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  1. THE SUNGEI BULOH LEPROSARIUM
    JOHN JC
    Indian J Dermatol, 1965 Jan;10:62-4.
    PMID: 14266440
  2. Fulltext Hepatitis A virus: declining seroprevalence in children and adolescents in Southeast Asia
    Kunasol P, Cooksley G, Chan VF, Isahak I, John J, Loleka S, et al.
    Southeast Asian J. Trop. Med. Public Health, 1998 Jun;29(2):255-62.
    PMID: 9886108
    The prevalence of hepatitis A virus (HAV) in a country largely reflects its standards of hygiene and socioeconomic conditions. Countries which undergo socioeconomic development show major change in HAV prevalence from high to low endemicity, and this is largely reflected in patterns of age-related seroprevalence. This paper presents age-related HAV seroprevalence patterns of SE Asian countries, and highlights how these patterns have changed over recent decades. Singapore, Thailand and Malaysia have experienced a decline in childhood and adolescent HAV seroprevalence, typical of countries which undergo socioeconomic development. By contrast, India has remained a country of high endemicity, with almost universal seroconversion in childhood. The Philippines and Vietnam show age-related seroprevalence patterns typical of high to moderate endemicity, while Indonesia shows significant regional variation in HAV seroprevalence. Populations within countries which exhibit major improvements in endemicity and age related HAV seroprevalence patterns are at risk of HAV epidemics, and a paradoxical increase in incidence tends to occur as seroconversion shifts from children to adults. The residents of these countries, a significant number of whom are at-risk, would benefit from a program of vaccination, as would non-infected individuals visiting high-risk areas.
  3. A review of Hib epidemiology in Asia
    Lolekha S, Cooksley G, Chan V, Isahak I, Ismael S, John J, et al.
    Southeast Asian J. Trop. Med. Public Health, 2000 Dec;31(4):650-7.
    PMID: 11414406
    Meningitis due to an invasive Haemophilus influenzae type b (Hib) infection, has been previously perceived to be relatively uncommon in Asia. However, the incidence of disease and its impact may have been underestimated. In addition to a lack of microbiological facilities in some hospitals, difficulties in culturing the organism and the widespread use of antibiotics may have hidden the true incidence of the disease in some countries. Furthermore, the reported disease burden probably underestimates the incidence of Hib pneumonia. The epidemiology of invasive Hib disease for various Asian nations is reviewed in this paper. Hospital-based studies show that Hib is a major cause of bacterial meningitis and/or pneumonia in the Philippines, India, Thailand, Malaysia, Indonesia and Vietnam. Singapore and Hong Kong have a low incidence of infection compared with Western and other Asian nations. This low incidence is not due to a higher level of natural protective antibodies, but may be related to an interaction between environmental and genetic factors. Therefore the widespread belief that Hib infection is unimportant in Asia does not refer to Asia as a whole and possibly to Chinese patients only, and failure to recognize this has serious implications. The inclusion of Hib vaccine in the routine infant immunization schedule in many industrialized nations has significantly reduced the incidence of invasive disease. Recent studies have shown Hib vaccination is also effective in preventing invasive disease in children in developing countries. While population-based data may be required to confirm the need for public-funded infant Hib immunization in Asia, its introduction in countries with a high incidence of Hib meningitis and/or pneumonia has the potential to significantly improve pediatric health and survival.
  4. Fulltext Oral health care in the elderly population in Malaysia--a review
    John J, Mani SA, Azizah Y
    Med J Malaysia, 2004 Aug;59(3):433-9.
    PMID: 15727396
    One of the undeniable facts about living is that everyday we are getting older. By 2050, it is projected that one out of every five Malaysians will be 60 or older. The economic challenge of this demographic change will affect development and the financial implications of sustaining well being of this group are formidable and complex. This population group has extensive oral disease, medical problems that complicate their oral care, and unique dental treatment challenges. The authors discuss the problem of oral healthcare among the aged, its impediments and propose some approaches for improvement to better serve the needs of this group of vulnerable members of our nation.
  5. Fulltext Helminth infections in small mammals from Ulu Gombak Forest Reserve and the risk to human health
    Paramasvaran S, Krishnasamy M, Lee HL, John J, Lokman H, Naseem BM, et al.
