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Fulltext Reliability and construct validity of the Bahasa Malaysia version of transtheoretical model (TTM) questionnaire for smoking cessation and relapse among Malaysian adult

Yasin SM, Taib KM, Zaki RA

Asian Pac J Cancer Prev, 2011;12(6):1439-43.
PMID: 22126478

The transtheoretical model (TTM) has been used as one of the major constructs in developing effective cognitive behavioural interventions for smoking cessation and relapse prevention, in Western societies. This study aimed to examine the reliability and construct validity of the translated Bahasa Malaysia version of TTM questionnaire among adult smokers in Klang Valley, Malaysia. The sample consisted of 40 smokers from four different worksites in Klang Valley. A 26-item TTM questionnaire was administered, and a similar set one week later. The questionnaire consisted of three measures; decisional balance, temptations and impact of smoking. Construct validity was measured by factor analysis and the reliability by Cronbach' s alpha (internal consistency) and test-retest correlation. Results revealed that Cronbach' s alpha coefficients for the items were: decisional balance (0.84; 0.74) and temptations (0.89; 0.54; 0.85). The values for test retest correlation were all above 0.4. In addition, factor analysis suggested two meaningful common factors for decisional balance and three for temptations. This is consistent with the original construct of the TTM questionnaire. Overall results demonstrated that construct validity and reliability were acceptable for all items. In conclusion, the Bahasa Malaysia version of TTM questionnaire is a reliable and valid tool in ass.
Fulltext Predictors of smoking cessation among staff in public Universities in Klang Valley, Malaysia

Yasin SM, Masilamani R, Ming MF, Koh D

Asian Pac J Cancer Prev, 2011;12(3):811-6.
PMID: 21627389

Smoking cessation studies are often performed in clinic based settings. The present example aimed to find predictors of success among staff in worksite smoking cessation programmes in two major public universities in Klang Valley, Malaysia. All staff from both universities received an open invitation via staff e-mail and letters to participate. At the start of treatment, participants were administered the Rhode Island Stress and Coping Questionnaire and Family Support Redding's Questionnaire. Behaviour therapy with free nicotine replacement therapy (NRT) were given as treatment. After two months, they were contacted to determine their smoking status. 185 staff from University A (n=138) and University B (n=47), responded and voluntarily showed interest to quit. There was no significant difference in respondents with respect to socio demographic characteristics and smoking history. After two months of treatment, quit rates were 24% in University A vs. 38 % in University B (p>0.05). Univariate predictors of cessation were adherence to NRT (p<0.001), smoking fewer cigarettes per day (p<0.05) and the number of behaviour therapy sessions attended (p<0.001). Logistic regression identified 3 significant predictors of smoking cessation. Participants attending more than one session (OR= 27.00; 95% CI : 6.50; 111.6), and having higher pre-treatment general stress (OR= 2.15; 95% CI: 1.14; 4.05) were more likely to quit, while a higher number of cigarettes smoked (OR= 0.19: 95% CI: 0.06; 0.59) reduced the likelihood of quitting. Increasing age, ability to cope with stress and family support were not significant predictors. We conclude that factors such as the number of counseling sessions, the amount of cigarettes smoked at baseline, adherence to NRT and pretreatment stress are important considerations for success in a worksite smoking cessation programme.
Fulltext Smokers can quit regardless of motivation stage in a worksite smoking cessation programme in Malaysia

