Browse publications by year: 2021

  1. Anwar MN, Shabbir M, Tahir E, Iftikhar M, Saif H, Tahir A, et al.
    J Hazard Mater, 2021 08 15;416:125851.
    PMID: 34492802 DOI: 10.1016/j.jhazmat.2021.125851
    This study examines point and non-point sources of air pollution and particulate matter and their associated socioeconomic and health impacts in South Asian countries, primarily India, China, and Pakistan. The legislative frameworks, policy gaps, and targeted solutions are also scrutinized. The major cities in these countries have surpassed the permissible limits defined by WHO for sulfur dioxide, carbon monoxide, particulate matter, and nitrogen dioxide. As a result, they are facing widespread health problems, disabilities, and causalities at extreme events. Populations in these countries are comparatively more prone to air pollution effects because they spend more time in the open air, increasing their likelihood of exposure to air pollutants. The elevated level of air pollutants and their long-term exposure increases the susceptibility to several chronic/acute diseases, i.e., obstructive pulmonary diseases, acute respiratory distress, chronic bronchitis, and emphysema. More in-depth spatial-temporal air pollution monitoring studies in China, India, and Pakistan are recommended. The study findings suggest that policymakers at the local, national, and regional levels should devise targeted policies by considering all the relevant parameters, including the country's economic status, local meteorological conditions, industrial interests, public lifestyle, and national literacy rate. This approach will also help design and implement more efficient policies which are less likely to fail when brought into practice.
  2. Chen WH, Chang CM, Mutuku JK, Lam SS, Lee WJ
    J Hazard Mater, 2021 08 15;416:125856.
    PMID: 34492805 DOI: 10.1016/j.jhazmat.2021.125856
    Inhalation of aerosols such as pharmaceutical aerosols or virus aerosol uptake is of great concern to the human population. To elucidate the underlying aerosol dynamics, the deposition fractions (DFs) of aerosols in healthy and asthmatic human airways of generations 13-15 are predicted. The Navier-stokes equations governing the gaseous phase and the discrete phase model for particles' motion are solved using numerical methods. The main forces responsible for deposition are inertial impaction forces and complex secondary flow velocities. The curvatures and sinusoidal folds in the asthmatic geometry lead to the formation of complex secondary flows and hence higher DFs. The intensities of complex secondary flows are strongest at the generations affected by asthma. The DF in the healthy airways is 0%, and it ranges from 1.69% to 52.93% in the asthmatic ones. From this study, the effects of the pharmaceutical aerosol particle diameters in the treatment of asthma patients can be established, which is conducive to inhibiting the inflammation of asthma airways. Furthermore, with the recent development of COVID-19 which causes pneumonia, the predicted physics and effective simulation methods of bioaerosols delivery to asthma patients are vital to prevent the exacerbation of the chronic ailment and the epidemic.
    MeSH terms: Aerosols; Computer Simulation; Humans; Lung; Models, Biological; Particle Size
  3. Ahmed SF, Mofijur M, Nuzhat S, Chowdhury AT, Rafa N, Uddin MA, et al.
    J Hazard Mater, 2021 08 15;416:125912.
    PMID: 34492846 DOI: 10.1016/j.jhazmat.2021.125912
    Emerging contaminants (ECs) in wastewater have recently attracted the attention of researchers as they pose significant risks to human health and wildlife. This paper presents the state-of-art technologies used to remove ECs from wastewater through a comprehensive review. It also highlights the challenges faced by existing EC removal technologies in wastewater treatment plants and provides future research directions. Many treatment technologies like biological, chemical, and physical approaches have been advanced for removing various ECs. However, currently, no individual technology can effectively remove ECs, whereas hybrid systems have often been found to be more efficient. A hybrid technique of ozonation