Browse publications by year: 2021

Fulltext Evaluation of an Online Gottman's Psychoeducational Intervention to Improve Marital Communication among Iranian Couples

Deylami N, Hassan SA, Alareqe NA, Zainudin ZN

Int J Environ Res Public Health, 2021 08 25;18(17).
PMID: 34501535 DOI: 10.3390/ijerph18178945

Amounting evidence indicates that insufficient knowledge of marital communication skills leads to destructive interactions and poor marital adjustments in couples, especially during stressful situations. Despite the high effectiveness of Gottman's psychoeducational intervention, there is a lack of study on the online Gottman's psychoeducation intervention (O-GPI) to improve marital communication and dyadic adjustments. The aim of this study was to evaluate the effectiveness of O-GPI on the improvement of marital communication patterns among Iranian couples.
METHOD: The study followed a single-blind parallel group in a randomized controlled trial using an experimental longitudinal design, comprising 72 heterosexual couples living in Shiraz, Iran, with a 1-7-year marital age and no severe marital problems. The experimental group received eight consecutive O-GPIs via the Zoom platform, while the control group received information related to parenting skills via email. The outcome measures were the three patterns of communication: (i) constructive communication; (ii) demand-withdraw communication; and (iii) mutual avoidance communication-the screening measure was the dyadic adjustment scale.
RESULTS: The findings indicated that O-GPI could improve couples' constructive communication significantly (45% for husbands and 40% wives) and decrease their total demand-withdrawal (51% for husbands and 65% wives) and mutual avoidance communication (60% for husbands and 62% wives).
LIMITATIONS: Due to the homogenous nature of the sample, generalizations should be made with caution.
CONCLUSIONS: This study demonstrates the feasibility and effectiveness of the online Gottman's psychoeducational intervention to improve couples' communication patterns.

MeSH terms: Communication*; Humans; Iran; Marriage*; Single-Blind Method; Spouses
Fulltext Effects of Brain Breaks Video Intervention of Decisional Balance among Malaysians with Type 2 Diabetes Mellitus: A Randomised Controlled Trial

Hidrus A, Kueh YC, Norsa'adah B, Chang YK, Kuan G

Int J Environ Res Public Health, 2021 08 26;18(17).
PMID: 34501562 DOI: 10.3390/ijerph18178972

Brain Breaks® are structured physical activity (PA) web-based videos designed to promote an interest in learning and health promotion. The objective of this study was to examine its effects on decision balance (DB) which consists of the perceived benefits (Pros) and perceived barriers (Cons) of exercise in people with type 2 diabetes mellitus (T2DM). A randomised controlled trial was conducted among people with T2DM at Hospital Universiti Sains Malaysia. The intervention group received Brain Breaks videos for a period of four months. The intervention and control groups completed the validated Malay version of DB questionnaire for five times, at pre-intervention, the first month, the second month, the third month, and post-intervention. Multivariate Repeated Measures Analysis of Variance was performed for data analysis. A total of 70 participants were included (male = 39; female = 31) with a mean age of 57.6 years (SD = 8.5). The intervention group showed a significant change in the Pros and Cons factors of DB scores over time. The intervention group showed significantly higher scores for the Pros (p-value < 0.001) and lower scores for the Cons (p-value = 0.008) factors than the control group. In conclusion, the Brain Breaks video is an effective intervention to improve decisional balance in patients with T2DM to help them in deciding on behaviour change to be more physically active.

MeSH terms: Brain; Female; Health Promotion; Humans; Learning; Male; Middle Aged; Exercise
Fulltext The Executive Skills Questionnaire-Revised: Adaptation and Psychometric Properties in the Working Context of Malaysia

Nasir H, Tan CS, Pheh KS

Int J Environ Res Public Health, 2021 08 26;18(17).
PMID: 34501571 DOI: 10.3390/ijerph18178978

