reduce respiratory droplets in the air, such as installing mechanical ventilation, should be considered for MRI rooms.
Composition of Heavy Metals in Indoor Dust and Their Possible Exposure: A Case Study in Laboratories of Faculty Applied Sciences UiTM Shah Alam
Given the growing concern over metal pollution in interior dust, this study aims to advance knowledge of the heavy metal composition and potential causes of indoor dust pollution. Materials and methods: Indoor dust samples were collected from three laboratories in the Faculty of Applied Sciences University Teknologi MARA, Shah Alam. The laboratory included the Food Chemicals Analysis Laboratory, Emission Control and Air Analysis Laboratory, and Textile Chemistry Laboratory, which were chosen based on stratified random sampling. The analysis of the dust samples' compositions for lead (Pb), chromium (Cr), zinc (Zn), and nickel (Ni) was carried out using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). Results: The heavy metals were present in the following order of concentrations: Zn > Ni > Cr > Pb. This study also discovers how to calculate the Index of geo-accumulation (Igeo). The vast majority of Zn and Ni Igeo values fall within the "very highly polluted" category with the highest Igeo class, 13.2584 and 7.355, respectively, exceeding background levels above 5. In addition, this study identified the possible sources of heavy metals in laboratory dust and found two primary sources of heavy metal contamination in the laboratory dust. Pb, Cr, and Ni pose as Cluster 1, which comes from anthropogenic sources such as laboratory-related activities, while Zn, as Cluster 2, originates from natural sources. Conclusion: To ensure the safety of laboratory occupants, future research monitoring assessments of indoor dust should be considered.
Volunteerism as a Means of Emergency Management: A Study Among Nursing Students in India
Navigating challenges posed by infrastructure, vast population, geography, and diversity, India grapples with health emergency management. Volunteers stand as crucial pillars, bridging capacity gaps and confronting global health challenges. Leveraging the awareness and expertise of nursing students, this paper endeavours to anticipate the intentions of BSc final-year nursing students in Himachal Pradesh, India, towards volunteerism during health-related emergencies. Materials and methods: In this study, 300 questionnaires were distributed to final-year BSc nursing students in Himachal Pradesh, India, between February and August 2023. The online survey achieved a 91% response rate, with 273 participants, frequency and percentage were used to describe the respondent’s characteristics and multiple regression was applied for inferential analysis. Results: Among 273 female nursing students, 89.4% (n = 244) had an age range of 20–25 years, and 97% (n = 265) were unmarried. 82.05% (n = 224) of students would like to volunteer in the future. The study demonstrated that the five factors used in the current study, significantly influence the intention to volunteer (F(5, 267) = 112.092, p < 0.05). Conclusion: The study delves into the psychological and social factors influencing Indian nursing students' intent to volunteer in emergencies, fostering cultural sensitivity, adaptability, and resilience. The results provide insights for effective interventions in emergency situations through volunteerism, emphasizing the mutually beneficial impact of student nurses on immediate responsiveness and long-term healthcare efficacy in the nation.
Influence of Meteorological, Entomological and Environmental Parameters with Dengue Incidence in Kota Kinabalu, Sabah
Dengue fever represents a significant challenge to public health, affecting 3.9 billion individuals residing in 129 dengue endemic countries. Local dengue incidence is influence by environmental factors, including rainfall, temperature, humidity, and wind speed. This study aimed to determine the relationship between meteorological, entomological, and environmental parameters and dengue cases in Kota Kinabalu, Sabah. Materials and methods: An ecological study was conducted from 2016 to 2021 using the dengue database and meteorological data. Pearson's correlation coefficient was used to examine the correlation between the predictor variables and number of dengue cases in Kota Kinabalu. Results:A significant negative linear correlation (r=-0.28, p < 0.01) was observed between the weekly maximum temperature and weekly number of dengue cases. There was a significant negative linear correlation (r=-0.22, p < 0.01) between the weekly minimum temperature and weekly number of dengue cases. A strong positive correlation was observed between the weekly number of Aedes albopictus (r=0.65, p < 0.01) and the Aedes index (r=0.64, p < 0.01) and the weekly number of dengue cases. A significant positive linear correlation was found (r=0.39, p < 0.01) between the weekly number of vacant lots and weekly number of dengue cases. Conclusion: This clearly shows that temperature, entomological factors, and the presence of vacant lots play crucial roles in dengue occurrence in Kota Kinabalu, Sabah. Comprehensive dengue control strategies that consider environmental management, efficient vector control, and community engagement should not be overlooked.
The Optical Refractive Correction Questionnaire (ORCQ): A Face Validity
Uncorrected refractive error is a major global public health challenge that significantly affects an individual's quality of life (QoL). Despite its impact, no validated questionnaire is specifically designed to comprehensively assess the optical correction prescriptions and characteristics for ametropic individuals. The absence of such tools prevents a thorough evaluation of the factors influencing ametropes' QoL. This study aimed to conduct a thorough face validity of the Optical Refractive Correction Questionnaire (ORCQ) to ensure its clarity, relevance, and overall quality. Materials and methods: The ORCQ serves as an instrument designed to assess the optical prescription and characteristics of correction modes worn by individuals with refractive errors. It encompasses 11 items across four domains: the optical prescription (Items 1-2), spectacle frame characteristics (Items 3-5), ophthalmic lens characteristics (Items 6-8) and contact lens characteristics (Items 9-11) currently worn by individuals with refractive errors. Face validity was carried out by six panel of experts (PEs) who are experienced optometrists. The validation criteria included evaluating grammar, clarity, and instrument layout. Quantitative responses were analysed for agreement, and adjustments were implemented based on the qualitative feedback provided by the PEs. Results: Items 1 and 2 in the optical prescription domain garnered solid agreement, confirming their clarity and appropriateness. Adjustments were made in the response box position for items 3 to 5 in the spectacle frame characteristics domain and items 6 to 8 in the ophthalmic lens characteristics domain, refining the overall layout of the instrument. In the contact lens characteristics domain, items 9 to 11 incorporated English terminologies to address clarity concerns raised by the PEs. Conclusion: The ORCQ has successfully undergone a meticulous face validity process. Therefore, it can be effectively utilised to evaluate optical correction prescriptions and characteristics among individuals wearing spectacles and contact lenses.