Yasin SM, Retneswari M, Moy FM, Koh D, Isahak M

Asian Pac J Cancer Prev, 2011;12(9):2193-8.
PMID: 22296355

BACKGROUND: There is an unclear relationship between smoker's early motivation and success rates. Here we aimed to explore the correlates of motivation and smoking abstinence and relapse in worksite smoking cessation programmes.
METHODS: This prospective cohort study involved employees from two major public universities in Malaysia. Participants were actively recruited into a smoking cessation programme. At the start of treatment, participants were administered a questionnaire on sociodemographic variables, smoking habits and 'stage of change'. Behaviour therapy with free nicotine replacement therapy (NRT) was given as treatment for two months. A similar stage of change questionnaire was given at six months, and their smoking status was determined.
RESULTS: There were 185 smokers from both Universities, who joined the programme. At six months, 24 smokers reported sustained abstinence while the others had relapsed. Prior to the programme, the majority of smokers were seriously planning on quitting (59.5%--preparation stage), but over a third had no plans to quit (35.5%--contemplation stage). There was no significant difference noted in changes of motivation stage among the relapsers and the non quitters. In addition, logistic regression showed that sustained abstinence was not predicted by pre-session motivation stage, but this did predict higher relapse for the participants, compared to those in the preparation stage.
CONCLUSION: It is possible to help smokers in the lower motivation groups to quit, provided extra caution is taken to prevent relapse. Healthcare providers' recruitment strategies for cessation programmes should thus encompass smokers in all motivation stages.
Fulltext Can initial perceptions about quitting predict smoking cessation among Malaysian smokers?

Yasin SM, Masilamani R, Ming MF, Koh D, Zaki RA

Southeast Asian J. Trop. Med. Public Health, 2012 Mar;43(2):501-9.
PMID: 23082600

Perceived risks and benefits of quitting smoking may be important factors in successful treatment. This study examined the association between initial perceived risks and benefits of quitting smoking and outcomes during a two month smoking cessation attempt. Participants (n = 185) were treatment-seeking smokers attending two smoking cessation clinics in Klang Valley, Malaysia. They received structured behavioral therapy and free Nicotine Replacement Therapy (NRT). Prior to treatment, a 12 item Perceived Risks and Benefits Questionnaire (PRBQ) was administered. This was used to assess the smoker's initial perceptions during their quit attempt. Participants were re-contacted at the end of two months to determine their smoking status. The results show participants intending to quit demonstrated a greater understanding of the benefits of quitting smoking than the risks of quitting. Those with a higher education level had a greater understanding of the benefits of quitting (p = 0.02). PRBQ items, such as perceived risks of quitting (ie weight gain, negative affect, social ostracism, loss of enjoyment and craving) were not associated with abstinence at two months. However, those who perceived a benefit of higher physical attraction post-cessation were less likely to have stopped smoking at two months (OR 0.18; 95% CI 0.08-0.45). Other perceived benefits at baseline, such as health, general well-being, self-esteem, finances and social approval, were not associated with smoking cessation at two months. The results suggest that in our study population, smokers' baseline perceptions of the benefits of cessation of smoking prior to therapy are not associated with quit results at two months. Counseling patients regarding the advantages and disadvantages of quitting may have changed their perceptions during quitting process and should be further explored in future studies.
Study site: Smoking cessation clinics, University Malaya and Universiti Teknology Mara, Klang Valley, Malaysia
Fulltext Job stressors and smoking cessation among Malaysian male employees

Yasin SM, Retneswari M, Moy FM, Darus A, Koh D

Occup Med (Lond), 2012 Apr;62(3):174-81.
PMID: 22362839 DOI: 10.1093/occmed/kqs005

Job stressors may reduce the likelihood of quitting smoking.
Timing and risk factors associated with relapse among smokers attempting to quit in Malaysia

Yasin SM, Moy FM, Retneswari M, Isahak M, Koh D

Int J Tuberc Lung Dis, 2012 Jul;16(7):980-5.
PMID: 22507850 DOI: 10.5588/ijtld.11.0748

Many smokers attempt to quit smoking, but very few succeed.
Predictors of sustained six months quitting success: efforts of smoking cessation in low intensity smoke-free workplaces

