Browse publications by year: 2023

  1. Tham YB, Ahmad Asnawi AW, Lau NS, Fauzi AM, Syed Abd Kadir SS, Liew PK, et al.
    Case Rep Oncol, 2023;16(1):827-836.
    PMID: 37933311 DOI: 10.1159/000531924
    Hepatosplenic T-cell lymphoma is a rare form of T-cell lymphoma that predominantly emerges from neoplastic proliferation of cytotoxic T cells of γ/δ T-cell receptor-expressing lymphocytes. Isochromosome 7q and trisomy 8 are the most prevalent chromosomal abnormalities associated with hepatosplenic T-cell lymphoma, and most patients have mutations in genes related to chromatin remodeling or the JAK/STAT system. Hepatosplenic T-cell lymphoma can mimic various infectious diseases, immunological conditions, and other malignancies. Patients usually present with nonspecific constitutional symptoms and spleen and liver enlargement, with variable degrees of cytopenia. The rarity of this disease, coupled with the lack of lymph node involvement that is usually seen in lymphomas, causes significant difficulty in diagnosis, which inevitably delays the initiation of treatment. Managing this lymphoma is arduous because of its late presentation and aggressive nature, frequently resulting in rapid progression in its clinical course and refractoriness to conventional chemotherapy. There is a lack of international guidelines for its treatment, and in most cases, treatment is guided by case series. Here, we highlight the clinicopathological features and management of hepatosplenic T-cell lymphoma over a 10-year span in a single hematology referral center and review the literature.
  2. Alam MK, Abutayyem H, Alotha SN, H Alsiyat BM, K Alanazi SH, Hammad Alrayes MH, et al.
    Cureus, 2023 Oct;15(10):e48054.
    PMID: 37933372 DOI: 10.7759/cureus.48054
    Due to the clear depiction of facial aesthetics and other craniofacial parameters, portraiture photography (PP) is becoming more and more necessary in modern clinical practice. The studies chosen for this review's inclusion looked at how PP affected the orthodontic treatment and diagnostic procedure on the subjects who were watched in the studies. Studies published within the last decade precisely from 2013 were searched for across major online databases after devising a proper search strategy. Multiple reviewers created a specific data extraction form that was used for the investigation, followed by the evaluation of bias and the variables found in each of the chosen papers. This form was meant for the assessment for various variables encountered in this study. According to the meta-analysis, using PP was related with a statistically significant decrease in the risk of orthodontic treatment and diagnostic modalities, with odds ratios (OR) of 0.52 with a 95% confidence interval (CI) of (0.28, 0.96), and a relative risk (RR) of 0.66 with a CI of (0.45, 0.96). In orthodontics, PP is an important tool that offers useful data for diagnosis, treatment planning, and tracking treatment success. To validate the results of studies like ours, a sizable evidence sample is required due to the limited number of trials that have been performed in this area.
  3. Ling MTM, Govindaraju K, Lokanathan Y, Abidin AZ, Ibrahim B
    Cell Biochem Funct, 2023 Dec;41(8):1044-1059.
    PMID: 37933415 DOI: 10.1002/cbf.3881
    Metabolic syndrome (MetS) represents a cluster of metabolic abnormalities. The prevalence of MetS has surged, transforming it into a pressing public health concern that could potentially affect around 20%-25% of the global population. As MetS continues its ascent, diverse interventions, pharmacological, nonpharmacological and combined have been deployed. Yet, a comprehensive remedy that fully eradicates MetS symptoms remains elusive, compounded by the risks of polypharmacy's emergence. Acknowledging the imperative to grasp MetS's intricate pathologies, deeper insights for future research and therapy optimisation become paramount. Conventional treatments often target specific syndrome elements. However, a novel approach emerges in mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) therapy, promising a holistic shift. MSC-EVs, tiny membranous vesicles secreted by mesenchymal stem cells, have garnered immense attention for their multifaceted bioactivity and regenerative potential. Their ability to modulate inflammation, enhance tissue repair and regulate metabolic pathways has prompted researchers to explore their therapeutic application in MetS. This review primarily aims to provide an overview of how MSC-EVs therapy can improve metabolic parameters in subjects with MetS disease and also introduce the usefulness of NMR spectroscopy in assessing the efficacy of MSC-EVs therapy for treating MetS.
  4. Yan MP, Wee CE, Yen KP, Stevens A, Wai LK
    Future Med Chem, 2023 Nov;15(21):1987-2009.
    PMID: 37933551 DOI: 10.4155/fmc-2023-0202
