Browse publications by year: 2021

  1. Sattar MU, Palaniappan S, Lokman A, Shah N, Riaz Z, Khalid U
    J Pak Med Assoc, 2021 Jul;71(7):1730-1735.
    PMID: 34410236 DOI: 10.5455/JPMA.22992
    OBJECTIVE: To investigate the effects of design parameters on the user experience of virtual reality medical training.

    Methods: The quantitative study was conducted at Punjab (Pakistan) from July 2018 to October 2018, and comprised final year students from eight medical colleges in Pakistan. Each respondent was given to experience laparoscopy operation in text, video and virtual reality-based learning methodologies. User experience and usefulness was assessed against a pre-validated scale and compared with the three learning methodologies.

    RESULTS: Of the 87, students, 50(57.5%) were male and 37(42.5%) were female. The overall mean age was 22.5±4 years. Result of virtual reality was better than others (p<0.05). Data was analysed using SPSS 20.

    CONCLUSIONS: Virtual reality-based learning provided better user experience than traditional learning methodologies.

    MeSH terms: Adolescent; Adult; Clinical Competence; Female; Humans; Male; Pakistan; Laparoscopy*; User-Computer Interface; Young Adult
  2. Gopinath D, Menon RK
    Methods Mol Biol, 2021;2327:1-15.
    PMID: 34410636 DOI: 10.1007/978-1-0716-1518-8_1
    Evidence on the role of the oral microbiome in health and disease is changing the way we understand, diagnose, and treat ailments. Numerous studies on diseases affecting the oral cavity have revealed a large amount of data that is invaluable for the advancements in diagnosing and treating these diseases. However, the clinical translation of most of these exploratory data is stalled by variable methodology between studies and non-uniform reporting of the data.Understanding the key areas that are gateways to bias in microbiome studies is imperative to overcome this challenge faced by oral microbiome research. Bias can be multifactorial and may be introduced in a microbiome research study during the formulation of the study design, sample collection and storage, or the sample processing protocols before sequencing. This chapter summarizes the recommendations from literature to eliminate bias in the microbiome research studies and to ensure the reproducibility of the microbiome research data.
    MeSH terms: Mouth; RNA, Ribosomal, 16S; Specimen Handling; Reproducibility of Results; Microbiota*
  3. Barathan M, Zulpa AK, Vellasamy KM, Mariappan V, Shivashekaregowda NKH, Ibrahim ZA, et al.
    In Vivo, 2021 8 20;35(5):2675-2685.
    PMID: 34410956 DOI: 10.21873/invivo.12551
    BACKGROUND/AIM: Isoniazid is an antibiotic used for the treatment of tuberculosis. Previously, we found that the isoniazid derivative (E)-N'-(2,3,4-trihydroxybenzylidene) isonicotinohydrazide (ITHB4) could be developed as novel antimycobacterial agent by lead optimization. We further explored the ability of this compound compared to zerumbone in inhibiting the growth of MCF-7 breast cancer cells.

    MATERIALS AND METHODS: Cytotoxicity was measured by the MTT assay and further confirmed via apoptosis, ROS, cell cycle, DNA fragmentation and cytokine assays.

    RESULTS: ITHB4 demonstrated a lower IC50 compared to zerumbone in inhibiting the proliferation of MCF-7 cells. ITHB4 showed no toxicity against normal breast and human immune cells. Apoptosis assay revealed that ITHB4, at a concentration equal to the IC50, induces apoptosis of MCF-7 cells and cell cycle arrest at the sub-G1 and G2/M phases. ITHB4 triggered accumulation of intracellular ROS and nuclear DNA fragmentation. Secretion of pro-inflammatory cytokines induced inflammation and potentially immunogenic cell death.

    CONCLUSION: ITHB4 has almost similar chemotherapeutic properties as zerumbone in inhibiting MCF-7 growth, and hence provide the basis for further experiments in animal models.