Yasin SM, Retneswari M, Moy FM, Taib KM, Ismail N

Ann Acad Med Singap, 2013 Aug;42(8):401-7.
PMID: 24045376

INTRODUCTION: This study aims to identify the predictors of a 6-month quitting success among employees involved in workplace smoking cessation with low-intensity smoke-free policy.
MATERIALS AND METHODS: A multicentre prospective cohort study was conducted among employees from 2 different public universities in Malaysia. Interventions include at least 2 sessions of behavioural therapy combined with free nicotine replacement therapy (NRT) for 8 weeks. Participants were followed up for 6 months. Independent variables assessed were on sociodemographic and environmental tobacco smoke. Their quit status were determined at 1 week, 3 months and 6 months.
RESULTS: One hundred and eighty- five smokers volunteered to participate. Among the participants, 15% and 13% sustained quit at 3 months and 6 months respectively. Multivariate analysis revealed that at 6 months, attending all 3 behavioural sessions predicted success. None of the environmental tobacco exposure variables were predictive of sustained cessation.
CONCLUSION: Individual predictors of success in intra-workplace smoking cessation programmes do not differ from the conventional clinic-based smoking cessation. Furthermore, environmental tobacco exposure in low intensity smoke-free workplaces has limited influence on smokers who succeeded in maintaining 6 months quitting.
Testing the transtheoretical model in predicting smoking relapse among Malaysian adult smokers receiving assistance in quitting

Yasin SM, Retneswari M, Moy FM, Taib KM, Isahak M, Koh D

Asian Pac J Cancer Prev, 2013;14(4):2317-23.
PMID: 23725134

The role of The Transtheoretical Model (TTM) in predicting relapse is limited. We aimed to assess whether this model can be utilised to predict relapse during the action stage. The participants included 120 smokers who had abstained from smoking for at least 24 hours following two Malaysian universities' smoking cessation programme. The smokers who relapsed perceived significantly greater advantages related to smoking and increasing doubt in their ability to quit. In contrast, former smokers with greater self-liberation and determination to abstain were less likely to relapse. The findings suggest that TTM can be used to predict relapse among quitting smokers.
Fulltext Gender differences in responses towards anti-smoking messages and policy implementation among future doctors in Malaysia

Yasin SM, Ismail N, Noor NM, Mohd Azman MS, Taib H, Jusop JM, et al.

Asian Pac J Cancer Prev, 2013;14(1):303-8.
PMID: 23534742

BACKGROUND: Medical students' views may provide some direction for future policy considerations.

AIM: The aim of this study was to assess gender differences in future doctors' receptiveness to currently implemented anti-smoking messages and the effectiveness of those messages.

MATERIALS AND METHODS: We administered a questionnaire to all students at a medical university in Malaysia, asking how frequently they noted anti- smoking policies, anti-smoking campaigns, and anti-smoking messages in schools. In addition, the questionnaire investigated most effective methods to convey these messages.

RESULTS: A total of 522 (59.7%) students responded. Students were least likely to approve of total bans on cigarettes and increasing the price of cigarettes, and most likely to approve of bans on use of cigarettes in public places and sales to individuals less than 16 years old. Approval of total bans on cigarettes was more common in female students than in males OR=0.39 (95%CI: 0.18- 0.86). Furthermore, compared to the female students, the male students thought that printed media; OR=2.32 (95%CI: 1.31-4.10), radio; OR=1.93 (95%CI: 1.15-3.22) and the internet; OR=1.96 (95%CI: 1.15-3.33) were very effective at delivering anti-smoking messages.

CONCLUSIONS: Gender differences existed in the future doctors' perception of the effectiveness of anti-smoking initiatives. Taking this gender difference into account may increase the receipt of anti-smoking messages in adolescents.
Fulltext Effect of zirconium oxide nanofiller and dibutyl phthalate plasticizer on ionic conductivity and optical properties of solid polymer electrolyte

Yasin SM, Ibrahim S, Johan MR

ScientificWorldJournal, 2014;2014:547076.
PMID: 25133244 DOI: 10.1155/2014/547076

New solid polymer electrolytes (SPE) based on poly(ethylene oxide) (PEO) doped with lithium trifluoromethanesulfonate (LiCF3SO3), dibutyl phthalate (DBP) plasticizer, and zirconium oxide (ZrO2) nanoparticles were prepared by solution-casting technique. The conductivity was enhanced by addition of dibutyl phthalate (DBP) plasticizer and ZrO2 nanofiller with maximum conductivity (1.38 × 10(-4) Scm(-1)). The absorption edge and band gap values showed decreases upon addition of LiSO3CF3, DBP, and ZrO2 due to the formation of localized states in the SPE and the degree of disorder in the films increased.
Does change in perception following counseling result in improved quitting outcome among Malaysian smokers?