    Trop Biomed, 2005 Dec;22(2):191-4.
    PMID: 16883287 MyJurnal
    A survey for small mammal parasites carried out in a secondary forest of Ulu Gombak, Selangor, Peninsula Malaysia yielded the following animals: Rattus bowersi (7), Rattus tiomanicus jalorensis (2), Maxomys rajah (12), Maxoyms whiteheadi (3), Leopoldamys sabanus(13), Sundamys muelleri(10), Lariscus insignis (1), Sundasciurus tenuis (1) and Tupaia glis (2). The following nematodes: Capillaria hepatica, Hepatojarakus malayae, Trichostrongylus sp. and Streptopharagus sp., the following cestodes: Hymenolepis sp., Raillietina sp. and Taenia taeniaformis; and trematode, Zonorchis sp. from Tupaia glis were recovered. No parasites were observed during blood examination. No endoparasite was seen in Maxomys whiteheadi, Lariscus insignis and Sundasciurus tenuis. The following parasites, Capillaria hepatica, Hymenolepis sp., Raillietina sp. and Taenia taeniaformis are considered of medical importance.
  6. Fulltext On the predation of fly, Chrysomya rufifacies (Macquart) by a spider, Oxyopes sp. Latreille (Oxyopidae)
    Heo CC, Mohamad AM, John J, Baharudin O
    Trop Biomed, 2008 Apr;25(1):93-5.
    PMID: 18600210 MyJurnal
    During a forensic entomological study conducted in a palm oil plantation in Tg.Sepat, Selangor in September 2007, a spider (Arachnida), Oxyopes sp. (Oxyopidae) was found to predate on a calliphorid fly (Chrysomya rufifacies). The female spider laid a silk thread, or "drag line", behind it as it moved. This spider bites its prey by using a pairs of chelicerae, and injecting venom into the fly. The fly was moving its wing trying to escape, however, it succumbed to the deadly bite.
  7. Fulltext Insect succession on a decomposing piglet carcass placed in a man-made freshwater pond in Malaysia
    Heo CC, Mohamad AM, John J, Baharudin O
    Trop Biomed, 2008 Apr;25(1):23-9.
    PMID: 18600201
    This entomological study was conducted in a man-made freshwater pond in a palm oil plantation in Tanjung Sepat, Selangor from 23 July 2007 by using pig (Sus scrofa) as a carcass model. A 1.5 month old piglet (5 kg), which died of asphyxia after being accidentally crushed by its mother, was thrown into a pond. Observation was made for ten days; one visit per day and climatological data were recorded. On the first two days, the piglet carcass sunk to the bottom of the pond. The carcass floated to the surface on the third day but no fly activities were seen. The blow fly, Chrysomya megacephala and Chrysomya rufifacies started to oviposit on the fourth day. Other than adult flies, a spider (Arachnida) was also observed on the carcass. Bubbles accumulated at the mouthpart, and the abdomen was greenish black. A lot of blow fly eggs were seen on the body surface on the fifth day (floating decay), along with first and second instars C. megacephala crawling under the piglet's skin. On the sixth day, adult blow fly, C. megacephala,and C. rufifacies,and muscid flies, Ophyra spinigera and Musca domestica were observed on to the carcass. High numbers of first and second instars of flies were observed wandering around the body surface with C. megacephala larvae being the predominant species. Two prominent maggot masses occurred on seventh and eighth days. Bloated deterioration stage began on day eighth exposing rib bones, humerus bones and intestines. Carcass was partially sinking and the maggot masses were at the water level. On day ninth, the carcass was partially sinking and three maggot masses were observed on the exposed surface. There were very few adult flies, including a scarab beetle was sighted on the carcass at this stage. The carcass along with the maggots sunk on day tenth, leaving an oily layer on the water surface.
  8. Comparison of two methods of dental age estimation in 7-15-year-old Malays
    Mani SA, Naing L, John J, Samsudin AR
    Int J Paediatr Dent, 2008 Sep;18(5):380-8.
    PMID: 18284472 DOI: 10.1111/j.1365-263X.2007.00890.x
    BACKGROUND: Numerous methods of age estimation have been proposed. The Demirjian method is the most frequently used, which was first applied in a French Canadian population in 1973. The Willems method is a modification of the above and was applied in a Belgian population in 2002.
