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
Safety Evaluation of Important Mineral Formulation of Rajatha Bhasma: Chronic Toxicity, Histopathological Evaluation- A Review
Rajatha Bhasma (RB), a revered Ayurvedic mineral formulation derived from purified silver, has long been used in traditional medicine for its therapeutic benefits. However, the safety of its chronic use has not been thoroughly evaluated, raising concerns about its long-term effects. This review examines the chronic toxicity of Rajatha Bhasma, drawing from both animal models and clinical studies. We analysed, the methodologies employed in these evaluations, highlighting the outcomes observed in various organ systems, potential genotoxicity, and overall biocompatibility. The review also explores the physicochemical characteristics of RB that influence its bioavailability and toxicological profile. By comparing findings across animal models and human clinical studies, the review highlights the importance of having consistent testing methods and suggests more research is needed to connect traditional use with modern safety guidelines. This approach helps to make sure that RB can continue to be used safely and effectively.
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Handgrip Strength Predicts Cardiovascular Disease Prevalence and Mortality Among Hypertension Patients: Results from National Health and Nutrition Examination Survey (NHANES) 2011–2014
Background: Handgrip strength (HGS) has emerged as a potential biomarker for cardiovascular risk, yet its predictive value in hypertensive populations remains unclear. This study aimed to investigate the association between HGS and cardiovascular disease (CVD) prevalence and mortality among hypertensive adults. Methodology: This cross-sectional study included 3,431 hypertensive participants from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 cycles, a nationally representative survey in the U.S., linked to mortality data through 2018. HGS was assessed using standardized grip strength protocols and categorized into quintiles. Logistic regression and Cox proportional hazards models were used to examine associations between HGS and CVD prevalence, all-cause mortality, and CVD-specific mortality, adjusting for demographic and clinical confounders. A two-sided p-value < 0.05 was considered statistically significant. Results: Individuals in the lowest HGS quintile (Q1: HGS <26.1 kg) had a 38% higher CVD prevalence (OR: 1.38, 95% CI: 1.28–1.52, p < 0.001), a 77% increased risk of all-cause mortality (HR: 1.77, 95% CI: 1.26–2.33, p < 0.001), and a 57% higher risk of CVD mortality (HR: 1.57, 95% CI: 1.10–2.21, p = 0.02) compared to those in the highest quintile (Q5: HGS >47.1 kg), even after adjusting for demographic and clinical factors. Conclusion: These findings suggest that HGS could be incorporated into cardiovascular risk stratification models to improve early detection strategies for hypertensive individuals. Unlike prior studies that focused on general or elderly populations, our study uniquely evaluates HGS as a predictor of CVD outcomes in hypertensive individuals, an understudied high-risk group.
Exploring Ankle Sprain Dynamics: A New Experimental Model in WISTAR Rats
Background: Ankle sprain is one of the most common orthopedic injuries that results in pain, swelling and ankle instability, all of which greatly affect functional activities and gait. The present study aims to develop an experimental model of grade 2 ankle sprain in WISTAR rats in a cost-economical surgical setting, while ensuring good animal welfare and humane surgical interventions according to established guidelines and after obtaining ethical approval. Methods: Twelve four-week-old female WISTAR rats were divided into two groups namely, control (n=6) and surgery (n=6). Rats in the control group were used as reference, while rats in the surgery group underwent a minor surgical procedure to induce ankle sprain under a magnifying glass. The swelling was assessed using the figure-of-eight measurement and MRI. Functional activities were evaluated using open field test and spontaneous rears, and gait changes were analyzed and compared using step length asymmetry, stride length asymmetry, paw overlap asymmetry, hindfoot base width and forefoot base width during gait of the reference and ankle sprain rats. Results: Gait analysis revealed that ankle sprain rats demonstrated poorer locomotion, reduced spontaneous rears, reduction in contralateral step length, ipsilateral stride length, greater ipsilateral paw asymmetry and greater forelimb and hindlimb base width. Conclusion: We have successfully developed an ankle sprain model in WISTAR rats using our surgical protocol based on our outcome measures on inflammation, reduced functional activities and impairment of gait.
Enhancing Glycaemic Control: The Impact of Medical Nutrition Therapy on HbA1c Reduction in Malaysia's Primary Healthcare Clinics (2017-2022)
Background: Diabetes Mellitus (DM) presents a major public health challenge, leading to serious complications. Medical Nutrition Therapy (MNT), provided by dietitians, is crucial for reducing HbA1c levels and improving glyceamic control. Objective: To evaluate the impact of MNT on HbA1c reduction in adults with Type 2 diabetes (T2DM) attending public health clinics in Malaysia, highlighting the importance of dietitian coverage in diabetes care. Methods: A retrospective cohort study was conducted among 4,680 adult T2DM patients who received MNT from 2017 to 2022. Patients with baseline HbA1c levels >8% were included, while those with chronic kidney disease, psychiatric conditions, pregnancy, or bedridden status were excluded. Pre- and post-MNT HbA1c levels were analysed using paired t-tests and regression models. Results: The mean HbA1c level dropped significantly from 10.83 ± 1.88% to 8.65 ± 1.92% post-intervention (p < 0.001), with an average reduction of 2.18%. Significant predictors of HbA1c reduction included pre-consultation HbA1c, gender, and ethnicity, with the strongest association seen in pre-consultation HbA1c. A target HbA1c ≤6.5% was achieved by 12.5% of patients. Conclusion: This study affirms MNT as a critical component of diabetes management, significantly improving HbA1c outcomes. Expanding dietitian services in Malaysia’s primary care is essential to provide equitable access to effective diabetes care.
Association of Anger Expression Towards Anxiety Among General Adult Population in Malaysia: A Cross-sectional Study
Introduction: Anger expression and anxiety are two significant psychological states that often occur simultaneously and have a profound impact on individuals' mental health and well-being. This study aims to investigate the prevalence of anger expression, anxiety levels, and the socio-demographic factors associated with both emotions among the general adult population in Malaysia. Methods: This cross-sectional study was conducted in Malaysia. Data was collected through an online structured questionnaire that assessed socio-demographic information, anger expression using the Clinical Anger Scale (CAS), and anxiety levels using the Generalized Anxiety Disorder-7 (GAD-7) scale. Convenience sampling was employed to gather respondents within Malaysia. Results: A total of 413 respondents’ data were collected. Respondents from urban areas exhibited significantly higher levels of anxiety compared to their rural counterparts (aOR 2.50, 95%CI: 1.15, 5.4). Respondents with prior experience or attendance in anger management sessions were less likely to have moderate to severe anxiety (aOR 0.22, 95%CI: 0.10, 0.51). A significant relationship was also found between clinical anger levels and anxiety. Respondents with mild anger (aOR 7.39, 95%CI: 3.07, 17.80), with moderate anger (aOR 12.08, 95%CI: 5.09, 23.84), and with severe anger (aOR 27.10, 95%CI: 10.03, 59.09) showed a higher association with moderate to severe anxiety. Conclusion: Our study highlights the relationship between anger expression, anxiety, and their associated factors in Malaysia’s general adult population. Addressing anger management and anxiety in a holistic manner is crucial for enhancing the emotional well-being of individuals and communities, especially in urban areas.
