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Fulltext Drug Utilization and Drug Pricing in the Private Primary Healthcare System in Malaysia: An Employer Price Control Mechanism

Zin CS, Taufek NH, Bux SH

Front Public Health, 2020;8:551328.
PMID: 33365294 DOI: 10.3389/fpubh.2020.551328

Uncontrolled drug pricing in the private healthcare system in Malaysia leads to high drug prices; however, its impact on employee drug utilization and employer reimbursement coverage is unclear. This study examined patterns of drug pricing and drug utilization among employees covered by employer medical insurance. A drug price control mechanism was also devised for the employer to ensure fair benefits to all parties without compromising the quality of patient care. This retrospective study was conducted among International Islamic University Malaysia (IIUM) community members who sought outpatient treatment at the IIUM panel of health clinics serviced by general practitioners from January 2016 to September 2019. Prescription data (drug type, dose, quantity, duration, price, and manufacturer), patient characteristics (age, sex, and diagnosis) and total charges were extracted from the claims database of PMCare, the insurance company managing IIUM medical claims. Patterns of commonly prescribed drugs, drug pricing, profit margins, and total charges per clinic visit were evaluated. Descriptive statistics were used, and all analyses were performed using Stata v15.1. There were a total of 161,146 prescriptions for 10,150 patients in the IIUM community during the study period (48.85% women, mean ± standard deviation; age: 26.33 ± 17.63 years). The most commonly prescribed drug was paracetamol (25.3%), followed by chlorpheniramine (9.46%), cetirizine (7.3%), diphenhydramine (6.13%), loratadine (4.57%), and diclofenac (4.36%). Generic paracetamol (500 mg), which serves as a prime example for details on drug pricing, is commonly charged between Ringgit Malaysia (RM) 5 and 10 for 10 tablets with a profit between 2,400 and 4,900% according to the average cost price of RM 0.20 per 10 tablets. Most patients were charged within the approved coverage limit of RM 45 per clinic visit, with only 2.41% of patients being charged with costs that exceeded this limit. Uncontrolled drug pricing in the private healthcare system in Malaysia indicates that drug prices differ greatly across private healthcare providers most of the prices were charged with high profit margins. Employers may consider a multilayer capping system to prevent inappropriate drug pricing, which will inevitably benefit patients clinically and economically and provide greater patient access to better drug treatment.
Fulltext Molecular Phylogenesis and Spatiotemporal Spread of SARS-CoV-2 in Southeast Asia

Zhu M, Shen J, Zeng Q, Tan JW, Kleepbua J, Chew I, et al.

Front Public Health, 2021 07 30;9:685315.
PMID: 34395364 DOI: 10.3389/fpubh.2021.685315

Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to public health in Southeast Asia, a tropical region with limited resources. This study aimed to investigate the evolutionary dynamics and spatiotemporal patterns of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the region. Materials and Methods: A total of 1491 complete SARS-CoV-2 genome sequences from 10 Southeast Asian countries were downloaded from the Global Initiative on Sharing Avian Influenza Data (GISAID) database on November 17, 2020. The evolutionary relationships were assessed using maximum likelihood (ML) and time-scaled Bayesian phylogenetic analyses, and the phylogenetic clustering was tested using principal component analysis (PCA). The spatial patterns of SARS-CoV-2 spread within Southeast Asia were inferred using the Bayesian stochastic search variable selection (BSSVS) model. The effective population size (Ne) trajectory was inferred using the Bayesian Skygrid model. Results: Four major clades (including one potentially endemic) were identified based on the maximum clade credibility (MCC) tree. Similar clustering was yielded by PCA; the first three PCs explained 46.9% of the total genomic variations among the samples. The time to the most recent common ancestor (tMRCA) and the evolutionary rate of SARS-CoV-2 circulating in Southeast Asia were estimated to be November 28, 2019 (September 7, 2019 to January 4, 2020) and 1.446 × 10-3 (1.292 × 10-3 to 1.613 × 10-3) substitutions per site per year, respectively. Singapore and Thailand were the two most probable root positions, with posterior probabilities of 0.549 and 0.413, respectively. There were high-support transmission links (Bayes factors exceeding 1,000) in Singapore, Malaysia, and Indonesia; Malaysia involved the highest number (7) of inferred transmission links within the region. A twice-accelerated viral population expansion, followed by a temporary setback, was inferred during the early stages of the pandemic in Southeast Asia. Conclusions: With available genomic data, we illustrate the phylogeography and phylodynamics of SARS-CoV-2 circulating in Southeast Asia. Continuous genomic surveillance and enhanced strategic collaboration should be listed as priorities to curb the pandemic, especially for regional communities dominated by developing countries.
Fulltext Effects of active video games on physical activity among overweight and obese college students: a systematic review