Exploring Students’ Feedback and Perception Towards an E-Learning Mobile Application for Radiation Protection
Radiation protection awareness are crucial for minimizing the harmful effects of ionizing radiation. In line with the continuing growth of information and communication technology, this study aimed to explore the perception of medical imaging students towards the radiation protection mobile application as an approach to enhance student engagement in radiation protection courses. Materials and methods: Forty-one medical imaging students who enrolled in radiation protection courses in second semester were purposefully selected in this study. The mobile app known as the e-RadGo© app was introduced in radiation protection courses. A cross-sectional survey covering five aspects of student’s satisfactions and one open-ended questions were conducted to gather initial feedback. Four weeks later, students completed a five-point Likert scale questionnaire to evaluate their perception of e-learning through the app. Descriptive statistics were utilised for data analysis. Results: This study revealed that the majority of students (> 80%) responded positively to the usefulness of the mobile app as an e-learning tool for radiation protection courses. More than 80% expressed satisfaction and maintained motivation throughout the e-learning process, with a mean score of 4.07 ± 0.69. Additionally, 51% of the students agreed that the e-learning facilitated the teaching and learning process, considering it as effective as traditional learning methods, reflected in a mean score of 3.5 ± 1.00. Students reported positive experiences and perceptions, highlighting the app's potential to enhance engagement and understanding in radiation protection courses. Conclusion: This study highlights the potential of integrating an e-learning mobile application in radiation protection courses which may improve teaching and learning process.
EMS System Performance for Sudden Cardiac Arrest in Malang - Indonesia
Sudden cardiac arrest (SCA) represents a significant public health challenge characterized by a high mortality rate. Timely resuscitation is essential for survival, highlighting the critical role of the emergency medical services (EMS) system in improving patient outcomes. This study aims to examine the performance of the EMS system in managing SCA cases in Malang, Indonesia, with a focus on identifying the factors that contribute to limitations in its effectiveness. Materials and methods: This study evaluates the performance gaps of the EMS system based on key interventions outlined by the Global Resuscitation Alliance (GRA). A qualitative design was employed, involving nine key informants, with data collected through observations, supporting documentation of all SCA cases managed by EMS, and interviews. Thematic analysis was used to identify key themes, with data analyzed through reduction, presentation, and conclusion drawing. Results: Time metrics recording recommended by GRA had not been completely implemented because lack of protocol and evaluation by the department resulted in officers' doubts in recording. The GRA performance metrics had never been put into practise because lack of equipment and knowledge resulting in lacking of confidence of the officer in carrying out life support measures. Conclusion: A gap analysis of the GRA key elements for EMS revealed limitations in the EMS system's performance in managing prehospital SCA cases in Malang, Indonesia. Improvement strategies are necessary to enhance EMS effectiveness and achieve a higher survival rate for SCA patients.
Expression of FoxP3+ Tregs and its Association with Stage and Grade of Colorectal Cancer Patients
Forkhead-box protein P3 regulatory T cells (FoxP3+ Tregs) play an important role in tumour progression by evading the immune escape mechanism. However, the prognostic significance of these FoxP3+ Tregs in colorectal cancer (CRC) remains to be elucidated. This study aims to evaluate the association between the FoxP3+ Tregs immunohistochemistry expression with clinicopathological features of CRC. Materials and methods: This study is a cross-sectional study assessing immunohistochemistry expression of FoxP3+ Tregs in 202 CRC cases from two tertiary hospitals: Hospital Sultanah Bahiyah (HSB), Kedah and Hospital Universiti Sains Malaysia (HUSM), Kelantan, from January 2017 to December 2019. FoxP3+ Tregs immunoexpression was divided into a low and high group expression using the median value (19.7) as a separating point. Pearson’s Chi-square and Fisher’s exact tests were used to analyze the association. P value of less than 0.05 was considered statistically significant. Results: 102 (50.5%) cases showed high expression of FoxP3+ Tregs within the intra- and peritumoral stroma of CRC, while 100 (49.5%) showed low expression. There is a significant association between FoxP3+ Tregs immunoexpression with pathologic T stage (p=0.001), lymph node involvement (p=0.025), and Modified Dukes staging (p=0.032). Conclusion: This study suggests that FoxP3+ Tregs immunoexpression could serve as a novel marker for classifying CRC and predicting its prognosis in the future.
Incidence of Rheumatic Fever and Rheumatic Heart Disease and Its Associated Factors Among Paediatric Patients in Malaysia
In impoverished and developing regions, acute rheumatic fever (ARF) remains a significant cause of morbidity and premature death. In Malaysia, particularly in the East Coast of Peninsular Malaysia and East Malaysia, ARF continues to be a leading cause of acquired cardiac disease. Despite this, there is a lack of published data on ARF incidence. This study aimed to determine the incidence of ARF and identify associated risk factors to enhance ARF prevention strategies. Materials and methods: The study, conducted over one year from July 2021 to June 2022 across 23 centres in Malaysia, included all newly diagnosed ARF and RHD cases, with a ratio of one case to two control patients. Sociodemographic and clinical data were collected, and multivariate analyses were conducted to identify associated risk factors. Results: The incidence of ARF was found to be 34.1 per 100,000 paediatric admissions, primarily concentrated in Kelantan and Sabah. Carditis (85.7%) and migrating polyarthritis (31.4%) were the most common clinical manifestations, with valve involvement, particularly mitral regurgitation, being the most frequent anomaly (97.1%). Multivariate analysis indicated that age, low income, and rural residence were significant risk factors for ARF. Conclusion: This study highlighted a persistently high incidence of acute rheumatic fever in Malaysia, with strong correlations observed between age, low socioeconomic status, and rural residence, and the likelihood of contracting ARF. These findings can inform more effective strategies for ARF prevention in the country.
Geographic Information System (GIS) Mapping of Fluoride Levels in Reticulated Water System and Dental Caries Experience in Pahang Preschool Children
This study identified the range of fluoridation levels, mapped the spatial pattern of the fluoridated public water supply, and correlated by mapping it with the caries trends of preschool children in Pahang. Materials and methods: Secondary data on fluoride level readings in water supply from reticulation points of water treatment plants (WTP) and dental caries experience of preschool children in Pahang from 2015 to 2019 was obtained from the Ministry of Health’s Health Information System. Each WTP's Global Positioning System (GPS) coordinates were verified in Google Maps and Google Street View and further analysed using Quantum Geographic Information System (QGIS). Results: All WTPs have had a suboptimal fluoride range (below 0.4 ppm) since 2018. Areas without fluoride in the water supply were in Kuantan, Bera, Rompin, and Cameron Highlands. Caries prevalence in preschool children in Pahang from 2015 to 2019 increased (42.1% to 42.9%). In 2019, the preschool children's mean caries index of 'dmft' (the sum number of decayed, missing, filled deciduous teeth per individual) was 2.45 (SD=±1.29). Rompin had the highest mean dmft (3.74) compared to others, with a dmft mean of 2.45 in the same year. Higher severity nationwide was reported in the National Oral Health Preschool Survey Malaysia (NOHPS) 2015 (dmft 4.8).Conclusion: All WTPs in Pahang have the suboptimal range of fluoride. With the decreasing trend of fluoride levels in the water supply, the caries experience among preschool children in Pahang increased by 0.8%.
