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Fulltext Optimizing human resource strategies: Investigating the dynamics of high-performance practices, psychological empowerment, and responsible leadership in a moderated-mediation framework

Sarwar U, Aslam MK, Khan SA, Shenglin S

Acta Psychol (Amst), 2024 Aug;248:104385.
PMID: 38968810 DOI: 10.1016/j.actpsy.2024.104385

Even though existing literature frequently finds High Performance Human Resource Practices' (HPHRPs) positive impact on job performance in organizational setting, still it remains short to study unexplored underlying methods by which High Performance Human Resource Practices (HPHRPs) affect employee job performance. This gap is filled by our research, which proposes psychological empowerment as a mediator in the aforementioned relationship. Based on signaling theory, the present study examines the mediating role of psychological empowerment (PE) in the relationship between high-performance human resource practices (HPHRPs) and job performance (JP). In addition, this study tests the interactive effect of HPHRPs and responsible leadership on psychological empowerment. Data were collected in three waves from representative sample of education sector employees and their supervisors (T1-557, T2-342, T3-210 responses) in Pakistan. The hypotheses were evaluated using the PROCESS macro with SPSS to measure moderated-mediated relationships. The findings of the study reveal that HPHRPs positively influence employee performance through psychological empowerment. Responsible leadership positively moderates HPHRPs' effects on psychological empowerment. Furthermore, responsible leadership moderates the mediated relationship such that this positive indirect effect is stronger for individuals possessing low levels of responsible leadership. Our study is the first of its type to investigate whether a responsible leader may moderate the indirect impact of HPHRPs on JP through psychological empowerment. The findings carry critical implications for the practitioners and academics to devise interventions for better work environments.
Fulltext Assessment of Direct Medical Cost of Hospitalized COVID-19 Adult Patients in Kuwait During the First Wave of the Pandemic

AlManie SA, AlHazami MS, Ebrahim A, Attique MS

Clinicoecon Outcomes Res, 2024;16:509-522.
PMID: 39069972 DOI: 10.2147/CEOR.S467543

OBJECTIVE: This study aims to estimate the direct medical cost of COVID-19 hospitalizations and to utilize prevalence estimates from Jaber Al-Ahmad Hospital to estimate the direct medical cost of all hospitalized adult patients in Kuwait using a decision tree analysis.
METHODS: A cost-of-illness model was developed. The Ministry of Health perspective was considered, direct medical costs were estimated from July 1st to September 30th, using a bottom-up approach. The mean cost per hospitalized patient was estimated using a decision analysis model. Prevalence estimates of ambulance use, use of ER, ICU admission, and mortality were considered in the current study. Patients aged 18 years and above with a confirmed diagnosis of COVID-19 were included. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were performed.
RESULTS: Data for 2986 patients were analyzed. The mean age was 61 (SD= 11) years old. Most of the patients were Kuwaiti (2864, 95.91%), and more than half were females (1677, 56.16%). Of the total hospital admissions, 417 patients (14%) were admitted to the ICU. The average length of the hospital stay was 11 (SD= 9) days, and among all hospital admissions, 270 (9.04%) patients died. The total estimated direct medical cost of hospitalized patients at Jaber Al-Ahmad Hospital was $47,213,768 (14,283,203.6 KD). The average cost of hospital stay per patient was estimated at $15,498 (4,688.60 KD). The weighted average cost per hospitalized patient in Kuwait was estimated at $16,373 (4,953.08 KD). The total direct medical cost of hospitalized COVID-19 patients in Kuwait during the study period was estimated at $174,372,450 (52,751,502 KD).
CONCLUSION: The COVID-19 pandemic constituted a significant burden on the Kuwaiti healthcare system. The findings of this study urge the need for preventive care strategies to reduce adverse health outcomes and the economic impact of the pandemic.
Innovative solutions for the removal of emerging microplastics from water by utilizing advanced techniques

Noornama, Abidin MNZ, Abu Bakar NK, Hashim NA

Mar Pollut Bull, 2024 Sep;206:116752.
PMID: 39053257 DOI: 10.1016/j.marpolbul.2024.116752