Zhao Y, Soh KG, Saad HA, Liu C, Ding C

Front Public Health, 2024;12:1320112.
PMID: 38420024 DOI: 10.3389/fpubh.2024.1320112

BACKGROUND: The purpose of this study was to critically review the existing literature on the effects of active video games (AVGs) on physical activity in overweight and obese college students to determine whether AVGs can promote and achieve recommended levels of physical activity. The results should provide constructive input for future research.
METHODS: A total of five international databases including PubMed, SCOPUS, Web of Science, CINAHL Plus, and EBSCOhost were searched with keywords related to "active video games," "physical activity," and "obese college students" from July 2022. A systematic review was conducted using the PRISMA guidelines and randomised controlled trial (RCT) studies that met the inclusion criteria were included. Furthermore, the quality assessment of the studies was measured using the PEDro scale.
RESULTS: One thousand and twenty-three articles were retrieved, of which eight randomised controlled trial studies met the inclusion criteria. AVGs can reduce sedentary behaviour and positively affect physical activity, time spent on moderate-to-vigorous physical activity (MVPA), positive psychological factors, and game attendance rate. Combining AVGs with other assistive devices (such as mini-trampolines and stationary bikes) can enhance the effects of AVGs and provide greater physiological stimulation. Different types of AVGs and game modes can achieve different emotional responses, physiological stimulation, and physical activity levels.
CONCLUSION: The research findings prove that AVGs can be a viable intervention to increase physical activity in overweight or obese college students, ultimately reaching the recommended physical activity level(PAL). Physical activity can be further increased by incorporating assistive devices or using features supported by self-determination theory (SDT). As a new modality, AVGs could be a potential alternative to traditional physical activity.Systematic Review Registration:https://www.crd.york.ac.uk/prospero, identifier: CRD42022363993.
Fulltext The reciprocal relationships between meaning in life and smartphone addiction among Chinese college students: evidence from a three-wave cross-lagged panel model

Zhao H, Song T, Rafik-Galea S, Dong J, Fitriana M, Ji Y, et al.

Front Public Health, 2023;11:1202741.
PMID: 37521981 DOI: 10.3389/fpubh.2023.1202741

BACKGROUND: Previous cross-sectional studies have shown that meaning in life (MIL) is closely associated with college students' smartphone addiction (SA), but the causal relationship between MIL and college students' SA is uncertain. Therefore, conducting a longitudinal study to explore their relationship is very necessary. Furthermore, some studies have implied possible gender differences in the relationship between MIL and SA and the relationship between SA and MIL. Therefore, it is necessary to further examine whether there are gender differences in the above relationships.
METHODS: The present study constructed a three-wave cross-lag panel model to explore the relationships between MIL and college students' SA. Three waves of data were collected from 705 college students (male: 338; female: 367) in China for three consecutive years, and the interval of data collection was 1 year. These college students completed the same online questionnaire regarding MIL and SA.
RESULTS: (1) The MIL of male college students was significantly stronger than that of female college students at time 1, time 2, and time 3, (2) Female college students' SA at time 1, time 2, and time 3 was more serious than that of male college students, (3) There were reciprocal relationships between MIL and college students' SA, (4) The influence of MIL on female college students' SA was significantly stronger than that of male college students, and (5) The influence of SA on female college students' MIL was significantly stronger than that of male college students.
CONCLUSION: This study showed reciprocal relationships between MIL and SA among male college students and female college students. The findings further deepen our understanding of the relationship between MIL and SA and provide a gender perspective for preventing or intervening with college students' SA.
Fulltext Sourcing and framing in cancer control continuum: A content analysis of Malaysian English and Chinese online cancer news

Zhang TH, Tham JS, Yu X, Chang PK, Kho SN

Front Public Health, 2022;10:924027.
PMID: 36530718 DOI: 10.3389/fpubh.2022.924027