Enhancing Well-being in Older Adults: Exploring the Impact of Paid Companionship Services Through Outdoor Mobility and Activity Engagement
The challenges associated with outdoor mobility and activity participation significantly impede the ability of older individuals to navigate and engage in outdoor pursuits. A potential solution employed is companionship, a prevalent intervention utilized to support older adults facing physical or mental health challenges, frequently facilitated by volunteers. This study was conducted to investigate the factors influencing the utilization of paid companionship services in conjunction with outdoor mobility and activity participation in enhancing the well-being of older adults. Materials and methods: A comprehensive, semi-structured, one-on-one virtual interview was conducted with seven individuals, encompassing founders and operators of companionship companies. The interviews were meticulously recorded and transcribed verbatim. Subsequently, coding was executed by one researcher and independently cross-checked by a second researcher. Following this, two researchers convened to identify and discuss emerging themes, resolving any disagreements with the assistance of a third researcher. Results: This study revealed that older adults sought companion services primarily due to health-related conditions and the need for assistance, often due to living alone or the unavailability of family members. Companions provide essential support to older adults in outdoor mobility, assisting with medical appointments, engaging in exercise, recreational and leisure activities, and shopping for necessities and services. The study demonstrated that companionship plays a vital role in assisting older adults in preserving their independence. Conclusion: Companionship emerges as a valuable resource in helping the elderly overcome obstacles related to outdoor mobility and activity participation, allowing them to pursue their interests, experience autonomy, and find pleasure in life.
A Tale of Two Scenarios: Vaccination's Impact on Covid-19 Trajectories in Jordan
The novel coronavirus Severe Acute Respiratory Syndrome (SARS)-Coronavirus-2 (CoV-2) has resulted in an ongoing pandemic and has affected most of the countries around the world. Mathematical epidemic models can be used to predict the course of an epidemic and ensure the significance of vaccination by comparing it to no vaccination. Materials and methods: Extended SIR models were used to show and understand the predicted progression of Covid-19 with and without vaccination strategy. SEIRD model was used to predict Covid-19 cases and deaths in the no vaccination scenario while SEIRDV model was used for the vaccination scenario. Parameters were taken from published articles and reports. Results: SEIR models indicated higher infection and death rates without vaccination. Number of infected cases reached its peak in the first 100 days of 2021, with a gradual declining in the number of infections and becomes plateaued after day 100 which approximately at the end of March. At its peak, the infection could affect up to about 10% of the population leading to 109,671 deaths in the absence of vaccination but with the effect of social distancing and control measurements taken in Jordan in 2020. Number of infected cases with the effect of vaccination and maintaining social distances reached its peak in the first 10 days of 2022. At its peak, the infection could affect up to approximately 15,629 cases leading to 746 death cases which makes the total of deaths 13,399 cases. Conclusion: Vaccination significantly reduced Covid-19 impact, leading to fewer cases and deaths compared to no vaccination.
Knowledge, Attitude and Practice on the Provision of Long-acting Reversible Contraception Among Primary Healthcare Workers in Malaysia: Questionnaire Development and Validation
Long-acting reversible contraception (LARC) is a pivotal strategy in mitigating unintended pregnancies. However, its utilisation in Malaysia remains low. Healthcare workers significantly influence clients' adoption of LARC but existing questionnaires were not adequately validated. This study aimed to develop and validate a new questionnaire to measure the knowledge, attitude and practice of LARC provision among local primary healthcare workers. Materials and methods: The questionnaire development involved a comprehensive literature review, discussion with healthcare workers and consultations with experts. Validation procedures included content validity, cognitive interviews and psychometric evaluation of internal structure. The knowledge section was analysed using a two-parameter logistic item response theory (2-PL IRT) analysis. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to assess both attitude and practice sections. A total of 444 healthcare workers involved in the study were randomly selected from health clinics throughout Kelantan, Malaysia. Results: Following IRT analysis, 15 items in the knowledge section displayed satisfactory difficulty and discrimination values. The construct validity analyses of the attitude section revealed 13 items that loaded onto three factors: ‘client-related’, ‘method-related resources’, and ‘method-related limitations’. In the practice section, the construct validity analyses revealed nine items that loaded onto two factors: counselling and clinical evaluation. The final model exhibited acceptable model fitness, with all items having good factor loading (>0.32) and all factors having acceptable composite reliability (Raykov’s rho>0.60). Conclusion: The questionnaire was shown to have acceptable psychometric properties and reliability, making it a robust instrument.
Knowledge, Attitude and Practice related to the Consumption of Dietary Fibre Among Adults in Kelantan
Adults in Malaysia are rarely aware of the benefits of dietary fibre (DF) consumption for overall health. The purpose of this study was to examine adults' knowledge, attitude, and practice (KAP) on dietary fibre consumption and their association in Kelantan, Malaysia. Materials and methods: A cross-sectional study of adults in Kelantan included 192 respondents with a mean age of 30.4 (SD 10.4) years. Participants who met the inclusion and exclusion criteria provided a completed socio-demographic questionnaire and a validated KAP on the DF consumption questionnaire. Results: This study showed that respondents had moderate knowledge (64.0, IQR 28.0) %, positive attitude (91.7, IQR 16.7) % and good practice (84.6, IQR 23.1) % scores towards DF consumption. The results of this study demonstrated a statistically significant weak correlation between attitude and practice (r=0.193, p=0.007) and knowledge and practice on DF consumption (r= 0.153, p=0.034). However, there was no statistically significant correlation (p=0.815) between knowledge and attitude towards DF consumption. Conclusion: These findings suggest multiple avenues for future research that could further clarify and expand upon the results. Longitudinal studies could provide significant insights into how fluctuations in knowledge, attitudes, and practices affect DF consumption over time.
Determining the Quality of Life of People with Alopecia areata and Associated Factors in Tertiary Hospitals in Capital City of Malaysia
Alopecia areata (AA) is a disabling hair disorder which usually begins in teenage years. Worldwide prevalence is 0.1-0.2%, with no data of prevalence in Malaysia. The aim of this study was to determine the quality of life of people with AA and associated factors in major tertiary hospitals in the capital city of Malaysia. Materials and methods: A cross-sectional study was conducted at three Dermatology Outpatient Clinics in three tertiary hospitals in the capital city of Malaysia over one year starting September 2021. A validated questionnaire incorporating the Dermatology Life Quality Index (DLQI) was used. A total of 150 participants with AA were successfully recruited. Results: The Dermatology Life Quality Index (DLQI) mean score was 28.9 with those scoring 29 and above classified as having a poor quality of life and those scoring 28 or less as having a good quality of life. Univariate and bivariate analysis showed that marital status and presence of diabetes was significantly associated with a poorer quality of life. In multivariate analysis, it was found that those who were not married had 1.39 higher odds of having poor quality of life as compared to those who were married (95% CI 1.23-1.65, p=0.04). It was also found that those with diabetes had 2.99 higher odds of having poor quality of life (95% CI 1.83-4.12, p=0.02). Conclusion: In conclusion, participants with AA who weren’t married and with diabetes had poor quality of life. These findings can help physicians build on the body of literature in managing AA.
