Browse publications by year: 2021

Fulltext Synergistic Field Crop Pest Management Properties of Plant-Derived Essential Oils in Combination with Synthetic Pesticides and Bioactive Molecules: A Review

Dassanayake MK, Chong CH, Khoo TJ, Figiel A, Szumny A, Choo CM

Foods, 2021 Aug 27;10(9).
PMID: 34574123 DOI: 10.3390/foods10092016

The management of insect pests and fungal diseases that cause damage to crops has become challenging due to the rise of pesticide and fungicide resistance. The recent developments in studies related to plant-derived essential oil products has led to the discovery of a range of phytochemicals with the potential to combat pesticide and fungicide resistance. This review paper summarizes and interprets the findings of experimental work based on plant-based essential oils in combination with existing pesticidal and fungicidal agents and novel bioactive natural and synthetic molecules against the insect pests and fungi responsible for the damage of crops. The insect mortality rate and fractional inhibitory concentration were used to evaluate the insecticidal and fungicidal activities of essential oil synergists against crop-associated pests. A number of studies have revealed that plant-derived essential oils are capable of enhancing the insect mortality rate and reducing the minimum inhibitory concentration of commercially available pesticides, fungicides and other bioactive molecules. Considering these facts, plant-derived essential oils represent a valuable and novel source of bioactive compounds with potent synergism to modulate crop-associated insect pests and phytopathogenic fungi.
Fulltext Locally-Procured Fish Is Essential in School Feeding Programmes in Sub-Saharan Africa

Ahern MB, Thilsted SH, Kjellevold M, Overå R, Toppe J, Doura M, et al.

Foods, 2021 Sep 02;10(9).
PMID: 34574190 DOI: 10.3390/foods10092080

Fish make an important contribution to micronutrient intake, long-chained polyunsaturated omega-3 fatty acids (n-3 LC-PUFAS), and animal protein, as well as ensuring food and nutrition security and livelihoods for fishing communities. Micronutrient deficiencies are persistent in sub-Saharan Africa (SSA), contributing to public health issues not only in the first 1000 days but throughout adolescence and into adulthood. School feeding programs (SFPs) and home-grown school feeding programs (HGSF), which source foods from local producers, particularly fisherfolk, offer an entry point for encouraging healthy diets and delivering essential macro- and micronutrients to schoolchildren, which are important for the continued cognitive development of children and adolescents and can contribute to the realization of sustainable development goals (SDGs) 1, 2, 3, 5, and 14. The importance of HGSF for poverty alleviation (SDG1) and zero hunger (SDG 2) have been recognized by the United Nations Hunger Task Force and the African Union Development Agency-New Partnership for African Development (AUDA-NEPAD), which formulated a strategy for HGSF to improve nutrition for the growing youth population across Africa. A scoping review was conducted to understand the lessons learned from SFPs, which included fish and fish products from small-scale producers, identifying the challenges and best practices for the inclusion of fish, opportunities for improvements across the supply chain, and gaps in nutritional requirements for schoolchildren which could be improved through the inclusion of fish. Challenges to the inclusion fish in SFPs include food safety, supply and access to raw materials, organizational capacity, and cost, while good practices include the engagement of various stakeholders in creating and testing fish products, and repurposing fisheries by-products or using underutilized species to ensure cost-effective solutions. This study builds evidence of the inclusion of nutritious fish and fish products in SFPs, highlighting the need to replicate and scale good practices to ensure sustainable, community-centred, and demand-driven solutions for alleviating poverty, malnutrition, and contributing to greater health and wellbeing in adolescence.
Fulltext Migration of Various Nanoparticles into Food Samples: A Review

Paidari S, Tahergorabi R, Anari ES, Nafchi AM, Zamindar N, Goli M

Foods, 2021 Sep 07;10(9).
PMID: 34574224 DOI: 10.3390/foods10092114

Nanotechnology has provided new opportunities for the food industry with its applications in food packaging. The addition of nanoparticles, such as clay, silver and copper, can improve the mechanical and antimicrobial properties of food packaging. However, nanoparticles may have an adverse impact on human health. This has led to legislative and regulatory concerns. The inhibitory effects of nano packaging on different microorganisms, such as Salmonella, E. coli, and molds, have been studied. Nanoparticles, like other materials, may have a diverse set of properties that need to be determined. In this review, different features of silver, clay and copper nanoparticles, such as their anti-microbial, cell toxicity, genetic toxicity, mechanical properties, and migration, are critically evaluated in the case of food packaging. Specifically, the viewpoints of WHO, FDA, and ESFA, concerning the nano-silver application in food packaging, are discussed as well.
Fulltext Optimisation of Stingless Bee Honey Nanoemulsions Using Response Surface Methodology