    MeSH terms: Animals; Cell Survival; Female; Humans; Isoniazid/therapeutic use; Isoniazid/toxicity; Apoptosis; Reactive Oxygen Species; Cell Proliferation; MCF-7 Cells
  4. Tan CS, Tew WY, Jingying C, Yam MF
    Chem Biol Interact, 2021 Oct 01;348:109620.
    PMID: 34411564 DOI: 10.1016/j.cbi.2021.109620
    Naringenin is a naturally occurring flavanone (flavonoid) known to have bioactive effects on human health. It has been reported to show cardiovascular effects. This study aimed to investigate the possible vasorelaxant effect of naringenin and the mechanism behind it by using a Sprague Dawley rat aortic ring assay model. Naringenin caused significant vasorelaxation of endothelium-intact aortic rings precontracted with phenylephrine (pD2 = 4.27 ± 0.05; Rmax = 121.70 ± 4.04%) or potassium chloride (pD2 = 4.00 ± 0.04; Rmax = 103.40 ± 3.82%). The vasorelaxant effect decreased in the absence of an endothelium (pD2 = 3.34 ± 0.10; Rmax = 62.29 ± 2.73%). The mechanisms of the vasorelaxant effect of naringenin in the presence of antagonists were also investigated. Indomethacin, 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, atropine, 4-aminopyridine, Nω-nitro-l-arginine methyl ester, glibenclamide and propranolol significantly reduced the relaxation stimulated by naringenin in the presence of endothelium. Besides that, the effect of naringenin on the voltage-operated calcium channel (VOCC) in the endothelium-intact aortic ring was studied, as was intracellular Ca2+ release from the sarcoplasmic reticulum (SR) in the endothelium-denuded aortic ring. The results showed that naringenin also significantly blocked the entry of Ca2+ via the VOCC, SERCA/SOCC and suppressed the release of Ca2+ from the SR. Thus, the vasorelaxant effect shown by naringenin mostly involve the COX pathway, the endothelium-dependent pathway via NO/sGC/prostaglandin, calcium and potassium channels.
    MeSH terms: Animals; Aorta/drug effects; Aorta/metabolism; Calcium/metabolism; Male; Phenylephrine/pharmacology; Vasodilation/drug effects; Rats, Sprague-Dawley*; Rats
  5. Yoshino T, Argilés G, Oki E, Martinelli E, Taniguchi H, Arnold D, et al.
    Ann Oncol, 2021 12;32(12):1496-1510.
    PMID: 34411693 DOI: 10.1016/j.annonc.2021.08.1752
    The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of localised colon cancer was published in 2020. It was decided by both the ESMO and the Japanese Society of Medical Oncology (JSMO) to convene a special virtual guidelines meeting in March 2021 to adapt the ESMO 2020 guidelines to take into account the ethnic differences associated with the treatment of localised colon cancer in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with localised colon cancer representing the oncological societies of Japan (JSMO), China (CSCO), India (ISMPO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug availability and reimbursement situations in the different Asian countries.
    MeSH terms: Asia/epidemiology; Follow-Up Studies; Humans; Medical Oncology*; Republic of Korea
  6. Choo BKM, Kundap UP, Faudzi SMM, Abas F, Shaikh MF, Samarut É
    Biomed Pharmacother, 2021 Oct;142:112035.
    PMID: 34411917 DOI: 10.1016/j.biopha.2021.112035