The Effectiveness of the UMAR Module in Improving Dentists' Knowledge and Attitude in Delivering Smoking Cessation Interventions to Adult Patients: A Pre-post Evaluation
Dentists are well-suited to provide smoking cessation interventions, as they can educate patients about the adverse effects of smoking on oral health. Acknowledging the significance of this, the study aims to evaluate the effectiveness of the newly developed UMAR (Usaha Memerangi Asap Rokok) module in improving dentists' knowledge and attitudes towards delivering smoking cessation interventions to patients. Materials and methods: Between November 2022 and May 2023, a pre-post study was conducted among 80 government dentists working at primary dental clinics in Kelantan. The UMAR module was developed based on the Theory of Planned Behaviour (TPB) and was then disclosed to the participants through workshops that included lectures and practicals. A validated questionnaire was administered before and after the workshop through Google Forms to assess the improvement of knowledge and attitudes. Results: Participants' overall knowledge increased significantly from 7.29 (2.194) to 10.39 (1.026), t=10.990, p<0.001. Participants' overall attitudes also increased significantly from 18.64 (1.669) to 19.49 (1.060), t=5.074, p<0.001. There was no significant association between demographic factors, working characteristics, smoking cessation training, and the availability of a quit smoking clinic with the post-intervention knowledge and attitude. Conclusion: The UMAR module was effective in improving dentists' knowledge and attitudes towards delivering smoking cessation interventions to patients.
Yoga Exercise in Series Decreased Soluble Fms-like Tyrosine Kinase-1 (SFLT-1) Level Among the High-risk Preeclampsia Mother
An essential part of the pathophysiology of PE is played by SFlt-1. According to earlier studies, sFlt-1 expression starts to rise five weeks prior to conception and increases dramatically in the placenta preeclampsia at 11 weeks of pregnancy. For mothers who are at high risk, exercise in series can avoid preeclampsia. The purpose of this study is to examine how yoga practice affects blood sFLT-1 levels in moms who are at high risk of developing preeclampsia. Materials and methods: Forty-six high-risk mothers with preeclampsia, aged 9-16 weeks pregnant randomly grouped into control groups and yoga exercises. All subjects get standard treatment for preeclampsia. The yoga sports group also performed 20 sets of yoga under supervision. SFLT-1 levels were measured before and after the treatment course. Results: In the yoga group the sFLT1 levels differed significantly (p=0.010), before (1.13 ± 0.42 ng/ml) and after (0.94 ±0.38 ng/mL) the treatment program. In the control group the levels of sFTL-1 also differed signally (p = 0.049). before (0.85 ± 0.029 ng/ ml) and following (1.01 ± 0,38 ng / ml) the therapy program. Conclusion: Yoga consistently lowers serum sFLT-1 levels in mothers at high risk of preeclampsia.
Factors Associated with Hypertension-related Strokes at a Community Hospital in Southern Thailand
Stroke rates are increasing significantly worldwide. Comorbidity disease especially hypertension that an important modifiable risk factor for increasing the incidence of stroke and worsening outcomes. Furthermore, the burden of hypertension as a comorbidity of stroke in rural areas was limited, Therefore, the aim of this study was focus to evaluate factors associated with stroke patients having hypertension at Ratsada Hospital, Trang Province, southern Thailand. Materials and methods: A retrospective study was conducted by utilizing data from the January 1, 2018, to December 31, 2022 hospital database. Diagnoses of patients are identified by using ICD-10 (I60-I69), totaling, 333 patient records. The cumulative incidence rates of stroke with or without hypertension were calculated by using Logistic regression models to evaluate risk factors. Results: A total of 191 stroke patients with hypertension (57.36%); median [25th-75th percentile] age 72 [61-80] years) and 142 stroke patients without hypertension (42.64%); median [25th-75th percentile] age 61 [52-71] years. Factors associated with increased risk of stroke were age 60 years and above (AOR=2.66; CI:1.59-4.44; p<0.001), and high diastolic blood pressure (≥85 mmHg) (AOR=2.05; CI:1.19-3.53; p=0.010). In addition, glomerular filtration rate values of 60-89 ml/min/1.73 m2 (AOR=1.95; CI:1.14-3.34; p=0.014) and 30-59 ml/min /1.73 m2 (AOR=1.99; CI:1.02-3.89; p=0.043) were significant. Conclusion: This study found that age 60 and above, high diastolic blood pressure and specific glomerular filtration rate ranges were the potential risk factors of stroke with hypertension as a comorbidity disease. This finding suggests that providing intensive care for controlling and managing risk factors, especially in older adults.
Navigating Challenges and Cultivating Resilience: Enhancing Support Systems for Novice Critical Care Nurses
Novice critical care nurses (NCCN) face unique challenges as they navigate the complexities of patient care. It is essential to understand their support system in providing holistic care to the patients. Therefore, this study aims to explore the needs and support that is received and required by them. Materials and methods: The researcher opted for descriptive qualitative research using a practical approach. Using multiple data collection methods (interviews, observations, and document analysis) was a deliberate choice to enhance the study's credibility and depth, facilitating convergence and triangulation. Results: Total of 29 participants agreed to participated in the study. Three themes were derived from the data collected. Conclusion: In summary, this study highlights the crucial need for creating a supportive and empowering environment for NCCNs as they face the challenges of their specialized field.
Lived Experiences of Non-suicidal Self-injury (NSSI) Cessation Among Adults in Malaysia
Non-suicidal self-injury (NSSI) remains to be a pervasive behaviour that affects clinical and non-clinical youths all around the world. However, treatment and prevention efforts lack specificity in targeting NSSI as a disorder in its own right. This is more so in developing countries like Malaysia where lived experiences of individuals who had engaged in and ceased NSSI remains unavailable. To address this gap, this qualitative study utilised the phenomenology approach aimed to explore the thoughts, emotions, emotion regulation, and behaviours leading up to NSSI cessation. The consideration of complex individual experiences provided a deeper understanding of the human processes behind recovery amongst Malaysian adults. Materials and methods: Semi-structured online interviews were conducted with a total of 7 participants aged between 23 and 31 years old. Results: The findings offered insight into the development of motivation to move forward, the perception of control, the development of self-compassion, a sense of thankfulness and acceptance, importance of non-judgemental support, the practical coping strategies utilised as well as the challenges that were encountered during the journey. Conclusion: This study provides insight into the nuanced stages of change leading to NSSI cessation. An increased understanding of the processes towards cessation impacts the potential intervention and preventative programs that can be implemented in the Malaysian context.