Microplastic pollution is one of the most pressing global environmental problems due to its harmful effects on living organisms and ecosystems. To address this issue, researchers have explored several techniques to successfully eliminate microplastics from water sources. Chemical coagulation, electrocoagulation, magnetic extraction, adsorption, photocatalytic degradation, and biodegradation are some of the recognized techniques used for the removal of microplastics from water. In addition, membrane-based techniques encompass processes propelled by pressure or potential, along with sophisticated membrane technologies like the dynamic membrane and the membrane bioreactor. Recently, researchers have been developing advanced membranes composed of metal-organic frameworks, MXene, zeolites, carbon nanomaterials, metals, and metal oxides to remove microplastics. This paper aims to analyze the effectiveness, advantages, and drawbacks of each method to provide insights into their application for reducing microplastic pollution.
Caudal regression syndrome associated with obstructive genital tract anomaly

Harun MHH, Mohd Nor NF, Ramli R

BMJ Case Rep, 2024 Jul 30;17(7).
PMID: 39079904 DOI: 10.1136/bcr-2024-261142

Transverse vaginal septum (TVS) is a rare obstructive genital tract anomaly. It is associated with primary amenorrhoea and typically presents with cyclical abdominal pain due to obstruction of the menstrual flow. Caudal regression syndrome (CRS) is also a rare congenital anomaly that is frequently associated with anomalies of the neurological, musculoskeletal, cardiac, genitourinary and gastrointestinal systems. Obstructive genital tract anomaly in CRS is exceptionally rare. This report describes the case of a girl in early adolescence with underlying CRS who presented with severe abdominal pain associated with primary amenorrhoea. Clinical and radiological assessment revealed 'haematocolpos' manifesting as a tender 20 weeks' size abdominal mass and an absent vaginal opening. TVS was identified during examination under anaesthesia. The patient subsequently underwent a successful vaginoplasty with no recurrence of symptoms after 2 years.
Ocular Hornet Injury: A Case Report on Corneal Microperforation and Endophthalmitis

Mohd Amin MHA, Rosli AH, Salam A

Cureus, 2024 Jul;16(7):e65515.
PMID: 39188476 DOI: 10.7759/cureus.65515

The lesser-banded hornet (Vespa affinis indosinensis) is a prevalent species in tropical and subtropical regions of Asia, including Malaysia. Its stings can result in local reactions, severe anaphylactic shock, and even death. We report a rare case of corneal microperforation and endophthalmitis following an ocular hornet injury. A 76-year-old farmer was attacked by hornets and suffered multiple stings, including one to his right eye. He developed right eye pain, redness, and visual impairment. Ocular examination revealed right corneal haziness with a retained stinger. Attempts to remove the retained stinger were unsuccessful, as the stinger broke and stayed deep in the corneal tissue layer. Corneal microperforation occurred at the site of the retained stinger. Subsequently, he developed endophthalmitis despite extensive topical and systemic antibiotics. He also required a scleral patch procedure for sclerokeratouveitis. This report highlights the importance of quick and vigilant management to prevent severe complications and preserve vision after a hornet sting injury. Retained stingers pose unique challenges that require specialized interventions. There is a need for continuous research and awareness in the management of ocular hornet injuries, aiming to establish standardized treatment guidelines and improve patient outcomes.
COP 28 Policy Perspectives: Achieving Environmental Sustainability through FDI, Technological Innovation Index, Trade Openness, Energy Consumption, and Economic Development in N-11 Emerging Economies

Abbass K, Zafar MW, Khan F, Begum H, Song H

J Environ Manage, 2024 Sep 04;369:122271.
PMID: 39236618 DOI: 10.1016/j.jenvman.2024.122271

Despite remarkable success in attracting foreign direct investment (FDI) to achieve maximum economic growth, the Next-11 emerging economies grappling with an undesirable situation of environmental degradation have become a hot topic at COP28. Researchers have long focused on this connection, emphasizing the urgent need for international and national environmentalists to promote sustainable development (SD) in these rapidly growing economies under the United Nations (UN) Framework Convention on Climate Change action plans. As a result, this study examines the role of FDI in the N-11 emerging economies, focusing on energy usage and technological innovation within the theoretical framework of the Halo-Haven hypothesis, covering the period from 1990 to 2022. We utilize ARDL, FMOLS, and DOLS techniques to analyze both short-term dynamics and long-term equilibrium relationships, effectively managing heterogeneity, time dynamics, and cross-sectional dependence issues to produce comprehensive results. The long-term analysis supports the haven hypothesis, demonstrating an affirmative relationship between FDI, economic growth, and carbon emissions, whereas energy usage is negatively associated with carbon emissions. Furthermore, the D-H test established a reciprocal causal relationship between variables such as FDI, economic growth, trade openness, and environmental pollution. However, we found a one-way causal correspondence in the usage of green energy, the technological innovation index, and carbon emissions. Given the mixed findings, policymakers should focus on attracting FDI to the green energy sector while reinforcing regulations and implementing stringent oversight for FDI in energy-intensive industries. This approach will ensure that such investments adhere to high environmental standards, thereby benefiting future generations.
Accreditation Made Easy: Step-by-Step Guide for Healthcare Institutions