Development and Feasibility Testing of the Aku Rawat Application for Self-care Management in Diabetes Mellitus Patients
Introduction: Self-care is a natural decision-making process to maintain health and control disease. Self-care management is carried out independently to overcome the inability to manage the disease independently, which can cause complications in people with Diabetes Mellitus. This study aims to develop the Aku Rawat application to improve self-care management in people with Diabetes Mellitus. Method: The study design used is a mixed-methods approach to assess the development and implementation of a structured educational application for Diabetes Mellitus patients at Gondang Tulungagung Community Health Center. Development of structured educational applications through material preparation, exploration, descriptive surveys, focus group discussions, expert consultations, due diligence, and training of application use. According to the inclusion and exclusion criteria determined and adjusted at each stage, the research sample amounted to eighty respondents. Data collection was carried out using questionnaires and evaluation sheets. Data analysis was carried out using descriptive statistics. Data collection was carried out using questionnaires and evaluation sheets. Data analysis was carried out using descriptive statistics. Result: The reliability test showed a Cronbach's Alpha of 0.947, indicating that all question items are reliable. The SUS result was 72.25, which indicates Acceptance, Good in terms of adjective rating, and C in the grade scale. Feasibility testing and training session showed that the application was accepted and received a positive response from users. Conclusion: Structured educational applications can be used as a health education medium so that people with Diabetes can change their behavior towards good self-care management.
The Succession Pattern and Development of Predominant Species of Blowflies to Suitcase-enclosed Rabbit Carcasses on Outdoor Versus Indoor Sites
Introduction: Blowfly succession on animal carcasses aids in estimating the minimum post-mortem interval of decomposed bodies. However, colonization differs in cases where the decomposing bodies are enclosed. This study examines blowfly succession on enclosed rabbit carcasses to establish patterns relevant to forensic investigations. Materials & methods: Fifteen domestic rabbit (Oryctolagus cuniculus) carcasses were divided into three groups; enclosed indoors and outdoors, and exposed outdoor carcasses. Each carcass was placed in a suitcase as the mode of enclosure. Entomological and environmental data were observed and recorded. Results: Enclosement of the carcasses have altered the insect succession pattern during carcasses decomposition. Four species of calliphorid flies were identified on control carcasses, compared to only two species were found on enclosed carcasses. However, both groups of carcasses were colonised by two main blowfly’s species; Chrysomya megacephala (51.4%) and Chrysomya rufifacies (33.5%). The enclosement has caused delayed in oviposition which took around 49-76 and 50-77 hours for Ch. megacephala and Ch. rufifacies respectively. During fly development, longer eclosion time was also observed in Ch. megacephala (142.5-147.5 hrs) and Ch. rufifacies (162.5-169 hrs) compared to exposed carcasses (96-97 hrs). Consequently, the carcasses enclosure disrupted the normal blowfly’s oviposition and development, thus affecting the minPMI estimation. Conclusion: The enclosement of carcasses significantly altered blowfly succession, delayed oviposition, and prolonged the developmental time. These findings highlight the impact of physical barriers on blowflies succession and colonization of decomposing carcass in forensic investigation, emphasizing the need to consider the effect of enclosure when estimating the minimum post-mortem interval.
Impact of Pharmacist-led Heart Failure Clinic Towards Clinical Outcomes of Heart Failure Patients With Reduced Ejection Fraction
Introduction: Heart failure causes high mortality and hospitalization. Pharmacist interventions help, but studies on pharmacist-led HF clinics in Malaysia are limited. Method: This study aimed to evaluate the influence of a pharmacist-led heart failure clinic on the clinical outcomes of heart failure patients with reduced ejection fraction. This was a quasi-experimental study conducted at Hospital Pulau Pinang in Malaysia. New patients attending the heart failure clinic were screened, and through convenient sampling, they were enrolled into intervention (HF-MTAC) and usual care (UC) groups. At the clinic, pharmacists provided patient education, counselling, and recommended dosage adjustments to physicians. Patients were observed and followed up for 9 months. Results: A total of 70 patients were recruited for each group. Pharmacist intervention led to significantly lower cardiovascular (CV) hospitalizations among the patients (40.0% in UC versus 18.6% in HF-MTAC group, p = 0.005). A significantly higher rate of CV-related emergency department (ED) visits was observed in the HF-MTAC group (11.4%) compared to the UC group (1.4%) (p = 0.033). However, no significant difference was observed in the CV-related mortality rate between the UC group (5.7%) and the HF-MTAC group (4.3%). The HF-MTAC group showed significant improvement in health-related quality of life according to the Minnesota Living with Heart Failure Questionnaire (MLHFQ), with median MLHFQ scores dropping from 7.00 to 2.00 (p < 0.001). Meanwhile, no significant change was observed in the UC group. Conclusion: These findings underscore the benefits of pharmacist-led heart failure clinics and suggest their implementation in Malaysian hospitals.
Correlation Between Anxiety and Blood Pressure in Patient With Pre-operative Laparoscopy: A Cross-sectional Study
Introduction: Laparoscopy surgery is a minimally invasive procedure that utilizes a laparoscope to visualize the abdominal cavity, providing benefits such as faster diagnosis, shorter hospitalization, and reduced morbidity. However, changes in blood pressure, particularly in the pre-operative phase, are common and can impact patient outcomes. Additionally, pre-operative anxiety, which affects a significant portion of patients, can further contribute to blood pressure variability and complicate the surgical process. This study aims to determine the relationship between anxiety and blood pressure patients. Methods: This study uses a quantitative design with a cross-sectional method. The sample size in the study amounted to 100 respondents using the total sampling technique. Anxiety was measured using APAIS, while blood pressure was measured using a bedside monitor that had been calibrated 10 minutes after respondents arrived at the Operating Room. Data analysis was carried out using the Person Product-Moment test. Results: This study found that there was a significant relationship between anxiety and blood pressure in pre-laparoscopic surgery patients at Tarakan Hospital, Jakarta, with a p-value of 0.001 (p-value < 0.05) and r = 0.728[Igp2.1][Igp2.2]. Conclusion: The anxiety felt will increase blood pressure in the patient. Interventions to lower anxiety in pre-laparoscopic patients need to be performed.