Rozman AS, Hashim N, Maringgal B, Abdan K

Foods, 2021 Sep 09;10(9).
PMID: 34574242 DOI: 10.3390/foods10092133

Nanoemulsions (NEs) have been used in a wide range of products, such as those produced by the food, cosmetics, and pharmaceutical industries, due to their stability and long shelf life. In the present study, stingless bee honey (SBH) NEs were formulated using SBH, oleic acid, tween 80, glycerol, and double-distilled water. SBH NEs were prepared using a high-pressure homogeniser and were characterised by observing their stability and droplet size. Fourier Transform-Infrared (FTIR) analysis was used to observe the functional groups of the SBH NEs after being subjected to high-pressure homogenisation. Transmission Electron Microscopy (TEM) images were then used to confirm the particle size of the SBH NEs and to investigate their morphology. The effects of the independent variables (percentage of oleic acid, storage time, and storage temperature) on the response variables (particle size and polydispersity index) were investigated using the response surface methodology, along with a three-level factorial design. The results showed that the models developed via the response surface methodology were reliable, with a coefficient of determination (R2) of more than 0.90. The experimental validation indicated an error of less than 10% in the actual results compared to the predicted results. The FTIR analysis showed that SBH NEs have the same functional group as SBH. Observation through TEM indicated that the SBH NEs had a similar particle size, which was between 10 and 100 nm. Thus, this study shows that SBH NEs can be developed using a high-pressure homogeniser, which indicates a new direction for SBH by-products.
Fulltext Implementation of Food Safety Management Systems along with Other Management Tools (HAZOP, FMEA, Ishikawa, Pareto). The Case Study of Listeria monocytogenes and Correlation with Microbiological Criteria

Lee JC, Daraba A, Voidarou C, Rozos G, Enshasy HAE, Varzakas T

Foods, 2021 Sep 13;10(9).
PMID: 34574279 DOI: 10.3390/foods10092169

The food industry's failure in planning and designing of and in implementing a Food Safety Management System and its foundation elements leads, in most instances, to compromised food safety and subsequent foodborne illness outbreaks. This phenomenon was noticed, worldwide, for all food processors, but with a much higher incidence in the medium- and small-sized food processing plants. Our study focuses on the importance of Food Safety Management System (FSMS), Critical Control Points Hazard Analysis (HACCP) and the Prerequisite Programs (PRPs) as the foundation of HACCP, in preventing foodborne outbreaks. For emphasis, we make use of the example of organizational food safety culture failures and the lack of managerial engagement which resulted in a multi-state listeriosis outbreak in USA. Moreover, we correlate this with microbiological criteria. Implementation of food safety management systems (ISO 22000:2018) along with incorporation of management tools such as HAZOP, FMEA, Ishikawa and Pareto have proved to be proactive in the maintenance of a positive food safety culture and prevention of cross-contamination and fraud.
Fulltext Muscle and Serum Metabolomics for Different Chicken Breeds under Commercial Conditions by GC-MS