BACKGROUND: In health news production, sourcing and framing are two critical mechanisms that influence how newsreaders think about and perceive the severity of a health issue. Understanding how local media covers the cancer control continuum is vital. However, very limited studies have looked at the effect of sourcing and framing in cancer news coverage, and it is still unknown how sources and news frames shape cancer coverage, especially in non-Western countries.
OBJECTIVE: This study examines framing and sourcing patterns in news stories reporting on cancer control in Malaysian mainstream (English) and ethnicity (Chinese) online news sites, uncovering underlining associations between essential news components, source, and framing.
METHODS: We used a predesigned code book to conduct a quantitative content analysis on cancer news stories (n = 841) published on two Malaysian English and Chinese online news sites from 2017 to 2019. Cancer news received adequate coverage in Malaysian English and Chinese media and was also session-centered.
RESULTS: Two logistic regression models demonstrated the internal relationships between sourcing, framing, and different elements in cancer coverage. In terms of news sources, the results revealed that medical journals were the most likely to be cited when the news focused on medical research, followed by primary cancer prevention. When the news concentrated on statistical cancer reports and environmental/occupational risk factors, government agencies were more likely to be interviewed. Of news frames, when the news articles engaged with medical institutions and mentioned medical publications, the lifestyle frame was very likely to be shown, but the environmental frame was more likely to be portrayed when interviewing medical practitioners.
CONCLUSION: This study is the first comprehensive assessment to analyze and compare Malaysian English and Chinese online cancer news coverages and uncover underlying associations between news components, sourcing, and framing paradigms. We contributed to the scholarly understanding of cancer news coverage. This study can serve as a model for future health promotion researchers, journalists, and policymakers. Implications for cancer risk communication research, health journalist practices, and health policymaking were discussed.
Fulltext Assessment of Healthcare System Capabilities and Preparedness in Yemen to Confront the Novel Coronavirus 2019 (COVID-19) Outbreak: A Perspective of Healthcare Workers

Zawiah M, Al-Ashwal FY, Saeed RM, Kubas M, Saeed S, Khan AH, et al.

Front Public Health, 2020;8:419.
PMID: 32850608 DOI: 10.3389/fpubh.2020.00419

Background: In the past decade, Yemen has witnessed several disasters that resulted in a crumbled healthcare system. With the declaration of COVID-19 a global pandemic, and later the appearance of first confirmed cases in Yemen, there is an urgent need to assess the preparedness of healthcare facilities (HCFs) and their capacities to tackle a looming COVID-19 outbreak. Herein, we present an assessment of the current state of preparedness and capabilities of HCFs in Yemen to prevent and manage the COVID-19 outbreak. Methods: An online survey for HCFs was developed, validated, and distributed. The questionnaire is divided into five main sections: (1) Demographic variables for participants. (2) HCFs capabilities for COVID-19 outbreak. (3) Support received to face the emergence and spread of COVID-19. (4). Current practices of infection prevention and control measures in the HCFs. The last section focused on the recommendations to ensure effective and timely response to this outbreak in Yemen. Descriptive analysis was used to analyze data using statistical package for social sciences (SPSS), version 23. Results: Responses were received from healthcare workers (HCWs) from 18 out of 22 governorates in Yemen. Out of the 296 HCWs who participated in the study, the vast majority (93.9%) believed that the healthcare system in Yemen does not have the resources and capabilities to face and manage a COVID-19 outbreak. Approximately 82.4% of participants rated the general preparedness level of their HCFs as very poor or poor. More specifically, the majority of HCWs rated their HCFs as very poor or poor in term of availability of the following: an adequate number of mechanical ventilators (88.8%), diagnostic devices (88.2%), ICU rooms and beds (81.4%), and isolation rooms (79.7%). Conclusions: The healthcare facilities in Yemen are unprepared and lack the most basic resources and capabilities to cope with or tackle a COVID-19 outbreak. With the current state of a fragile healthcare system, a widespread outbreak of COVID-19 in Yemen could result in devastating consequences. There is an urgent need to provide support to the healthcare workers and HCFs that are on the frontline against COVID-19.
Fulltext Influence of communication determinants on safety commitment in a high-risk workplace: a systematic literature review of four communication dimensions

Zara J, Nordin SM, Isha ASN

Front Public Health, 2023;11:1225995.
PMID: 37614453 DOI: 10.3389/fpubh.2023.1225995

Health, safety, and environment (HSE) are critical aspects of any industry, particularly in high-risk environments, such as the oil and gas industry. Continuous accident reports indicate the requirement for the effective implementation of safety rules, regulations, and practices. This systematic literature review examines the relationship between safety communication and safety commitment in high-risk workplaces, specifically focusing on the oil and gas industry. The review comprises 1,439 articles from 2004 to 2023, retrieved from the Scopus and Web of Science databases following the PRISMA comprehensive guidelines. This study considers safety communication, communication climate, and communication satisfaction to evaluate their influence on safety commitment under occupational health and safety. This study identifies safety commitment issues and their underlying factors, discussing measures for preventing and reducing accidents and incidents and highlighting preventive measures for future research. It also signifies the variables influencing accident and incident rates. The research underscores the importance of communication dimensions and the need for workers to possess adequate skills, knowledge, and attitudes regarding occupational safety and health procedures. Moreover, the study contributes to the industrial and academic domains by improving organizational safety commitment, promoting a safety culture, and developing effective communication strategies. Furthermore, practitioners may benefit from this comprehensive overview in developing, evaluating, and enhancing occupational safety.
Fulltext A Systematic Review of Medical Equipment Reliability Assessment in Improving the Quality of Healthcare Services