accompanied by activated carbon was found significantly effective in removing some ECs, particularly pharmaceuticals and pesticides. Despite the lack of extensive research, nanotechnology may be a promising approach as nanomaterial incorporated technologies have shown potential in removing different contaminants from wastewater. Nevertheless, most existing technologies are highly energy and resource-intensive as well as costly to maintain and operate. Besides, most proposed advanced treatment technologies are yet to be evaluated for large-scale practicality. Complemented with techno-economic feasibility studies of the treatment techniques, comprehensive research and development are therefore necessary to achieve a full and effective removal of ECs by wastewater treatment plants.
    MeSH terms: Humans; Pesticides*; Waste Disposal, Fluid; Water Purification*; Waste Water/analysis
  4. Li Y, Shaheen SM, Rinklebe J, Ma NL, Yang Y, Ashraf MA, et al.
    J Hazard Mater, 2021 08 15;416:126012.
    PMID: 34492887 DOI: 10.1016/j.jhazmat.2021.126012
    The rapid thermal cracking technology of biomass can convert biomass into bio-oil and is beneficial for industrial applications. Agricultural and forestry wastes are important parts of China's energy, and their high-grade utilization is useful to solve the problem of energy shortages and environmental pollution. To the best of our knowledge, the impact of nanocatalysts on converting biowastes for bio-oil has not been studied. Consequently, we examined the production of bio-oil by pyrolysis of Aesculus chinensis Bunge Seed (ACBS) using nanocatalysts (Fe2O3 and NiO catalysts) for the first time. The pyrolysis products of ACBS include 1-hydroxy-2-propanone (3.97%), acetic acid (5.42%), and furfural (0.66%). These chemical components can be recovered for use as chemical feedstock in the form of bio-oil, thus indicating the potential of ACBS as a feedstock to be converted by pyrolysis to produce value-added bio-oil. The Fe2O3 and NiO catalysts enhanced the pyrolysis process, which accelerated the precipitation of gaseous products. The pyrolysis rates of the samples gradually increased at DTGmax, effectively promoting the catalytic cracking of ACBS, which is beneficial to the development and utilization of ACBS to produce high valorization products. Combining ACBS and nanocatalysts can change the development direction of high valorization agricultural and forestry wastes in the future.
    MeSH terms: Hot Temperature; Plant Oils; Seeds; Biomass; Aesculus*; Biofuels; Polyphenols
  5. Azrizal-Wahid N, Sofian-Azirun M, Low VL, Chen CD, Shohaimi S
    J Appl Anim Welf Sci, 2021 Sep 07.
    PMID: 34493142 DOI: 10.1080/10888705.2021.1975539
    A structured questionnaire was distributed to a total of 531 cat owners in Peninsular Malaysia to evaluate their perceptions toward fleas and flea-borne diseases (FBD) using a knowledge-attitude-practice (KAP) approach. This study showed that majority of cat owners (50.5%) had a moderate level of knowledge on fleas, while 65.3% of them had a relatively low level of knowledge on FBD. However, most of them had positive attitudes (87.9%) and good practices (94.5%) toward efforts on prevention from flea infestation and FBD. Statistical analysis showed significant associations between knowledge on fleas and FBD toward demographic and pet ownership profiles of the respondents. Educated cat owners from urban area were more likely to have positive attitudes toward prevention of fleas and FBD. Female cat owners with monthly income of RM 5,001-7,000 ($1143-1600) were more likely to have good practices. Middle-aged cat owners showed the highest odds toward both positive attitudes and good practices. Correlation analyses indicated significant linear relationships between both knowledge, which were also associated with attitudes, but not with practices.
  6. Ahmad Nazri KA, Haji Mohd Saad Q, Mohd Fauzi N, Buang F, Jantan I, Jubri Z
    Pharm Biol, 2021 Dec;59(1):1203-1215.
    PMID: 34493166 DOI: 10.1080/13880209.2021.1970199
    CONTEXT: Gynura procumbens (Lour.) Merr. (Asteraceae) has been reported to have various pharmacological activities including anti-inflammatory effects.