Executive functions (EFs) are a set of high-level cognitive and behavioral monitoring skills that are important to employees' work performance. The 25-item Executive Skills Questionnaire-Revised (ESQ-R) measures executive dysfunction in five dimensions (e.g., emotional regulation). Nevertheless, the usability of this newly developed scale for employees remains unclear. The present study evaluated the psychometric properties of the adopted ESQ-R for working adults in Malaysia. A total of 325 employees responded to an online survey consisted of the ESQ-R, Executive Function Index (EFI), self-rated creativity scale (SRCS), and 9-item Utretch Work Engagement Scale (UWES-9) and Employee Well-being Scale. Several CFAs were conducted to compare three competing models. While all models showed a good fit, the 5-factor second-order model that is in line with the theoretical structure is preferable. The ESQ-R showed excellent internal consistency. Moreover, the ESQ-R score was negatively correlated with EFI, creativity, and UWES-9 scores, supporting the convergent, discriminant, and concurrent validity. The ESQ-R score also explained incremental variance in well-being above and beyond scores of the UWES-9 and SRCS. Taken together, the ESQ-R is a useful tool for assessing employees' executive dysfunction and suggesting intervention programs helping employees with deficits in EFs.

MeSH terms: Malaysia; Psychometrics; Surveys and Questionnaires; Reproducibility of Results; Workplace*
Fulltext Evaluation of the Policy Effect of China's Environmental Interview System for Effective Air Quality Governance

Jin X, Sumaila UR, Yin K, Qi Z

Int J Environ Res Public Health, 2021 08 26;18(17).
PMID: 34501589 DOI: 10.3390/ijerph18179006

The Ministry of Ecology and Environment of the People's Republic of China formally proposed an environmental interview system in May 2014, which applies pressure on local governments to fulfill their responsibility toward environmental protection by conducting face-to-face public interviews with their officials. In this paper, 48 cities that were publicly interviewed from 2014-2020 were considered the experimental group and 48 cities surrounding them were the control group. First, the dynamic panel model is applied to initially determine the effect of the policy. Then, a regression discontinuity method (Sharp RD) is used to analyze the short-term and long-term effects and compare the reasons for the differences observed among the estimates of various types of samples. Finally, a series of robustness tests were also conducted. The results show that the environmental interview system can improve air quality. However, because an emergency short-term local governance system exists at present, the governance effect is not long-term and, therefore, not sustainable. Therefore, it suggests that the government should continue to improve the environmental interview system, establish an optimal environmental protection incentive mechanism, and encourage local governments to implement environmental protection policies effectively in the long term. The results of the research are of great significance to the environmental impact assessment system of the world, especially in countries with similar economic systems, which are facing a trade-off between economic growth and environmental sustainability.

MeSH terms: China; Cities; Humans; Local Government; Environmental Policy
Fulltext The Prevalence of Limited Health Literacy and Its Associated Factors among Elderly Patients Attending an Urban Academic Primary Care Clinic in Malaysia

Abd-Rahim SNH, Mohamed-Yassin MS, Abdul-Razak S, Isa MR, Baharudin N

Int J Environ Res Public Health, 2021 08 27;18(17).
PMID: 34501632 DOI: 10.3390/ijerph18179044

Limited health literacy (HL) is linked to many negative health outcomes, including poor self-management of chronic diseases and medication adherence among patients. There are a lack of data regarding HL in the elderly population in Malaysia. This study aimed to determine the prevalence of limited HL levels and its associated factors among elderly patients in an urban academic primary care clinic in Selangor, Malaysia. A cross-sectional study was conducted among 413 elderly patients (≥60 years old) who attended this academic primary care clinic between January 2020 and January 2021. Sociodemographic data, clinical characteristics, and health literacy scores were collected. Descriptive statistics (median with interquartile ranges (IQR), frequency, and percentages) and multiple logistic regression were utilized. The prevalence of limited HL in our population was 19.1% (95% CI: 15.3, 23). The middle-old (70-79 years) and very-old (≥80 years) age groups were more likely to have limited HL (aOR 4.05; 95% CI: 2.19, 7.52 and aOR 4.36; 95% CI: 1.02, 18.63, respectively). Those with at least secondary school education (aOR 0.06; 95% CI: 0.02, 0.24) and those who found medical information via the internet/television (aOR 0.21; 95% CI: 0.05, 0.93) had lower odds of having limited HL. In conclusion, having limited HL levels was not common among elderly patients in this primary care clinic. Further studies involving rural and larger primary care clinics in Malaysia are required to support these findings.
Fulltext Addressing Gaps for Health Systems Strengthening: A Public Perspective on Health Systems' Response towards COVID-19

Balqis-Ali NZ, Fun WH, Ismail M, Ng RJ, Jaaffar FSA, Low LL

Int J Environ Res Public Health, 2021 08 27;18(17).
PMID: 34501637 DOI: 10.3390/ijerph18179047