Zamzam AH, Abdul Wahab AK, Azizan MM, Satapathy SC, Lai KW, Hasikin K

Front Public Health, 2021;9:753951.
PMID: 34646808 DOI: 10.3389/fpubh.2021.753951

Medical equipment highly contributes to the effectiveness of healthcare services quality. Generally, healthcare institutions experience malfunctioning and unavailability of medical equipment that affects the healthcare services delivery to the public. The problems are frequently due to a deficiency in managing and maintaining the medical equipment condition by the responsible party. The assessment of the medical equipment condition is an important activity during the maintenance and management of the equipment life cycle to increase availability, performance, and safety. The study aimed to perform a systematic review in extracting and categorising the input parameters applied in assessing the medical equipment condition. A systematic searching was undertaken in several databases, including Web of Science, Scopus, PubMed, Science Direct, IEEE Xplore, Emerald, Springer, Medline, and Dimensions, from 2000 to 2020. The searching processes were conducted in January 2020. A total of 16 articles were included in this study by adopting Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The review managed to classify eight categories of medical equipment reliability attributes, namely equipment features, function, maintenance requirement, performance, risk and safety, availability and readiness, utilisation, and cost. Applying the eight attributes extracted from computerised asset maintenance management system will assist the clinical engineers in assessing the reliability of medical equipment utilised in healthcare institution. The reliability assessment done in these eight attributes will aid clinical engineers in executing a strategic maintenance action, which can increase the equipment's availability, upkeep the performance, optimise the resources, and eventually contributes in providing effective healthcare service to the community. Finally, the recommendations for future works are presented at the end of this study.
Fulltext Prioritisation Assessment and Robust Predictive System for Medical Equipment: A Comprehensive Strategic Maintenance Management

Zamzam AH, Al-Ani AKI, Wahab AKA, Lai KW, Satapathy SC, Khalil A, et al.

Front Public Health, 2021;9:782203.
PMID: 34869194 DOI: 10.3389/fpubh.2021.782203

The advancement of technology in medical equipment has significantly improved healthcare services. However, failures in upkeeping reliability, availability, and safety affect the healthcare services quality and significant impact can be observed in operations' expenses. The effective and comprehensive medical equipment assessment and monitoring throughout the maintenance phase of the asset life cycle can enhance the equipment reliability, availability, and safety. The study aims to develop the prioritisation assessment and predictive systems that measure the priority of medical equipment's preventive maintenance, corrective maintenance, and replacement programmes. The proposed predictive model is constructed by analysing features of 13,352 medical equipment used in public healthcare clinics in Malaysia. The proposed system comprises three stages: prioritisation analysis, model training, and predictive model development. In this study, we proposed 16 combinations of novel features to be used for prioritisation assessment and prediction of preventive maintenance, corrective maintenance, and replacement programme. The modified k-Means algorithm is proposed during the prioritisation analysis to automatically distinguish raw data into three main clusters of prioritisation assessment. Subsequently, these clusters are fed into and tested with six machine learning algorithms for the predictive prioritisation system. The best predictive models for medical equipment's preventive maintenance, corrective maintenance, and replacement programmes are selected among the tested machine learning algorithms. Findings indicate that the Support Vector Machine performs the best in preventive maintenance and replacement programme prioritisation predictive systems with the highest accuracy of 99.42 and 99.80%, respectively. Meanwhile, K-Nearest Neighbour yielded the highest accuracy in corrective maintenance prioritisation predictive systems with 98.93%. Based on the promising results, clinical engineers and healthcare providers can widely adopt the proposed prioritisation assessment and predictive systems in managing expenses, reporting, scheduling, materials, and workforce.
Fulltext An automated solid waste detection using the optimized YOLO model for riverine management

Zailan NA, Azizan MM, Hasikin K, Mohd Khairuddin AS, Khairuddin U

Front Public Health, 2022;10:907280.
PMID: 36033781 DOI: 10.3389/fpubh.2022.907280