    OBJECTIVE: This study sought to determine whether Gynura procumbens (GP) could improve vascular reactivity by suppressing inflammation in postmenopausal rats fed with five-times heated palm oil (5HPO) diet.

    MATERIALS AND METHODS: Forty-eight female Sprague-Dawley rats were randomly divided into sham [non-ovariectomized; grouped as control, GP extracts (250 and 500 mg/kg), atorvastatin (ATV, 10 mg/kg)] and postmenopausal (PM) groups [ovariectomized rats fed with 5HPO; grouped as PM, GP extracts (250 and 500 mg/kg) and ATV (10 mg/kg)]. Each group (n = 6) was either supplemented with GP extract or ATV orally once daily for 6 months.

    RESULTS: In comparison with the untreated PM group, 250 and 500 mg/kg GP supplementation to PM groups reduced the systolic blood pressure (103 ± 2.7, 86 ± 2.4 vs. 156 ± 7.83 mmHg, p 

    MeSH terms: Atorvastatin Calcium/pharmacology; Ethanol/chemistry; Animals; Anti-Inflammatory Agents/administration & dosage; Anti-Inflammatory Agents/isolation & purification; Anti-Inflammatory Agents/pharmacology*; Blood Pressure/drug effects; Disease Models, Animal; Dose-Response Relationship, Drug; Female; Inflammation/drug therapy*; Inflammation/pathology; Plant Extracts/administration & dosage; Plant Extracts/pharmacology*; Vasoconstriction/drug effects; Vasodilation/drug effects; Rats, Sprague-Dawley; Postmenopause*; Asteraceae/chemistry; Rats; Carotid Intima-Media Thickness; Diet, High-Fat
  7. Nik-Ahmad-Zuky NL, Seoparjoo A, Husna EIE
    J Med Case Rep, 2021 Sep 08;15(1):448.
    PMID: 34493340 DOI: 10.1186/s13256-021-03030-x
    BACKGROUND: Placenta accreta is known to be associated with significant maternal morbidity and mortality-primarily due to intractable bleeding during abortion or delivery at any level of gestation. The complications could be reduced if placenta accreta is suspected in a patient with a history of previous cesarean delivery and the gestational sac/placenta is located at the lower part of the uterus. Then, a proper management plan can be instituted, and complications can be reduced. The diagnosis of placenta accreta in the first trimester of pregnancy is considered uncommon.

    CASE PRESENTATION: A 34-year-old Malay, gravida 4, para 3, rhesus-negative woman was referred from a private hospital at 13 weeks owing to accreta suspicion for further management. She has a history of three previous lower-segment cesarean sections. She also had per vaginal bleeding in the early first trimester, which is considered to indicate threatened miscarriage. Transabdominal ultrasound revealed features consistent with placenta accreta spectrum. She was counseled for open laparotomy and hysterectomy because of potential major complication if she continued with the pregnancy. Histopathological examination revealed placenta increta.

    CONCLUSION: A high index of suspicion of placenta previa accreta must be in practice in a patient with a history of previous cesarean deliveries and low-lying placenta upon ultrasound examination during early gestation.