    G-quadruplexes (G4s) within the human genome have undergone extensive molecular investigation, with a strong focus on telomeres, gene promoters and repetitive regulatory sequences. G4s play central roles in regulating essential biological processes, including telomere maintenance, replication, transcription and translation. Targeting these molecular processes with G4-binding ligands holds substantial therapeutic potential in anticancer treatments and has also shown promise in treating neurological, skeletal and muscular disorders. The presence of G4s in bacterial and viral genomes also suggests that G4-binding ligands could be a critical tool in fighting infections. This review provides an overview of the progress and applications of G4-binding ligands, their proposed mechanisms of action, challenges faced and prospects for their utilization in anticancer treatments, neurological disorders and antiviral activities.
    MeSH terms: Humans; Ligands; Telomere; G-Quadruplexes*
  5. Zhu C, Liu G, Abdullah ALB, Han M, Jiang Q, Li Y
    Fish Shellfish Immunol, 2023 Dec;143:109207.
    PMID: 37923183 DOI: 10.1016/j.fsi.2023.109207
    Plastics are widely produced for industrial and domestic applications due to their unique properties, and studies on the toxic effects of nanoplastics (NPs) on aquatic animals are essential. In this study, we investigated the transcriptomic patterns of Litopenaeus vannamei after NPs exposure. We found that the lysosome pathway was activated when after NPs exposure, with up-regulated DEGs, including glucocerebrosidase (GBA), hexosaminidase A (HEXA), sphingomyelin phosphodiesterase-1 (SMPD1), and solute carrier family 17 member 5 (SLC17A5). In addition, the PI3K-Akt signaling pathway was strongly affected by NPs, and the upstream genes of PI3K-Akt, including epidermal growth factor receptor (EGFR), integrin subunit beta 1 (ITGB1) and heat shock protein 90 (HSP90) were up-regulation. Other genes involved in lipogenesis, such as sterol regulatory element binding transcription factor 1 (SREBP-1c), fatty acid synthase (FASN) and stearoyl-CoA desaturase (SCD-1), were down-regulated. However, the contents of triglycerides (TG) and total cholesterol (TCH) in L. vanname hepatopancreas were reduced, which indicated that the ingestion of NPs led to the disturbance of hepatic lipid metabolism. What more, NPs treatment of L. vannamei also caused oxidative stress. In addition, NPs can damage part of the tissue structure and affect the physiological function of shrimps. The results of this study provide valuable ecotoxicological data to improve the understanding of the biological fate and effects of nanoplastics in L. vannamei.
    MeSH terms: Animals; Polystyrenes; Phosphatidylinositol 3-Kinases/genetics; Hepatopancreas/metabolism; Proto-Oncogene Proteins c-akt/genetics; Transcriptome*
  6. Sadrkhanloo M, Paskeh MDA, Hashemi M, Raesi R, Bahonar A, Nakhaee Z, et al.
    Pathol Res Pract, 2023 Nov;251:154902.
    PMID: 37922723 DOI: 10.1016/j.prp.2023.154902
    Osteosarcoma (OS) is a malignant bone carcinoma that affects people in childhood and adulthood. The heterogeneous nature and chromosomal instability represent certain characteristics of OS cells. These cancer cells grow and migrate abnormally, making the prognosis undesirable for patients. Conventional and current treatments fail to completely eradicate tumor cells, so new therapeutics targeting genes may be considered. PI3K/Akt is a regulator of events such as growth, cell death, migration, and differentiation, and its expression changes during cancer progression. PTEN reduces PI3K/Akt expression, and its mutations and depletions have been reported in various tumors. Experimental evidence shows that there is upregulation of PI3K/Akt and downregulation of PTEN in OS. Increasing PTEN expression may suppress PI3K/Akt to minimize tumorigenesis. In addition, PI3K/Akt shows a positive association with growth, metastasis, EMT and metabolism of OS cells and inhibits apoptosis. Importantly, overexpression of PI3K/Akt causes drug resistance and radio-resistance and its level can be modulated by miRNAs, lncRNAs and circRNAs. Silencing PI3K/Akt by compounds and drugs can suppress OS. Here, we review in detail the function of the PTEN/PI3K/Akt in OS, revealing its biological function, function in tumor progression, resistance to therapy, and pharmacological significance.
    MeSH terms: Humans; Signal Transduction; Phosphatidylinositol 3-Kinases/metabolism; Cell Line, Tumor; Cell Proliferation/genetics; Proto-Oncogene Proteins c-akt/metabolism; PTEN Phosphohydrolase/genetics; PTEN Phosphohydrolase/metabolism; Carcinogenesis
  7. Juhan N, Zubairi YZ, Mahmood Zuhdi AS, Mohd Khalid Z
    BMJ Open, 2023 Nov 03;13(11):e066748.
    PMID: 37923353 DOI: 10.1136/bmjopen-2022-066748
    OBJECTIVES: Despite extensive advances in medical and surgical treatment, cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Identifying the significant predictors will help clinicians with the prognosis of the disease and patient management. This study aims to identify and interpret the dependence structure between the predictors and health outcomes of ST-elevation myocardial infarction (STEMI) male patients in Malaysian setting.