Yasin SM, Masilamani R, Ming MF, Koh D

Asia Pac J Public Health, 2015 Mar;27(2):NP143-53.
PMID: 22199150 DOI: 10.1177/1010539511426472

OBJECTIVE: The authors examined the effects that change in perception about the advantages and disadvantages of smoking and quitting had on quitting outcome among smokers enrolled in a program for smoking cessation.
METHODS: A total of 185 smokers from 2 public universities who were interested in quitting received smoking cessation counseling on understanding the risks and benefits of quitting (or smoking) in addition to a course of free nicotine replacement therapy (NRT). A decisional balance questionnaire (DBQ) was administered at baseline and at 2 months postcounseling to determine and assess changes in smoking perception.
RESULTS: After counseling, 72.3% of smokers had reduced their perceptions about the advantages of smoking, and 66.4% had increased perceptions of disadvantages of smoking. At the eighth week, 51 participants (27%) had quit. Smokers who had reduced perceptions of the advantages of smoking had significantly higher quit rates compared with those with no improvement in perception (82.6% vs 17.4%; odds ratio = 2.47; 95% confidence interval = 1.00-6.10).
CONCLUSION: After counseling, smokers did change their perception of the advantages and disadvantages of smoking during the quitting process. These changes are associated with a higher likelihood of smoking cessation.
KEYWORDS: Malaysian; counseling; decisional balance; perception; smoking cessation
Support for a Campus Tobacco-Free Policy among Non- Smokers: Findings from a Developing Country

Yasin SM, Isa MR, Fadzil MA, Zamhuri MI, Selamat MI, Mat Ruzlin AN, et al.

Asian Pac J Cancer Prev, 2016;17(1):275-80.
PMID: 26838223

BACKGROUND: A tobacco-free workplace policy is identified as an effective means to reduce tobacco use and protect people from second-hand smoke; however, the number of tobacco-free policies (TFP) remains very low in workplaces in Malaysia. This study explored the factors affecting support for a tobacco-free policy on two healthcare campuses in Malaysia, prior to the implementation of TFP.
MATERIALS AND METHODS: This cross- sectional study was conducted among 286 non-smokers from two healthcare training centres and two nearby colleges in Malaysia from January 2015 to April 2015. A standardized questionnaire was administered via staff and student emails. The questionnaire collected information on sociodemographic characteristics, support for a tobacco-free policy and perceived respiratory and sensory symptoms due to tobacco exposure. Bivariate and multivariate logistic regression analyses were performed to estimate the independent effects of supporting a tobacco-free campus.
RESULTS: The percentage of individuals supporting completely tobacco-free facilities was 83.2% (N=238), as opposed to 16.7% (N=48) in support of partially tobacco-free facilities. Compared to the supporters of partially tobacco-free facilities, non-smokers who supported completely tobacco-free health facilities were more likely to be female, have higher education levels, to be very concerned about the effects of other people smoking on their health and to perceive a tobacco-free policy as very important. In addition, they perceived that tobacco smoke bothered them at work by causing headaches and coughs and, in the past 4 weeks, had experienced difficulty breathing. In the multivariate model, after adjusting for sociodemographic characteristics and other factors, only experiencing coughs and headaches increased the odds of supporting a completely tobacco-free campus, up to 2.5- and 1.9-fold, respectively.
CONCLUSIONS: Coughs and headaches due to other people smoking at work enhances support for a completely tobacco-free campus among non-smokers.
Fulltext Perspective of a smoke-free home among second-hand smokers during pregnancy: a qualitative study