    MeSH terms: Adult; Cesarean Section; Female; Humans; Mothers; Pregnancy; Pregnancy Trimester, First
  8. Ngu CYV, Saniasiaya J, Kulasegarah J
    BMJ Case Rep, 2021 Sep 07;14(9).
    PMID: 34493558 DOI: 10.1136/bcr-2021-244012
    Paediatric upper airway obstruction is an emergency that requires immediate intervention. Among the myriad factors that leads to upper airway obstruction in paediatric age group, bilateral vocal cord palsy is not commonly encountered in clinical practice. The underlying cause of bilateral vocal cord palsy requires thorough investigation prior to deciding on the appropriate intervention. Herein, we report a 4-month-old baby boy who presented with recurrent inspiratory stridor with bilateral vocal cord palsy secondary to Arnold Chiari II malformation. Immediate intervention to drain the hydrocephalous resulted in complete resolution of stridor without having to perform a tracheostomy. We highlight the importance of meticulous and thorough investigations especially in children, as emergent airway intervention such as tracheostomy may result in detrimental effect to speech, swallowing as well as quality of life.
    MeSH terms: Arnold-Chiari Malformation*; Child; Humans; Infant; Laryngoscopy; Male; Quality of Life; Respiratory Sounds/etiology
  9. Zainal Abidin DH, Mohd Nor SA, Lavoué S, A Rahim M, Jamaludin NA, Mohammed Akib NA
    Sci Rep, 2021 Sep 07;11(1):17800.
    PMID: 34493747 DOI: 10.1038/s41598-021-97324-1
    The Merbok Estuary comprises one of the largest remaining mangrove forests in Peninsular Malaysia. Its value is significant as it provides important services to local and global communities. It also offers a unique opportunity to study the structure and functioning of mangrove ecosystems. However, its biodiversity is still partially inventoried, limiting its research value. A recent checklist based on morphological examination, reported 138 fish species residing, frequenting or subject to entering the Merbok Estuary. In this work, we reassessed the fish diversity of the Merbok Estuary by DNA barcoding 350 specimens assignable to 134 species initially identified based on morphology. Our results consistently revealed the presence of 139 Molecular Operational Taxonomic Units (MOTUs). 123 of them are congruent with morphology-based species delimitation (one species = one MOTU). In two cases, two morphological species share the same MOTU (two species = one MOTU), while we unveiled cryptic diversity (i.e. COI-based genetic variability > 2%) within seven other species (one species = two MOTUs), calling for further taxonomic investigations. This study provides a comprehensive core-list of fish taxa in Merbok Estuary, demonstrating the advantages of combining morphological and molecular evidence to describe diverse but still poorly studied tropical fish communities. It also delivers a large DNA reference collection for brackish fishes occurring in this region which will facilitate further biodiversity-oriented research studies and management activities.
    MeSH terms: Animals; Conservation of Natural Resources; DNA/genetics; Fishes/classification*; Fishes/genetics; Malaysia; Reference Standards; Species Specificity; Gene Library; Ecosystem*; Rhizophoraceae; Biodiversity; DNA Barcoding, Taxonomic*; Estuaries
  10. Cheong AR, Baltazar MAK
    Genus, 2021;77(1):18.
    PMID: 34493875 DOI: 10.1186/s41118-021-00129-3
    This study extends Thaddeus and Maine's (1994) "three delays" framework to model the interrelated barriers to maternal health care and birth registration. We focus on stateless persons and irregular migrants, populations that are especially at risk of being "left behind" in United Nations member states' efforts to "provide legal identity to all" as part of the 2030 Sustainable Development Agenda. Drawing on qualitative fieldwork conducted in Sabah, Malaysia, we model delays in accessing maternal health care and birth registration as an integrated, cyclical process. We identify the political and legal barriers that stateless or migrant families confront while deciding to make institutional contact (Phase I), identifying and reaching health or registering institutions (Phase II), and receiving adequate and appropriate treatment (Phase III). We find that exclusion from one system raises the risk of exclusion from the other, resulting in a range of negative consequences, including increased health risks, governments' impaired ability to monitor population health, and the perpetuation of intergenerational cycles of legal exclusion.
  11. Zorgati I, Garfatta R
    J Econ Asymmetries, 2021 Nov;24:e00223.
    PMID: 34493939 DOI: 10.1016/j.jeca.2021.e00223
    The purpose of this paper is to examine the effect of spatial proximity on financial contagion during the COVID-19 outbreak. We use the daily stock index series of Asian, American, and European countries from January 1, 2014 to January 30, 2021. Two groups of countries are considered: the first includes China and geographically close countries, namely Taiwan, Hong Kong, Singapore, India, Australia, Indonesia, Malaysia, South Korea, Singapore, Vietnam and Russia. The second group includes countries that are geographically distant from China: the United States, Brazil, Mexico, Argentina, Italy, France and Germany. Using local correlation measurement and polynomial regressions, we show that the spatial contagion effect exists between China and geographically distant countries. However, this effect is absent for geographically close countries (Taiwan, Vietnam and Hong Kong). These findings have strong implications for investors and present guidance for regulators and policymakers in understanding the true impact of the COVID-19 on financial markets.