The Influence of Driving Duration, Body Mass Index, Types of Roads and Gender on Decision-Making Skills through β-Waves Analysis in Fatigue Driving
The research on driving fatigue is gaining popularity as the frequency of fatigue-related accidents increases in many countries. However, there has been limited study on the importance of cognitive skills like decision-making skills (DMS) and the variables that influence them in indicating driving fatigue. The study aims to conduct a regression analysis to determine whether variables such as driving duration, body mass index (BMI), types of roads and gender are relevant in influencing DMS and how these variables interact to suggest driving fatigue. Previous research has not examined the combination of these four variables. Materials and methods: DMS was assessed using an electroencephalogram (EEG) through beta, β brain waves. The EEG frequency was recorded for five minutes before driving and completing the driving assignment. The regression analysis was performed using Design Expert software. Results: The Analysis of Variance (ANOVA) found that all variables have Prob > F values less than 0.05, indicating significant effect on β-waves (DMS). Overall, as the driver fatigues, β-waves decrease, indicating an impairment in DMS. β-waves decrease as driving duration and BMI increase due to the stress of dealing with hazardous driving conditions and obesity-related health concerns, respectively. β-waves drop as road geometry changes from winding to monotonous and gender changes from male to female because of physiological signs of boredom generated by road geometry and sex hormone variations, respectively. Conclusion: The findings could be a reference to road safety professionals to control the cause of driving fatigue and hence lower the number of road accidents.
Development of a Pre-operative Behavioural Treatment Model to Reduce the Risks of Occupational Hazards Among Dental Practitioners: A Qualitative Study
Despite technological advances available in modern dentistry, occupational hazards such as back pain and eye strain, are still reported. These risks cannot be completely eliminated in dental practice. Therefore, appropriate occupational health and safety measures need to be adopted by dental practitioners. This study aimed to develop a pre-operative behavioural treatment model (BTM: Pre-Op) for preventive measures of back pain and eye strain among dental practitioners, drawing from the perspectives of dental specialist, orthopaedic specialists, and optometrists. Materials and methods: This qualitative study utilised purposive sampling method. Focus group discussions (FGDs) were conducted separately among dental specialists, orthopaedic specialists, and optometrists to gather the expert views on the best approach to reduce back pain and eye strain in dental practice. The FGDs were audio recorded and transcribed. The transcripts were analysed using the framework analysis method to develop a comprehensive BTM: Pre-Op. Results: The transcripts were analysed using framework analysis, revealing three main themes and associated subthemes based on the FGD discussion. Pre-operative preventive measures that dental practitioners may adopt include developing a healthy working schedule, maintaining fit and healthy personnel, and fostering a supportive and healthy working environment. Conclusion: The BTM: Pre-Op is properly developed. The main theme and subthemes are systematically arranged to address the risks of back pain and eye strain among dental practitioners.
The Role of the Maternal and Child Health Book (Buku KIA) in Optimizing the Growth of Toddlers
Early childhood development is crucial, particularly within the first 1,000 days of life. Maternal care significantly influences this phase, with tools like the Maternal and Child Health Book (KIA) in Indonesia intended to support child growth and development. Despite its widespread use, the impact of KIA book utilization on toddler growth outcomes needs further investigation. This study evaluates the effectiveness of the KIA book for optimizing toddler growth in Karanganyar Regency, Indonesia. Materials and methods: An analytical observational cross-sectional study was conducted with 99 mothers of toddlers aged 1-5 years from Sidomukti Village. Data were collected through questionnaires and anthropometric measurements, including height-for-age, a key indicator of stunting status. The study focused on the relationship between KIA book usage and toddler stunting status. Data analysis was performed using STATA version 17. Results: Of the 99 children, 87.9% had normal growth status. Effective use of the KIA book was significantly associated with better growth outcomes, showing an adjusted odds ratio of 4.6 (95% CI: 1.2-18.4, p < 0.05). While maternal age, education, number of children, and employment status were examined, none of these factors showed statistically significant associations with toddler growth (p > 0.05), highlighting that the KIA book utilization may be a more influential factor in promoting normal growth. Conclusion: The proper use of the KIA book correlates with improved toddler growth, indicating the potential benefits of increased engagement with this tool. The findings emphasize the need for interventions aimed at increasing maternal use of health monitoring resources to support child development effectively.
Enhancing Fine Motor Skills in Early Childhood Education Programs Through Playing the Traditional Congklak Game: A Quantitative Study
The Traditional Congklak game, a popular activity in Indonesia, has potential benefits for enhancing fine motor skills in early childhood education. This study aims to evaluate the effectiveness of the Congklak game in improving fine motor skills among early childhood education students. Materials and methods: A quasi-experimental study was conducted with children from four Early Childhood Education schools in Sawangan, Depok, West Java, Indonesia. Participants underwent pretest and posttest assessments to measure fine motor skills before and after the intervention. Results: The analysis of pretest and posttest scores revealed a statistically significant improvement in fine motor skills following the intervention, indicating the effectiveness of the Traditional Congklak game in enhancing these skills. Conclusion: The findings support the integration of play-based occupational therapy principles in early childhood education, highlighting the importance of personalized approaches to skill development. Despite limitations such as a small sample size and a short intervention period, the study concludes that the Traditional Congklak game can be a valuable tool for improving fine motor skills in early childhood settings. Future research should explore the long-term effects and broader demographic contexts to enhance the generalizability of the findings.
Working Characteristic, Occupational Sitting, Dietary Practices and Its Relationship with Nutritional Status among University Staff Population
Sedentary behaviour and unhealthy diets are common among university staff, driven by work demands and affecting their health. This study aimed to describe the working characteristics, occupational sitting, and nutritional status of Universiti Malaysia Terengganu (UMT) staff and examine their relationships. Materials and methods: A cross-sectional study using quota sampling was adopted (n=219). The Malay Occupational Sitting and Physical Activity Questionnaire (OSPAQ) and Dietary Practices were self-administered, while medical staff assessed nutritional status. Descriptive analysis, Independent t-test, Pearson correlation and Multivariate Linear Regression were employed. Results: Respondents had a mean daily computer usage of 6.70 ± 2.41 hours and occupational sitting time of 266.76 ± 130.79 minutes/day. Poor eating habits were prevalent including irregular practice of the Healthy Plate Concept, and insufficient intake of fruits, vegetables, and water. The majority had normal total cholesterol (36.5%) and fasting blood glucose (78.5%), yet 63.9% were overweight or obese, with mean values of 5.54 ± 0.99 mmol/L for cholesterol, 5.92 ± 1.42 mmol/L for glucose, and 27.35 ± 5.44 kg/m2 for BMI. Females had significantly higher total cholesterol (p=0.001) and those with secondary education had higher BMI than tertiary-educated respondents (p=0.002). No significant relationship was found between work characteristics and nutritional status, but female (β = 0.582, 95% CI = 0.304, 0.861) and computer usage (β = -0.064, 95% CI = -0.125, -0.004) were predictors of total cholesterol. Conclusion:The study highlights the need for targeted interventions to improve dietary practices among university staff, warranting further research on work-related influences on nutritional status.