Mohd Asri IA, Abd Rani NA, Dzulkifli Z, Muhamad Jamil MI, Ahmad Saman MS, Yasin SM

Pertanika Journal of Science & Technology, 2017;25(104):191-204.
MyJurnal

Tobacco use is one of the largest causes of preventable diseases across the world. It is interesting to note that second-hand smoke exposure is a major public health problem in Malaysia. The objectives of this study are first, to explore the perspectives of pregnant mothers whose partners are smokers, and second, to explore barriers and facilitators to creating a smoke-free environment in their home. This study uses a qualitative method in analysing the experiences of 15 pregnant mothers taken from a specialist healthcare centre in Sungai Buloh, Malaysia. It discusses the perspectives of these pregnant mothers towards their partners’ smoking habits, as well as the barriers and facilitators in creating a smoke-free home. From the interviews, it became apparent that pregnant mothers despised their partners’ smoking habits due to smoke odour, lack of money, and poor health. The barriers in creating a smoke-free home include the attitude of the smoking spouse, difficulty in weaning off the habit, excessive encouragement by a spouse, difficultly in advising a smoking spouse, influences from friends, and wrong perceptions. Meanwhile, the facilitators towards creating a smoke-free home are illnesses developed through smoking, multiple reminders from family members, and nicotine replacement therapy (NRT) were perceived to work on certain smokers and habitual cues in quitting smoking. The transition process towards making homes smoke-free is complex and individualistic; healthcare professionals may need to tailor strategies to take into account the specific contexts of each individual. More education programmes on the impacts of smoking and second-hand smoke exposures to family members and smoking cessation are needed for both pregnant mothers and their smoking partners.
Study site: Gynaecology Clinic, public teaching hospital, Malaysia
Physician-patient interaction satisfaction and its influence on medication adherence and type-2 diabetic control in a primary care setting

Nasir NM, Ariffin F, Yasin SM

Med J Malaysia, 2018 06;73(3):163-169.
PMID: 29962500 MyJurnal

INTRODUCTION: Medication adherence has been found to be an important determinant in achieving glycaemic control in Type 2 Diabetes (T2DM) patients. In other patient populations, physician-patient interaction satisfaction was found to influence medication adherence. It is then important to identify if this is also a factor amongst T2DM patients on insulin as poor adherence was associated with increased all-cause mortality.
METHODS: This was a cross sectional study involving 197 T2DM patients on insulin from two government primary health clinics in Gombak. Physician-patient interaction satisfaction was assessed using Skala Kepuasan Interaksi Perubatan (SKIP-11) consisting of 3 subdomains (Distress Relief, Rapport and Interaction Outcome). Medication adherence level was measured using a single item selfreport question. Data analysis for descriptive, inferential and multivariate analysis statistics were performed.
RESULTS: The mean age of the study participants was 57.12 (SD: 9.27). Majority were Malay, female, unemployed with mean BMI of 27.5. Majority reported full adherence (62.9%). High scores in the Interaction Outcome subdomain was associated with better adherence. Factors associated with high scores in this subdomain included patient education level, number of oral hypoglycaemic agent and type of insulin regime taken. This study also found that high scores in the Interaction Outcome domain is associated with lower HbA1c (p<0.05).
CONCLUSION: Physician-patient interaction satisfaction is an important factor in achieving better medication adherence which also leads to better glycaemic control in this group of patients. There is a need to identify strategies to improve satisfaction in this domain to improve patient adherence.
Fulltext Reliability and construct validity of the Malay version of Theory of Planned Behaviour (TPB) for smoking cessation

Ruslan NH, Yasin SM, Isa MR, Mohd Nasir N, Ahing T, Rajikin MH

Asian Pac J Cancer Prev, 2018 Oct 26;19(10):2815-2820.
PMID: 30361039 DOI: 10.22034/APJCP.2018.19.10.2815