Strengthening the health systems through gaps identification is necessary to ensure sustainable improvements especially in facing a debilitating outbreak such as COVID-19. This study aims to explore public perspective on health systems' response towards COVID-19, and to identify gaps for health systems strengthening by leveraging on WHO health systems' building blocks. A qualitative study was conducted using open-ended questions survey among public followed by in-depth interviews with key informants. Opinions on Malaysia's health systems response towards COVID-19 were gathered. Data were exported to NVIVO version 12 and analysed using content analysis approach. The study identified various issues on health systems' response towards COVID-19, which were then mapped into health systems' building blocks. The study showed the gaps were embedded among complex interactions between the health systems building blocks. The leadership and governance building block had cross-cutting effects, and all building blocks influenced service deliveries. Understanding the complexities in fostering whole-systems strengthening through a holistic measure in facing an outbreak was paramount. Applying systems thinking in addressing gaps could help addressing the complexity at a macro level, including consideration of how an action implicates other building blocks and approaching the governance effort in a more adaptive manner to develop resilient systems.

MeSH terms: Disease Outbreaks; Government Programs; Humans; Leadership; Public Health
Fulltext A Systematic Review of E-Waste Generation and Environmental Management of Asia Pacific Countries

Andeobu L, Wibowo S, Grandhi S

Int J Environ Res Public Health, 2021 Aug 27;18(17).
PMID: 34501640 DOI: 10.3390/ijerph18179051

Due to the rapid increase in the use of electrical and electronic equipment (EEE) worldwide, e-waste has become a critical environmental issue for many governments around the world. Several studies have pointed out that failure to adopt appropriate recycling practices for e-waste may cause environmental disasters and health concerns to humans due to the presence of hazardous materials. This warrants the need for a review of the existing processes of e-waste management. In view of the growing e-waste generation in the Asia Pacific region and the importance of e-waste management, this study critically reviews previous research on e-waste generation and management practices of major e-waste producing nations (Australia, China, India, Indonesia, and Malaysia) in the Asia Pacific region, provides an overview of progress made and identifies areas for improvement. To fulfil the aims of this research, previous studies from 2005 to 2020 are collected from various databases. Accordingly, this study focuses on e-waste generation and environmental management of these countries. This study found that e-waste management practices of the selected countries need to be enhanced and recommends several best practices for effectively managing e-waste.

MeSH terms: Asia; Conservation of Natural Resources; Humans; Waste Management*; Recycling
Fulltext Impact of Substantive Staging and Communicative Staging of Sustainable Servicescape on Behavioral Intentions of Hotel Customers through Overall Perceived Image: A Case of Boutique Hotels

Khalil-Ur-Rehman, Adnan M, Ahmad N, Scholz M, Khalique M, Naveed RT, et al.

Int J Environ Res Public Health, 2021 08 30;18(17).
PMID: 34501713 DOI: 10.3390/ijerph18179123

Customers have become very sensitive regarding the innovative evaluation of services. Due to competition in the hospitality industry, it is a challenge for hotel marketers to understand customers' behavior. There is scant research in the hotel industry of Pakistan and especially on boutique hotels. This research seeks to measure the relationship between substantive, communicative elements of the sustainable servicescape and behavioral intentions (word of mouth) in a boutique hotel setting. However, the mediating effect of the overall perceived image is examined between these constructs. Responses of boutique hotel visitors were collected from Lahore, Islamabad, Faisalabad, and Murree. Data were analyzed by using structural equation modeling (SEM). Results display that both substantive and communicative servicescape elements positively affect the perceived image of customers, which has a positive influence on behavioral intentions such as word of mouth (WOM). Theoretical and practical implications are also discussed.
Fulltext Prevalence of Psychological Impacts on Healthcare Providers during COVID-19 Pandemic in Asia

Norhayati MN, Che Yusof R, Azman MY

Int J Environ Res Public Health, 2021 Aug 30;18(17).
PMID: 34501747 DOI: 10.3390/ijerph18179157