    OBJECTIVES: The objectives of this study were to test the applicability of the two methods, namely Demirjian and Willems, for age estimation in a Malay population, and to find the correlation between body mass index and the difference between the dental age and the chronological age.
    MATERIALS AND METHODS: A cross-sectional study involving 214 boys and 214 girls, selected by a simple stratified random sampling method was carried out. The orthopantomograph was used to score the seven left mandibular teeth, and the calculated maturity score was used to obtain the Demirjian dental age. Willems dental age was estimated using the tables proposed in the Willems method. Results. The Demirjian method overestimated the age by 0.75 and 0.61 years, while the Willems method overestimated the age by 0.55 and 0.41 years among boys and girls, respectively. In boys, the body mass index was significantly correlated to the difference in age using the Willems method.
    CONCLUSION: Further modification of either method is indicated for dental age estimation among the Malay population.
  9. Fulltext Endo-parasite fauna of rodents caught in five wet markets in Kuala Lumpur and its potential zoonotic implications
    Paramasvaran S, Sani RA, Hassan L, Hanjeet K, Krishnasamy M, John J, et al.
    Trop Biomed, 2009 Apr;26(1):67-72.
    PMID: 19696729
    Rodents were collected from five wet markets (Chow Kit, Dato Keramat, Setapak, Jinjang and Kepong) in Kuala Lumpur, Federal Territory between March to April 2006. Ninety seven rats were trapped using wire traps measuring 29 x 22 x 50 cm baited with fruits, coconuts, dried fish or sweet potatoes. A total of 17 different species of parasites were identified from three species of rats out of which 11 (65%) were identified to be zoonotic. The helminths identified from the urban rats were nematodes- Capillaria hepatica, Gongylonema neoplasticum, Heterakis spumosa, Heterakis sp., Masterphorus muris, Nippostrongylus brasiliensis, Physolaptera sp., Pterogodermatis sp., Rictularia tani and Syphacia muris; cestodes- Hymenolepis nana, Hymenolepis diminuta, Hymenolepis sabnema, Hymenolepis sp., Raillietina sp. and Taenia taeniaeformis, and acanthocephalan- Moniliformis moniliformis. The following parasites are of potential medical importance: C. hepatica, G. neoplasticum, R. tani, S. muris, H. diminuta, H. nana, Raillietina sp. and T. taeniaeformis.
  10. Fulltext Ants (Hymenoptera: Formicidae) associated with pig carcasses in Malaysia
    Heo CC, Mohamad AR, Rosli H, Nurul Ashikin A, Chen CD, John J, et al.
    Trop Biomed, 2009 Apr;26(1):106-9.
    PMID: 19696735
    An observational study was conducted in an oil palm plantation in Tanjung Sepat, Selangor, Malaysia on August until September 2007 to note the decomposition process of pigs and their related faunal succession. We collected six species of ants (Formicidae) from 3 subfamilies: Formicinae (Oecophylla smaragdina and Anoplolepis gracilipes), Myrmicinae (Tetramorium sp. and Pheidologeton sp.) and Ponerinae (Odontoponera sp. and Diacamma sp.) that were associated with pig carcasses placed on the ground. Oecophylla smaragdina, Pheidologeton sp. and Tetramorium sp. were found on a partially burnt pig carcass whereas the other species were recovered from unburned pig carcass. These ants predated on fly eggs, larvae, pupae and adults. Ants could be found at all stages of decomposition starting from fresh until dry stage. Predatory ants can reduce fly population and thus may affect the rate of carcass decomposition but this was not seen in our study. Even though O. smaragdina was seen at all stages of decomposition of the burnt pig, this did not alter much the decomposition process by fly larvae.
  11. Fulltext Knowledge, attitude and practice of oral health promoting factors among caretakers of children attending day-care centers in Kubang Kerian, Malaysia: a preliminary study
    Mani SA, Aziz AA, John J, Ismail NM
    J Indian Soc Pedod Prev Dent, 2010 Apr-Jun;28(2):78-83.
    PMID: 20660972 DOI: 10.4103/0970-4388.66741
    The role of caretakers at day-care centers has become more imperative in promoting oral health care in children since many new mothers opt to work outside their homes, leaving their children at day-care centers. The aim of this study is to assess the knowledge, attitude and practice of oral health promoting factors among secondary caretakers of children attending day-care centers.