Tan C, Selamat J, Jambari NN, Sukor R, Murugesu S, Khatib A

Foods, 2021 Sep 14;10(9).
PMID: 34574284 DOI: 10.3390/foods10092174

Globally, village chicken is popular and is known as a premium meat with a higher price. Food fraud can occur by selling other chicken breeds at a premium price in local markets. This study aimed to distinguish local village chicken from other chicken breeds available in the market, namely, colored broiler (Hubbard), broiler (Cobb), and spent laying hen (Dekalb) in pectoralis major and serum under commercial conditions using an untargeted metabolomics approach. Both pectoralis major and serum were analyzed using gas chromatography-mass spectrometry (GC-MS). The principal component analysis (PCA) results distinguished four different chicken breeds into three main groups for pectoralis major and serum. A total of 30 and 40 characteristic metabolites were identified for pectoralis major and serum, respectively. The four chicken breeds were characterized by the abundance of metabolites such as amino acids (L-glutamic acid, L-threonine, L-serine, L-leucine), organic acids (L-lactic acid, succinic acid, 3-hydroxybutyric acid), sugars (D-allose, D-glucose), sugar alcohols (myo-inositol), and fatty acids (linoleic acid). Our results suggest that an untargeted metabolomics approach using GC-MS and PCA could discriminate chicken breeds for pectoralis major and serum under commercial conditions. In this study, village chicken could only be distinguished from colored broiler (Hubbard) by serum samples.
Fulltext Polystyrene Microplastics Exposure: An Insight into Multiple Organ Histological Alterations, Oxidative Stress and Neurotoxicity in Javanese Medaka Fish (Oryzias javanicus Bleeker, 1854)

Usman S, Abdull Razis AF, Shaari K, Amal MNA, Saad MZ, Mat Isa N, et al.

Int J Environ Res Public Health, 2021 09 07;18(18).
PMID: 34574375 DOI: 10.3390/ijerph18189449

Microplastics (MPs) have become pollutants of concern due to their unknown human health effect and negative impact on terrestrial and aquatic ecosystems. There is increasing number of experimental research on MPs globally with its effects not fully understood; recent animal studies explore its effects on the intestines, yet on other vital organs. Javanese medaka fish was exposed to polystyrene microplastics (PS-MPs) beads for a period of 21 days. Histological alterations, intestinal oxidative stress, permeability and neurotoxicity were evaluated. Significant inflammatory changes and tissue damage were observed in the intestine, liver and kidney. Intestinal oxidative stress and permeability were found to be significantly increased. In the brain, neurotoxicity characterised by a significant induction of oxidative stress, lipid peroxidation and the inhibition of acetylcholinesterase enzyme were elucidated. This study provided an insight into the multiple organ effect of microplastics exposure, necessitating further exploration and identification of biomarkers to be utilised for biomonitoring population at risk in the future.

MeSH terms: Acetylcholinesterase; Animals; Indonesia; Oryzias*; Plastics; Polystyrenes/analysis; Ecosystem; Oxidative Stress
Fulltext Policy Inertia on Regulating Food Marketing to Children: A Case Study of Malaysia

Ng S, Kelly B, Yeatman H, Swinburn B, Karupaiah T

Int J Environ Res Public Health, 2021 09 12;18(18).
PMID: 34574531 DOI: 10.3390/ijerph18189607

Unhealthy food marketing shapes children's preference towards obesogenic foods. In Malaysia, policies regulating this food marketing were rated as poor compared to global standards, justifying the need to explore barriers and facilitators during policy development and implementation processes. The case study incorporated qualitative methods, including historical mapping, semi-structured interviews with key informants and a search of cited documents. Nine participants were interviewed, representing the Federal government (n = 5), food industry (n = 2) and civil society (n = 2). Even though the mandatory approach to government-led regulation of food marketing to children was the benchmark, more barriers than facilitators in the policy process led to industry self-regulations in Malaysia. Cited barriers were the lack of political will, industry resistance, complexity of legislation, technical challenges, and lack of resources, particularly professional skills. The adoption of industry self-regulation created further barriers to subsequent policy advancement. These included implementer indifference (industry), lack of monitoring, poor stakeholder relations, and policy characteristics linked to weak criteria and voluntary uptake. These underlying barriers, together with a lack of sustained public health advocacy, exacerbated policy inertia. Key recommendations include strengthening pro-public health stakeholder partnerships, applying sustained efforts in policy advocacy to overcome policy inertia, and conducting monitoring for policy compliance and accountability. These form the key lessons for advocating policy reforms.
Fulltext A Qualitative Investigation on the Roles of Social Support on Physical Activity Behaviour among the Rural-Dwelling Older Women in Malaysia

Marthammuthu T, Hairi FM, Choo WY, Salleh NAM, Hairi NN

Int J Environ Res Public Health, 2021 09 12;18(18).
PMID: 34574533 DOI: 10.3390/ijerph18189609