Building Minds and Communities: A Participatory, Culturally Grounded, and Digitally Enhanced Model for Promoting Executive Function skills in Preschoolers in Northeastern Thailand
Introduction: While existing executive function skills interventions primarily focus on structured classroom activities or cognitive training models, they often fail to integrate cultural narratives and community-based learning approaches. Methods: This study aimed to develop and evaluate a participatory executive function skills promotion model that integrates community collaboration, cultural narratives, and digital engagement. A participatory action research approach was employed to co-design and implement the intervention with key stakeholders, including parents, teachers, Buddhist monks, and folk philosophers. Forty participants engaged in focus group discussions, non-participant observations, and interactive executive function skills training sessions delivered through LINE Official Account, a widely used mobile platform in Thailand. Thematic analysis was conducted to identify key barriers, enablers, and impacts of the intervention on executive function skills development. Results: Findings revealed that integrating executive function skills development into everyday cultural practices strengthened children’s cognitive flexibility, perseverance, and self-regulation while fostering intergenerational knowledge transfer. Parents and caregivers reported increased confidence in guiding executive function skills development, and digital reinforcement via LINE Official Account enhanced accessibility and engagement. The intervention demonstrated feasibility and scalability, with high participation rates and sustained community involvement. Conclusion: This study highlights the effectiveness of a culturally grounded and technology-supported approach to executive function skills development in preschool children. By blending traditional wisdom with mobile-based reinforcement strategies, the model offers a sustainable, community-driven alternative to conventional executive function skills interventions. These findings provide a replicable framework for integrating culturally responsive cognitive training into early childhood education, particularly in low-resource, high-context cultural settings.
The Price of Protection: How Much Urban Muslim Communities in Selangor Are Accepting and Willing to Pay for Covid-19 Vaccines?
Introduction: The novel coronavirus disease 2019 (COVID-19) has been a major public health crisis worldwide since early 2020. In Malaysia, a religious gathering in Seri Petaling resulted in the largest cluster with 3,375 cases and 34 deaths, leading the government to impose movement restriction policies. However, after these policies were eased in mid-2021, cases involving religious institutions and communities increased again. The COVID-19 vaccination and other preventive practices were believed to be the way forward to ending the pandemic. This research aimed to measure the acceptability and willingness to pay (WTP) for the COVID-19 vaccine and the associated factors among the Muslim community if it were available at private health institutions. Method: In 2021, an online survey was conducted using the contingent valuation method (CVM) among Muslim residents of Bandar Baru Bangi, a suburban town in Selangor state, Malaysia, who attended prayers at mosques and prayer rooms (surau) in that area. Results: The analysis indicated that 97.35% (n=478) of the 491 respondents accepted COVID-19 vaccination, and 81.71% (n=388) were willing to pay for the vaccine, with a mean value of MYR141.05 (±98.70) (US$34.07, ±23.85) per dose. The predictors of WTP, as analysed by multiple logistic regression, were age group under 51 years and monthly household income of more than MYR4,850 (US$1,147). Conclusion: Most respondents accepted the COVID-19 vaccine, and more than 80% were willing to pay. This research highlighted the acceptability and price range residents would pay if the vaccine were available.
Prevalence of Dental Anxiety and Fear, Barriers to Utilisation of Oral Healthcare Services and Their Relation With Oral Health Care Seeking Behaviour Among Adults Attending Hospital Universiti Sains Malaysia
Introduction: Malaysian adults have been exposed to school dental treatments since childhood; yet poor dental utilisation has been observed. This study aims to determine the prevalence of DAF (dental anxiety and fear), other barriers to utilisation of oral healthcare services as well as comparing their OHCSB score (oral health care seeking behaviour) with those who did not have such barriers. Materials and methods: A cross-sectional study was conducted among 209 adults who were otherwise healthy, accompanying those attending the family medicine outpatient clinic, Hospital Universiti Sains Malaysia (USM) from April to May 2023 using a self-administered validated Malay questionnaire to obtain their sociodemographic profiles, prevalence of DAF, other barriers to utilisation and OHCSB score. Data was analysed using SPSS version 26. Results: Most of the respondents were Malay (96.2%), female (53.1%), at the mean(SD) age of 37.3(10.83) years old and categorised under the B40 group (54.5%). The prevalence of DAF was 30.6% (95% CI:24.3%,36.9%). Common barriers reported were perception of not having a dental problem (52.2%), and busy work schedules (53.1%). The mean(SD) OHCSB score was 9.62(1.670) out of 12. The mean(SD) OHCSB score was significantly lower in those with DAF 9.03(1.502);p=0.001; and in those who perceived having a dental problem 9.32(1.762);p=0.017. However, it was significantly higher among those without self-transportation 10.73(1.223);p=0.007. Conclusion: The prevalence of DAF was high. The OHCSB score was significantly lower with the presence of DAF and in those perceived of having a dental problem and higher among those with no self-transportation.
Exploring the Impact of Subchorionic Hematoma on Pregnancies in Women With Recurrent Pregnancy Loss Experiences
Purpose: This prospective study aimed to evaluate the impact of subchorionic hematoma (SCH) on pregnancy outcomes in women with recurrent pregnancy loss (RPL) and to explore the relationship between SCH, thrombophilia, and low-dose aspirin (LDA) use. SCH characteristics such as size and location were inconsistently recorded and thus excluded from the final analysis. Patients and Methods: A case-control study was conducted between May 1, 2009, and June 30, 2017, at Mosul Teaching Hospitals. A total of 274 women with a history of RPL were enrolled, of whom 31 were diagnosed with SCH during early pregnancy and monitored with serial ultrasounds alongside standard miscarriage management. Demographic and clinical data were collected, and pregnancy outcomes were compared between women with and without SCH. A subgroup analysis assessed the impact of continued LDA use on SCH duration and pregnancy outcomes. Univariable and multivariable analyses were used to control for confounding variables. Results: SCH was significantly associated with thrombophilia (61.3% vs. 29.6%, p = 0.041), suggesting a potential link between hypercoagulability and SCH formation. No significant differences were found between the SCH and non-SCH groups regarding maternal age, BMI, parity, or RPL etiology. Live birth rates (70.9% vs. 81.2%, p = 0.209) and miscarriage rates (25.8% vs. 15.6%, p = 0.209) were similar. LDA use did not significantly affect live birth rates, SCH duration, or resolution. Conclusion: SCH does not significantly impact pregnancy outcomes in RPL. Thrombophilia may contribute to SCH formation, but continued LDA use appears to have no effect on outcomes.
Knowledge, Attitude, and Practice Towards Dental Ergonomics of Undergraduate Students From Faculty of Dentistry, Manipal University College Malaysia.
Introduction: Ergonomics, a crucial aspect in dentistry, addresses the interaction between individuals and their work environment, aiming to prevent musculoskeletal disorders (MSDs). The aim of the present study was to assess the KAP of dental students in a university college in Malaysia. Material & methodology: A cross-sectional study was conducted, involving 207 students from Years 2 to 5, using a self-administered validated 27-item questionnaire assessing the KAP towards ergonomics among dental students at Manipal University College Malaysia (MUCM). The KAP of various academic years was compared and association between knowledge, attitude and practice was assessed using chi-square test. Bonferroni post-hoc comparison test was done to identify which academic years are significantly different from each other. Results: The respondents were distributed across academic levels as follows: 25.12% in Year 2, 21.74% in Year 3, 28.50% in Year 4, and 24.64% in Year 5. Only 17.2% of students demonstrated adequate knowledge, yet 59.6% maintained a positive attitude towards ergonomics. However, a concerning 81.3% exhibited poor ergonomic practices. There was significant different in knowledge (p≤ 0.001) and attitude (p≤ 0.001) across the years, however, difference in the practice (p≤ 0.562) was not statistically significant. A strong association was found between knowledge, attitude and practice. Conclusion: The knowledge of dental ergonomics among undergraduate dental students at MUCM is fair. Academic year has and influence on knowledge and attitude but not on practice. However generally students with better knowledge about dental ergonomics tend to have better attitude and practice towards the same.