    Seizures are the outward manifestation of abnormally excessive or synchronous brain activity. While seizures can be somewhat symptomatically managed with anti-epileptic drugs (AEDs), many patients are still refractory to the currently available AEDs. As a result, there is a need to identify new molecules with anti-seizure properties. Curcumin is the principle curcuminoid of Curcuma longa, or colloquially turmeric, and has been experimentally proven to have anti-convulsive properties, but its poor bioavailability has dampened further therapeutic interest. Hence, this study aimed to ask if structural analogues of curcumin with an adequate bioavailability could have an anti-seizure effect in vivo. To do so, we tested these analogues following a multipronged approach combining the use of several zebrafish seizure models (chemically-induced and genetic) and complementary assays (behavioural and brain activity). Overall, from the 68 analogues tested, we found 15 different derivatives that were able to significantly decrease the behavioural hyperactivity induced by pentylenetetrazol. Of those, only a few showed an effect on the hyperactivity phenotype of two genetic models of brain seizures that are the gabra1 and gabrg2 knockouts. Two analogues, CA 80(1) and CA 74(1), were able to significantly alleviate brain seizures of gabrg2-mutant larvae. As a result, these analogues are good candidates as novel anti-seizure agents.
    MeSH terms: Animals; Anticonvulsants/pharmacology*; Anticonvulsants/chemistry; Behavior, Animal/drug effects; Biological Availability; Curcumin/analogs & derivatives; Curcumin/pharmacokinetics; Curcumin/pharmacology*; Disease Models, Animal; Larva; Pentylenetetrazole; Receptors, GABA-A/genetics*; Seizures/drug therapy*; Seizures/genetics; Zebrafish; Gene Knockout Techniques
  7. Bakar NS
    Drug Metab Pers Ther, 2021 Mar 19;36(3):173-181.
    PMID: 34412170 DOI: 10.1515/dmpt-2020-0153
    Compared to Europe, data on genetic variation in genes transcribing drug metabolizing enzymes among Asian is limited due to ethnic diversity. Here we compare frequencies for clinically relevant single nucleotide polymorphism (SNP) commonly observed in drug metabolizing enzymes between European and Malaysian/Singaporean. Minor allele frequencies (MAF) for the indicated SNPs for European, South Asian and East Asian populations were obtained from the NCBI website (https://www.ncbi.nlm.nih.gov/snp). The SNP prevalence among Malaysian/Singaporean was characterized from gene association studies. Generally, some SNPs in CYP2D6 and CYP2C19 do not show good agreement between the two populations as to the MAF value obtained. CYP2D6*4 tends to be more common among European, whereas CYP2D6*10 is more common in Malays and Chinese among Singaporean. Regardless of different phenotype, MAF of CYP2D6*4 for Indians is similar to that seen by the European. Singaporeans show smaller MAF for CYP2C19*17 but higher CYP2C19*2 frequencies as opposed to European ones. Following growing attention to the contribution of CYP3A4/5, N-acetyltransferases (NAT2), thiopurine methyltransferase (TPMT) and uridine diphosphate glucuronosyltransferases (UGT)2B7 in predicting drug response across Europe, there are limited pharmacogenetics (PGx) studies examining the gene-drug interaction among Malaysian/Singaporean. To better understand the heterogeneity of the drug response, PGx studies for the abovementioned enzymes between ethnics in Malaysian/Singaporean should be identified.
  8. Abd Aziz F, Ibrahim B, Murugaiyah V, Sarriff A
    Drug Metab Pers Ther, 2021 Mar 04;36(3):189-197.
    PMID: 34412173 DOI: 10.1515/dmpt-2020-0154
    OBJECTIVES: A database comprising multivariate data in developing a model from nuclear magnetic resonance (NMR) analysis using human bio fluids are necessary to have reproducibility and reliability of the data. To achieve reproducibility of the data, standardised experiments, including internal standard and preservative used should be attained, especially for samples such as human bio fluids to hinder the variation among samples. The aim of the study was to optimise in commonly used human bio fluids (serum and urine) for a suitable internal standard and preservative used in extended storage samples for NMR analysis.