Despite many health benefits of physical activities, both physically and mentally, the majority of the older women in the rural areas of Malaysia are showing a low prevalence of physical activities. Understanding the roles of social support to improve physical activities is imperative to promote active and healthy ageing among the rural-dwelling older women in Malaysia. Hence, this qualitative study adopted an inductive design using 17 in-depth interviews to understand the role of social support on physical activity behaviour among the rural community-dwelling older woman in Kuala Pilah District, Negeri Sembilan, Malaysia from December 2019 to January 2020. Three categories of themes were identified in this study. Firstly, adaptive social support in terms of informational, companionship and emotional supports reported enhancing physical activity levels among older women. Secondly, the absence of help and assistance from the social network asserts independence and triggers the older women to perform the activities by themselves, thus engage in physically active lifestyles. Thirdly, lacking social support demotivate older women to be engaged in physical activities. In particular, loss of companionship support, poor acceptance or appraisal support, logistic issues to attend exercise programmes and neighbourhood safety and security issues were among the main barriers of physical activities reported by the older women. The main findings of this study shed some light on the exigency of strengthening social support from the social network to engage the older women in physical activities. The roles of social media, effective patient-doctor communication and interventions targeting the spouses and family members must be strengthened to create a supportive atmosphere to enhance physical activity levels among older women.
Fulltext Relationships between Psychopathology, Psychological Process Variables, and Sociodemographic Variables and Comparison of Quarantined and Non-Quarantined Groups of Malaysian University Students in the COVID-19 Pandemic

Pang NTP, James S, Giloi N, Rahim SSSA, Omar A, Jeffree MS, et al.

Int J Environ Res Public Health, 2021 Sep 14;18(18).
PMID: 34574581 DOI: 10.3390/ijerph18189656

The COVID-19 pandemic has had considerable psychological health impacts across the globe. This study aimed to establish the psychological process variables underlying psychopathology in Malaysian public university students during the national Movement Control Order (MCO). The aim was to craft structured and sustainable psychological support programs with these students. We conducted a cross-sectional study involving Malaysian university students subjected to the Malaysian MCO. Structured questionnaires measuring sociodemographic factors, measures of depression, anxiety, stress, psychological mindedness, psychological flexibility and state mindfulness were employed. A total of 515 students participated in this study with 12 students (2.3%) being quarantined at the time. Many of them scored 'moderate' or above on the Depression, Anxiety and Stress Scale (DASS) with 20.2%, 25.0% and 14.2%, respectively. Quarantined students had higher depressive symptoms, with female students scoring significantly higher for depression, anxiety, and stress. Multiple regressions suggested gender and quarantine status predicted depression scores. However, only gender significantly predicted anxiety and stress. Psychological flexibility and psychological mindedness (Insight subscale) are significantly correlated with depression, anxiety, and stress, with psychological mindedness predicting all three psychopathologies. This study demonstrates that gender, psychological flexibility, and psychological mindedness are key demographic and psychological factors impacting students. Targeting psychological flexibility and psychological mindedness may enable timely prevention and intervention programs for our students to support their mental and physical health as we move through, and out of, the pandemic.

MeSH terms: Anxiety/epidemiology; Anxiety Disorders/epidemiology; Cross-Sectional Studies; Depression/epidemiology; Female; Humans; Quarantine; Surveys and Questionnaires; Stress, Psychological/epidemiology; Students; Universities; Pandemics*
Fulltext Understanding the Effect of Internal and External Factors on Households' Willingness to Sort Waste in Dammam City, Saudi Arabia

Labib OA, Manaf L, Sharaai AH, Zaid SSM

Int J Environ Res Public Health, 2021 09 14;18(18).
PMID: 34574604 DOI: 10.3390/ijerph18189685

The acceleration of growth in the population in Saudi Arabia and the increase in municipal solid waste generation have caused a problem in Dammam city: an increase in solid waste production. Therefore, solid waste sorting is an important practice of municipal solid waste management. The main objectives in this research are understanding the effect of internal and external factors on household willingness in sorting waste in Dammam city and studying the attempts to construct a theoretical research model by adding market incentives, government facilitators, and awareness into the popular planned behaviour theory to explain residents' waste sorting intentions. The data collection and analysis are based on the questionnaire study, which is based on the questionnaire survey data from 450 households in Dammam. This study revealed that social influence significantly predicts households' willingness to sort and recycle, that is, to promote recycling. Additionally, the variable social influence has a significant but low influence on households' willingness to sort and recycle. The result of the structural equation model shows that perceived behavioural control significantly predicts households' willingness to sort and recycle waste. This finding is consistent with the theoretical expectation. Therefore, this research shows that attitude, social influence, perceived behavioural control, market incentives, government facilitators and awareness positively and significantly affect residents' waste sorting intentions. Additionally, this research corroborates the discrepancy between internal and external variables.