    DESIGN: Retrospective study.

    SETTING: Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry years 2006-2013, which consists of 18 hospitals across the country.

    PARTICIPANTS: 7180 male patients diagnosed with STEMI from the NCVD-ACS registry.

    PRIMARY AND SECONDARY OUTCOME MEASURES: A graphical model based on the Bayesian network (BN) approach has been considered. A bootstrap resampling approach was integrated into the structural learning algorithm to estimate probabilistic relations between the studied features that have the strongest influence and support.

    RESULTS: The relationships between 16 features in the domain of CVD were visualised. From the bootstrap resampling approach, out of 250, only 25 arcs are significant (strength value ≥0.85 and the direction value ≥0.50). Age group, Killip class and renal disease were classified as the key predictors in the BN model for male patients as they were the most influential variables directly connected to the outcome, which is the patient status. Widespread probabilistic associations between the key predictors and the remaining variables were observed in the network structure. High likelihood values are observed for patient status variable stated alive (93.8%), Killip class I on presentation (66.8%), patient younger than 65 (81.1%), smoker patient (77.2%) and ethnic Malay (59.2%). The BN model has been shown to have good predictive performance.

    CONCLUSIONS: The data visualisation analysis can be a powerful tool to understand the relationships between the CVD prognostic variables and can be useful to clinicians.

    MeSH terms: Bayes Theorem; Humans; Malaysia/epidemiology; Male; Registries; Retrospective Studies; Risk Factors; Percutaneous Coronary Intervention*
  8. Hamid H, Zulkifli K, Naimat F, Che Yaacob NL, Ng KW
    Curr Pharm Teach Learn, 2023 Dec;15(12):1017-1025.
    PMID: 37923639 DOI: 10.1016/j.cptl.2023.10.001
    INTRODUCTION: With the increasing prevalence of artificial intelligence (AI) technology, it is imperative to investigate its influence on education and the resulting impact on student learning outcomes. This includes exploring the potential application of AI in process-driven problem-based learning (PDPBL). This study aimed to investigate the perceptions of students towards the use of ChatGPT) build on GPT-3.5 in PDPBL in the Bachelor of Pharmacy program.

    METHODS: Eighteen students with prior experience in traditional PDPBL processes participated in the study, divided into three groups to perform PDPBL sessions with various triggers from pharmaceutical chemistry, pharmaceutics, and clinical pharmacy fields, while utilizing chat AI provided by ChatGPT to assist with data searching and problem-solving. Questionnaires were used to collect data on the impact of ChatGPT on students' satisfaction, engagement, participation, and learning experience during the PBL sessions.

    RESULTS: The survey revealed that ChatGPT improved group collaboration and engagement during PDPBL, while increasing motivation and encouraging more questions. Nevertheless, some students encountered difficulties understanding ChatGPT's information and questioned its reliability and credibility. Despite these challenges, most students saw ChatGPT's potential to eventually replace traditional information-seeking methods.

    CONCLUSIONS: The study suggests that ChatGPT has the potential to enhance PDPBL in pharmacy education. However, further research is needed to examine the validity and reliability of the information provided by ChatGPT, and its impact on a larger sample size.