COVID-19 has impacted people psychologically globally, including healthcare providers. Anxiety, depression, and stress are the most common impacts that have affected these people. Thus, this study was aimed to ascertain the estimated prevalence of psychological impacts among healthcare providers in the Asian region. A systematic search was performed in the MEDLINE, CINAHL, and Scopus databases for original research articles published between 2020 and April 2021. Only studies published in English were included. The quality of data was assessed using the Joanna Briggs Institute Meta-Analysis, and the analysis was performed using generic inverse variance with a random-effects model by Review Manager software. A total of 80 studies across 18 countries in Asia region were pooled to assess the data prevalence on anxiety (34.81% (95% CI: 30.80%, 38.83%)), depression (34.61% (95% CI: 30.87%, 38.36%)), stress (31.72% (95% CI: 21.25%, 42.18%)), insomnia (37.89% (95% CI: 25.43%, 50.35%)), and post-traumatic stress disorder (15.29% (95% CI: 11.43%, 19.15%)). Subgroup analyses were conducted across regions, type of healthcare providers, sex, and occupation. This review has identified a high prevalence of anxiety, depression, stress, and insomnia but a low prevalence of post-traumatic stress disorder among healthcare providers in Asia regions. Effective intervention support programs are urgently needed to improve psychological health of healthcare providers and maintaining the health system.

MeSH terms: Anxiety/epidemiology; Depression/epidemiology; Health Personnel; Humans; Stress, Psychological/epidemiology; Prevalence; Pandemics
Fulltext Behavioral theory-based framework for prediabetes self-care system-design perspectives and validation results

Subramaniam S, Dhillon JS, Wan Ahmad WF

Int J Environ Res Public Health, 2021 08 31;18(17).
PMID: 34501750 DOI: 10.3390/ijerph18179160

Type 2 diabetes (T2D) is a chronic condition that can lead to many life-threatening diseases. Prediabetes is defined as a state in which blood glucose levels are elevated but not high enough to be diagnosed as diabetes. This stage can be reversible with appropriate lifestyle and dietary modifications. Existing solutions are mostly developed to deal with T2D instead of preventing it in the first place. In this study, we propose a framework to aid in the development of self-care systems to prevent T2D, which integrates behavioral change theories and techniques and offers features, such as goal setting, activity planning, and health monitoring. We then assessed the feasibility of a prediabetes self-care system designed based on the proposed framework. Quantitative and qualitative methods were adopted in evaluating i-PreventDiabetes, a prototype. Numerous aspects of the prototype were evaluated, including (1) its effectiveness in assisting individuals with prediabetes in improving their health management behaviors, (2) its effect on users' attitudes toward diabetes prevention, (3) users' motivation levels, (4) user acceptability of the system, and (5) user experience. Users viewed i-PreventDiabetes positively and experienced a positive change in their attitude toward their health. Diabetes prevention systems, such as i-PreventDiabetes, have the potential to increase self-care behaviors among individuals with prediabetes, enabling them to manage their lifestyle and nutrition more effectively to avert a variety of potentially fatal conditions.

MeSH terms: Prediabetic State*
Fulltext Eco-Friendly Coagulant versus Industrially Used Coagulants: Identification of Their Coagulation Performance, Mechanism and Optimization in Water Treatment Process

Khairul Zaman N, Rohani R, Izni Yusoff I, Kamsol MA, Basiron SA, Abd Rashid AI

Int J Environ Res Public Health, 2021 08 31;18(17).
PMID: 34501755 DOI: 10.3390/ijerph18179164

The evaluation of complex organic and inorganic coagulant's performances and their relationships could compromise the surface water treatment process time and its efficiency. In this work, process optimization was investigated by comparing an eco-friendly chitosan with the industrially used coagulants namely aluminum sulfate (alum), polyaluminum chloride (PAC), and aluminum chlorohydrate (ACH) in compliance with national drinking water standards. To treat various water samples from different treatment plants with turbidity and pH ranges from 20-826.3 NTU and 5.21-6.80, respectively, 5-20 mg/L coagulant dosages were varied in the presence of aluminum, ferum, and manganese. Among all, 10 mg/L of the respective ACH and chitosan demonstrated 97% and 99% turbidity removal in addition to the removal of the metals that complies with the referred standard. However, chitosan owes fewer sensitive responses (turbidity and residual metal) with the change in its input factors (dosage and pH), especially in acidic conditions. This finding suggested its beneficial role to be used under the non-critical dosage monitoring. Meanwhile, ACH was found to perform better than chitosan only at pH > 7.4 with half dosage required. In summary, chitosan and ACH could perform equally at a different set of optimum conditions. This optimization study offers precise selections of coagulants for a practical water treatment operation.