    METHODS: Serum and urine samples were collected from healthy human subjects. The experiment was divided into two parts, part one to evaluate 2,2,2,2-tetradeutero-4,4-dimethyl-4-silapentanoic acid (TSP) and 4,4-dimethyl-4-silapentane-1-ammonium trifluoroacetate (DSA) as the optimal internal standard for the serum and urine samples. The second part investigated the effects of preservatives in the serum and urine samples on extended storage.

    RESULTS: Overall, TSP and DSA are suitable to be used as an internal standard in human urine samples. However, DSA is a superior internal standard in serum samples for NMR analysis. For the effect of preservative, the results indicated that human serum and urine samples could be stored without addition of preservative in -80 °C, as no changes in NMR fingerprinting have been observed during storage in the absence or presence of the preservative.

    CONCLUSIONS: The findings suggest the use of DSA and TSP as an internal standard in serum and urine samples, respectively. Storage of serum and urine samples without any addition of preservative for an extended period has no effect on the metabolites changes. By having a standardised method, it will offer a considerable saving in both operator and spectrometer time and most importantly produce reproducible and reliable data.

  9. VANITHA MARIAPPAN, KUMUTHA MALAR VELLASAMY
    Buletin Sains Kesihatan, 2021;5(1):47-52.
    MyJurnal
    Phosphatases are extracellular enzymes that catalyze the hydrolysis of phospho-ester bonds inorganic phosphate-containing substrates and release inorganic phosphate in the arrangement of orthophosphates that able to be consumed by organisms. In the current years, there has been a major escalation in the number of studies and publications focusing on alkaline phosphatases (ALPs). This expansion reveals more complexity of the functions of this enzyme. This review highlights multiple roles played particularly on ALP in relation to human health, aquaculture, bacteria, and mammals. Continuous research on this multifaceted enzyme will undeniably offer better insight into understanding the overall function in every living organism.
  10. HING HIANG LIAN, AHMAD ZORIN SAHALAN
    Buletin Sains Kesihatan, 2021;5(1):43-46.
    MyJurnal
    Elektron mikroskop digunakan untuk melihat tindakbalas bahan ekstrak air kantan atau Etilingera elatior akan mekanisma tindakbalasnya. Di dalam kajian ini kesan tindakbalas antibakteria bunga kantan telah di kaji. Pengimejan dari elektron mikroskop imbasan telah memberikan imej kerosakan pada permukaan bakteria yang disebabkan oleh ekstrak air kantan. Ekstrak kantan pada kepekatan 1.5mg/ml, merencat pertumbuhan bakteria S. aureus dan B.subtilis . Apa yang penting adalah kesan mekanisma tindakbalas ekstrak kantan yang menghasilkan kerosakan seperti lekukan pada bakteria Gram positif. Ini menunjukkan ekstrak air kantan sangat berkesan terhadap lapisan peptidoglikan pada permukaan Gram positif sehingga kerosakan ini menyebabkan kesan bakterisidal.
  11. MUHAMMAD IKRAM A. WAHAB, PRITHINA RAJENDRAN, SITI HAZIMAH AYU ISMAIN, ANIS NAJWA HARUN, NUR ‘AFIFAH NAJWA MOHD PAUZI, KHAIRATUL FARHANA MD RODZI, et al.
    Buletin Sains Kesihatan, 2021;5(1):36-42.
    MyJurnal
    This research was conducted to study the level of environmental literacy, attitude and behaviour of students in the Faculty of Health Sciences, UKM. A Google Form consisting of four sections: Demographic Information, Environmental Knowledge, Attitude, Practice and Challenges were distributed to students. Each section was scored based on the right answers given by the students. In this study, it was found that Nutritional Science Program students had the highest environmental knowledge, while Dietetics students practised the highest environmental attitude among the other courses. The second objective revealed a positive correlation r = 0.297; p < 0.05 between environmental knowledge and attitude among the students. However, this is a weak correlation, which means that students with higher levels of knowledge do not tend to have higher attitudes and vice versa. Students' main challenges to practice good environmental behaviour are lack of knowledge in the correct way of practising those behaviour. Poor legal enforcement is the second most reason why students take environmental issues for granted. Last but not least, the environmental challenges are directly proportional to the environmental attitude. In other words, when environmental challenges increase, the environmental attitude decreases. In conclusion, students' attitude towards the environment may always improve depending on their individual effort to contribute to a better environment.
  12. Edgar S, Ellis M, Abdul-Aziz NA, Goh KJ, Shahrizaila N, Kennerson ML, et al.
    Neurobiol Aging, 2021 12;108:200-206.
    PMID: 34404558 DOI: 10.1016/j.neurobiolaging.2021.07.008
    Recent studies have identified SOD1, FUS, TARDBP and C9orf72 as major ALS-related genes in both European and Asian populations. However, significant differences exist in the mutation frequencies of these genes between various ancestral backgrounds. This study aims to identify the frequency of mutations in the common causative ALS genes in a multi-ethnic Malaysian cohort. We screened 101 Malaysian ALS patients including 3 familial and 98 sporadic cases for mutations in the coding regions of SOD1, FUS, and TARDBP by Sanger sequencing. The C9orf72 hexanucleotide repeat expansion was screened using the repeat-primed polymerase chain reaction assay. Mutations were found in 5.9% (6 of 101) of patients including 3.0% (3 of 101) of patients with the previously reported SOD1 missense mutations (p.V48A and p.N87S) and 3.0% (3 of 101) of patients with the C9orf72 repeat expansion. No mutations were found in the FUS and TARDBP genes. This study is the first to report the mutation frequency in an ethnically diverse Malaysian ALS population and warrants further investigation to reveal novel genes and disease pathways.
  13. Tong CV, Ooi XY