MeSH terms: Surveys and Questionnaires; Refuse Disposal*; Saudi Arabia; Waste Management*; Recycling; Solid Waste
Fulltext Tuberculosis Death Epidemiology and Its Associated Risk Factors in Sabah, Malaysia

Avoi R, Liaw YC

Int J Environ Res Public Health, 2021 Sep 16;18(18).
PMID: 34574665 DOI: 10.3390/ijerph18189740

Tuberculosis (TB) is a leading killer from a single infectious agent globally. In 2019, Malaysia's TB incidence rate was 92 per 100,000 population, and the TB mortality rate was estimated at 4 cases per 100,000 population per year. However, the state of Sabah had a higher burden of TB with a notification rate of 128 per 100,000 population and a TB case fatality rate of 8% compared to the national figure. This study aims to provide a comprehensive report on TB deaths epidemiology and its associated factors at a sub-national level. This nested case-control study used Sabah State Health Department TB surveillance data from the Malaysia national case-based TB registry (MyTB) between 2014 and 2018. Cases were defined as all-cause TB deaths that occurred before anti-TB treatment completion from the time of TB diagnosis. Controls were randomly selected from TB patients who completed anti-TB treatment. The TB mortality rate had increased significantly from 9.0/100,000 population in 2014 to 11.4/100,000 population in 2018. The majority of TB deaths occurred in the first two months of treatment. TB-related deaths were primarily due to advanced disease or disseminated TB, whereas non-TB-related deaths were primarily due to existing comorbidities. Many important independent risk factors for TB deaths were identified which are useful to address the increasing TB mortality rate.

MeSH terms: Humans; Malaysia/epidemiology; Risk Factors; Case-Control Studies; Age Distribution; Sex Distribution
Fulltext Characterisation of Bacterial Isolates from Infected Post-Operative Patients in a Malaysian Tertiary Heart Care Centre

Yong YK, Wen NCM, Yeo GEC, Chew ZX, Chan LL, Md Zain NZ, et al.

Int J Environ Res Public Health, 2021 09 17;18(18).
PMID: 34574752 DOI: 10.3390/ijerph18189828

Several bacterial species cause post-operative infections, which has been a critical health concern among hospital patients. Our study in this direction is a much-needed exploratory study that was carried out at the National Heart Institute (IJN) of Malaysia to examine the virulence properties of causative bacteria obtained from postoperative patients. The bacterial isolates and data were provided by the IJN. Antibiotic resistance gene patterns, and the ability to form biofilm were investigated for 127 isolates. Klebsiella pneumoniae (36.2%) was the most common isolate collected, which was followed by Pseudomonas aeruginosa (26%), Staphylococcus aureus (23.6%), Streptococcus spp. (8.7%) and Acinetobacter baumannii (5.5%). There were 49 isolates that showed the presence of multidrug resistance genes. The mecA gene was surprisingly found in methicillin-susceptible S. aureus (MSSA), which also carried the ermA gene from those erythromycin-susceptible strains. The phenotypic antibiotic resistance profiles varied greatly between isolates. Findings from the biofilm assay revealed that 44 of the 127 isolates demonstrated the ability to produce biofilms. Our findings provide insights into the possibility of some of these bacteria surviving under antibiotic stress, and some antibiotic resistance genes being silenced.

MeSH terms: Anti-Bacterial Agents/pharmacology; Anti-Bacterial Agents/therapeutic use; Humans; Microbial Sensitivity Tests; Biofilms
Fulltext Conversational Task Increases Heart Rate Variability of Individuals Susceptible to Perceived Social Isolation

Feng YX, Roslan NS, Izhar LI, Abdul Rahman M, Faye I, Ho ETW

Int J Environ Res Public Health, 2021 09 18;18(18).
PMID: 34574777 DOI: 10.3390/ijerph18189858