    MeSH terms: Artificial Intelligence; Humans; Perception; Pharmacy Service, Hospital*; Students; Reproducibility of Results; Problem-Based Learning*
  9. Ong SQ, Isawasan P, Ngesom AMM, Shahar H, Lasim AM, Nair G
    Sci Rep, 2023 Nov 05;13(1):19129.
    PMID: 37926755 DOI: 10.1038/s41598-023-46342-2
    Machine learning algorithms (ML) are receiving a lot of attention in the development of predictive models for monitoring dengue transmission rates. Previous work has focused only on specific weather variables and algorithms, and there is still a need for a model that uses more variables and algorithms that have higher performance. In this study, we use vector indices and meteorological data as predictors to develop the ML models. We trained and validated seven ML algorithms, including an ensemble ML method, and compared their performance using the receiver operating characteristic (ROC) with the area under the curve (AUC), accuracy and F1 score. Our results show that an ensemble ML such as XG Boost, AdaBoost and Random Forest perform better than the logistics regression, Naïve Bayens, decision tree, and support vector machine (SVM), with XGBoost having the highest AUC, accuracy and F1 score. Analysis of the importance of the variables showed that the container index was the least important. By removing this variable, the ML models improved their performance by at least 6% in AUC and F1 score. Our result provides a framework for future studies on the use of predictive models in the development of an early warning system.
    MeSH terms: Machine Learning*; Algorithms; Humans; ROC Curve; Support Vector Machine
  10. Yeo HY, Liew AC, Chan SJ, Anwar M, Han CH, Marra CA
    Patient Prefer Adherence, 2023;17:2679-2706.
    PMID: 37927344 DOI: 10.2147/PPA.S432821
    OBJECTIVE: Conventionally, optimal treatment strategies for breast cancer have been largely determined by physicians, with a scant understanding of patients' treatment values and preferences. Incorporating patient preferences in the decision-making process for breast cancer treatment is gaining recognition and can potentially improve treatment outcomes and compliance. This scoping review aims to synthesize evidence on the key determinants that are most valued by breast cancer patients when deciding on their treatment options.

    METHODS: We searched three electronic databases (PubMed/MEDLINE, SCOPUS, and CINAHL Plus) utilizing a systematic scoping review method. Two reviewers independently screened, applied inclusion criteria, reviewed, and synthesized findings. A mixed-method narrative approach combining the inductive thematic analysis and content analysis methodologies was used to synthesize and summarize the findings.

    RESULTS: The review included 22 studies, leading to the conceptualization of 5 overarching themes and 17 sub-themes. Among these, the most frequently cited theme was treatment benefits, followed by treatment-related process, treatment-related risk, quality of life, and cost of treatment. Women with breast cancer highly value treatments that offer good effectiveness, prolong survival, prevent recurrence, and maintain quality of life. Patient concerns include treatment-related side effects, safety, the risk of secondary cancer, and direct or indirect out-of-pocket costs. Additionally, patients also consider treatment duration, mode of administration, physician recommendation, and treatment availability and accessibility when deciding on their preferred treatment.

    CONCLUSION: The evidence synthesized in this review offers insights into refining breast cancer treatment strategies to align more closely with patient values. Recognizing and integrating patient perspectives in breast cancer care could potentially lead to improved treatment outcomes, enhanced patient compliance, and more personalized care. Healthcare professionals are encouraged to incorporate these key determinants in their treatment decision-making processes, aiming to deliver a patient-centered care that aligns with the unique preferences and values of each patient.