  12. Randomized controlled trial of a good practice approach to treatment of childhood obesity in Malaysia: Malaysian Childhood Obesity Treatment Trial (MASCOT)
    Wafa SW, Talib RA, Hamzaid NH, McColl JH, Rajikan R, Ng LO, et al.
    Int J Pediatr Obes, 2011 Jun;6(2-2):e62-9.
    PMID: 21604965 DOI: 10.3109/17477166.2011.566340
    CONTEXT: Few randomized controlled trials (RCTs) of interventions for the treatment of childhood obesity have taken place outside the Western world.
    AIM: To test whether a good practice intervention for the treatment of childhood obesity would have a greater impact on weight status and other outcomes than a control condition in Kuala Lumpur, Malaysia.
    METHODS: Assessor-blinded RCT of a treatment intervention in 107 obese 7- to 11-year olds. The intervention was relatively low intensity (8 hours contact over 26 weeks, group based), aiming to change child sedentary behavior, physical activity, and diet using behavior change counselling. Outcomes were measured at baseline and six months after the start of the intervention. Primary outcome was BMI z-score, other outcomes were weight change, health-related quality of life (Peds QL), objectively measured physical activity and sedentary behavior (Actigraph accelerometry over 5 days).
    RESULTS: The intervention had no significant effect on BMI z score relative to control. Weight gain was reduced significantly in the intervention group compared to the control group (+1.5 kg vs. +3.5 kg, respectively, t-test p < 0.01). Changes in health-related quality of life and objectively measured physical activity and sedentary behavior favored the intervention group.
    CONCLUSIONS: Treatment was associated with reduced rate of weight gain, and improvements in physical activity and quality of life. More substantial benefits may require longer term and more intensive interventions which aim for more substantive lifestyle changes.
  13. Measuring service quality of public dental health care facilities in Kelantan, Malaysia
    John J, Yatim FM, Mani SA
    Asia Pac J Public Health, 2011 Sep;23(5):742-53.
    PMID: 20460281 DOI: 10.1177/1010539509357341
    This study investigates patients' expectations and perceptions of service quality in public dental health care and measures their "satisfaction gap." This descriptive study involved 481 dental outpatients in Kelantan, Malaysia. A modified SERVQUAL 20-item instrument was used to assess patients' expectations before and perceptions after receiving dental treatment. The "satisfaction gap" was then measured.
    RESULTS: showed that patients visiting for management of dental pain were more satisfied (P = .007) than those visiting with appointment. The most significant service quality dimensions were related to responsiveness, assurance, and empathy of the dental health care providers. There was a significant difference between the patients' expectations and their perceptions of service provided (P < .01) with regard to all dimensions. In conclusion, dental service providers should give emphasis to the compassionate and emotional aspects of care and to remember that they are integral components of quality service.
  14. Quality of life of obese children in Malaysia
    Hamzaid H, Talib RA, Azizi NH, Maamor N, Reilly JJ, Wafa SW
    Int J Pediatr Obes, 2011 Oct;6(5-6):450-4.
    PMID: 21767214 DOI: 10.3109/17477166.2011.590206
    BACKGROUND:Quality of life (QoL) is impaired in childhood obesity, but the literature on this is all from Western countries. Aim. To test for impairment of QoL in obese children in Malaysia, using parent-reported and child-reported QoL.
    METHODS:Health-related Quality of Life was measured using the Paediatric Quality of Life Inventory version 4.0. Comparison of QoL between a community sample of 90 obese children (as defined by US CDC and Cole-IOTF definitions), median age 9.5 y (interquartile range [IQR] 8.6, 10.5 y) and 90 control children of healthy weight (BMI less than the 85th centile of US reference data), median age 10.0 y (IQR 9.6, 10.5 y). Children were matched pair-wise for age, gender, and ethnic group, and controls were recruited from schools in the same area as obese participants.