Due to urbanization, solid waste pollution is an increasing concern for rivers, possibly threatening human health, ecological integrity, and ecosystem services. Riverine management in urban landscapes requires best management practices since the river is a vital component in urban ecological civilization, and it is very imperative to synchronize the connection between urban development and river protection. Thus, the implementation of proper and innovative measures is vital to control garbage pollution in the rivers. A robot that cleans the waste autonomously can be a good solution to manage river pollution efficiently. Identifying and obtaining precise positions of garbage are the most crucial parts of the visual system for a cleaning robot. Computer vision has paved a way for computers to understand and interpret the surrounding objects. The development of an accurate computer vision system is a vital step toward a robotic platform since this is the front-end observation system before consequent manipulation and grasping systems. The scope of this work is to acquire visual information about floating garbage on the river, which is vital in building a robotic platform for river cleaning robots. In this paper, an automated detection system based on the improved You Only Look Once (YOLO) model is developed to detect floating garbage under various conditions, such as fluctuating illumination, complex background, and occlusion. The proposed object detection model has been shown to promote rapid convergence which improves the training time duration. In addition, the proposed object detection model has been shown to improve detection accuracy by strengthening the non-linear feature extraction process. The results showed that the proposed model achieved a mean average precision (mAP) value of 89%. Hence, the proposed model is considered feasible for identifying five classes of garbage, such as plastic bottles, aluminum cans, plastic bags, styrofoam, and plastic containers.
Fulltext Acceptance of medical drone technology and its determinant factors among public and healthcare personnel in a Malaysian urban environment: knowledge, attitude, and perception

Za'im Sahul Hameed M, Nordin R, Ismail A, Zulkifley MA, Sham ASH, Sabudin RZAR, et al.

Front Public Health, 2023;11:1199234.
PMID: 38045974 DOI: 10.3389/fpubh.2023.1199234

INTRODUCTION: Unmanned aerial vehicles (UAVs) are used for commercial, medical, public safety, and scientific research purposes in various countries.
METHODS: This study aimed to explore the acceptance of medical delivery drones among medical practitioners as well as the public community in Malaysia using a knowledge, attitude, and perception (KAP) model and statistical analysis to decrease uncertainty. Bivariate and multivariate analyses of the results were performed in SPSS.
RESULTS: A total of 639 respondents took part in the survey, of which 557 complete responses were finally analyzed. The results showed that the overall acceptance rate for medical delivery drones was positive. The acceptance rate was significantly correlated with knowledge, attitude, and perception scores but not with sociodemographic factors.
DISCUSSION: Raising awareness and educating the medical as well as public communities regarding the potential role and benefits of drones are therefore important in garnering support for drone usage for medical purposes.
Fulltext Breast awareness mobile apps for health education and promotion for breast cancer

Yusuf A, P Iskandar YH, Ab Hadi IS, Nasution A, Lean Keng S

Front Public Health, 2022;10:951641.
PMID: 36324460 DOI: 10.3389/fpubh.2022.951641

BACKGROUND: Lack of knowledge, poor awareness, and attitude are barriers to breast cancer (BC) screening participation. The ubiquitous usage of mobile phones makes it a perfect platform for delivering interventions to increase knowledge and awareness in screening, a strategy for early identification of BC. However, although numerous applications for BC prevention are available on major mobile phone platforms, relatively few have been tested in scientific studies to determine their efficacy.
OBJECTIVE: This study aimed to assess the efficacy of BrAware Apps in increasing the knowledge of BC risk factors, awareness of warning signs and confidence in breast self-examination (BSE) among women in northeast peninsular Malaysia.
METHODS: A quasi-experimental pre and post-test research design were conducted with 41 women participants in Kelantan, Malaysia, before and after using the BrAware apps. Participants were given an online, adapted Breast Cancer Awareness Measure questionnaire. Post-test was 2 months after using the BrAware apps. Comparison using paired T-tests were conducted to evaluate the change in knowledge of risk factors, warning signs awareness and confidence level for BSE.
RESULTS: The mean age of women was 39.71(SD = 8.80). The participants' mean knowledge score of BC warning signs differs before using BrAware (mean 70.62, SD 11.74) and after using the BrAware app (mean 79.83, SD 10.15) at the <0.001 level of significance.
CONCLUSIONS: The BrAware mobile app had a positive effect in increasing the women's knowledge of risk factors of BC, warning signs awareness and confidence level for BSE. It can be concluded that the mobile app may be an adjunct in educating women on BC.
Fulltext TVET programme and health-related quality of life among low-income populations during the COVID-19 pandemic in Malaysia

Yasin RM, Tan MP, Said MA, Rasul MS, Thangiah N, Rizal H, et al.