  11. Afzal S, Abdul Manap AS, Attiq A, Albokhadaim I, Kandeel M, Alhojaily SM
    Front Pharmacol, 2023;14:1269581.
    PMID: 37927596 DOI: 10.3389/fphar.2023.1269581
    Increased production and buildup of reactive oxygen species (ROS) can lead to various health issues, including metabolic problems, cancers, and neurological conditions. Our bodies counteract ROS with biological antioxidants such as SOD, CAT, and GPx, which help prevent cellular damage. However, if there is an imbalance between ROS and these antioxidants, it can result in oxidative stress. This can cause genetic and epigenetic changes at the molecular level. This review delves into how ROS plays a role in disorders caused by oxidative stress. We also look at animal models used for researching ROS pathways. This study offers insights into the mechanism, pathology, epigenetic changes, and animal models to assist in drug development and disease understanding.
  12. Fuad M, Goh BS, Lokman FL, Mohamad Yunus MR
    Cureus, 2023 Oct;15(10):e46415.
    PMID: 37927667 DOI: 10.7759/cureus.46415
    Parotid lymphangioma is a benign lymphatic malformation commonly observed in infancy or early childhood. It often grows insidiously and presents as a painless, soft fluctuant mass. We report a case of an eight-year-old boy who was diagnosed from another center with right parotid lymphangioma of one-year duration. He presented with right painful preauricular swelling and trismus for nine days after a recent history of blunt trauma to the preauricular caused an acute expansion of the swelling and subsequently, the patient developed ipsilateral facial nerve palsy. Examination showed right preauricular swelling measuring about 6 x 6 cm that extended posteriorly until the mastoid region, superiorly until the zygoma, and inferiorly until the angle of the mandible, pushing the ear lobule anteromedially. There was bluish discoloration of the overlying skin. The swelling was warm and tender on palpation. Multiple shotty lymph nodes were palpable at the posterior triangle. Aspiration of the swelling revealed blood content, but it reaccumulated after a few hours. A magnetic resonance imaging (MRI) of the neck showed a lesion confined within the parotid gland. There was a presence of air-fluid level with dependent layers of hyperintense on the T1-weighted image (T1WI) and T2-weighted image (T2WI) with clumps of isointensity on T1WI, which are hypointense on T2WI, which is suggestive of acute-late subacute blood product. A diagnosis of lymphatic malformation complicated with hemorrhage was made. Hence, the patient underwent surgery for the evacuation of blood clot and right superficial parotidectomy. Histopathological examination of the intraoperative tissue biopsy revealed evidence of venolymphatic malformation of the parotid gland. Postoperatively, he was discharged home after three days. The facial nerve function recovered from House and Brackmann grade II to grade I three weeks after the surgery.
  13. Jimi N, Nakajima H, Sato T, Gonzalez BC, Woo SP, Rouse GW, et al.
    PeerJ, 2023;11:e16346.
    PMID: 37927790 DOI: 10.7717/peerj.16346
    Two new species of Hesionidae, Parahesione pulvinata sp. nov. and Parahesione apiculata sp. nov. are described based on materials collected at tidal flats in Okinawa (Japan) from burrows of the ghost shrimps Neocallichirus jousseaumei and Glypturus armatus. The two new species are characterized by having eight enlarged cirri, dorsal cirrophores with dorsal foliose lobe and biramous parapodia, and by lacking median antenna. Parahesione apiculata sp. nov. has digitate lobes on the posterior margin of the dorsal foliose lobe (absent in P. pulvinata sp. nov.). The two new species were never found outside the ghost shrimp burrows, suggesting they are obligate symbionts. Phylogenetic analyses based on four concatenated genes suggest that the symbiotic lifestyle has evolved several times in Hesionidae.
    MeSH terms: Animals; Animal Structures; Annelida*; Phylogeny; Polychaeta*; Decapoda (Crustacea)*; Animal Distribution
  14. Agarwal A, Subramaniam G, Khattak O, Begum G, Taha A, Bayomy NA, et al.
    PeerJ, 2023;11:e16184.
    PMID: 37927799 DOI: 10.7717/peerj.16184
    BACKGROUND: The incidence and aftermath of the COVID-19 pandemic brought about a drastic change in health professional education around the world. Traditional classrooms made way for online classrooms in order to ensure that learning continued in a safe and secure environment. However, how well health professional students perceived and accepted these changes have not been fully gauged yet. Therefore, this study aims to evaluate the perception of health professional students about their new educational climate.

    METHODS: A modified and validated Dundee Ready Education Environment Measure (DREEM) questionnaire was used to collect data regarding student perception of their educational environment.

    RESULTS: The mean DREEM scores for three time periods were in the accepted positive range of 101 to 150 indicating that most of the students perceived the changes positively. The results indicated that most students preferred blended learning over online learning or face-to-face learning alone. Areas where students were unsatisfied with their learning environment that need improvement were identified by poor item-wise scores.

    CONCLUSION: Strategic remedial measures for these concerns need to be developed to improve the quality of education received by the students. However, the results of our study indicated that most of the students were able to adapt positively to the new education environment due to the change in the circumstances during COVID.