Objective: The aim of this study was to evaluate the psychometric properties of the Malay translated version of the Theory of Planned Behavior (TPB) intention to quit smoking questionnaire.
Methods: A cross-sectional study was performed involving 185 male smokers. The forward-backward translation procedure was adopted to translate the questionnaire from English to Malay. The internal consistency and stability were assessed using Cronbach’s alpha and a correlation analysis and Exploratory Factor Analysis was conducted.
Result: The translated questionnaire showed good internal consistency with Cronbach’s alpha values of 0.86, 0.64, 0.74 and 0.90 for each of the four respective factors. The test-retest reliability revealed acceptable stability, with Spearman’s correlation coefficients ranging from low to moderate (r>0.30-0.50) and a satisfactory inter class correlation coefficient (ICCs). The construct validity achieved an acceptable factor loading for each construct which ranged from 0.40 to 0.90.
Conclusion: The current study provided
psychometric evidence for an appropriate, reliable and valid tool of TPB Malay version. This questionnaire could be applied in evaluating smoking cessation interventions in Malaysia.
A Systematic Review for Enabling of Develop a Blockchain Technology in Healthcare Application: Taxonomy, Substantially Analysis, Motivations, Challenges, Recommendations and Future Direction

Hussien HM, Yasin SM, Udzir SNI, Zaidan AA, Zaidan BB

J Med Syst, 2019 Sep 14;43(10):320.
PMID: 31522262 DOI: 10.1007/s10916-019-1445-8

Blockchain in healthcare applications requires robust security and privacy mechanism for high-level authentication, interoperability and medical records sharing to comply with the strict legal requirements of the Health Insurance Portability and Accountability Act of 1996. Blockchain technology in the healthcare industry has received considerable research attention in recent years. This study conducts a review to substantially analyse and map the research landscape of current technologies, mainly the use of blockchain in healthcare applications, into a coherent taxonomy. The present study systematically searches all relevant research articles on blockchain in healthcare applications in three accessible databases, namely, ScienceDirect, IEEE and Web of Science, by using the defined keywords 'blockchain', 'healthcare' and 'electronic health records' and their variations. The final set of collected articles related to the use of blockchain in healthcare application is divided into three categories. The first category includes articles (i.e. 43/58 scientific articles) that attempted to develop and design healthcare applications integrating blockchain, particularly those on new architecture, system designs, framework, scheme, model, platform, approach, protocol and algorithm. The second category includes studies (i.e., 6/58 scientific articles) that attempted to evaluate and analyse the adoption of blockchain in the healthcare system. Finally, the third category comprises review and survey articles (i.e., 6/58 scientific articles) related to the integration of blockchain into healthcare applications. The final articles for review are discussed on the basis of five aspects: (1) year of publication, (2) nationality of authors, (3) publishing house or journal, (4) purpose of using blockchain in health applications and the corresponding contributions and (5) problem types and proposed solutions. Additionally, this study provides identified motivations, open challenges and recommendations on the use of blockchain in healthcare applications. The current research contributes to the literature by providing a detailed review of feasible alternatives and identifying the research gaps. Accordingly, researchers and developers are provided with appealing opportunities to further develop decentralised healthcare applications through a comprehensive discussion of about the importance of blockchain and its integration into various healthcare applications.
Fulltext Characteristics of paediatric patients with tuberculosis and associated determinants of treatment success in Malaysia using the MyTB version 2.1 database over five years

Awaluddin SM, Ismail N, Zakaria Y, Yasin SM, Razali A, Mutalip MHA, et al.