MeSH terms: Aluminum; Flocculation; Water Purification*; Chitosan*
Fulltext Health Related Quality of Life Measurements for Diabetes: A Systematic Review

Oluchi SE, Manaf RA, Ismail S, Kadir Shahar H, Mahmud A, Udeani TK

Int J Environ Res Public Health, 2021 09 01;18(17).
PMID: 34501838 DOI: 10.3390/ijerph18179245

Health-related quality of life (HRQOL) is an essential measure that is used to assess the effect of chronic disease management on the health status of an individual. Previous studies have identified various instruments used in the measuring of diabetes-specific health-related quality of life (HRQOL). The aim of this paper is to provide a systematic review of the various instruments used for the diabetes-specific measure of HRQOL, and place emphasis on its content and measurement properties. Methods Preferred Reporting Items for Systematic Reviews and Meta analyses (PRISMA) guidelines was used. A systematic search strategy was used to identify publications reporting diabetes HRQOL measures. The search terms used were: "diabetes quality of life", "measurements", and "instruments". The database that was searched includes PubMed, Science Direct, CINAHL, and Medline. Articles written in the English language and published from January 1990 to December 2020 were included. Those articles that did not measure HRQOL for diabetic patients were excluded. Results: A total of seventeen instruments met the inclusion criteria and included in the review. The appraisal of diabetes scale (ADS), Audit of Diabetes-Dependent QOL measure (ADDQOL), Diabetes Health Profile (DHP), and Problem Areas in Diabetes (PAID) are more suitable for single-scale questionnaires when investigating one or more specific aspects of diabetes-specific quality of life (QOL). The ADDQOL, ADS, Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Clinical Trial Questionnaire (DQLCTQ-R), Malay Version of Diabetes Quality of Life (DQOL), Iranian Diabetes Quality of Life (IRDQOL), Brief Clinical Inventory, and PAID are relevant measures of HRQOL for insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM) patients. The Asian Diabetes Quality of Life AsianDQOL, The Chinese Short Version of DQOL, Elderly Diabetes Burden Scale (EDBS), Malay Version of Diabetes Quality of Life (DQOL), are relevant measures of HRQOL for NIDDM patients. Only two instruments assess for responsiveness, namely PAID and DQLCTQ-R. In PAID, the effect sizes ranged from 0.32 to 0.65 for interventions. The DQLCTQ-R four domains were responsive to clinical change in metabolic control. Based on this review ADDQOL, DSQOLS, and EDBS psychometric properties are sufficient. Conclusion: Most studies did not check for responsiveness, and future studies should prioritize responsiveness to change, which was not included in the psychometric finding of the reviewed instruments.
Fulltext Psychometric Properties of the Chinese-Language Attitude toward Physical Activity Scale: A Confirmatory Study on Chinese Children

Zhou Y, He S, Zhou K, Kuan G, Chin MK, Kueh YC, et al.

Int J Environ Res Public Health, 2021 09 02;18(17).
PMID: 34501842 DOI: 10.3390/ijerph18179253

Background: This study examined the psychometric properties of the Chinese version of the Attitude toward Physical Activity Scale (APAS) using a cross-sectional design. Methods: The sample consisted of 692 primary students in China (boy 52.6%, girl 47.4%). The mean age of the participants was 9.4 years (SD = 0.92). Psychometric properties of the 57-item APAS was examined using confirmatory factor analysis (CFA). Results: The hypothesized seven factors model was supported by CFA (CFI = 0.912, TLI = 0.901, SRMR = 0.041, RMSEA = 0.029) after 22 items were removed and the inclusion of seven residual covariance for items loaded on the same factor. Cronbach's alphas of the scales ranged between 0.50 and 0.76. The composite reliability (CR) was between 0.50 and 0.75. All inter-factor correlation coefficient was less than 0.85. Conclusions: Findings provided empirical evidence that the Chinese version of the APAS has adequate psychometric properties for assessing attitudes of primary school children in China toward physical activity.