    MeSH terms: Humans; Learning; Perception; Students, Medical*; Pandemics/prevention & control
  15. Al-Tahitah A, Al-Awlaqi MA, Habtoor N, Thabet SS, Abdulrab M, Ibrahim I
    Heliyon, 2023 Nov;9(11):e21178.
    PMID: 37928031 DOI: 10.1016/j.heliyon.2023.e21178
    This study seeks to understand and explore how women social entrepreneurs select their employees and how this can affect their social impact. This study has two objectives. The first is to explore the most attractive employees' employability characteristics chosen by women entrepreneurs. The second objective was to explore the relationship between employability characteristics and the social impact of the social enterprises. This study used an exploratory quantitative paradigm to reach the study's findings. Multiple correspondence analysis (MCA) explores employability characteristics the women social entrepreneurs select and the relationship between the selected employability characteristics and the social impact of the women's social enterprises. The data were collected using a cross-sectional questionnaire. Data were collected from 382 employees working in 174 female social enterprises. Women social entrepreneurs were found to prefer employees with high interpersonal skills, high ethics, high physical abilities, high abilities to learn, high implicit knowledge, high reliability, and low soft skills. Linking these employability skills to social impact revealed that implicit knowledge and interpersonal skills are the most influential. A paucity of research discusses how women social entrepreneurs recruit their employees. This problem is getting worse when it comes to small social enterprises. This study led to a discussion about employability characteristics in women's social enterprises and their impact on social impact.
  16. Xu G, Li Z, Chen Z, Lee SY, Kong X
    Mitochondrial DNA B Resour, 2023;8(10):1137-1140.
    PMID: 37928400 DOI: 10.1080/23802359.2023.2270207
    Oreocharis argyreia var. angustifolia of Gesneriaceae is widely distributed in South China, including Guangdong, Guangxi, Hunan, and Jiangxi provinces. However, genetic information of this species is limited, further contributing to the taxonomic complications surrounding this species. Thus, in this study, we assembled and characterized the complete chloroplast genome of O. argyreia var. angustifolia as a genomic resource for future studies. The complete plastid genome was 154,675 bp in size, with a pair of inverted repeat regions of 25,329 bp each, separating the 85,977-bp large and 18,040-bp small single copy regions. A total of 131 genes were predicted, consisting of 86 protein-coding, 37 tRNA, and eight rRNA genes. The overall GC content was 37.6%. Phylogenetic analysis based on 79 shared unique CDS resulted in a fully resolved phylogenetic tree using both the maximum likelihood and Bayesian inference methods. Based on current circumscription, both methods indicated that Oreocharis is monophyletic; O. argyreia var. angustifolia diverged after O. chienii, which then followed by the divergence of the other three species included namely, O. continifolia, O. esquirolii, and O. mileensis. The genomic data obtained will be useful for future studies on the phylogenetics and evolution of Gesneriaceae.
  17. Guraya SS, Harkin DW, Yusoff MSB, Guraya SY
    Front Med (Lausanne), 2023;10:1230620.
    PMID: 37928467 DOI: 10.3389/fmed.2023.1230620
    In order to ensure a strong research design, literature stresses the adoption of a research paradigm that is consistent with the researcher's beliefs about the nature of reality. In this article we provide an overview of research paradigm choices in relation to the creation of a Medical Education e-Professionalism (MEeP) framework discussing the research design, research methods, data collection and analysis to enhance the transparency of our previously published research. The MEeP framework was conceived to help Health Care Professionals (HCPs) safeguard the construct of professionalism in the digital context. This entire process was heavily informed by wider readings and deliberations of published literature on e-professionalism. Although the MEeP framework research journey has been published, the paradigms approach was not discussed in any detail. Considering that one of the duties of medical educator is to balance the service and science by bringing the theoretical underpinnings of one's research to public attention and scrutiny so as to nullify the notion of 'weak' research. We were compelled to unfold this paradigm story of the MEeP framework in a detailed manner. In an effort to make our research both robust and effective, this study portrays a philosophical approach to guide future research designs and methodological choices by detailing our rationale for pragmatism as a choice of paradigm.
  18. Zhou W, Zhan Y, Jawing E
    Front Psychol, 2023;14:1290034.
    PMID: 37928571 DOI: 10.3389/fpsyg.2023.1290034
    In second language and foreign language learning, demotivation in learning is a common occurrence. Almost all previous studies on learners' demotivation focused on traditional classroom learning environment rather than blended learning setting. This paper investigates learner perceptions of demotivating factors for Chinese EFL college students in blended learning context. 272 college sophomores with varied majors from a university in Mid-East China took part in a questionnaire survey. The questionnaire, consisted of 34 4-point Likert type items about learners' demotivation in a blended EFL learning environment, was adapted from Kikuchi's demotivation questionnaire and Xie's LPDS (Learner Perceptions of Demotivator Scale). An exploratory factor analysis was performed to explore the factor structure of the questionnaire items. Then mean scores of items loading on each factor were calculated and independent samples t-test analysis was adopted to examine the differences of demotivating factors between different groups of participants. Five demotivating factors from the questionnaire were extracted. The findings reveal a newly discovered factor: learners' lack of self-discipline in online learning. The paper indicates that there is no significant difference of these five demotivating factors between male and female learners, and between rural and urban learners. Whereas less motivated learners perceive four among the five factors to be more demotivating than more motivated learners.
  19. Haron MZ, Rohana AJ, Hamid NAA, Omar MA, Abdullah NH
    Malays J Med Sci, 2023 Oct;30(5):155-168.
    PMID: 37928780 DOI: 10.21315/mjms2023.30.5.13
    BACKGROUND: Child malnutrition problems still occur in Malaysia, particularly stunting. This study aimed to determine the proportion of stunting among children below 5 years old and investigate the factors associated with stunting on the East Coast of Peninsular Malaysia.