Petroleum Jelly as an Alternative Coupling Agent to Reduce Umbrella Artifacts in Ultrasound Superficial Scans
Umbrella artifacts, caused by air bubbles in ultrasound gels, can compromise the diagnostic accuracy especially superficial ultrasound scans. This study investigated whether petroleum jelly, a commonly available alternative, could reduce these artifacts than standard ultrasound gel. Materials and methods: A cross-sectional study was conducted from September 2022 to February 2023, including only adult patients (18-40 years old) with normal BMI. Patients were prospectively recruited using a random sampling method and informed consent was obtained. Patients with a history of eczema, surgery, or chronic diseases were excluded. Total scores of overall image quality based on high contrast spatial resolution (HCSR), signal-to-noise ratio (SNR), image contrast, and homogeneity were compared between petroleum-jelly based and ultrasound gel-based images using a paired t-tests. The presence of umbrella artifacts was assessed using McNemar’s test. Results: A total of 88 patients with 45 males (51.1%) and 43 females (48.9%) participated in this study. Petroleum jelly-based images demonstrated slightly lower image quality compared to ultrasound gel-based images (17.75±1.72 vs. 17.35±1.30; P = 0.018), with an overall mean difference score of 0.40 (95% CI; 0.07, 0.73). However, the umbrella artifacts were significantly reduced with petroleum jelly (n = 2, 2.27%) compared to ultrasound gel (n = 9, 10.23%) (P = 0.039). Conclusion: Petroleum jelly shows potential as an alternative coupling agent, significantly reducing umbrella artifacts, despite slightly lower image quality. Its potential application in resource-limited settings needs further investigation and optimisation for broader clinical use.
The Association Between Health-related Physical Fitness and BMI Among Secondary School Students: A Cross-sectional Study
Childhood obesity is a growing global health concern, driven by poor diet and insufficient physical activity. Health-related fitness is linked to obesity, and Body Mass Index (BMI) is a key indicator of overweight and obesity. Overweight, obesity, and low physical fitness are interconnected issues; changes in one factor can influence the others. This study, which focuses on critical health-related fitness components, aims to explore the correlation between BMI and physical fitness. Materials and methods: A simple random sampling method was used to select 150 participants (62 boys and 88 girls) aged 13 to 16 from three schools in Shah Alam, Selangor. BMI, sit-ups, push-ups, modified push-ups, the YMCA Bench Step Test (YMCA 3MST), and sit and reach were used to measure all the variables. Descriptive statistics were used to analyse the demographic data, while stepwise multiple regression was employed to carry out the inferential analysis. Results: The analysis of multiple regression shows cardiovascular fitness (CF) positively significantly (ß = .315, P < .05) and contributes 0.9 % (r=.315) toward variance changes in BMI score [F (1,149) = 16.451, P< .05]. Meanwhile, the combination of cardiovascular fitness and muscle strength (MS) contributes 13 % (r=.36), and regression model 2 demonstrates two components are the predictors of BMI [F (1,148) = 11.035, P< .05]. Conclusion: CF and MS should be emphasized in any intervention programs targeting obesity among adolescents. These two components are crucial for achieving an ideal BMI and reducing obesity in this age group.
Continuous Blood Glucose Monitoring: Potential Applications from Diabetes Management
Continuous glucose monitoring (CGM) is a transformative technology in diabetes management. By providing real-time interstitial glucose readings, CGM offers insights into glycemic patterns that were previously inaccessible with traditional self-monitoring of blood glucose. This review delves into the fundamentals of CGM, including sensor technology, placement considerations, and factors affecting measurement accuracy. Various CGM-derived metrics, such as Time in Range (TIR), Ambulatory Glucose Profile (AGP), Continuous Overall Nett Glycemic Action (CONGA), and Mean of Daily Differences (MODD), are examined, highlighting their distinct roles in assessing glycemic control. This review discusses the current clinical applications of CGM and its potential benefits for personalized therapy and patient self-management. Furthermore, this review explores ongoing research to refine CGM technology, develop novel metrics, and expand its applications beyond established diabetes care into areas such as prediabetes and athletic performance. Ultimately, CGM is poised to play an increasingly central role in optimizing glucose control, reducing diabetes-related complications, and improving the quality of life in individuals with diabetes.
Determinants Associated With Stunting Among Children Under Two Years Old In Asia: A Scoping Review
About 18.9 million stunted children were reported in 2022 in Asia. Although there was a reduction in prevalence, the numbers were still high. This review aimed to identify the determinants associated with stunting among children under two years old in Asia. A systematic search of English-language articles published between 2013 and 2023 was conducted using PubMed and Scopus. Only 32 articles were deemed eligible. The included studies indicated several main predictors of child stunting: 1) community and societal factors, 2) household and family factors, 3) inadequate complementary feeding, 4) breastfeeding, and 5) infection. A diverse range of contributing factors is, to varying degrees, associated with stunting, demonstrating the importance of considering how those predictors interact with nutrition. Integrated health promotion, prevention, and interventions by healthcare providers and communities are needed to address this issue.
Research Exploring Traditional and Complementary Medicine Use in Malaysia: A Scoping Review
Traditional and complementary medicine (T&CM) encompasses a broad spectrum of health practices and products outside conventional medicine. Many Malaysians use T&CM, but research on its prevalence and patterns of use in Malaysia is limited. This study aims to chart the landscape of published research on T&CM use in Malaysia and outline key focus areas. A systematic literature search in MEDLINE, EMBASE, CINAHL, and Scopus databases up to April 25, 2023, identified 153 relevant studies. Most studies lacked an operational definition for T&CM, leading to ambiguity regarding their scope and limiting cross-study comparisons. Research predominantly focused on sub-populations in Kuala Lumpur and Selangor, with few nationwide studies. Studies found substantial T&CM use and highlighted consumer knowledge, attitudes, and perceptions towards T&CM. Consumers spend substantial amounts of money out-of-pocket for T&CM. This review highlights the need for further nationally representative studies to inform evidence-based policies and healthcare strategies for T&CM in Malaysia.
Reversed Clock Drawing Phenomenon in a Patient with Vascular Dementia and Vascular parkinsonism: A Case Report
Reversed Clock Phenomenon (RCP) occurs when the numbers are drawn counterclockwise in a clock drawing test. It is commonly associated with the decline in visuospatial function in dementia associated with lesions in the right cerebral hemisphere. While RCP typically manifests in the acute phase, this case reported a 64-year-old man with vascular dementia (VaD) and vascular parkinsonism who had exhibited persistent RCP one year after his last stroke. He presented with worsening memory impairment and frequent episodes of falls following recurrent strokes in 2018 and 2020. His Clinical Dementia Rating (CDR) was 1. MRI of the brain showed a hypodense lesion at the bilateral temporoparietal lobes. After treatment with acetylcholinesterase inhibitors and rehabilitation, his condition improved, suggesting the potential benefits of this combined approach in managing persistent RCP and visuospatial deficits in vascular dementia.