Behind the Desk: Sociodemographic and Lifestyle Factors Associated With Obesity Among Working Adults in Kuala Lumpur
Introduction: The rising prevalence of obesity is a growing concern nationwide and increases the risk of non-communicable diseases. This study aims to determine the association between sociodemographic characteristics, lifestyle factors, and work environment, with overweight/obesity among Malaysian working adults in Kuala Lumpur. Methods: A cross-sectional study design is carried out among Malaysian workers aged 18 to 64 years with data collected through online administered questionnaires. A total of 290 respondents were involved using convenient sampling. Multiple logistic regression analysis was used to determine the odds of overweight/obesity among working adults for each study factor. Results: In this study, 24.8% of workers were found to be overweight/obese. Male workers had 3.47 times greater odds of being overweight/obese, while married individuals had 4.39 times greater odds. Those who slept less than seven hours per night had 2.75 times greater odds and individuals who skipped breakfast daily had 2.46 times greater odds of being overweight/obese compared to those workers who are not overweight/obese. Conclusion: Overall, one in four working adults were classified as overweight/obese. This research found that gender, marital status, sleeping hours and frequency of meals were associated with being overweight/obesity among workers, significantly. Further research is warranted to explore additional occupational and lifestyle determinants such as work-related stress, dietary quality, and specific job categories that may contribute to elevated BMI, particularly within the Malaysian workforce.
“From Cigarettes to Clarity: Insights into an Islamic-Based Smoking Cessation Program for Undergraduate Students”
Introduction: Smoking-related diseases contribute to Malaysia’s huge economic and physiological burden. Despite several smoking cessation interventions in Malaysia, most focus mainly on pharmacotherapy or behavioural therapy, or both leaving the religious aspects behind. Since religiosity plays an important role in regulating one’s health behaviour, it is crucial to integrate religious aspects into smoking cessation intervention programmes. Moreover, smoking cessation programmes rarely target the young adult population, primarily undergraduate university students. The study aims to explore the experiences of undergraduate smokers concerning the Islamic-based smoking cessation programme (ISCP). Methods: This study applied a qualitative approach and a semi-structured interview of the participants (n = 10) to explore their experiences regarding the ISCP. The study population were male students of the foundation studies who were active smokers. Thematic analysis was applied in analysing the semi-structured interview data. Results: Three themes have been identified from the in-depth interviews: 1) strengths of the programme, 2) strategies to quit smoking, and 3) reflection on the smoking cessation barriers. Conclusion: The findings suggest that ISCP is a worthwhile programme among young adults.
Evaluating Knowledge, Awareness, and Satisfaction Regarding Solid Waste Management and Associated Health Risks Among Ampang Jaya Residents
Introduction: Solid waste management (SWM) poses a global challenge with serious environmental, health and economic impacts, particularly in rapidly urbanizing countries like Malaysia due to rising waste generation, limited landfill capacity, and associated public health risks. Improper waste handling leads to pollution, disease outbreaks, and public dissatisfaction. Objective: This study aimed to assess the knowledge, awareness and satisfaction of residents in Ampang Jaya regarding SWM and the potential health problems from waste generation. Methodology: Conducted in Ampang Jaya, Selangor, this study involved 420 respondents across 42 Ampang Jaya Municipal Council (MPAJ) waste collection zones. A set of well-structured questionnaires in Bahasa Malaysia was adapted from a previous validated study and administered to assess respondents' knowledge, awareness, and satisfaction with solid waste collection performance in their area. Data was analyzed using IBM SPSS Statistics for descriptive statistics, one-way ANOVA, independent t-tests, and multiple linear regression. Results: Significant demographic differences were observed among respondents, who were generally young, well educated, and had high household incomes. Knowledge of SWM was low (score < 0.5), with educational level being the only sociodemographic factor affecting knowledge (p < 0.05). Most respondents displayed medium awareness (scores ranging 12–55), also influenced solely by educational level (p < 0.05). Satisfaction with SWM showed significant association with age (p < 0.05), and trends indicated consistent satisfaction, likely due to uniform SWM services across the area. Conclusion: Findings from this study can aid local authorities in improving SWM strategies and encourage community involvement in maintaining a cleaner environment.
Abnormal PHQ-9 score for Depressive Symptoms and its Associated Factors among Medical Students of a Local University
Introduction: Depression is a prevalent mental health concern among medical students due to academic pressures and personal challenges. Understanding its prevalence and identifying key associated factors are crucial for targeted interventions aimed at reducing its impact on students’ well-being. Materials and methods: This study assessed the prevalence of depressive symptoms and examined associated factors among 498 medical students at a public university using the Patient Health Questionnaire-9 (PHQ-9). Sociodemographic and lifestyle data, including social support, family history, and involvement in physical and social activities, were analyzed through multiple logistic regression. Results: 60.2% of students exhibited depressive symptoms, with 33.5% reporting mild symptoms, 15.3% moderate, 7.4% moderately severe, and 4.0% severe depression. Key factors significantly associated with severe depressive symptoms included lack of social support (Adjusted Odd Ratio (AOR)=5.75), family history of depression (Adjusted Odd Ratio (AOR)=22.02), history of being bullied (AOR=4.06), unwillingness to pursue medicine (AOR=19.08), absence of close friends (AOR=3.42), no participation in sports (AOR=3.14), and no involvement in societal or community activities (AOR=7.19). Conclusion: These findings highlight the urgent need for targeted interventions to address modifiable factors contributing to depression. Strengthening social support networks, promoting extracurricular and community involvement, and providing accessible mental health services can mitigate the impact of depression on medical students, enhancing their well-being and academic performance.
Molecular Characterization and Physiological Tolerances of Acanthamoeba Isolated from Recreational River Water in Templer Forest Eco Park, Selangor: A Preliminary Study
Introduction: Acanthamoeba species are ubiquitous free-living protozoa that can be found worldwide. Acanthamoeba in recreational waters is concerning because it can cause serious human health issues, particularly Acanthamoeba keratitis and granulomatous amoebic encephalitis. Currently, this amoeba can be classified into 23 different genotypes, labeled T1 to T23. This study targets the identification of Acanthamoeba genotypes and their pathogenic characteristics within Templer Forest Eco Park, Selangor. Materials and Methods: To conduct this research, purposive sampling was performed, resulting in the collection of ten water samples from March to April 2023. Each sample underwent filtration using a nitrocellulose membrane, followed by analysis for Acanthamoeba presence through cultivation and PCR utilizing specific primers. Physiological tolerance assessments were executed on all samples that tested positive for Acanthamoeba. Results: PCR testing confirmed the presence of Acanthamoeba in 8 out of the 10 sampled water sources. Phylogenetic analysis classified six of these samples as genotype T18, while remaining samples were identified as genotypes T4 and T17. Tolerance assessments revealed one Acanthamoeba strain (genotype T4) exhibited significant pathogenicity. Conclusion: This is the first time that Acanthamoeba genotypes have been reported in recreational waters in Selangor. The findings suggest that Acanthamoeba strains present in the river water of Selangor may pose a potential health risk to humans. Therefore, it is recommended that health authorities implement regular monitoring of river water and install warning signage to mitigate the risk of diseases linked to pathogenic Acanthamoeba.