Newera A, Alomari FK, Al-Ghamdi AM, Fouda M

Glob J Qual Saf Healthc, 2024 Nov;7(4):232-235.
PMID: 39534238 DOI: 10.36401/JQSH-24-X5
An assessment of live hard coral cover distribution and its physicochemical factors in the Strait of Malacca from 1995 to 2016

Huang DM, Sigid MF, Yusup Y, Fadhlullah W, Salleh S

Mar Environ Res, 2024 Nov 12;203:106833.
PMID: 39541794 DOI: 10.1016/j.marenvres.2024.106833

The Strait of Malacca is well-known as an important trade route with high marine biodiversity. Among the organisms residing in the strait are the reef-building hard corals. Studies have shown that climate change and other anthropogenic stressors have induced severe degradation of coral reefs through the disruption of coral productivity and metabolisms. Moreover, in-depth investigations of causal inference of coral degradation and its correlations with potential coral-affecting physicochemical factors within the strait are limited. Hence, this study presents the analyses of the latest bi-decadal time-series trend from 1995 to 2016 of the live hard coral coverage (or live coral cover) and six coral-affecting physicochemical factors (significant wave height, sea surface salinity, particulate inorganic carbon, particulate organic carbon, turbidity, and sea surface temperature) using remote sensing and reanalysis datasets. Their potential correlations were interpreted by implementing meta- and statistical analyses of past coral surveys and remote sensing data. This study revealed the overall persistent bi-decadal decline in live hard coral coverage within the Strait of Malacca and the complex correlations among the factors that correspond to the spatial stratification of the marine environment. Among the six physicochemical factors, sea surface temperature, turbidity, and sea surface salinity were determined to be the most influential parameters on live coral cover distribution within the strait.
Biopsy-based normalizations of gill monogenean-infected European catfish (Silurus glanis L., 1758) stocks for laboratory-based experiments

Bognár A, Borkhanuddin MH, Nagase S, Sellyei B

PeerJ, 2024;12:e18288.
PMID: 39553726 DOI: 10.7717/peerj.18288

Ectoparasites cause serious problems during the aquaculture production of food fishes. In this study, we set out to develop and test protocols for maintenance and sampling European catfish (Silurus glanis L., 1758) stocks infected with a gill monogenean, Thaparocleidus vistulensis (Siwak 1932) Lim 1996. When we compared the feasibility of two cohabitation-based parasite culture systems (i.e., static vs. flow-through), we found that the life cycle of T. vistulensis was completed in both habitats. In our experience, static tank systems with regular water exchange allowed better daily quality control of the parasite culture than continuous flow-through systems. We investigated the microhabitat preference of T. vistulensis on the gills of infected European catfish. A balanced distribution on the two lateral gill sets and a decreasing trend in parasite numbers from anterior gill holobranches towards the posterior ones was observed. Using these results, we developed a minimally invasive sampling protocol to estimate the parasite load of individuals. The biopsy aimed at four sectors (#6, #7, #10, and #11) situated within the distal and middle zones of the first holobranch on the left side, encompassing both rows of filaments. Biopsy-based estimates of parasite loads were validated by comparing them to full parasite counts of the same individuals and showed statistically significant correlations. Our biopsy-based method is designed to identify experimental animals with similar parasite loads and create groups of hosts with comparable burdens. This setup is expected to generate reduced between-group differences for expensive experiments (e.g., high throughput transcriptomic or epigenetic studies). We propose that the biopsy-based pre-sorting procedure should be considered in similar experiments with other cultured fish species and their gill monogeneans following a thorough fine-tuning of the experimental conditions.
Educational Interventions for Perinatal Depression Management Among Non-Specialist Providers in Resource-Constrained Settings: A Descriptive Systematic Review of Limited Evidence

Mohd Salleh MK, Hairi NN, Krishna Supramanian R

Asia Pac J Public Health, 2026 Oct 25.
PMID: 42928544 DOI: 10.1177/10105395261489325