MeSH terms: Attitude; Child; China; Cross-Sectional Studies; Female; Humans; Language*; Male; Psychometrics; Surveys and Questionnaires; Reproducibility of Results; Exercise*
Fulltext Associations between Socio-Demographic Factors and Hypertension Management during the COVID-19 Pandemic: Preliminary Findings from Malaysia

Elnaem MH, Kamarudin NH, Syed NK, Huri HZ, Dehele IS, Cheema E

Int J Environ Res Public Health, 2021 09 03;18(17).
PMID: 34501893 DOI: 10.3390/ijerph18179306

The perspectives of hypertensive patients on the state of hypertension control during the ongoing pandemic restrictions have not been extensively studied in Malaysia. Therefore, this study aimed to assess the impact of socio-demographic factors, health literacy, and adherence on the overall hypertension management in a group of Malaysian hypertensive patients during the COVID-19 pandemic. An anonymous, online cross-sectional study was conducted over three months that involved a group of Malaysian adults with hypertension. A validated, self-administered 30-item questionnaire was prepared in Malay and English languages on Google Forms. The link was then distributed to participants on social media (Facebook and WhatsApp). Following survey validation, a pilot study with 30 participants who met the inclusion criteria was carried out. The total scores for health literacy, adherence, and pandemic impact on hypertension control were calculated and compared across all independent variables. In a total of 144 study participants, controlled blood pressure was reported in 77% (N = 111). There were good levels of adherence and health literacy scores but moderate levels of pandemic impact scores. The total adherence scores showed a statistically significant difference between age groups (χ2 = 6.48, p = 0.039) and those who reported having controlled and uncontrolled blood pressure (U = 1116, p = 0.001). Moreover, the analysis revealed statistically significant differences in total pandemic impact scores based on the age group (χ2 = 15.008, p = 0.001), household income (χ2 = 6.887, p = 0.032), employment (U = 1712, p = 0.006), and marital status (U = 520.5, p < 0.001). The youngest age group (18-39) years, the lowest income group, unemployed and unmarried individuals, had significantly higher pandemic impact scores. This denotes that those individuals were more prone to be negatively affected by the pandemic regarding their hypertension management. Most participants reported relatively controlled blood pressure and good levels of health literacy as well as adherence amidst the pandemic. To a moderate extent, study participants perceived that the pandemic had a negative effect on hypertension management. The perceived negative impact of the pandemic was attributed to several socio-demographic factors, such as age, household income, employment, and marital status.

MeSH terms: Adolescent; Adult; Cross-Sectional Studies; Demography; Humans; Malaysia/epidemiology; Pilot Projects; Surveys and Questionnaires; Young Adult; Pandemics
Fulltext Validation of the Champion Health Belief Model Scale for an Investigation of Breast Cancer Screening Behaviour in Malaysia

Htay MNN, Schliemann D, Dahlui M, Cardwell CR, Loh SY, Tamin NSBI, et al.

Int J Environ Res Public Health, 2021 Sep 03;18(17).
PMID: 34501903 DOI: 10.3390/ijerph18179311

Breast cancer (BC) is the most common cancer among women globally, including in Malaysia. There is a need to assess women's beliefs about BC and screening in different cultural settings. This study aimed to translate and validate an adapted version of the United States (US) Champion Health Belief Model Scale (CHBMS) for an investigation of predictors of BC screening in Malaysia. The CHBMS was adapted, and forward and backward translated into the Malay language. The validity and reliability of the CHBMS-BC-M (M for Malay language) was investigated in a community sample of 251 multi-ethnic Malay-speaking women. Principal component analysis with varimax rotation indicated that the structure of the adapted CHBMS-BC-M comprised three subscales with 21 items, and an Item-Content Validity Index (I-CVI) of 0.83 and above for all items. The explanatory factor analysis (EFA) showed acceptable to high factor loadings on items. Cronbach's alpha for the subscales ranged from 0.59 to 0.87. The reproducibility of the scale was fair to high, with an Intraclass Correlation Coefficient (ICC) of 0.53 to 0.80 for the subscales. Overall, the analysis indicated that the translated CHBMS-BC-M is a valid and reliable scale to measure beliefs about BC and screening in the Malay-speaking ethnic population of Malaysia.