Studies showed that introversion is the strongest personality trait related to perceived social isolation (loneliness), which can predict various complications beyond objective isolation such as living alone. Lonely individuals are more likely to resort to social media for instantaneous comfort, but it is not a perpetual solution. Largely negative implications including poorer interpersonal relationship and depression were reported due to excessive social media usage. Conversational task is an established intervention to improve verbal communication, cognitive and behavioral adaptation among lonely individuals. Despite that behavioral benefits have been reported, it is unclear if they are accompanied by objective benefits underlying physiological changes. Here, we investigate the physiological signals from 28 healthy individuals during a conversational task. Participants were ranked by trait extraversion, where greater introversion is associated with increased susceptibility to perceived social isolation as compared to participants with greater extraversion as controls. We found that introverts had a greater tendency to be neurotic, and these participants also exhibited significant differences in task-related electrodermal activity (EDA), heart rate (HR) and HR variability (HRV) as compared to controls. Notably, resting state HRV among individuals susceptible to perceived loneliness was below the healthy thresholds established in literature. Conversational task with a stranger significantly increased HRV among individuals susceptible to isolation up to levels as seen in controls. Since HRV is also elevated by physical exercise and administration of oxytocin hormone (one form of therapy for behavioral isolation), conversational therapy among introverts could potentially confer physiological benefits to ameliorate social isolation and loneliness. Our findings also suggest that although the recent pandemic has changed how people are interacting typically, we should maintain a healthy dose of social interaction innovatively.

MeSH terms: Communication; Extraversion (Psychology); Heart Rate; Humans; Loneliness*; Social Isolation*
Fulltext Quality of Life and Child's Autism-Specific Difficulties among Malaysian Main Caregivers: A Cross-Sectional Study

Asahar SF, Malek KA, Isa MR

Int J Environ Res Public Health, 2021 09 18;18(18).
PMID: 34574788 DOI: 10.3390/ijerph18189861

Caring for children with autism spectrum disorder (ASD) negatively impacts quality of life (QoL). This cross-sectional study aimed to determine the factors associated with perceived QoL and how problematic a child's autism-specific difficulties are among the main caregivers of children with ASD who attend specialized preschool programs at the National Autism Society of Malaysia and IDEAS Autism Centre located in Selangor and Kuala Lumpur. Utilizing the questions from Parts A and B of the Quality of Life in Autism Questionnaire (QoLA), the data from 116 responders were analyzed using univariate and multivariate linear regression. The mean scores of Part A and Part B were 88.55 ± 17.25 and 56.55 ± 12.35, respectively. The QoL was significantly associated with staying in an apartment/flat -11.37 (95%CI: -19.52, -1.17, p = 0.008), main caregivers attending two training sessions 10.35 (95%CI: 1.17, 19.52, p = 0.028), and more than three training sessions 13.36 (95%CI: 2.01, 24.70, p = 0.022). Main caregiver perceptions of their child's autistic-specific difficulties were significantly associated with not receiving additional help for childcare: no maid -13.54 (95%CI: -24.17, -12.91, p = 0.013); no grandparent -8.65 (95%: -14.33, -2.96, p = 0.003); and main caregivers not having asthma 8.44 (95%CI: 0.02, 16.86, p = 0.049). These identified factors can be considered to inform main caregivers and health care providers on targeted ways to improve the QoL of main caregivers.

MeSH terms: Autism Spectrum Disorder*; Autistic Disorder*; Child; Child, Preschool; Cross-Sectional Studies; Humans; Quality of Life; Caregivers
Fulltext Influence of Population Density for COVID-19 Spread in Malaysia: An Ecological Study

Ganasegeran K, Jamil MFA, Ch'ng ASH, Looi I, Peariasamy KM

Int J Environ Res Public Health, 2021 Sep 18;18(18).
PMID: 34574790 DOI: 10.3390/ijerph18189866