  12. Kamble CB, Raju R, Vishnu R, Rajkanth R, Pariatamby A
    Waste Manag Res, 2021 Nov;39(11):1427-1436.
    PMID: 34494917 DOI: 10.1177/0734242X211029159
    Management of waste is one of the major challenges faced by many developing countries. This study therefore attempts to develop a circular economy (CE) model to manage wastes and closing the loop and reducing the generation of residual wastes in Indian municipalities. Through extant literature review, the researchers found 30 success factors of CE implementation. Using the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) SIMOS approach, the rating and weight of decision makers (DMs) for each factor were collected. A structured questionnaire has been developed incorporating all these 30 factors, to extract the most important factors. The data was collected from top 10 officials (DMs) from the Chennai municipality, who handle three regions (metropolitan, suburbia and industrial). Based on the TOPSIS SIMOS analysis, nine CE implementing factors (critical success factors (CSFs)) among the 30 variables that were significant based on the cut-off value was identified. A CE model has been proposed based on these nine CSFs for waste management in India.
    MeSH terms: Cities; India; Waste Management*; Models, Economic; Recycling*
  13. Akmal Muhamat N, Hasan R, Saddki N, Mohd Arshad MR, Ahmad M
    PLoS One, 2021;16(9):e0257035.
    PMID: 34495979 DOI: 10.1371/journal.pone.0257035
    In several nations, caries in pre-school children remain a significant oral health issue. In an outbreak period such as the Coronavirus disease 2019 (COVID-19), remote contact and education aimed at the prevention of oral diseases and the preservation of children's oral health are more relevant than ever. Currently, the amount of published applications is far higher than the published scientific studies while the problems of usability remains vulnerable. The goal of this paper was to comprehensively document the phase of development and usability testing of a mobile application for diet and oral health, namely Gigiku Sihat, which was primarily intended to be used by parents and guardians of pre-school children. The mobile application was developed using the System Development Life Cycle principle. Apart from searching for the available oral health application on Android platform, the initial requirement gathering process consisted of situational analysis, concept generation, content development, and features and functional requirement determination. The mobile application design and implementation evolved at each phase before being finalised. Gigiku Sihat was successfully developed in the Bahasa Malaysia. Finalised Gigiku Sihat was installed on mobile devices to determine the usability using translated and validated System Usability Scale questionnaire namely Skala Kebolehgunaan Aplikasi Mudah Alih (SKAMA). The mean score usability with score of 68 and above was deemed to have good usability. This study found that Gigiku Sihat mean (SD) usability score was 77.0 (14.18). The results were promising as they showed that Gigiku Sihat had a good usability. Thus, the development of this mobile application focusing on diet and oral health served as a new source of oral health education and provided a necessary foundation in developing future improved mobile application development for parents in the prevention of early childhood caries.
    MeSH terms: Adult; Diet/statistics & numerical data; Female; Humans; Malaysia; Oral Health/statistics & numerical data*; User-Computer Interface; Mobile Applications/statistics & numerical data*
  14. Kong SR, Yamamoto M, Shaari H, Hayashi R, Seki O, Mohd Tahir N, et al.
    PLoS One, 2021;16(9):e0256853.
    PMID: 34495997 DOI: 10.1371/journal.pone.0256853
    The reconstruction of fire history is essential to understand the palaeoclimate and human history. Polycyclic aromatic hydrocarbons (PAHs) have been extensively used as a fire marker. In this work, the distribution of PAHs in Borneo peat archives was investigated to understand how PAHs reflect the palaeo-fire activity. In total, 52 peat samples were analysed from a Borneo peat core for the PAH analysis. Pyrogenic PAHs consist of 2-7 aromatic rings, some of which have methyl and ethyl groups. The results reveal that the concentration of pyrogenic PAHs fluctuated with the core depth. Compared to low-molecular-weight (LMW) PAHs, the high-molecular-weight (HMW) PAHs had a more similar depth variation to the charcoal abundance. This finding also suggests that the HMW PAHs were mainly formed at a local fire near the study area, while the LMW PAHs could be transported from remote locations.
    MeSH terms: Borneo; Charcoal/analysis; Fires/history*; Humans; Molecular Weight; Polycyclic Hydrocarbons, Aromatic/analysis*; Polycyclic Hydrocarbons, Aromatic/classification; Polycyclic Hydrocarbons, Aromatic/chemistry; Soil/chemistry*; Geologic Sediments/analysis*; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval
  15. Hamdoon Z, Jerjes W, Rashed D, Kawas S, Sattar AA, Samsudin R, et al.
    Photodiagnosis Photodyn Ther, 2021 Sep 05;36:102520.
    PMID: 34496299 DOI: 10.1016/j.pdpdt.2021.102520
    BACKGROUND: The primary aim of this prospective study is to demonstrate the technical feasibility of OCT to map real tumor margins and to monitor skin changes that occurred post- PDT. Moreover, to optimize PDT efficacy based on the relationship between measured OCT features and treatment outcome.