This descriptive systematic review synthesizes evidence from resource-constrained primary and non-specialist care settings on the structural components of educational interventions for frontline health care workers regarding perinatal depression (PND). A comprehensive search was conducted across CINAHL, Cochrane Library, PubMed, and Scopus for experimental and quasi-experimental studies published between January 1, 2019, and August 31, 2025, in Resource-Constrained Settings. Three quasi-experimental, non-randomized studies met the pre-specified inclusion criteria, representing a total of 351 participants across Nigeria, Saudi Arabia, and Thailand. Quality appraisal conducted via the Risk of Bias in Non-randomized Studies of Interventions, Version 2 (ROBINS-I V2) tool judged all 3 studies to be at an overall critical risk of bias. A descriptive narrative synthesis was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) guidelines, as high clinical and methodological heterogeneity precluded a statistical meta-analysis. Preliminary patterns across the included studies suggest that educational models in these settings commonly feature standardized reference frameworks such as the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) and structured active learning approaches. Multi-session delivery formats, cascade (train-the-trainer) models, and practical clinical phases accompanied by remote mobile supervision were reported alongside improvements in immediate provider-level metrics. The extremely narrow evidence base, high attrition rates, lack of comparative control groups, and complete absence of patient outcomes severely constrain the ability to draw definitive conclusions regarding intervention effectiveness or causal mechanisms. The findings are presented as hypothesis-generating, emphasizing the critical need for methodologically rigorous trials in global maternal mental health.
Fulltext Advanced Multi-architecture Deep Learning Framework for BIRADS-Based Mammographic Image Retrieval: Comprehensive Performance Analysis with Super-Ensemble Optimization

Rahman MDS, Humayara F, Rabbi SME, Rashid MM

J Imaging Inform Med, 2026 Oct;39(5):3972-3986.
PMID: 41402617 DOI: 10.1007/s10278-025-01770-6

Content-based mammographic image retrieval requires exact BIRADS categorical matching across five classes, posing far greater complexity than conventional binary classification. Existing studies remain limited by small sample sizes, improper patient-level separation, and inadequate statistical validation, restricting clinical translation. We developed a comprehensive evaluation framework systematically comparing CNN architectures (DenseNet121, ResNet50, VGG16) under advanced training strategies: fine-tuning, metric learning, and super-ensemble optimization. Rigorous patient-stratified splits (1003 patients, two images each), 602 test queries, and bootstrap confidence intervals (1000 resamples) ensured reliable assessment. Advanced fine-tuning and test-time augmentation (TTA) yielded a precision@10 of 34.71% for DenseNet121 _AdvancedFT_TTA, a 25.74% improvement over the baseline ResNet50 (27.6%). Selective super-ensemble and metric learning approaches were further benchmarked under patient-exclusive splits, confirming robust performance across architectures. Statistical analysis (bootstrap CIs, n = 1000; t-tests p 0.8) validated significant gains and reproducibility. These results establish DenseNet121_AdvancedFT_TTA as the new state-of-the-art for five-class BIRADS retrieval while reducing computational cost.
Endothelial barrier disruptive effect of IFN-Ƴ and TNF-α: Synergism of pro-inflammatory cytokines