The rapid transmission of highly contagious infectious diseases within communities can yield potential hotspots or clusters across geographies. For COVID-19, the impact of population density on transmission models demonstrates mixed findings. This study aims to determine the correlations between population density, clusters, and COVID-19 incidence across districts and regions in Malaysia. This countrywide ecological study was conducted between 22 January 2021 and 4 February 2021 involving 51,476 active COVID-19 cases during Malaysia's third wave of the pandemic, prior to the reimplementation of lockdowns. Population data from multiple sources was aggregated and spatial analytics were performed to visualize distributional choropleths of COVID-19 cases in relation to population density. Hierarchical cluster analysis was used to synthesize dendrograms to demarcate potential clusters against population density. Region-wise correlations and simple linear regression models were deduced to observe the strength of the correlations and the propagation effects of COVID-19 infections relative to population density. Distributional heats in choropleths and cluster analysis showed that districts with a high number of inhabitants and a high population density had a greater number of cases in proportion to the population in that area. The Central region had the strongest correlation between COVID-19 cases and population density (r = 0.912; 95% CI 0.911, 0.913; p < 0.001). The propagation effect and the spread of disease was greater in urbanized districts or cities. Population density is an important factor for the spread of COVID-19 in Malaysia.

MeSH terms: Communicable Disease Control; Humans; Malaysia/epidemiology; Population Density
Fulltext Assessing Patient-Perceived Hospital Service Quality and Sentiment in Malaysian Public Hospitals Using Machine Learning and Facebook Reviews

A Rahim AI, Ibrahim MI, Musa KI, Chua SL, Yaacob NM

Int J Environ Res Public Health, 2021 09 21;18(18).
PMID: 34574835 DOI: 10.3390/ijerph18189912

Social media is emerging as a new avenue for hospitals and patients to solicit input on the quality of care. However, social media data is unstructured and enormous in volume. Moreover, no empirical research on the use of social media data and perceived hospital quality of care based on patient online reviews has been performed in Malaysia. The purpose of this study was to investigate the determinants of positive sentiment expressed in hospital Facebook reviews in Malaysia, as well as the association between hospital accreditation and sentiments expressed in Facebook reviews. From 2017 to 2019, we retrieved comments from 48 official public hospitals' Facebook pages. We used machine learning to build a sentiment analyzer and service quality (SERVQUAL) classifier that automatically classifies the sentiment and SERVQUAL dimensions. We utilized logistic regression analysis to determine our goals. We evaluated a total of 1852 reviews and our machine learning sentiment analyzer detected 72.1% of positive reviews and 27.9% of negative reviews. We classified 240 reviews as tangible, 1257 reviews as trustworthy, 125 reviews as responsive, 356 reviews as assurance, and 1174 reviews as empathy using our machine learning SERVQUAL classifier. After adjusting for hospital characteristics, all SERVQUAL dimensions except Tangible were associated with positive sentiment. However, no significant relationship between hospital accreditation and online sentiment was discovered. Facebook reviews powered by machine learning algorithms provide valuable, real-time data that may be missed by traditional hospital quality assessments. Additionally, online patient reviews offer a hitherto untapped indication of quality that may benefit all healthcare stakeholders. Our results confirm prior studies and support the use of Facebook reviews as an adjunct method for assessing the quality of hospital services in Malaysia.

MeSH terms: Machine Learning; Delivery of Health Care; Hospitals, Public; Humans; Malaysia; Social Media*
Fulltext Validity of Pneumonia Severity Assessment Scores in Africa and South Asia: A Systematic Review and Meta-Analysis

Al Hussain SK, Kurdi A, Abutheraa N, AlDawsari A, Sneddon J, Godman B, et al.

Healthcare (Basel), 2021 Sep 11;9(9).
PMID: 34574976 DOI: 10.3390/healthcare9091202

BACKGROUND: Although community-acquired pneumonia (CAP) severity assessment scores are widely used, their validity in low- and middle-income countries (LMICs) is not well defined. We aimed to investigate the validity and performance of the existing scores among adults in LMICs (Africa and South Asia).
METHODS: Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus and Web of Science were searched to 21 May 2020. Studies evaluating a pneumonia severity score/tool among adults in these countries were included. A bivariate random-effects meta-analysis was performed to examine the scores' performance in predicting mortality.
RESULTS: Of 9900 records, 11 studies were eligible, covering 12 tools. Only CURB-65 (Confusion, Urea, Respiratory Rate, Blood Pressure, Age ≥ 65 years) and CRB-65 (Confusion, Respiratory Rate, Blood Pressure, Age ≥ 65 years) were included in the meta-analysis. Both scores were effective in predicting mortality risk. Performance characteristics (with 95% Confidence Interval (CI)) at high (CURB-65 ≥ 3, CRB-65 ≥ 3) and intermediate-risk (CURB-65 ≥ 2, CRB-65 ≥ 1) cut-offs were as follows: pooled sensitivity, for CURB-65, 0.70 (95% CI = 0.25-0.94) and 0.96 (95% CI = 0.49-1.00), and for CRB-65, 0.09 (95% CI = 0.01-0.48) and 0.93 (95% CI = 0.50-0.99); pooled specificity, for CURB-65, 0.90 (95% CI = 0.73-0.96) and 0.64 (95% CI = 0.45-0.79), and for CRB-65, 0.99 (95% CI = 0.95-1.00) and 0.43 (95% CI = 0.24-0.64).
CONCLUSIONS: CURB-65 and CRB-65 appear to be valid for predicting mortality in LMICs. CRB-65 may be employed where urea levels are unavailable. There is a lack of robust evidence regarding other scores, including the Pneumonia Severity Index (PSI).
Fulltext Training Characteristics, Personal Factors and Coping Strategies Associated with Burnout in Junior Doctors: A Multi-Center Study