MeSH terms: Female; Humans; Malaysia; Psychometrics; Surveys and Questionnaires; Reproducibility of Results; Early Detection of Cancer
Fulltext Prevalence of Work-Related Musculoskeletal Disorders: Psychological and Physical Risk Factors

Krishnan KS, Raju G, Shawkataly O

Int J Environ Res Public Health, 2021 Sep 04;18(17).
PMID: 34501950 DOI: 10.3390/ijerph18179361

Purpose-This study aimed to estimate the prevalence and risk factors of MSD pain in various anatomical regions among nurses. Method-A cross-sectional study involving a self-administered questionnaire by registered nurses with clinical experience. Data was collected using convenience sampling after obtaining informed consent. The results were drawn from a total of 300 nurses. Results-The nurses presented with occasional mental exhaustion (44.3%) and often physical exhaustion (44.0%). Almost all (97.3%) the nurses complained of having work-related pain during the last 12 months. Body parts with the most pain were the lower back (86.7%), ankles (86.7%), neck (86.0%), shoulders (85.0%), lower legs (84.7%) and upper back (84.3%). The pain frequency was rated as occasional pain for the neck and upper back, pain was often felt for the rest of the parts. Nurses complained of severe pain in the lower back (19.7%), right shoulder (29.7%) and left shoulder (30.3%). The frequency of having musculoskeletal symptoms in any body region was increased with age, lower education level, female gender, high BMI, job tenure and lifestyle. Conclusions-Nurses' WRMSD complaints should be taken seriously to curb further risk and musculoskeletal hazards.

MeSH terms: Cross-Sectional Studies; Female; Humans; Surveys and Questionnaires; Risk Factors; Prevalence
Fulltext Predisposing Factors and Impact of Child Victimization: A Qualitative Study

Wahid Satar SNA, Norhayati MN, Sulaiman Z, Othman A, Yaacob LH, Nik Hazlina NH

Int J Environ Res Public Health, 2021 09 05;18(17).
PMID: 34501964 DOI: 10.3390/ijerph18179373

Sexual abuse of children is increasing at an alarming rate. This study aims to describe the risk factors and the effects of sexual abuse on children. This unobtrusive qualitative study was conducted on children aged 10 to 18 years old who experienced sexual abuse and followed-up at a psychiatric clinic between the years 2019 and 2021. The information from case records was transcribed. Thematic analysis was performed. Thirty case records were reviewed. The mean age of the victims was 14.6 years; 94% of the victims had experienced vaginal penetration, and 23% of the cases involved incest. The results indicated that socio-psychological predisposing factors involving family structure and dynamic dysfunction, low intrapersonal strength, social influence, and low family socioeconomic status could lead to sexual victimization. This sexual victimization can then lead to emotional turmoil, negative effects on cognitive, academic and social function, negative parental reactions toward the incident, the creation of baby-mother relationships and love-hate relationships, and a lack of goals and hope for the future. Children who experienced sexual abuse may show rape or pregnancy symptoms but may also show entirely non-specific ones. A thorough examination of their history, including biopsychosocial aspects, is necessary to appropriately care for them.

MeSH terms: Adolescent; Child; Child Abuse, Sexual*; Female; Humans; Incest; Pregnancy; Rape*; Risk Factors; Sex Offenses*; Crime Victims*
Fulltext Psychometric Properties of the 34-Item Short-Form Supportive Care Need Survey (SCNS-SF34) Scale in the Malaysian Cancer Healthcare Context

Azman N, Thien LM, Abdullah MFIL, Mohd Shariff N

Int J Environ Res Public Health, 2021 09 06;18(17).
PMID: 34501991 DOI: 10.3390/ijerph18179403

(1) Background: This study aimed to assess the psychometric properties of the Malay version of SCNS-SF34 among Malaysian cancer patients. (2) Methods: This cross-sectional study involved 171 cancer patients. Data were collected using the structured five-factor survey via telephone call or face-to-face interviews. The internal reliability and the construct validity of SCNS-34M were analysed using principal component analysis with varimax rotation. (3) Results: The health system and information need (HSI) was the domain with the highest mean score (2.73 ± 0.88), followed by patient care and support needs (2.16 ± 0.90), as well as physical and daily living needs (1.99 ± 0.98). The confirmatory factor analysis indicated a moderate model fit for RMSEA with 0.070, TLI = 0.911 and CFI = 0.924. (4) Conclusions: The SCNS-SF34M was found to be a conceptually applicable and culturally appropriate scale in measuring the supportive care for cancer patients within the Malaysian context.