    MATERIAL AND METHODS: A series of 12 patients with overall 18 facial skin lesions were investigated by OCT before surface illumination by PDT to determine tumor free margins. Monitoring of the healing process was undertaken at 3, 6 and 12 months post-PDT. Parameters measured by the in vivo OCT during healing phase were the organization of skin layer and the degree skin fibroses for the active center and peripheral transit zone of the treated lesion. Clinical and aesthetics assessment was carried out at 12-month post-PDT.

    RESULTS: Distinct microstructural differences between normal skin, pre-cancer, cancer, and the transition zone between the two tissues were observed on OCT images. In the subsequent healing phase, OCT demonstrate marked delineation and organization of skin layer at late stage of healing. Early features showing bizarre non-homogenous disorganized layering (scab) but afterwards, OCT was able to differentiate between different histological layers. One lesion demonstrated clinical healing by fibrosis (scar) without sign of recurrence. Another lesion demonstrated skin erythema. Only one lesion did not response to treatment despite margins clearance. The CR rate was 95% at the end of the study. The cosmetic effect was "excellent" in 89% of the patients.

    CONCLUSIONS: This feasibility study lays the groundwork for using OCT as a real-time, noninvasive monitoring device for PDT in patients with skin cancer.

  16. Ngah NA, Ratnayake J, Cooper PR, Dias GJ, Tong DC, Mohd Noor SNF, et al.
    Molecules, 2021 Jan 20;26(3).
    PMID: 33498167 DOI: 10.3390/molecules26030517
    OBJECTIVE: The use of platelet concentrates (PCs) in oral and maxillofacial surgery, periodontology, and craniofacial surgery has been reported. While PCs provide a rich reservoir of autologous bioactive growth factors for tissue regeneration, their drawbacks include lack of utility for long-term application, low elastic modulus and strength, and limited storage capability. These issues restrict their broader application. This review focuses on the lyophilization of PCs (LPCs) and how this processing approach affects their biological and mechanical properties for application as a bioactive scaffold for craniofacial tissue regeneration.

    MATERIALS AND METHODS: A comprehensive search of five electronic databases, including Medline, PubMed, EMBASE, Web of Science, and Scopus, was conducted from 1946 until 2019 using a combination of search terms relating to this topic.

    RESULTS: Ten manuscripts were identified as being relevant. The use of LPCs was mostly studied in in vitro and in vivo craniofacial bone regeneration models. Notably, one clinical study reported the utility of LPCs for guided bone regeneration prior to dental implant placement.