Ng CT, Fong LY, Tan JJ, Abdullah MNH

Cytokine, 2025 Mar 29;190:156922.
PMID: 40158467 DOI: 10.1016/j.cyto.2025.156922

Crosstalk and synergy between interferon-γ (IFN-Ƴ) and tumor necrosis factor-α (TNF-α) in endothelial cells have previously been documented, however, there is an absence of articles reviewing the synergistic effect of IFN-Ƴ and TNF-α in regulating the endothelial barrier function. This review discusses the regulatory mechanisms and recent evidence of the synergism of IFN-γ and TNF-α in causing destabilization of endothelial junctions in various clinical studies and preclinical models. Articles were retrieved from electronic databases such as Web of Science, PubMed, Google Scholar, and Scopus. The search terms used were "interferon", "interferon-gamma", "tumor necrosis factor-α", "vascular inflammation", "endothelial barrier", "endothelial permeability" and "synergism". We selected articles published between 2004 and 2024. Through the Rho-associated protein kinase (ROCK) and p38 mitogen-activated protein (MAP) kinase pathways, our results showed that IFN-γ controls the remodeling of actin and the stability of junctions. In comparison to IFN-γ, the signaling cascades triggered by TNF-α involve a variety of pathways such as nuclear factor-kappa B (NF-κB), small GTPases, tyrosine kinases, integrin receptors, and barrier-stabilizing molecules such as Ras-related proteins 1A (Rap1A) and Rac family small GTPase 1 (Rac1). In the context of IFN-γ and TNF-α synergism, combined IFN-γ and TNF-α alter adherens and tight junctions. It is deduced that c-Jun N-terminal kinase (JNK), signal transducers and activators of transcription (STAT1), and caspase signaling pathways regulate endothelial barrier disruption caused by IFN-γ and TNF-α. Collectively, the mechanism underlying the synergistic action of IFN-γ and TNF-α is still lacking. Future work is needed to explore the crosstalk pathways of IFN-γ and TNF-α involved in the regulation of endothelial barrier function such as modulation of extracellular matrix (ECM) structure, involvement of tyrosine kinases and roles of small GTPases.
Advancements in Selective Laser Melting (SLM) of titanium alloy scaffolds for bone tissue engineering

Yan K, Ngadiman NHA, Saman MZM, Mustafa NS

Biofabrication, 2025 Mar 28.
PMID: 40153868 DOI: 10.1088/1758-5090/adc6c0

Selective Laser Melting (SLM) has emerged as a transformative technology in bone tissue engineering, particularly for fabricating porous scaffolds from titanium alloys. These scaffolds offer a promising solution for treating critical-sized bone defects, providing mechanical support while promoting bone regeneration. A comprehensive review on recent advancements of SLM is provided by presenting a detailed analysis of cutting-edge research in the application of SLM for titanium alloy scaffold production. Key areas explored include structural designs like Triply Periodic Minimal Surfaces (TPMS), material and process parameters optimization to enhance scaffold properties such as porosity, mechanical strength, and biocompatibility. Furthermore, the review emphasizes recent innovations in surface modification techniques which improve bioactivity and osseointegration to enable scaffolds to mimic the host tissues. In addition, this review provides essential insights in related to the potential of SLM to be adopted in producing personalized and high-performance medical implants. By synthesizing the latest trends and identifying key areas for future research, this paper aims to serve as a vital resource for the advancement and usage of SLM-fabricated scaffolds in clinical applications. The findings underscore the importance of continued innovation in this field, which has the potential to significantly improve patient outcomes in orthopaedics and beyond. .
New freshwater Ceratomyxa species, Ceratomyxa schwanefeldii n. sp. (Myxozoa: Ceratomyxidae) from the gall bladder of tinfoil barb, Barbonymus schwanefeldii (Cyprinidae, Cypriniformes) in Malaysia

Suhaimi NS, Székely C, Cech G, Sellyei B, Borkhanuddin MH

Parasitol Int, 2025 Apr 02;108:103073.
PMID: 40185307 DOI: 10.1016/j.parint.2025.103073

Genus Ceratomyxa comprises coelozoic parasites of mainly marine and brackish water fish. This study describes a new Ceratomyxa species, Ceratomyxa schwanefeldii n. sp. which parasitizes the gall bladder of Barbonymus schwanefeldii collected from Sungai Tong in Setiu, Terengganu, Malaysia. The new species was described using morphological characteristics, and on nucleotide sequences of small subunit ribosomal DNA (SSU rDNA) and large subunit ribosomal DNA (LSU rDNA). Ceratomyxa schwanefeldii n. sp. exhibited vermiform shape plasmodia with slow undulatory motility, measuring 151.6 ± 86.0 (43.0-271.0) μm in length and 15.1 ± 4.8 (9.3-22.7) μm in width, with blunt poles at both ends. The mature spores were crescent-shaped, strongly arched in frontal view, with a sutural line between the two valves tapering to blunt ends. Formalin-fixed spores were 3.0 ± 0.4 (2.4-3.9) μm in length, 12.6 ± 1.2 (10.8-15.4) μm in thickness, with a concave posterior angle, 104.8° ± 10.2° (73.4-123.8). Two equal-sized spheroid polar capsules measured 1.5 ± 0.2 (1.2-1.8) μm in length and 1.3 ± 0.2 (0.9-1.7) μm in width. Phylogenetic analyses by Maximum likelihood and Bayesian Inference algorithms positioned C. schwanefeldii n. sp. as a sister species to Unicapsulocaudum mugilum and clustered within the clade of Amazonian freshwater Ceratomyxa species. The LSU rDNA phylogeny revealed that C. schwanefeldii n. sp. clusters within the marine Ceratomyxa clade and forms a sister relationship with C. leatherjacketi. This study represents the first description of a freshwater Ceratomyxa in Malaysia and the fourth recorded detection in the Asian region.
Fulltext Genetic Diversity in the Fusion Gene of Respiratory Syncytial Virus (RSV) Isolated From Iraqi Patients: A First Report