Management of Traumatic Dens Invaginatus Using Regenerative Endodontics in an Adult Patient
This study details a case report of a 26-year-old patient with a discoloured immature maxillary lateral incisor, linked to type II Dens Invaginatus (DI). The development of the root and apex were affected by pulp necrosis due to trauma. Despite the patient's age, a regenerative endodontic procedure (REP) was selected. The treatment was completed over two visits: the first involved chemomechanical debridement and applying Triple Antibiotic Paste, followed by pulpal regeneration on the second visit. After one year, the follow-up revealed incomplete healing, with no apical closure, root canal wall thickening, or increased root length. However, the periapical radiolucency had significantly decreased in size. Within the study’s limitations, the result demonstrates that REP in immature adult teeth can successfully achieve the primary goal of resolving signs and symptoms along with periapical radiolucency.
Double Trouble Following Pterygium Excision: A Case Report
Pterygium is a common disease and the gold standard surgical treatment is excision with conjunctival autograft. Pterygium excision has various complications, including recurrence and rarely, conjunctival granuloma. Inflammation is a risk factor for postoperative pterygium recurrence and granuloma formation. Aside from steroids, adjuvants may be used to curb postoperative inflammation but has limited use due to its various side effects. Psoriasis, a systemic inflammatory disease, also affects the eyes. We report a case of a patient with psoriasis who underwent pterygium excision with conjunctival graft which was complicated with both granuloma and recurrence. The granuloma resolved with medical management and the recurrent pterygium was stable at one year after the initial surgery. Patients with inflammatory disorders require careful perioperative planning aimed to reduce postoperative inflammation and subsequent complications, and avoiding the need for a second surgery.
Paediatric Unilateral Sudden Hearing Loss: Treatment Challenges
Acute labyrinthitis is an inflammation of the labyrinth which leads to sudden vestibular and auditory function loss at affected side. It is an otologic emergency requiring prompt treatment, however there is limited data on management in paediatric population. We would like to present a case of acute labyrinthitis in a child, and highlight the management, particularly intratympanic steroid injection as a salvage treatment for sudden unilateral hearing loss.
Metastatic Follicular Variant of Papillary Thyroid Carcinoma Arising From Struma Ovarii: A Case Report
The follicular variant of papillary thyroid carcinoma arising from struma ovarii rarely occurs, usually asymptomatic with a risk of distant metastasis. We present a case of a 37-year-old female diagnosed with malignant struma ovarii, which has histopathologic characteristics of a follicular variant of papillary thyroid carcinoma. She was discovered to have a left ovarian cyst during her second pregnancy, and laparoscopic cystectomy was performed for the left multiloculated follicular cyst. The histopathological examination came back as struma ovarii. During a subsequent pregnancy, she underwent open left salpingo-oophorectomy for a twisted left ovarian cyst. The histopathology of her left ovary revealed a follicular type of papillary thyroid carcinoma arising from struma ovarii. Following that, total thyroidectomy was performed and histopathology revealed papillary thyroid microcarcinoma. Computed tomography (CT) scan staging showed bilateral lung metastases. Subsequently, she underwent radioactive iodine therapy and survived without recurrence after six years of follow-up.
A Case Report: Termination of Pregnancy in Peripartum cardiomyopathy and Adoption as an Alternative Solution
Peripartum cardiomyopathy is a rare cause of heart failure that affects a woman in her late pregnancy or within the early months of the postpartum period. The failure symptoms can develop gradually or in an acute state if precipitated by other uncontrolled medical conditions commonly hypertension. This case report illustrated a woman in her 30s at 14 weeks 4 days period of gestation, who presented to the hospital with worsened heart failure symptoms. She was categorized as a high-risk pregnancy and thus proceeded with termination of pregnancy (TOP) due to maternal reasons. The case report highlights important discussions regarding the legal aspects of TOP in Malaysia and available options for high-risk women to have children through adoption or surrogacy.
Colonic Tuberculosis Mimicking Crohn's Disease: A Case Report
Intestinal tuberculosis (TB) presents a diagnostic challenge since its symptoms, imaging, and pathological features frequently resemble those of Crohn's disease (CD) and colon cancer. In 2022, 10.6 million people worldwide contracted tuberculosis, with Southeast Asia and Africa being the most impacted. Extrapulmonary tuberculosis, including abdominal TB, accounts for up to 20% of cases in immunocompetent persons and up to 50% in immunosuppressed patients. Abdominal tuberculosis usually affects the ileocecal region and is difficult to detect it since the symptoms overlap with those of other gastrointestinal disorders. We discuss the case of a 21-year-old male who was suspected to have inflammatory bowel disease with initial diagnostic workup that suggestive of CD. However, Ziehl-Neelsen staining on biopsy specimens confirmed Mycobacterium tuberculosis, resulting in a colonic TB diagnosis. This case underscores the importance of considering intestinal TB in chronic intestinal conditions, particularly in endemic regions.
Hidden in Plain Sight: A Vallecular Cyst Case Report
Vallecular cysts, although rare, can cause stridor and respiratory distress in neonate. In severe cases, large vallecular cysts may even lead to life-threatening airway obstruction. Herein, we report a case involving a neonate with stridor in which the diagnosis was confirmed via flexible laryngoscopy, revealing the presence of a vallecular cyst. Post-endoscopic marsupialisation, the patient was asymptomatic and thrived well. This case report highlights the importance of considering vallecular cyst as a differential diagnosis in newborns presenting with stridor and respiratory distress at birth. It underscores that early diagnosis and timely intervention result in favourable clinical outcomes, with complete symptom resolution following endoscopic marsupialisation and a low recurrence rate of 0.02%.
Acquired Aplastic Anaemia Due to Epstein-barr Virus Infection Aggravated by Bacteremia: A Case Report and Review of Literature
One of the infectious causes of aplastic anaemia (AA) is EBV. A comprehensive range of examinations are required to discover the causes of aplastic anaemia. We describe a case of a one-year-and-three-month-old boy who presented with pancytopenia and marrow hypocellularity due to EBV infection that maybe aggravated by bacteremia. The case was effectively treated with a combination of cyclosporine and anti-thymocyte globulin (ATG), and the diagnosis was confirmed serologically. This case is supported by a recent review of the literature.