Front Public Health, 2024;12:1164056.
PMID: 38504686 DOI: 10.3389/fpubh.2024.1164056

INTRODUCTION: Education improves the economy and quality of life. The availability of skilled education in Malaysia is not restricted to the younger generation but is available to people of all ages, including those with low incomes.
METHODS: This study used the EuroQol 5-Dimension 5-Level (EQ- 5D-5L) tool during the COVID-19 pandemic to examine relationships between socio-demographics, knowledge, and attitudes towards education and outcomes of health-related quality of life (HRQOL). Between September and October 2020 and January and February 2021, a cross-sectional study using a multi-stage sampling technique was carried out.
RESULTS: A total of 1,997 adults participated, with a mean age of 45.17 (SD 14.113). In total, 74.9% had good knowledge, while 59.8% had a positive attitude towards skill education. In univariate analyses, the EQ-5D-5L score was related to age, income, education level, marital status, employment status, financial strain level, and knowledge and attitude towards skilled education. Generalised linear model analyses demonstrated that lower EQ-5D-5L scores were associated with older age, financial constraints, and a negative attitude towards skills education. However, additional adjustments for knowledge and attitude towards skills education show only an increase in age and financial strain was significant.
CONCLUSION: The findings suggest that appropriate strategies be implemented to increase low-income populations' knowledge and attitude towards skill education. Improving education may improve the quality of life for this vulnerable group. Additionally, a qualitative study can be conducted to determine the barriers to low-income households participating in skilled education to fill in the knowledge gap.
Fulltext Predicting the Mass Adoption of eDoctor Apps During COVID-19 in China Using Hybrid SEM-Neural Network Analysis

Yang Q, Al Mamun A, Hayat N, Md Salleh MF, Salameh AA, Makhbul ZKM

Front Public Health, 2022;10:889410.
PMID: 35570961 DOI: 10.3389/fpubh.2022.889410

Technology plays an increasingly important role in our daily lives. The use of technology-based healthcare apps facilitates and empowers users to use such apps and saves the burden on the public healthcare system during COVID-19. Through technology-based healthcare apps, patients can be virtually connected to doctors for medical services. This study explored users' intention and adoption of eDoctor apps in relation to their health behaviors and healthcare technology attributes among Chinese adults. Cross-sectional data were collected through social media, resulting in a total of 961 valid responses for analysis. The hybrid analysis technique of partial least squares structural equation modeling (PLS-SEM) and artificial neural network (ANN) analysis was applied. The obtained results revealed the significant influence of eDoctor apps in terms of usefulness, compatibility, accuracy, and privacy on users' intention to use eDoctor apps. Intention and product value were also found to suggestively promote the adoption of eDoctor apps. This study offered practical recommendations for the suppliers and developers of eHealth apps to make every attempt of informing and building awareness to nurture users' intention and usage of healthcare technology. Users' weak health consciousness and motivation are notable barriers that restrict their intention and adoption of the apps. Mass adoption of eDoctor apps can also be achieved through the integration of the right technology features that build the product value and adoption of eDoctor apps. The limitations of the current study and recommendations for future research are presented at the end of this paper.
Fulltext Risk Factors of Candida parapsilosis Catheter-Related Bloodstream Infection

Yamin DH, Husin A, Harun A

Front Public Health, 2021;9:631865.
PMID: 34458217 DOI: 10.3389/fpubh.2021.631865