BMC Public Health, 2020 Dec 10;20(1):1903.
PMID: 33302908 DOI: 10.1186/s12889-020-10005-y

BACKGROUND: Tuberculosis (TB) among children remains a significant public health problem in many parts of the world. The objective of this study was to describe the characteristics of TB patients and to determine the predictors of treatment success among children in Malaysia.
METHODS: Secondary data from MyTB version 2.1, a national database, were analysed using R version 3.6.1. Descriptive analysis and multivariable logistic regression were conducted to identify treatment success and its determinants.
RESULTS: In total, 3630 cases of TB cases were registered among children in Malaysia between 2013 and 2017. The overall treatment success rate was 87.1% in 2013 and plateaued between 90.1 and 91.4% from 2014 to 2017. TB treatment success was positively associated with being a Malaysian citizen (aOR = 3.43; 95% CI = 2.47, 4.75), being a child with BCG scars (aOR = 1.93; 95% CI = 1.39, 2.68), and being in the older age group (aOR = 1.06; 95% CI = 1.03, 1.09). Having HIV co-infection (aOR = 0.31; 95% CI = 0.16, 0.63), undergoing treatment in public hospitals (aOR = 0.38; 95% CI =0.25, 0.58), having chest X-ray findings of advanced lesion (aOR = 0.48; 95% CI = 0.33, 0.69), having EPTB (aOR = 0.58; 95% CI = 0.41, 0.82) and having sputum-positive PTB (aOR = 0.58; 95% CI = 0.43, 0.79) were negatively associated with TB treatment success among children.
CONCLUSIONS: The overall success rate of treatment among children with TB in Malaysia has achieved the target of 90% since 2014 and remained plateaued until 2017. The socio-demographic characteristics of children, place of treatment, and TB disease profile were associated with the likelihood of TB treatment success among children. The treatment success rate can be increased by strengthening contact tracing activities and promoting early identification targeting the youngest children and non-Malaysian children.
Fulltext Parents' Experiences and Perspectives Toward Tuberculosis Treatment Success Among Children in Malaysia: A Qualitative Study

Awaluddin SM, Ismail N, Yasin SM, Zakaria Y, Mohamed Zainudin N, Kusnin F, et al.

Front Public Health, 2020;8:577407.
PMID: 33384977 DOI: 10.3389/fpubh.2020.577407

Introduction: The trends of tuberculosis (TB) treatment success rate among children in Malaysia plateaued at 90% from 2014 to 2017. Malaysia sets a higher treatment success target of 95% to be achieved in line with an affordable, accessible, and holistic approach in managing TB among children. Objective: This study aims to explore the parents' experiences and perspectives toward achieving treatment success among children who were diagnosed with TB in two districts in Selangor state, Malaysia. Methods: The study was conducted using phenomenology study design via an in-depth interview of 15 mothers who were purposively sampled from the list of pediatric TB cases in the MyTB version 2.1 database in Klang and Petaling Districts of Selangor state. The R-based qualitative data analysis package of R version 0.2-8 was used to perform the thematic analysis. Results: Two main themes were identified from this study. The first theme was trust toward the healthcare services with the subthemes of acceptance, self-efficacy, holistic care, and perceived benefits. The second theme was the motivation to take or continue medication. The subthemes were support from family, healthcare workers' (HCWs') support, the convenience of healthcare services, community support, personal strength, and child's character. Conclusion: TB treatment success for children can be achieved when parents develop trust in healthcare services and have strong motivational factors to remain steadfast in achieving a successful treatment goal. Psychosocial support should be provided to the primary caregiver who faced any difficulty, while good relationships between parents and HCWs should be maintained. These results will inform the TB program managers to strengthen the holistic approach and identify the motivational factors among parents of children with TB disease.
Fulltext Blockchain-Based Access Control Scheme for Secure Shared Personal Health Records over Decentralised Storage