Development and Validation of a Culturally Adapted Motivational Enhancement Intervention for High-Risk Drinking
Introduction: Excessive alcohol consumption is a growing concern in some indigenous communities in Sabah, affecting health, society, economy and wellbeing overall. With Sabah’s rich cultural diversity, alcohol plays a traditional role in many ethnic groups. Addressing alcohol-related issues requires diverse approaches, with motivation being key to long-term success. Therefore, this study aims to develop a module to enhance motivation through an intervention method designed to change drinking behavior. Methods: An adapted module, sensitive to cultural practices, was designed to engage the indigenous communities' sense of responsibility in addressing alcohol consumption. A qualitative approach was used, involving 28 participants. The development of the intervention module occurred in two phases. In the first phase, participants were screened, and relevant data were gathered to inform the module’s content. The second phase focused on designing the intervention, incorporating culturally appropriate strategies and motivational techniques. Results: The finalized module was developed based on insights gathered during both phases, ensuring it aligned with the participants' needs and cultural context. The module consists of 10 sections divided into 4 sessions over a 12-week period. The second phase includes guidelines to address drinking behaviors, helping individuals explore ambivalence, develop discrepancies, and overcome resistance to change. Conclusion: This study provides an additional methodology to address alcohol-related issues, contributing to the existing literature and offering practical insights for community interventions.
Cytotoxicity Test of Indonesian-made Pmma Acrylic Bone Cement on Fibroblasts and Osteoblasts
Introduction: Polymethyl methacrylate (PMMA) bone cement is widely used due to its affordability, durability, and suitability for large defects. However, Indonesia lacks PMMA products designed specifically for cranio-maxillofacial use. Institut Teknologi Sepuluh Nopember (ITS) has developed the first national PMMA bone cement for this purpose, using DmpT and DmoT as its catalysts. This study assesses the biocompatibility of ITS’s PMMA bone cement through cytotoxicity testing on fibroblast and osteoblast cells, and also the first to evaluate the cytotoxicity of DmoT-based PMMA bone cement, a cost-effective alternative to conventional DmpT-based products in Indonesia. Method: Cytotoxicity tests were conducted on BHK-21 fibroblast cells and hFOB osteoblast cells using MTT assay. The tests compared two types of ITS’s PMMA bone cement (PMMA-DmpT and PMMA-DmoT) to OGM® bone cement, a commercially established product. Results: ITS’s PMMA bone cement showed no toxicity to fibroblast or osteoblast cells, with cell viability levels similar to OGM® bone cement. Among the tested materials, OGM® bone cement had the highest cell viability, followed by PMMA-DmpT and PMMA-DmoT. Conclusion: PMMA bone cement developed by ITS using DmpT and DmoT catalysts is non-toxic to fibroblast and osteoblast cells.
Understanding and Perception of Artificial Intelligence in Medicine Among the Undergraduate Medical Students of a Private University in Malaysia
Background : Artificial intelligence (AI) has been widely integrated into medical practice. The level of understanding of AI, perceptions of its role in medical practice, and its impact on medical education among clinical undergraduate medical students in a private university in Malaysia was studied. Methodology : A descriptive, cross-sectional study using self-administered survey questionnaire was done. Multi-stage sampling methods, comprising purposive sampling followed by random sampling, were employed to recruit all the clinical students in the semesters 6 to 10 of the Bachelor of Medicine and Bachelor of Surgery (MBBS) program at the University. Results : A total of 281 students responded (response rate 65.3%). The students had a median score of 16 for the level of understanding on AI, a mean score of 54.28 (SD 9.01) for perceived ability of AI, and a median score of 32 for perceived impact of AI. Significant differences were observed across gender (p<0.001), nationality (p=0.013), having any knowledge on Information Technology (IT) related to AI (p<0.001), and whether the students had attended or viewed any talks or lectures on AI (p<0.001). Statistically significant differences were found in the medians of perceived impact of AI for the variable of gender (p=0.001). Conclusion : The undergraduate medical students had moderate level of understanding on AI, good perceptions of the role of AI in medical practice, and its impact of AI on medical profession. AI topics should be incorporated into the undergraduate medical curriculum so that the medical students could be exposed early to AI knowledge and skills.
Rasch Analysis of the Indonesian PHQ-9 in ICU Patients with CHD
Background: Screening and management of depression in patients with CHD is essential. PHQ-9 is a measurement that can be used, yet its reliability in investigating depression among CHD patients at the ICU has not been widely performed. Purpose: This study aimed to examine the construct validity of the Indonesian version of the PHQ-9 in CHD patients undergoing ICU treatment. Methods: Construct validity and differential item functioning (DIF) were analyzed using the Rasch model. A total of 102 CHD patients completed the Indonesian PHQ-9. Analyses included reliability and separation indices, infit-outfit MNSQ, ZSTD, point-measure correlations, unidimensionality, item-person maps, and DIF assessment. Results: Item and person reliabilities were 0.97 and 0.67, respectively, with a person separation strata of 2.25. Most items fit the Rasch model, with minor misfits (items 7 and 9 for MNSQ; items 1, 4, and 8 for ZSTD). All items had positive point-measure correlations and met at least one fit criterion. The measure explained 52.8% of the variance, with 5.6%–10.2% unexplained variance across the first five contrasts. Thresholds ranged from 1.35 to 2.38. Local dependence was low (r = 0.29), and no significant DIF was identified. Item 3 was the easiest; item 9 the most difficult. Conclusion: The Indonesian version of the PHQ-9 is a valid and reliable tool for detecting depression in ICU patients with CHD. However, its sensitivity to both mild and major depressive disorders remains limited. Instrument refinement, the use of complementary assessments, and a larger sample size are recommended for further analysis.
Association Between Body Composition and Protein Intake Among Patients With Breast Cancer in Klang Valley
Introduction: Cancer is a catabolic disease that can significantly impact dietary intake and body composition of the patients. This study aimed to evaluate the association between dietary intake and body composition of patients with breast cancer. Materials and Methods: This cross-sectional study involved patients with breast cancer stage I-III visiting a state hospital and a cancer support centre. Socio-demographic, medical history, anthropometric, and dietary data were collected. Body composition was evaluated using a bioimpedance analyser and handgrip strength was assessed using a hand dynamometer. Sarcopenia was defined by low appendicular skeletal muscle index and low handgrip strength according to the cutoff values recommended by the Asian Working Group for Sarcopenia. The associations between the parameters were analysed. Results: A total of 71 patients with median age of 60.7 (50.6 - 67.1) years were recruited. The median BMI of the patients was 25.1 (21.8 – 29.8) kg/m² with majority being obese (55%). About one-third were sarcopenic. The mean energy and protein intake adjusted by body weight were 20 ± 8 kcal/kg/day and 0.9 ± 0.4 g/kg/day, respectively. While no correlation was found between protein intake and skeletal muscle mass, protein intake was negatively correlated with fat mass (r = -0.247, p = 0.038) and fat mass index (r = -0.275, p = 0.020). Conclusion: Sarcopenia was prevalent among patients living with breast cancer and most patients did not meet their nutrition requirements. Protein intake potentially influences body composition, particularly fat mass. These findings warrant the importance of individualised nutritional care for cancer.