Catheter-related bloodstream infection (CRBSI) is an important healthcare-associated infection caused by various nosocomial pathogens. Candida parapsilosis has emerged as a crucial causative agent for the CRBSI in the last two decades. Many factors have been associated with the development of CRBSI including, demography, pre-maturity, comorbidities (diabetes mellitus, hypertension, heart diseases, neuropathy, respiratory diseases, renal dysfunction, hematological and solid organ malignancies, and intestinal dysfunction), intensive care unit (ICU) admission, mechanical ventilation (MV), total parenteral nutrition (TPN), prior antibiotic and/or antifungal therapy, neutropenia, prior surgery, immunosuppressant, and type, site, number, and duration of catheters. This study aims to determine C. parapsilosis CRBSI risk factors. A retrospective study has been performed in an 853-bedded tertiary-care hospital in north-eastern Malaysia. All inpatients with C. parapsilosis positive blood cultures from January 2006 to December 2018 were included, and their medical records were reviewed using a standardized checklist. Out of 208 candidemia episodes, 177 had at least one catheter during admission, and 31 cases had not been catheterized and were excluded. Among the 177 cases, 30 CRBSI cases were compared to 147 non-CRBSI cases [81 bloodstream infections (BSIs), 66 catheter colonizers]. The significance of different risk factors was calculated using multivariate analysis. Multivariate analysis of potential risk factors shows that ICU admission was significantly associated with non-CRBSI as compared to CRBSI [OR, 0.242; 95% CI (0.080-0.734); p = 0.012], and TPN was significantly positively associated with CRBSI than non-CRBSI [OR, 3.079; 95%CI (1.125-8.429); p = 0.029], while other risk factors were not associated significantly. Patients admitted in ICU were less likely to develop C. parapsilosis CRBSI while patients receiving TPN were more likely to have C. parapsilosis CRBSI when compared to the non-CRBSI group.
Fulltext Modeling the adoption of medical wearable devices among the senior adults: Using hybrid SEM-neural network approach

Xinyan Z, Mamun AA, Ali MH, Siyu L, Yang Q, Hayat N

Front Public Health, 2022;10:1016065.
PMID: 36388276 DOI: 10.3389/fpubh.2022.1016065

The world is witnessing an increasing number of senior adult residents who experience health issues. Healthcare innovation facilitates monitoring the health conditions of senior adults and reducing the burden on healthcare institutions. The study explored the effect of health improvement expectancy, effort expectancy, price value, perceived vulnerability, health consciousness, and perceived reliability on the intention and adoption of medical wearable devices (MWD) among senior adults in China. Furthermore, a cross-sectional design was adopted, while quantitative data was collected from 304 senior adults through an online survey. A hybrid approach of partial least square structural equational modeling and artificial neural network-based analysis technique was adopted. The findings demonstrated that health improvement expectancy, perceived vulnerability, price value, and perceived reliability significantly affected the intention to adopt MWDs. Moreover, the intention to adopt MWDs significantly positively affected the actual adoption of MWDs among senior adults. Although the moderating effect of the pre-existing conditions and income between the intention to use MWDs and actual adoption of MWDs was positive, it was not statistically significant. The artificial neural network analysis has proven that perceived reliability, price value, and vulnerability are the most critical factors contributing to the intention to use MWDs. The current study offered valuable insights into the factors affecting the intention and adoption of MWDs among senior adults. Following that, theoretical and practical contributions were documented to improve the ease of use and price value for the prospective users of MWDs. The correct healthcare policies could curtail the influx of senior adults into the hospital and empower these adults to track and manage their health issues at home.
Fulltext Assessment of Impact of Containment During the COVID-19 Epidemic and Coping Behaviours Using Newly Developed Assessment Tools

Wong LP, Alias H, Danaee M, Lee HY, Tan KM, Tok PSK, et al.

Front Public Health, 2021;9:787672.
PMID: 35004587 DOI: 10.3389/fpubh.2021.787672

Background: The confinement measures during COVID-19 had a massive effect on physical and psychological health in public. This study assessed the impact of containment and coping behaviour among the Malaysia public during the COVID-19 pandemic. Questions assessing the impact of containment and coping behaviours were developed and psychometrically tested. Methods: Exploratory factor analysis (EFA) was conducted with the items using principal component analysis extraction and Varimax rotation. Partial least squares structural equation modelling was used to determine the relationship between coping and impact. Results: The 13-item of impact and 10-item coping instruments were developed with three dimensions identified through EFA. Both scales demonstrated excellent composite reliability and good convergent validity. The survey findings revealed that the impact on individual psychological aspects was prominent, followed by well-being and lifestyle. Mindfulness and physical coping strategies were most commonly reported. Coping through seeking help from health professionals and hotlines had a positive direct effect on well-being and lifestyle (b = 0.231, p < 0.001), psychological (B = 0.132, p < 0.001), and employment-related (0.194, p < 0.001) impacts. Coping through mindfulness practise had a negative effect on well-being and lifestyle-related impact (B = -0.180, p < 0.001) and employment-related impact (B = -0.096, p = 0.008). Conclusions: Despite some limitation, the scales for measuring impact and coping behaviours have the potential to be used as a measurement tool in future studies. Findings highlight the enormous impact of the pandemic on psychological well-being and lifestyles. Health authorities should support individual coping as it was found to be an important resilience-related factor to mitigate the impacts of containment during the pandemic.
Fulltext Preventing Re-Emergence of COVID-19: A National Survey of Public Risk Perceptions and Behavioural Intentions Concerning Travel Plan Among Taiwanese