    RESULTS:For child self-report, the healthy weight group had significantly higher QoL for the physical (median 82.9, IQR 65.7, 90.6), and psychosocial domains (median, 73.3, IQR 64.4, 83.3), and total QoL (median 76.1, IQR 64.1, 84.8) compared to the obese group (median 67.2, IQR 59.4, 81.3; median 62.5, IQR 53.3, 75.4; median 60.9, IQR 50.8, 73.9; all p < 0.001). There were no significant differences between the obese and healthy weight group for parent-reported physical health, psychosocial health, or total QoL.
    CONCLUSION:Obese children in Malaysia have markedly poorer QoL than their peers, but this is not evident when parent reports of QoL are used.
    Study name: Malaysian Childhood Obesity Treatment Trial (MASCOT)
    Study site: Two primary schools, Kuala Lumpur, Malaysia
  15. Malaysian undergraduates' knowledge and opinions on Early Childhood oral health
    Mani SA, Burhanudin NA, John J
    Eur J Paediatr Dent, 2012 Mar;13(1):64-8.
    PMID: 22455531
    AIM: In Malaysia, Early Childhood Caries (ECC) was found to affect 76.2% of 5-year-olds (2005). General practitioners are more likely to encounter preschool children and are in a better position to educate parents and caretakers about ECC and make appropriate referrals. This study assessed the knowledge and opinions on early childhood oral health among medical and dental undergraduates.

    MATERIALS AND METHODS: This cross sectional study involved 245 students enrolled in the first year medical (M1) and dental (D1) course and fourth year medical (M4) and dental (D4) course. The students completed a self-administered questionnaire which included knowledge and opinions on early childhood oral health. Comparisons between the groups were done using chi-square test.

    RESULTS: Dental students showed significantly better knowledge than medical students. D1 students showed significantly better knowledge of age of first tooth eruption over M1. Knowledge of recommended age for bottle weaning was higher among D4 students but not significantly more than M4 students.

    CONCLUSION: The majority of medical students showed inadequate knowledge indicating that medical curriculum should emphasise on oral health topics of public health relevance like ECC and its prevention. Dental students had better knowledge regarding early childhood oral health, but lacked knowledge on its preventive aspects.

  16. Fulltext Quantification of the dental morphology of orangutans
    Nambiar P, John J, Al-Amery SM, Purmal K, Chai WL, Ngeow WC, et al.
    ScientificWorldJournal, 2013;2013:213757.
    PMID: 24348143 DOI: 10.1155/2013/213757
    Orangutans are believed to have close biological affinities to humans. Teeth being the hardest tissue provide useful information on primate evolution. Furthermore, knowledge of the pulp chamber and root canal morphology is important for dental treatment. A female Bornean orangutan and a Sumatran male orangutan skull were available for this study. Both of their dentitions, comprising 50 teeth, were scanned employing the cone-beam computed tomography for both metrical and nonmetrical analyses. Measurements included tooth and crown length, root length, enamel covered crown height, root canal length (posterior teeth), length of pulpal space (anterior teeth), and root canal width. Nonmetrical parameters included number of canals per root, number of foramina in each root, and root canal morphology according to Vertucci's classification. It was found that the enamel covered crown height was the longest in the upper central incisors although the canine was the longest amongst the anterior teeth. Both the upper premolars were three-rooted while the lower second premolar of the Sumatran orangutan was two-rooted, with two foramina. The mandibular lateral incisors of the Bornean orangutan were longer than the central incisors, a feature similar to humans. In addition, secondary dentine deposition was noticed, a feature consistent with aged humans.
  17. Prevalence and patterns of tooth agenesis among Malay children
    Mani SA, Mohsin WS, John J
    Southeast Asian J. Trop. Med. Public Health, 2014 Mar;45(2):490-8.
    PMID: 24968691
    Tooth agenesis in Malay children, hitherto unreported, was assessed retrospectively from orthopantomograms of 834 healthy children aged 12-16 years who attended the Dental Clinic of Universiti Sains Malaysia. All teeth, including third molars, were assessed for agenesis. On an average, 2.3 teeth were missing per child. Missing third molars were found in 25.7% of children with one or two third molars found to be missing in 18.3% of children. Three point two percent of children had missing teeth other than third molars. After third molars, the upper lateral incisors were found to be the most common missing tooth (1.7%), followed by upper and lower second premolars (1.5%). Eight missing upper canines were also seen (1%). Bilateral agenesis was more common than unilateral agenesis. There were no significant differences between males and females. There was a significant difference between missing teeth between the maxilla and the mandible and right and left side, with more missing teeth in the maxilla and on the right side. The odds of any 3rd molar missing were increased 3.3 times when there was any other missing tooth. In conclusion, the prevalence of tooth agenesis among the studied population was within the normal range, but less than some Asian countries. Unlike other Asian countries, the upper lateral incisor was the most common missing tooth. The prevalence of maxillary canine agenesis was higher than most previous reports. Missing teeth were associated with missing third molars, which is likely due to a genetic abnormality.