Ultrasound Transducer Infection Control in Emergency Department: Bacterial Load and Effectiveness of Different Cleaning Methods
Introduction: Point-of-care ultrasonography (POCUS) is increasingly used across medical fields, highlighting the need to prevent cross-contamination through ultrasound probes. This study aims to assess bacterial contamination on ultrasound probes and evaluate the effectiveness of different cleaning methods. Methods: A prospective cross-sectional study was conducted in the emergency department of a hospital in Kelantan from August 2023 to February 2024. Pre- and post-cleaning samples were collected from ultrasound probes meeting the inclusion criteria. Three cleaning methods were compared: 4% chlorhexidine (CHD), quaternary ammonium compound, and clean papers. Results were measured in colony-forming units per millilitre (CFU/ml). Results: A total of 99 samples were collected, with equal distribution among the three cleaning methods. Most probes (83.8%) were used in non-trauma cases, and 99% of gross contamination was from wet gel, with blood accounting for 1%. Curvilinear probes showed the highest bacterial growth, with a median of 3450 CFU/ml (range: 0–7.2 × 10⁵). All cleaning methods significantly reduced bacterial contamination (p<0.001), with 4% CHD showing the greatest reduction. No other factors were significantly associated with bacterial load. Conclusion: Ultrasound probes are prone to bacterial contamination, but proper cleaning methods, particularly using 4% CHD, can significantly reduce contamination levels.
Prevalence of Refractive Errors in the Indonesian Paediatric Population at a Tertiary Eye Centre
Introduction: Visual impairment occurs when the visual system and vision functions are affected due to an eye condition. Visual impairment among the paediatric population is a significant public health issue due to the long-term impact on life-years. Methods: A cross-sectional study was conducted at Island Hospital in Penang, Malaysia, a medical tourism facility, enrolling Indonesian school-aged children aged 5–12 years. The study included interviews, uncorrected distance visual acuity measurements using the Snellen chart, cycloplegic refraction with a streak retinoscope refined subjectively, and detailed slit-lamp examinations of the anterior and posterior segments. Results: In this study, 229 children aged 5 to 12 years who attended the Ophthalmology Clinic at Island Hospital in Penang were assessed for refractive errors. The average age of the participants was 8.82 years (standard deviation: 2.37), with a gender distribution of 118 males (51.5%) and 111 females (48.5%). The overall prevalence of refractive errors was 70.7%, comprising 15.7% hyperopia, 55% myopia, and 29.3% emmetropia. Mann-Whitney tests indicated significant differences in SE values across ethnicities and age groups for both eyes, with a p-value of <0.05, while no significant differences were found between genders. Age showed a weak negative correlation with SE in the right eye (r = -0.172, p = 0.009) and left eye (r = -0.183, p = 0.005). Conclusion: Refractive errors are highly prevalent among Indonesian paediatric patients, with myopia being the most common at 55%. Early detection and interventions are crucial, particularly for high-risk groups such as Indonesian Chinese children.
Association Between Dental Anxiety, Utilisation and Oral Health-related Quality of Life Among Young Adults in Malaysia
Introduction: Dental anxiety (DA) is a potential barrier to dental care among young adults in Malaysia, yet its influence on dental utilisation (DU) and oral health-related quality of life (OHRQoL) remains unclear. This study aims to investigate the relationship between DA and DU, as well as their impact on OHRQoL for Malaysian young adults. Methods: A cross-sectional study was conducted among 601 young adults in Selangor using convenience sampling. Participants completed a self-administered questionnaire assessing DA, DU and OHRQoL. Results: The mean age of participants was 20.67 ± 2.71 years. While 94.8% perceived dental visits as important, only 72.5% reported intent to attend preventive check-ups. The most common barriers to DU were time (67.2%), cost (17%), and fear (6.8%). The mean MDAS score was 11.87 ± 4.42. Higher DA was significantly associated with sex and unknown fear items (p<0.05). However, DA was not significantly related to actual DU behaviour. Multiple linear regression identified key predictors of poorer OHRQoL, including older age (p = 0.016), Malay ethnicity (p < 0.001), proximity to a dental clinic (≤5 km: p = 0.014), and high DA (MDAS ≥ 13: p < 0.001). The model demonstrated moderate explanatory power (Adjusted R² = 0.143, F = 8.153, p < 0.001). Conclusions: Although DA did not significantly influence DU, it was associated with OHRQoL, along with age, ethnicity, and proximity to dental clinics. These findings highlight the need to address DA to enhance oral health-related quality of life among young Malaysian adults.
Herbal Medicines Prescription among Health Care Providers in Primary Health Settings in Rural Thailand: Perceptions and Experiences
Introduction: Although the Thai Ministry of Public Health has set a benchmark prescribing rate of 15% for herbal medicines, recent trends indicate a decline in this rate. This study explored perceptions of and experiences with herbal medicine prescriptions among health providers working in primary health settings. Methods: A descriptive qualitative approach was employed, utilising three focus group discussions with 12 primary care unit administrators, 10 public health providers from primary healthcare units and five Thai traditional medicine practitioners. The data were analysed using thematic analysis method. Results: Four key themes emerged: 1) Perceptions and experiences of herbal medicine policies, 2) The current situation of prescribing herbal medicines in primary healthcare units, 3) Barriers to enhancing the prescription of herbal medicines, and 4) Strategies for increasing the prescription of herbal medicines in primary healthcare units. The findings revealed that healthcare facilities with Thai traditional medicine practitioners had a higher frequency of herbal medicine prescription. Despite supportive health policies promoting herbal medicine integration, many facilities without Thai traditional medicine practitioners did not prioritise the prescription of such medicines. Concerns about the potential adverse effects of combining modern and herbal treatments contributed to hesitancy among healthcare providers in prescribing herbal remedies. Conclusion: This research highlights the importance of enhancing traditional medicine use in primary healthcare, particularly in rural areas. Increasing awareness of herbal medicine policies and providing support to healthcare professionals are essential steps towards boosting the prescription of traditional medicines and ultimately promoting local wisdom and practices in rural communities in Thailand.