    METHODS: This study utilised data from the 2016 National Health and Morbidity Survey (NHMS). Multiple logistic regression was used to determine the factors associated with malnutrition among non-stunted and stunted children.

    RESULTS: The proportion of stunting among children below 5 years old in this East Coast region was 26.2%. When divided by state, Kelantan had the highest proportion of stunting, followed by Pahang and Terengganu, at 28.8%, 26.2% and 23.4%, respectively. In this study, the factors associated with stunting were children aged 24 months old-59 months old (adjusted odds ratio [aOR]: 1.52; 95% CI: 1.26, 1.83; P < 0.001), male children (aOR: 1.47; 95% CI: 1.23, 1.76; P < 0.001), Orang Asli children (aOR: 2.84; 95% CI: 1.86, 4.32; P < 0.001), children with low birth weight from 1,500 g to 2,499 g (aOR: 1.86; 95% CI: 1.36, 2.55; P < 0.001) and children from households that practice unsanitary waste disposal (aOR: 1.42; 95% CI: 1.16, 1.74; P = 0.001).

    CONCLUSION: Stunting among children under the age of 5 years old on the East Coast of Peninsular Malaysia remains a public health problem. To reduce the prevalence of stunting in this region, intervention programmes should be intensified. Emphasis should be placed on public health programmes that target the associated factors, such as dietary habits, Orang Asli children, low birth weight and unsanitary waste disposal.

  20. Ab Hakimee NI, Atan A, Sutantri S, Lee SP
    Malays J Med Sci, 2023 Oct;30(5):181-191.
    PMID: 37928781 DOI: 10.21315/mjms2023.30.5.15
    BACKGROUND: The unique nature of adolescence makes youths highly susceptible to high-risk behaviours. Thus, prevention and health promotion are imperative for this influential age. Despite various approaches towards health promotion, knowledge related to adolescent health is still low among Malaysian adolescents. This study aims to investigate adolescent health information-seeking behaviours related to high-risk behaviours.

    METHODS: A cross-sectional study was conducted among 370 adolescents aged 10 years old-19 years old throughout Malaysia. The questionnaire used was adapted from a previous study and the pilot study resulted in Cronbach's alpha of 0.85. IBM SPSS Statistics version 25.0 software was used for data analysis at two statistical levels: descriptive and inferential (Mann-Whitney U test).

    RESULT: The most important health information needs related to high-risk behaviour according to the adolescents were 'violence' (3.72 score out of 5), 'sexual activity-related disease' (3.64 score out of 5) and 'physical activity and effect of lack in physical activity' (3.61 score out of 5). 'Physician' (4.01 score out of 5) and 'the internet' (3.95 score out of 5) were the most important sources for obtaining health information related to high-risk behaviours. The main criterion for the quality of health information was the 'validity and reliability of the information' (4.55 score out of 5). The findings indicate that adolescents have a positive attitude towards health information-seeking behaviour, although slight differences between boys and girls are exhibited. The most common barrier to health information seeking experienced by adolescents is 'difficulty in determining the quality of information found'.

    CONCLUSION: Adolescents tend to use professional and informal sources, have good criteria in the selection of information and have a considerably high interest in seeking health information related to high-risk behaviour.

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