  18. Objectively measured habitual physical activity and sedentary behaviour in obese and non-obese Malaysian children
    Wafa SW, Hamzaid H, Talib RA, Reilly JJ
    J Trop Pediatr, 2014 Apr;60(2):161-3.
    PMID: 24213306 DOI: 10.1093/tropej/fmt093
    The present study examined objectively measured physical activity in Malaysian children and compared the differences in physical levels between obese and healthy weight children. Eighty-six obese children were matched for age and sex with 86 healthy weight children with median age 9.5 years. Habitual physical activity and sedentary behaviour were measured over 5 days using Actigraph accelerometers. Time spent sedentary was significantly higher in the obese group (90% vs. 86% of daytime; p = 0.001). Moderate-to-vigorous-intensity physical activity was significantly higher in the healthy weight group (1.2 vs. 0.7% of daytime, p < 0.001). In both healthy weight and obese children, physical activity levels were exceptionally low, although moderate-to-vigorous-intensity physical activity was significantly lower in the obese group than the healthy weight group. Efforts to prevent and treat obesity in Malaysian children will need a substantial focus on the promotion of reductions in sedentary behaviour and increases in physical activity.
  19. Search for top squark and Higgsino production using diphoton Higgs boson decays
    Chatrchyan S, Khachatryan V, Sirunyan AM, Tumasyan A, Adam W, Bergauer T, et al.
    Phys Rev Lett, 2014 Apr 25;112(16):161802.
    PMID: 24815637
    Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top quark (the top squark) and the Higgs boson (Higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7  fb-1 of proton-proton collision data at s=8  TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the top squark mass below 360 to 410 GeV, depending on the Higgsino mass.
  20. Fulltext Exploring intentions to discriminate against patients living with HIV/AIDS among future healthcare providers in Malaysia
    Earnshaw VA, Jin H, Wickersham J, Kamarulzaman A, John J, Altice FL
    Trop Med Int Health, 2014 Jun;19(6):672-679.
    PMID: 24666546 DOI: 10.1111/tmi.12306
    OBJECTIVES: Stigma towards people living with HIV/AIDS (PLWHA) is strong in Malaysia. Although stigma has been understudied, it may be a barrier to treating the approximately 81 000 Malaysian PLWHA. The current study explores correlates of intentions to discriminate against PLWHA among medical and dental students, the future healthcare providers of Malaysia.
    METHODS: An online, cross-sectional survey of 1296 medical and dental students was conducted in 2012 at seven Malaysian universities; 1165 (89.9%) completed the survey and were analysed. Socio-demographic characteristics, stigma-related constructs and intentions to discriminate against PLWHA were measured. Linear mixed models were conducted, controlling for clustering by university.
    RESULTS: The final multivariate model demonstrated that students who intended to discriminate more against PLWHA were female, less advanced in their training, and studying dentistry. They further endorsed more negative attitudes towards PLWHA, internalised greater HIV-related shame, reported more HIV-related fear and disagreed more strongly that PLWHA deserve good care. The final model accounted for 38% of the variance in discrimination intent, with 10% accounted for by socio-demographic characteristics and 28% accounted for by stigma-related constructs.
    CONCLUSIONS: It is critical to reduce stigma among medical and dental students to eliminate intentions to discriminate and achieve equitable care for Malaysian PLWHA. Stigma-reduction interventions should be multipronged, addressing attitudes, internalised shame, fear and perceptions of deservingness of care.
    KEYWORDS: HIV/AIDS; Malaisie; Malasia; Malaysia; VIH/SIDA; cuidados sanitarios profesionales; discriminación; discrimination; estigma; homosexuality; professional healthcare students; stigma; stigmatisation; substance abuse; étudiants en profession de soins de santé
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