Predictors of Self-management Behaviour Among Older Adults With Type 2 Diabetes Mellitus in Malaysia
Introduction: Proper self-management is proven to be the key to successful and effective management of the type 2 diabetes mellitus (T2DM). Objective: This study aimed to predict factors associated with self-management behaviour of T2DM among older adults. Methods: A cross-sectional study was conducted among older adults aged 60 years and above, with a month or more history of T2DM. A stratified proportionate-to-size random sampling was conducted in seven government health clinics in the Bera district, Pahang. A pre-tested interviewer-assisted questionnaire was used during data collection, containing six sections: sociodemographic, diabetes profile, knowledge, attitude, self-efficacy, and diabetes self-management behaviour. Descriptive and analytical analyses were performed using the IBM Statistical Package for Social Science Version 25.0. Results: A total of 532 eligible older adults participated in this study, with a response rate of 95.2%. The self-management behaviour mean score was 3.33 (SD 1.13). Higher self-management behaviour related to T2DM was predicted by being Malay (B = -0.545, 95% CI: -0.798, -0.292, p < 0.001), higher monthly income of RM 2500 - ≥ RM5000 (B = 0.328, 95% CI: 0.134, 0.523, p = 0.001), knowledge (B = 0.055, 95% CI: 0.021, 0.089, p = 0.002), and good self-efficacy (B = 0.028, 95% CI: 0.021, 0.036, p < 0.001). Conclusion: Higher self-efficacy was a significant predictor of better self-management behaviour in T2DM. Interventions to enhance knowledge and self-efficacy should be specifically targeted among the non-Malays and those with lower household income. These at-risk group should be targeted at primary, secondary, and tertiary prevention levels.
Influence of Family History of Diabetes Mellitus, Menopausal Status, and Physical Activity on Insulin Resistance in Indonesian Non-diabetic Women: A Cross-sectional Study
Background: Insulin resistance (IR) is a common complication of type 2 diabetes mellitus (T2DM). Women's risk of IR increases significantly after menopause. This Study aimed to determine the risk of IR and related risk variables in non- diabetic women. Methods: This cross-sectional study was conducted in East Java, Indonesia, between June - August 2024. Participants were 196 nondiabetic women selected using consecutive method. This study used a questionnaire and the FINDRISC tool. Results: The average FINDRISC score of respondents was 10.4. There were five risk categories for IR: low (24.3%), moderate (15.5%), high (24.3%), slightly increased (33.7%), and extremely high (2.2%). The FINDRISC score was significantly correlated with menopausal status, smoking, history of hypertension, and family history of DM (p-value = 0.000, p < α). Multivariate test results showed that age, menopausal status, waist circumference (WC), body mass index (BMI), physical activity, and family history of DM can significantly be used to predict the risk of insulin resistance (p-value = 0.000, p < α). Menopausal status (Coef. B = 3.489), lack of physical activity (Coef. B = 1.262), and family history of DM (Coef. B = 3.715) were the three factors that were most significant in predicting the likelihood of IR. Conclusion: The risk of IR is projected to increase with age, WC, BMI, and family history of DM and to decrease with increasing physical activity.
The Knowledge of Men on Emergency Contraception in Kinta District, Perak: A Cross-sectional Study
Introduction: Emergency contraception (EC) is an option to prevent pregnancy after unprotected sex. Most research focuses on women's knowledge and barriers to emergency contraception, overlooking men’s influential role in contraceptive decisions. The study has important policy implications that can help Malaysian health authorities improve reproductive health services. This article illustrates the importance of determining men’s knowledge of emergency contraception and its determinants. Method: A cross-sectional study was conducted in Kinta District, Perak among 534 males using a self-administered questionnaire. Information regarding the socio-demographic background of these men and their knowledge of emergency contraception were assessed and collected. Multinomial multivariate logistic regression analyses were conducted to identify determinants of knowledge regarding EC among these men. Results: Most of the men in the Kinta district are mainly Malay ethnicity (n = 373, 69.9%), Muslim religion (n = 383, 71.7%), with tertiary education background (n = 287, 53.7%). The majority are married (n = 312, 58.4%), sexually active (n = 320, 59.9%), and they desire to have children (n = 341, 63.9%). It is found that older men (AOR 1.022, 95% CI 1.000–1.043, p = 0.047) have better knowledge of EC as compared to those in the younger age group. Conclusions: This study found that older men have better knowledge of EC. The findings of this study have significant policy implications that can assist Malaysian health authorities in meeting the challenge of enhancing the quality of reproductive health services.
Exploring Sexual Education Among Malaysian Parents: A Qualitative Study on Approaches Through Diverse Religious Perspectives
Introduction: Malaysian parents face complex challenges in communicating sexual and reproductive health (SRH) to adolescents. Deeply rooted religious beliefs and cultural norms often shape parental attitudes and behaviours, creating barriers to open dialogue and limiting effective guidance on SRH within the family context. Methods: The objective of this study is to explore the experiences, views, and challenges faced by Malaysian parents in delivering sexual and reproductive health (SRH) education, with a particular emphasis on the influence and role of religion and cultural norms. A total of 31 parents from different ethnic backgrounds (Malay, Chinese, Indian, and Indigenous) and various religions (Islam, Christianity, Buddhism, and Hinduism) were interviewed in-depth to explore their views and find solutions that could enhance acceptance. The interviews were recorded, transcribed verbatim, and analysed using Atlas.TI software. Results: The study identified two main themes: (1) integrating religious doctrine and cultural practices in SRH education, and (2) how religion and culture shape gender roles and identity. Each main theme encompasses four subthemes. Discussion: The acceptance of SRH education among Malaysia's diverse ethnic and religious communities can be improved by adopting an SRH education framework that is sensitive to the country's religious principles and cultural values. The findings can inform national policymakers to design SRH education policies that are more culturally and religiously sensitive, increasing acceptance and participation among diverse Malaysian communities.
Nutritional Status, Dietary Diversity, and Health Complications Among Geriatric People in the Rural Areas of Bangladesh
Introduction: Elderly populations worldwide are particularly vulnerable to malnutrition, influenced by a complex interplay of socioeconomic, health, and dietary factors. Methods and materials: A cross-sectional study was conducted in rural areas of Bangladesh among male and female individuals aged 60 and above. The Mini Nutritional Assessment (MNI) tool was used to assess nutritional status. Food insecurity was measured based on the United States Department of Agriculture (USDA) guidelines, and diet variety was described by calculating the Individual Dietary Diversity Score (IDDS). Data were analyzed using R studio. Results: The participant's mean age was 67.9 (SD ±7.98) years. About 13.0% were malnourished, and 51.8% were at risk of malnutrition. Low-income individuals faced a substantially increased malnutrition risk (AOR = 11.271, 95% CI = 2.296–55.322) than their counterparts. Dementia (AOR = 6.33, 95% CI = 2.47–16.20) and anorexia (AOR = 6.10, 95% CI = 2.58–14.40) were major contributors, with severe Activity in Daily Living (ADL) impairment further elevating malnutrition risk (AOR = 8.58, 95% CI = 0.63–116.59). Almost 58.9% had high IDDS, with a higher score among males than females. Among respondents, 17.4% experienced low and 9.9% had very low food security. Dietary patterns showed a reliance on starchy staples, with decreased consumption of vegetables, proteins, and dairy with age. Conclusion: Over half of the participants were at malnutrition risk, highlighting significant associations with age, health status, and socioeconomic factors. Targeted interventions are essential to mitigate malnutrition and improve nutritional health among geriatrics.