MeSH terms: Cross-Sectional Studies; Humans; Psychometrics; Surveys and Questionnaires; Reproducibility of Results; Needs Assessment
Fulltext Adaptation and Psychometric Validation of the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) among Patients with Metabolic Syndrome in Primary Care

Sahar NH, Badlishah-Sham SF, Ramli AS

Int J Environ Res Public Health, 2021 09 06;18(17).
PMID: 34502011 DOI: 10.3390/ijerph18179405

Self-management support is one of the most important components of the Chronic Care Model (CCM). The EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was developed for patients with Metabolic Syndrome (MetS), inspired by the CCM. Assessing usability of a self-management tool is important in chronic disease management. However, there was no available instrument to assess usability of a self-management booklet, as most instruments were developed to assess usability of mobile application. Therefore, this study aimed to adapt Skala Kebolehgunaan Aplikasi Mudah Alih (SKAMA) into the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) and to determine its validity and reliability in assessing usability of a self-management booklet. A cross-sectional validation study was conducted among patients with MetS attending a university primary care clinic in Selangor, Malaysia. Content validation, adaptation and face validation of E-SUQ were performed according to recommended guidelines. It underwent two rounds of content validation as major revision was required for item 5. Subsequently, the revised E-SUQ was face-validated by 10 participants. Psychometric evaluation was conducted using principal component analysis with varimax rotation to determine the underlying structure of E-SUQ. Internal consistency reliability was assessed using Cronbach's α coefficient and the test-retest reliability was assessed using intraclass correlation coefficient (ICC (2,k)). A total of 205 patients participated in the study. The item-level content-validity-index (I-CVI) for item 5 improved from 0.57 to 1.0 after the second round of content validation. The final S-CVI/Ave value for ESUQ was >0.90. The item-level face-validity-index (I-FVI) ranged between 0.9 and 1.0. Kaiser-Meyer-Olkin value of 0.871 and Bartlett's test of sphericity p-value of <0.05 indicated good sample adequacy for factor analysis. Two factors with eigenvalues of >1 were extracted according to the Kaiser's Criteria. The two extracted factors explained 60.6% of the cumulative percentage of variance. The elbow of the scree plot occurred between the second and third component, suggesting two factors to be retained. The two factors were consistent with "Positive" and "Negative" tone model. The overall Cronbach's α coefficient was 0.77, indicating good internal reliability. The overall ICC was 0.85, indicating good reproducibility. The E-SUQ is shown to be valid, reliable and stable to measure the usability of a self-management booklet among patients with MetS in a university primary care clinic in Malaysia.

MeSH terms: Cross-Sectional Studies; Humans; Primary Health Care; Psychometrics; Surveys and Questionnaires; Reproducibility of Results; Metabolic Syndrome X*
Fulltext Leptospirosis and Coinfection: Should We Be Concerned?

Md-Lasim A, Mohd-Taib FS, Abdul-Halim M, Mohd-Ngesom AM, Nathan S, Md-Nor S

Int J Environ Res Public Health, 2021 09 06;18(17).
PMID: 34502012 DOI: 10.3390/ijerph18179411

Pathogenic Leptospira is the causative agent of leptospirosis, an emerging zoonotic disease affecting animals and humans worldwide. The risk of host infection following interaction with environmental sources depends on the ability of Leptospira to persist, survive, and infect the new host to continue the transmission chain. Leptospira may coexist with other pathogens, thus providing a suitable condition for the development of other pathogens, resulting in multi-pathogen infection in humans. Therefore, it is important to better understand the dynamics of transmission by these pathogens. We conducted Boolean searches of several databases, including Google Scholar, PubMed, SciELO, and ScienceDirect, to identify relevant published data on Leptospira and coinfection with other pathogenic bacteria. We review the role of the host-microbiota in determining the synanthropic interaction of Leptospira sp. with other bacteria, thus creating a suitable condition for the leptospira to survive and persist successfully. We also discuss the biotic and abiotic factors that amplify the viability of Leptospira in the environment. The coinfection of leptospira with pathogenic bacteria has rarely been reported, potentially contributing to a lack of awareness. Therefore, the occurrence of leptospirosis coinfection may complicate diagnosis, long-lasting examination, and mistreatment that could lead to mortality. Identifying the presence of leptospirosis with other bacteria through metagenomic analysis could reveal possible coinfection. In conclusion, the occurrence of leptospirosis with other diseases should be of concern and may depend on the success of the transmission and severity of individual infections. Medical practitioners may misdiagnose the presence of multiple infections and should be made aware of and receive adequate training on appropriate treatment for leptospirosis patients. Physicians could undertake a more targeted approach for leptospirosis diagnosis by considering other symptoms caused by the coinfected bacteria; thus, more specific treatment could be given.

MeSH terms: Animals; Humans; Leptospira*; Zoonoses/epidemiology

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