    BMJ Case Rep, 2021 Aug 17;14(8).
    PMID: 34404673 DOI: 10.1136/bcr-2021-245610
    MeSH terms: Diagnosis, Differential; Humans
  14. Ng CF, Tan HJ, Remli R
    BMJ Case Rep, 2021 Aug 17;14(8).
    PMID: 34404676 DOI: 10.1136/bcr-2021-245878
    MeSH terms: Humans; Nails, Malformed*
  15. Tan JJ, Guyette JP, Miki K, Xiao L, Kaur G, Wu T, et al.
    Nat Commun, 2021 08 17;12(1):4997.
    PMID: 34404774 DOI: 10.1038/s41467-021-24921-z
    Epicardial formation is necessary for normal myocardial morphogenesis. Here, we show that differentiating hiPSC-derived lateral plate mesoderm with BMP4, RA and VEGF (BVR) can generate a premature form of epicardial cells (termed pre-epicardial cells, PECs) expressing WT1, TBX18, SEMA3D, and SCX within 7 days. BVR stimulation after Wnt inhibition of LPM demonstrates co-differentiation and spatial organization of PECs and cardiomyocytes (CMs) in a single 2D culture. Co-culture consolidates CMs into dense aggregates, which then form a connected beating syncytium with enhanced contractility and calcium handling; while PECs become more mature with significant upregulation of UPK1B, ITGA4, and ALDH1A2 expressions. Our study also demonstrates that PECs secrete IGF2 and stimulate CM proliferation in co-culture. Three-dimensional PEC-CM spheroid co-cultures form outer smooth muscle cell layers on cardiac micro-tissues with organized internal luminal structures. These characteristics suggest PECs could play a key role in enhancing tissue organization within engineered cardiac constructs in vitro.
    MeSH terms: Calcium/metabolism; Cell Aggregation/physiology*; Cell Differentiation; Humans; Insulin-Like Growth Factor II/metabolism; Mesoderm; Stem Cells; Genes, Wilms Tumor; Coculture Techniques*; T-Box Domain Proteins/metabolism; Myocytes, Cardiac/physiology*; Myocytes, Smooth Muscle; Semaphorins; Retinal Dehydrogenase/metabolism; Basic Helix-Loop-Helix Transcription Factors; Bone Morphogenetic Protein 4; Induced Pluripotent Stem Cells
  16. Abiodun EO, Alabdulatif A, Abiodun OI, Alawida M, Alabdulatif A, Alkhawaldeh RS
    Neural Comput Appl, 2021;33(22):15091-15118.
    PMID: 34404964 DOI: 10.1007/s00521-021-06406-8
    Specialized data preparation techniques, ranging from data cleaning, outlier detection, missing value imputation, feature selection (FS), amongst others, are procedures required to get the most out of data and, consequently, get the optimal performance of predictive models for classification tasks. FS is a vital and indispensable technique that enables the model to perform faster, eliminate noisy data, remove redundancy, reduce overfitting, improve precision and increase generalization on testing data. While conventional FS techniques have been leveraged for classification tasks in the past few decades, they fail to optimally reduce the high dimensionality of the feature space of texts, thus breeding inefficient predictive models. Emerging technologies such as the metaheuristics and hyper-heuristics optimization methods provide a new paradigm for FS due to their efficiency in improving the accuracy of classification, computational demands, storage, as well as functioning seamlessly in solving complex optimization problems with less time. However, little details are known on best practices for case-to-case usage of emerging FS methods. The literature continues to be engulfed with clear and unclear findings in leveraging effective methods, which, if not performed accurately, alters precision, real-world-use feasibility, and the predictive model's overall performance. This paper reviews the present state of FS with respect to metaheuristics and hyper-heuristic methods. Through a systematic literature review of over 200 articles, we set out the most recent findings and trends to enlighten analysts, practitioners and researchers in the field of data analytics seeking clarity in understanding and implementing effective FS optimization methods for improved text classification tasks.
  17. Kow RY, Nik Abdul Adel NA, Abdul Razak AH, Low CL, Awang MS
    Cureus, 2021 Jul;13(7):e16289.
    PMID: 34405060 DOI: 10.7759/cureus.16289
    Ascorbic acid (vitamin C) is an essential micronutrient that the human's body cannot synthesize endogenously. Scurvy, a disease of ascorbic acid deficiency, can manifest in a myriad of presentations. Due to its rarity in the modern world, scurvy is considered as a disease of the past. We present a paediatric case of scurvy with musculoskeletal manifestations as a result of picky eating behavior.  We report a previously healthy nine-year-old boy who presented with unexplained progressive bilateral lower limb generalized weakness and pain for two months. All initial biochemical and radiological investigations were unremarkable. Upon further history taking, he had severe picky eating behavior which raised the suspicion of scurvy. The diagnosis was confirmed with a serum ascorbic acid test. After ascorbic acid supplementation, his symptoms resolved immediately. Further food behavioral modification counselling to his family members helped to change his diet in a lasting way. As a result, he had no recurrence of symptoms. This case highlights the importance of having a high index of suspicion for an uncommon disease and emphasizes the need for a detailed dietary history upon patient's presentation.
  18. Devkota HR, Bhandari B, Adhikary P
    J Migr Health, 2021;3:100013.
    PMID: 34405181 DOI: 10.1016/j.jmh.2020.100013
    Background: Poor mental health and illness among the working population have serious socioeconomic and public health consequences for both the individual and society/country. With a dramatic increase in work migration over the past decades, there is recent concern about the health and wellbeing of migrant workers and their accessibility to healthcare services in destination countries. This study aimed to explore the mental health and wellbeing experiences of Nepali male returnee-migrants and non-migrant workers, and their perceptions about risk factors for poor health and health service accessibility.