Usability Testing of a Database Management System for Nutritional Care Delivery
Introduction: Effective healthcare systems must integrate smoothly with clinical workflow by minimizing unnecessary steps and ensuring quick access to patient data. Poor integration can create difficulties for healthcare professionals, affecting their long-term use. Therefore, a well-designed system must prioritize usability and workflow integration to support high-quality care. As such, this paper evaluates the usability of a database management system for nutritional care in a diet clinic. Methodology: The evaluation involved four steps: (1) filling out a demographic form, (2) performing task-oriented scenarios using the think-aloud method to assess effectiveness and efficiency, (3) completing a survey using the System Usability Scale (SUS) to measure satisfaction, and (4) participating in an interview to provide suggestions for improvement. Results: The DietCARE system demonstrated an efficiency rate of 80.48%, with 100% effectiveness. Although all assigned tasks were completed, some had minor challenges, with Task 3 being the most difficult, as 80% of respondents struggled with scheduling appointments. The SUS score had a median (IQR) of 77.50 (76.25–91.25), indicating good user satisfaction. Four themes related to suggestions for improvement were identified: improving data interpretation, enhancing flexibility in data entry, tracking and monitoring patient progress, and expanding data scope for comprehensive patient profiling. Conclusion: Overall, the DietCARE system demonstrated good efficiency, effectiveness, and user satisfaction. While some improvements are needed based on user feedback, incorporating their suggestions could enhance the system’s usability, efficiency, and overall user experience. Addressing these usability issues will help create a more user-friendly system that meets the needs of its users.
From Growth to Greatness: Key Factors in Overcoming Stunting
Introduction: Child malnutrition, including stunting, continues to affect millions, hindering physical and cognitive growth and posing risks to national development. Addressing this issue requires a comprehensive approach integrating key factors to promote optimal child outcomes. This study analyzes the influence of key characteristics in overcoming child malnutrition to promote optimal child growth and development. Materials and methods: This study was conducted over six months (from March to November 2023) in Yogyakarta, Indonesia, using field research techniques with a cross-sectional study approach. Data collection involved questionnaires, structured interviews, and observations. A total of 200 respondents, comprising parents and their toddlers, participated in the study. The researchers used Structural Equation Modelling (SEM) to analyze the data. Results: The SEM conceptual test results for the model showed good fit indices (GFI = 0.865; AGFI = 0.829; RMSEA = 0.062, CFI = 0.904; TLI = 0.888; NFI = 0.806). The generated model is fit based on the goodness of fit statistics output from Amos version 26 software. Relationships between construct variables show that those with a significant direct effect on child growth are environmental health, family resilience, and holistic parenting. Meanwhile, social capital, the empowerment process, government support, and environmental health indicate significant indirect effects on child growth. Conclusion: This study identifies environmental health, family resilience, and holistic parenting as key direct factors influencing child growth, while social capital, empowerment, and government support have significant indirect effects. These findings highlight the need for integrated efforts to address child malnutrition through a multidimensional approach.
Outcome Analysis of Catheter-Directed Thrombolysis and Mechanical Thrombectomy in Intermediate- and High-Risk Pulmonary Embolism: A Systematic Review and Meta-Analysis
Introduction: Pulmonary embolism (PE) is a severe condition associated with high morbidity and mortality, particularly in intermediate- and high-risk patients. Catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT) have emerged as advanced treatment modalities. This study aimed to systematically compare clinical outcomes between CDT and MT in this population. Materials and Methods: This systematic review and meta-analysis was registered in PROSPERO (CRD42023460836) and conducted according to PRISMA guidelines. A comprehensive literature search was performed in PubMed, Scopus, ProQuest, SAGE Journals, and Cochrane up to January 6, 2025. Study quality was assessed using the Newcastle-Ottawa Scale, and statistical analyses were performed using Review Manager 5.4.1. Results: Eight studies involving 5,438 patients were included. In-hospital mortality was similar between groups (CDT: 2.31%; MT: 2.96%; RR 0.82, 95% CI: 0.48–1.38; p = 0.45). MT was associated with a significantly reduced ICU length of stay (SMD 0.38, 95% CI: 0.15–0.62; p = 0.001). Rates of significant bleeding (RR 1.02, 95% CI: 0.70–1.47; p = 0.93) and major complications (RR 0.73, 95% CI: 0.36–1.45; p = 0.37) were comparable between groups. Post-procedural pulmonary artery pressure improved in both groups, with a slight advantage toward MT (SMD −0.17, 95% CI: −0.29 to −0.05; p = 0.006). Conclusion: CDT and MT demonstrate favorable outcomes in intermediate- and high-risk PE. MT may offer shorter ICU stays and improved pulmonary artery pressure, whereas other clinical outcomes appear comparable. Treatment should be individualized according to patient condition, bleeding risk, and institutional expertise.
A Systematic Review of Health Literacy Status Among Local Community in Protected Area
Introduction: Protected areas (PAs) play a vital role in conservation but often impose restrictions that limit economic and educational opportunities for local communities. These constraints can negatively affect health literacy (HL), particularly in rural populations exposed to zoonotic diseases and environmental health risks. This systematic review aims to explore how living in protected areas influences health literacy status, with a focus on knowledge, attitudes, and practices (KAP) related to health risks. Methods: A systematic search was conducted across PubMed, Scopus, and Web of Science for studies published between 2014 and 2024. Articles were screened based on the PEO framework, and eligible studies were appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. A thematic synthesis was performed to identify common factors influencing HL among adults living in or near protected areas. Results: Nine studies met the inclusion criteria. Most studies assessed HL indirectly through KAP related to zoonotic diseases. Findings revealed that residents in PAs often demonstrated low awareness of disease transmission, poor preventive practices, and limited access to health information. Key influencing factors included low education levels, poverty, occupation (e.g., hunting, farming), and poor access to healthcare. Only communities exposed to prior outbreaks or targeted health programs showed improved HL. Conclusion: Communities in PAs exhibit generally low health literacy, shaped by structural inequalities and ecological constraints. Interventions should prioritize community-based health education, cross-sector collaboration, and culturally tailored messaging. Addressing HL in PAs is critical to reducing health disparities and achieving sustainable development goals (SDGs).
Pulmonary Artery Sling with Bridge Bronchus in a Premature Infant: A Diagnostic and Management Challenge in Malaysia
Pulmonary artery sling with bridge bronchus is a rare congenital vascular anomaly presenting significant diagnostic and management challenges, especially in resource-limited settings. This report details the case of a premature infant born at 34 weeks’ gestation, diagnosed with PA sling and bridge bronchus, compounded by severe tracheal stenosis and bronchopulmonary dysplasia. Despite intensive medical care, including ventilation and permissive hypercarbia, the infant remained critically ill, with recurrent desaturation episodes and hospital-acquired infections. Definitive surgical intervention was deferred due to low birth weight and resource limitations. The infant succumbed to death at day 50 of life. This case emphasizes the complex interplay of prematurity, congenital anomalies, and healthcare limitations in developing countries. Multidisciplinary approaches and targeted research are essential for improving outcomes in such challenging cases.