Hussien HM, Yasin SM, Udzir NI, Ninggal MIH

Sensors (Basel), 2021 Apr 02;21(7).
PMID: 33918266 DOI: 10.3390/s21072462

Blockchain technology provides a tremendous opportunity to transform current personal health record (PHR) systems into a decentralised network infrastructure. However, such technology possesses some drawbacks, such as issues in privacy and storage capacity. Given its transparency and decentralised features, medical data are visible to everyone on the network and are inappropriate for certain medical applications. By contrast, storing vast medical data, such as patient medical history, laboratory tests, X-rays, and MRIs, significantly affect the repository storage of blockchain. This study bridges the gap between PHRs and blockchain technology by offloading the vast medical data into the InterPlanetary File System (IPFS) storage and establishing an enforced cryptographic authorisation and access control scheme for outsourced encrypted medical data. The access control scheme is constructed on the basis of the new lightweight cryptographic concept named smart contract-based attribute-based searchable encryption (SC-ABSE). This newly cryptographic primitive is developed by extending ciphertext-policy attribute-based encryption (CP-ABE) and searchable symmetric encryption (SSE) and by leveraging the technology of smart contracts to achieve the following: (1) efficient and secure fine-grained access control of outsourced encrypted data, (2) confidentiality of data by eliminating trusted private key generators, and (3) multikeyword searchable mechanism. Based on decisional bilinear Diffie-Hellman hardness assumptions (DBDH) and discrete logarithm (DL) problems, the rigorous security indistinguishability analysis indicates that SC-ABSE is secure against the chosen-keyword attack (CKA) and keyword secrecy (KS) in the standard model. In addition, user collusion attacks are prevented, and the tamper-proof resistance of data is ensured. Furthermore, security validation is verified by simulating a formal verification scenario using Automated Validation of Internet Security Protocols and Applications (AVISPA), thereby unveiling that SC-ABSE is resistant to man-in-the-middle (MIM) and replay attacks. The experimental analysis utilised real-world datasets to demonstrate the efficiency and utility of SC-ABSE in terms of computation overhead, storage cost and communication overhead. The proposed scheme is also designed and developed to evaluate throughput and latency transactions using a standard benchmark tool known as Caliper. Lastly, simulation results show that SC-ABSE has high throughput and low latency, with an ultimate increase in network life compared with traditional healthcare systems.
Fulltext Systematic Review of Potential Occupational Respiratory Hazards Exposure Among Sewage Workers

Muzaini K, Yasin SM, Ismail Z, Ishak AR

Front Public Health, 2021;9:646790.
PMID: 33763402 DOI: 10.3389/fpubh.2021.646790

Background: Sewage workers have a higher risk of exposure to various potential occupational respiratory hazards found in sewage plants. Although previous studies discuss occupational respiratory hazard concentration impacting sewage workers' respiratory health, the results are scarce and mixed. Hence, there is a need to identify the potential respiratory hazards in sewage plants so as to clarify the short- and long-term respiratory health effects. Therefore, this systematic review (SR) aims to critically review previous studies investigating potential respiratory hazards found at sewage plants and their effects on sewage workers' respiratory health. Methods: An SR was conducted using PubMed, EBSCO Medline, Web of Science, Scopus, and Google Scholar on peer-reviewed studies published between January 1994 and October 2020 evaluating the impact of potential exposure to respiratory hazards and its effects on respiratory health among sewage workers. "Sewage treatment plant," "respiratory hazards," and "respiratory health effects" were the three main search terms chosen in this SR. The inclusion criteria were (1) studies on potential occupational respiratory hazard exposure among sewage workers, (2) manuscripts written in English, and (3) studies published in the peer-reviewed literature. The human observational studies' quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool. Results: We identified 5,660 articles through an initial database search. Only 26 items met the inclusion criteria and were included in this review; 15 human observational studies and 11 environmental assessment studies were conducted in the sewage industries. Most of the human observational studies were rated as moderate quality, two studies were rated as weak quality, and one study with strong quality was identified. Hydrogen sulfide, bioaerosols, particulate matter 2.5 (PM 2.5), and volatile organic compounds (VOC) were found to be potential respiratory hazards. Most of the risks contributed to adverse outcomes on the sewage workers' respiratory health with some inconsistent findings on the relationship between respiratory hazard exposure and respiratory health effects. Conclusion: Our review finds that, although this area is of great importance, quality studies are still lacking. There is a need for additional studies to clarify the effects of respiratory hazard exposure on sewage workers and respiratory health, especially PM 2.5 and VOC.

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