    Methods: This qualitative study was conducted among Nepali migrant and non-migrant workers in February 2020. Four focus group discussions comprising 25 men and a total of 15 in-depth interviews were conducted with male non-migrant and returnee migrant workers from Gulf countries and Malaysia. The discussions and interviews were audio-recorded, transcribed, translated into English and analysed thematically.

    Result: Migrant workers reported a higher risk of developing adverse mental health conditions than non-migrant workers. In addition, fever, upper respiratory infection, abdominal pain, ulcer, and occupational injuries were common health problems among both migrant and non-migrant workers. Other major illnesses reported by the migrant workers were heat burns and rashes, snake-bites, dengue, malaria, gallstone, kidney failure, and sexually transmitted diseases, while non-migrants reported hypertension, diabetes, and heart diseases. Adverse living and working conditions including exploitation and abuse by employers, lack of privacy and congested accommodation, language barriers, long hours' hard physical work without breaks, and unhealthy lifestyles were the contributing factors to migrant workers' poor mental and physical health. Both migrant and non-migrants reported poor compliance of job conditions and labor protection by their employers such as application of safety measures at work, provision of insurance and healthcare facilities that affected for their wellbeing negatively. Family problems compounded by constant financial burdens and unmet expectations were the most important factors linked with migrant workers' poor mental health.

    Conclusion: Both migrant and non-migrant workers experienced poor mental and physical health, largely affected by their adverse living and working conditions, unmet familial and financial needs and unhealthy life styles. Greater compliance is needed by employers of work agreements and the promotion of labor rights for worker's health and safety. In addition, policy interventions to raise awareness about occupational health risks and effective safety training for all workers (migrant and non-migrant) are recommended.

  19. Mak J, Zimmerman C, Roberts B
    J Migr Health, 2021;4:100042.
    PMID: 34405192 DOI: 10.1016/j.jmh.2021.100042
    Labour migration has become a crucial livelihood strategy in settings where employment options are limited. Such opportunities come with potential benefits but also introduce stressors. This study explores migration-related stressors amongst returnee male Nepali international labour migrants. We conducted a qualitative study in Kathmandu amongst 42 returnee male international labour migrants. We explored migration decisions, processes, experiences in destination and on return. The participants worked in low- and semi-skilled jobs in Malaysia, Qatar, and Saudi Arabia. Men reported stressors representing five broad areas: workplace/employer, family, recruitment, environment and legal. Most belonged to the workplace/employer category such as exploitative practices of document confiscation, contract discrepancies and poor working conditions. Family stressors were often due to disagreements about whether to migrate, and once in destination, being absent during illness and death in the family. Recruitment stressors were linked to the migration process and costs. Environmental stressors included over-crowdedness and poor hygiene, and poor security at the accommodation and in the wider town. Legal stressors were related to the lack of documentation, and negative encounters with the local police. Multiple stressors were often experienced simultaneously or in succession. Male labour migrants from Nepal who had worked in various countries and job-sectors reported multiple types of stress. The majority of stressors belong to the workplace category, where migrants may have limited power to challenge problems with their employers. The cumulative effect of such experiences may negatively impact on migrants' wellbeing. Future research should explore migrants' ability to cope with the many stressors encountered.
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