Wong LP, Chiu CJ, Alias H, Lee TS, Hu Z, Lin Y

Front Public Health, 2021;9:710508.
PMID: 34497793 DOI: 10.3389/fpubh.2021.710508

Background: The objectives of this study were to investigate risk perceptions and travel intention among the general public in Taiwan during the COVID-19 outbreak. Methods: This study used a cross-sectional online survey to collect data. The questionnaire was disseminated via the social media platform (LINE and Facebook) to the general public. Results: A total of 3,237 complete responses were received, of whom 5.8% (95% CI 5.1-6.7) of the participants reported intent to travel to overseas countries with an apparent community spread and 5.5% (95% CI 4.7-6.3) reported intent to travel to other overseas countries in the next 1 month. A relatively higher proportion (46.5%; 95% CI 44.7-48.2) reported intention for domestic travelling. Participants who viewed travelling to only be risky for older adults or those with medical conditions (OR = 2.19; 95% CI 1.38-3.47) and who perceived that one will not get infected if one takes recommended precautionary measures (OR = 3.12; 95% CI 1.85-5.27) reported higher travelling intention to overseas countries with an apparent community spread. Conclusions: Overall, the findings suggest that risk perceptions were depicted as a strong influence of travel intentions.
Fulltext Parent-child relationships and psychological distress: survey of parents from low-income families after the COVID-19 pandemic

Wong LP, Alias H, Farid NDN, Yusop SM, Musa Z, Hu Z, et al.

Front Public Health, 2023;11:1158698.
PMID: 37213607 DOI: 10.3389/fpubh.2023.1158698

INTRODUCTION: This study aims to shed light on parent-child relationships and the psychological health of parents from low-income families after the easing of the COVID-19 pandemic restrictions.
METHODS: This cross-sectional study recruited 553 parents of children aged 13-24 years in low-income community settings. The Parent-Child Conflict scale of the Parental Environment Questionnaire (PEQ) was used to measure parent-child conflict. Psychological distress was assessed using the Depression, Anxiety, and Stress Scale short form (DASS-21).
RESULTS: The study revealed a low level of parent-child conflict in the overall study population, with a median PEQ of 48.0 (interquartile range [IQR] 36 to 48). Concerning demographics, married parents reported a likelihood of having a higher level of parent-child conflict over 3 times higher than single parents (OR = 3.18 95%, CI 1.30-7.75). More parent-child conflicts were also found in parents aged 60-72 years old who were unemployed, retired, or housewives and from lower-income groups. In regard to lifestyle factors, a higher level of physical activity and having enough sleep were associated with lower levels of parent-child conflict. Only approximately 1% of the participants reported symptoms of depression, anxiety, or stress.
DISCUSSION: Low risk exists for parent-child conflict and psychological sequelae following the easing of the COVID-19 pandemic restrictions, which could be due to various support measures implemented by the government. Vulnerable parents identified as being at risk of parent-child conflict warrant attention in future advocacy efforts.
Fulltext Blended learning in physical education: A systematic review

Wang C, Omar Dev RD, Soh KG, Mohd Nasirudddin NJ, Yuan Y, Ji X

Front Public Health, 2023;11:1073423.
PMID: 36969628 DOI: 10.3389/fpubh.2023.1073423

This review aims to provide a detailed overview of the current status and development trends of blended learning in physical education by reviewing journal articles from the Web of Science (WOS) database. Several dimensions of blended learning were observed, including research trends, participants, online learning tools, theoretical frameworks, evaluation methods, application domains, Research Topics, and challenges. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a total of 22 journal articles were included in the current review. The findings of this review reveal that the number of blended learning articles in physical education has increased since 2018, proving that the incorporation of online learning tools into physical education courses has grown in popularity. From the reviewed journal articles, most attention is given to undergraduates, emphasizing that attention in the future should be placed on K-12 students, teachers, and educational institutions. The theoretical framework applied by journal articles is also limited to a few articles and the assessment method is relatively homogeneous, consisting mostly of questionnaires. This review also discovers the trends in blended learning in physical education as most of the studies focus on the topic centered on dynamic physical education. In terms of Research Topics, most journal articles focus on perceptions, learning outcomes, satisfaction, and motivation, which are preliminary aspects of blended learning research. Although the benefits of blended learning are evident, this review identifies five challenges of blended learning: instructional design challenges, technological literacy and competency challenges, self-regulation challenges, alienation and isolation challenges, and belief challenges. Finally, a number of recommendations for future research are presented.

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