Roslan NS, Yusoff MSB, Ab Razak A, Morgan K, Ahmad Shauki NI, Kukreja A, et al.

Healthcare (Basel), 2021 Sep 14;9(9).
PMID: 34574982 DOI: 10.3390/healthcare9091208

Physician burnout has been recognized as a public health crisis. However, there is a paucity of burnout studies in the context of medical internship. We assessed the prevalence and relationship between various training characteristics, personal variables, resilience, and coping with burnout in a cross-sectional study involving 837 interns from ten hospitals across Malaysian healthcare system. The instrument package included demographic questions, the Connor-Davidson Resilience Scale, Brief COPE and the Copenhagen Burnout Inventory. A total of 754 (90.1%) interns completed the inventories. We found a high prevalence of personal-related (73.3%), work-related (69.1%), and patient-related (43.4%) burnout among Malaysian interns. Multivariable analysis showed female gender (odds ratio (OR):1.50; 95% confidence interval (CI): 1.02-2.20), prior work experience (OR: 1.56; 95% CI: 1.05-2.30), and irregular spirituality routines (OR: 1.97; 95% CI: 1.30-2.99) were associated with increased odds of personal-related burnout. Irregular spirituality routines (OR: 2.24; 95% CI: 1.49-3.37) were associated with work-related burnout, while living with other people (OR: 1.77; 95% CI: 1.15-2.73) was associated with patient-related burnout. Lower resilience levels and avoidant copings were associated with personal-, work-, and patient-related burnout. Burnout prevalence among interns is high. The findings support the value of individual-targeted alongside organizational-targeted intervention in burnout reduction. As burnout is prevalent in both years of internship training, ongoing burnout prevention and wellbeing measures are deemed necessary.
Fulltext Early Spatiotemporal Patterns and Population Characteristics of the COVID-19 Pandemic in Southeast Asia

Zhu M, Kleepbua J, Guan Z, Chew SP, Tan JW, Shen J, et al.

Healthcare (Basel), 2021 Sep 16;9(9).
PMID: 34574997 DOI: 10.3390/healthcare9091220

This observational study aims to investigate the early disease patterns of coronavirus disease 2019 (COVID-19) in Southeast Asia, consequently providing historical experience for further interventions. Data were extracted from official websites of the WHO and health authorities of relevant countries. A total of 1346 confirmed cases of COVID-19, with 217 recoveries and 18 deaths, were reported in Southeast Asia as of 16 March 2020. The basic reproductive number (R0) of COVID-19 in the region was estimated as 2.51 (95% CI:2.31 to 2.73), and there were significant geographical variations at the subregional level. Early transmission dynamics were examined with an exponential regression model: y = 0.30e0.13x (p < 0.01, R2 = 0.96), which could help predict short-term incidence. Country-level disease burden was positively correlated with Human Development Index (r = 0.86, p < 0.01). A potential early shift in spatial diffusion patterns and a spatiotemporal cluster occurring in Malaysia and Singapore were detected. Demographic analyses of 925 confirmed cases indicated a median age of 44 years and a sex ratio (male/female) of 1.25. Age may play a significant role in both susceptibilities and outcomes. The COVID-19 situation in Southeast Asia is challenging and unevenly geographically distributed. Hence, enhanced real-time surveillance and more efficient resource allocation are urgently needed.

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