CT Classification Improved Precision of Left Appendicitis Diagnosis with Intestine Malrotation
Complicated left appendicitis is a rare condition in the left lower abdomen that can lead to serious complications like peritonitis and abscesses. Computed Tomography classification can improve anatomical detail and assist in surgical planning. This presentation reviews two cases of delayed diagnosis in patients with intestinal malrotation. Both patients had recurring lower left abdominal pain. The first exhibited localized tenderness, while the second had diffuse tenderness. Both showed leukocytosis and elevated neutrophil levels. A non-contrast CT for the first confirmed suppurative-phlegmonous acute appendicitis with a periappendiceal abscess, while the second CT revealed perforating acute appendicitis with ulcerative mucosa. The CT classification shows that both patients had intestine malrotation with DNJRCL and DYJRCL subtypes according to CT classification. Fortunately, both patients recovered after undergoing appendectomies. CT classification can improve awareness of anatomical variants, which is vital for accurately diagnosing left-sided appendicitis.
An Inguinal Lump, Please Put an Endometriosis Extra Pelvic on Your Diagnosis List : Cases Series of Deep Endometriosis
Deep Endometriosis is usually found in the ovaries, peritoneum, gynecological organs and in the pouch of Douglas. We have reported 5 rare cases of extra-pelvic endometriosis from 2018-2023 on a patient who had endometriosis surgery and suffered from a mass in her inguinal area, and the symptoms were going up and down along with the menstrual cycle. An unclear mass which was hard and elastic in the right side of inguinal area with an average diameter of 22.2 cm2 at the bottom edge of the rectus abdominal muscle. The patient was then given 2mm Dienogest therapy for 180 days and the mass tended to enlarge so that it was decided to undergo surgery. The rare incidence of DE at inguinal is one of the considerations as a differential diagnosis for painful inguinal hernias. Collaboration and multidisciplinary approach are needed to understand better and to find appropriate therapy to prevent a recurrence.
Toxic Effects of p-Cresyl sulfate and Indoxyl Sulfate on Bone: A Systematic Review
Chronic kidney disease (CKD) causes the accumulation of uremic toxins such as indoxyl sulfate (IS) and p-cresyl sulfate (pCS), leading to bone mineral disorders due to a dysfunction in the equilibrium between bone formation and resorption. Herein, we aimed to review and compile recent experimental and clinical studies that demonstrated the effect of pCS and IS on bone at the system, cellular, and molecular levels.Materials and methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a systematic review was performed using three electronic databases to appraise literature published between January 2005 to June 2023 on the effects of IS and pCS on bone. Results: Twenty-two relevant articles were included: 11 in vitro, 5 animal studies and 6 patient-based. IS and pCS induce toxic effects in bone cells by influencing cell viability, differentiation, proliferation, oxidative stress, and cell death, leading to bone morphometry alterations and low bone turnover. Higher doses of IS are needed to induce bone toxic effects compared to pCS. IS and pCS affect bone cells by upregulating sclerostin and decreasing levels of DMP-1, both vital for bone mineralization. Therapeutic interventions are available to reverse the toxic effects of IS and pCS on bone, namely probenecid, pravastatin, resveratrol and AST-120. IS and pCS also potentially serve as biomarkers for CKD-related bone diseases. Conclusion: The available evidence shows IS and pCS induce toxic effects on bone through various mechanisms. Further in-depth mechanistic studies are warranted to elucidate their underlying mechanisms in inducing bone changes.
Integration of Play Therapy in Paediatric Nursing Care: A Systematic Review
Hospitalisation is stressful and maybe a threatening experience of their life. Play therapy is a systematic use of the standard theoretical model by play therapists and physicians that can prevent psychosocial difficulties and attain targeted cognitive development with the assistance of paediatric nurses. Objectives: the recent study aimed to evaluate the effectiveness of integrated play intervention with paediatric nurse care to improve anxiety and negative emotions among hospitalised children. Materials and methods: Five electronic databases were used: PubMed, EMBASE, CINHAL, MEDLINE, and PsychINFO from January 2015 to December 2023. The Mesh keywords used such as (“Play therapy” OR “Play intervention”) AND (“paediatric nurse care” OR “Healthcare staff of paediatrics”) AND (“hospitalized children” OR “children in hospital”) to search data. Results: The CASP tool recognized 11 standards for quality assessment of 11 included studies. Conclusion: In our systematic review, findings proved that play therapy is effective in improving stress, anxiety levels, fear feelings, and negative emotional states among hospitalized children.
Subjective Self-report Questionnaires for Assessing Insomnia Among Adolescents: A Review
This systematic review aimed to evaluate the psychometric properties of the self-reporting questionnaires used to assess insomnia in adolescents. Design: We also used a PRISMA flow diagram. Data sources: Three electronic databases were used, CINAHL, PubMed, and SCOPUS, to get original articles published from inception to December 2022. MeSH was used to control vocabulary. The keywords were adolescents OR teenagers OR youth AND tools OR scale OR questionnaire OR scale OR self-report OR survey AND insomnia OR (sleep initiation and maintenance disorders) AND validity OR reliability OR validation. A table was used to present the articles. Review Methods: We limited the articles to the English language, to original articles that had already been published, to adolescents, to full-text articles, to the use of a quantitative design, and to the subjective measures of insomnia using self-reporting. Results: We obtained 471 articles from three databases. We excluded articles based on the criteria and 51 eligible articles were obtained through full text screening. Finally, the total number of studies was 6 articles. There were several self-reporting questionnaires able to be used to assess insomnia, such as the Basic Scale on Insomnia Complaints and Quality of Sleep (BaSIQS), the Adolescent Insomnia Questionnaire (AIQ), the Insomnia Severity Index (ISI), the Athens Insomnia Scale (AIS), the Sleep Quality Index (SQI), and the Youth Self‑Rating Insomnia Scale (YSIS). These questionnaires have adequate validity and reliability. Conclusion and Impact: These questionnaires can assist adolescents and health care providers in conducting initial screening and understanding insomnia symptoms.
Harnessing Generative Ai in Medical and Health Sciences Academia: Strategic Opportunities and Ethical Dilemmas for Malaysia
Artificial intelligence (AI) is rapidly transforming education and research across the medical and health sciences academia sectors. In Malaysia, universities are increasingly leveraging AI to enhance teaching, improve research productivity, and foster student engagement. From simulating patient scenarios to automating systematic reviews, AI’s potential is vast. Yet, this digital transformation is unfolding within a critical policy vacuum, particularly in the context of health education, raising urgent ethical, pedagogical, and discipline-specific concerns. While AI comprises various technologies, this editorial focuses specifically on generative AI (GenAI) tools that can produce human-like text, images, or analyses. As with any disruptive technology, GenAI represents a double-edged sword: its benefits are substantial, but so are the associated risks. This editorial explores these dualities within Malaysia’s healthcare academic landscape and proposes a path forward rooted in ethical integration and professional accountability.