    CONCLUSIONS: Lyophilization can enhance the inherent characteristics of PCs and extends shelf-life, enable their use in emergency surgery, and improve storage and transportation capabilities. In light of this, further preclinical studies and clinical trials are required, as LPCs offer a potential approach for clinical application in craniofacial tissue regeneration.

    MeSH terms: Blood Platelets; Bone Regeneration/drug effects*; Fibrin/therapeutic use*; Fibrin/chemistry; Humans; Surgery, Oral/methods; Platelet Transfusion/methods; Platelet-Rich Plasma/chemistry*
  17. GBD 2017 EMR Transport Injuries Collaborators, Safiri S, Sullman MJM, Lajunen T, Hill T, Almasi-Hashiani A, et al.
    Arch Iran Med, 2021 07 01;24(7):512-525.
    PMID: 34488316 DOI: 10.34172/aim.2021.74
    BACKGROUND: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age.

    METHODS: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs).

    RESULTS: In 2017, there were 5.5 million (UI 4.9-6.2) transport-related incident cases in the EMR - a substantial increase from 1990 (2.8 million; UI 2.5-3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5-876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3-1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100000, respectively. In 2017, there were 185.3 thousand (UI 170.8-200.6) transport-related fatalities in the EMR - a substantial increase since 1990 (140.4 thousand; UI 118.7-156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1-31.9) per 100000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8-47.3). In 2017, Somalia (54; UI 30-77.4) and Lebanon (7.1; UI 4.8-8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5-1651.3) per 100000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1-2,589.9). In 2017, the highest DALY rate was found in Pakistan (3454121; UI 2297890- 4342908) and the lowest was found in Bahrain (8616; UI 7670-9751).

    CONCLUSION: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently.

  18. Chew CC, Lim XJ, Chang CT, Rajan P, Nasir N, Low WY
    BMC Public Health, 2021 09 06;21(1):1623.
    PMID: 34488693 DOI: 10.1186/s12889-021-11679-8
    BACKGROUND: Social stigma against persons infected with COVID-19 is not uncommon. This qualitative study aimed to explore the experience of social stigma among COVID-19 positive patients and their family members.

    METHOD: This cross-sectional study was conducted between April to June 2020 in Malaysia. Patients who have recovered from COVID-19 for at least 1 month and their family members who were tested with negative results, Malaysian and aged 18-65 years old were purposively sampled. Cold call method was employed to recruit patients while their family members were recruited by their recommendations. Telephone interviews were conducted with the participants after obtaining their verbal consent.

    RESULTS: A total of 18 participants took part in this study. Three themes emerged from the interviews: (Ι) experience of stigmatization, (ΙΙ) perspective on disease disclosure, and (ΙΙΙ) suggestion on coping and reducing stigma. The participants expressed their experiences of being isolated, labelled, and blamed by the people surrounding them including the health care providers, neighbours, and staff at the service counters. Some respondents expressed their willingness to share their experience with others by emphasizing the importance of taking preventive measure in order to stop the chain of virus transmission and some of them chose to disclose this medical history for official purpose because of fear and lack of understanding among the public. As suggested by the respondents, the approaches in addressing social stigma require the involvement of the government, the public, health care provider, and religious leader.

    CONCLUSION: Individuals recovered from COVID-19 and their families experienced social stigma. Fear and lack of public understanding of the COVID-19 disease were the key factors for non-disclosure. Some expressed their willingness to share their experience as they perceived it as method to increase public awareness and thereby reducing social stigma. Multifaceted approaches with the involvement of multiple parties including the government, non-governmental organization as well as the general public were recommended as important measures to address the issues of social stigma.

    MeSH terms: Adolescent; Adult; Aged; Cross-Sectional Studies; Family; Humans; Middle Aged; Qualitative Research; Young Adult; Social Stigma*
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