Wali MH, Naif HM, Abdul Rahim NA, Yunus MA

Adv Virol, 2025;2025:8864776.
PMID: 40191805 DOI: 10.1155/av/8864776

Molecular evaluation of the respiratory syncytial virus (RSV) genome is one of the common strategies applied to understand the viral pathogenicity and control its spreading. In this study, we carried out molecular evaluation on the targeted fusion (F) gene region in the RSV-positive samples of Iraqi patients during the autumn and winter of 2022/2023. One hundred and fifty patients with lower respiratory tract infections were screened for RSV using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Sanger sequencing was performed on the RSV-positive samples targeting 1061 nucleotides (from nucleotide 6168 to 7228 within the RSV genome) and 1000 nucleotides (from nucleotide 6122 to 7121 within the RSV genome) of the F gene region for RSV-A and RSV-B, respectively. The results showed some nucleotide changes within the targeted F gene, which were grouped in distinct clade, closely related to isolates from Austria, Argentine, Finland, and France through phylogenetic analysis. In silico protein modeling using the SWISS-MODEL and I-TASSER web tools based on nonsynonymous changes of amino acid sequence showed some good-predicted models that can be utilized for antiviral screening. In summary, the identified nucleotide variations in the F gene could influence vaccine development as the F protein is the primary target for the major antigen of RSV. Molecular surveillance data of RSV local isolates are also essential for studying new genomic changes and enable the prediction of potential new antiviral agents.
Willingness to Pay for Preventive and Curative Dental Procedures in Malaysia: An Urban-Rural Analysis

Jusoh MH, Venkiteswaran A, Md Bohari NF, Md Sabri BA

Community Dent Oral Epidemiol, 2026 Oct 21.
PMID: 42908250 DOI: 10.1111/cdoe.70124

OBJECTIVES: To estimate willingness to pay (WTP) for selected preventive and curative dental procedures, identify demographic, socioeconomic and behavioural factors associated with WTP, and examine urban-rural differences among Malaysian adults.
METHODS: A cross-sectional study was conducted using a self-administered questionnaire based on the contingent valuation method. A total of 387 adults were recruited through multistage stratified sampling from UTC Selangor (urban) and UTC Keningau (rural). WTP was elicited for five preventive procedures (dental check-up, scaling and polishing, oral hygiene advice, fluoride varnish and fissure sealant) and two curative procedures (dental filling and extraction). Data were analysed using descriptive statistics, Mann-Whitney U tests and multiple linear regression.
RESULTS: Median (25th-75th percentile) WTP ranged from RM50 (RM20-RM100) for oral hygiene advice to RM130 (RM60-RM240) for dental filling. Median WTP was RM100 for dental check-up (RM35-RM150), scaling and polishing (RM50-RM160), fissure sealant (RM50-RM150) and dental extraction (RM50-RM172.50), and RM80 (RM40-RM130) for fluoride varnish application. Because the payment-card upper bounds differed across procedures, these between-procedure estimates should be interpreted as conditional on the ranges presented. Higher household income, medical and dental insurance coverage and regular dental attendance were positively associated with WTP across several procedures. In unadjusted analyses, urban participants reported significantly higher WTP for all seven procedures (p
Exploring Betel Quid Chewing Among Orang Asli: A Qualitative Study

Jamil MA, Sabri BAM, Yani AAM

J Community Health, 2025 Apr;50(2):235-243.
PMID: 39419886 DOI: 10.1007/s10900-024-01418-6

Betel quid chewing is a culturally significant practice among the indigenous people (Orang Asli) in Malaysia, but it poses serious health risks, including oral cancer and systemic diseases. Studies on betel quid chewing are limited, making it difficult to develop effective public health interventions. This study aimed to explore the cultural significance, perceived health effects, and misconceptions surrounding betel quid chewing among the indigenous people, assess their awareness of health risks, and explore factors influencing their intentions to quit or reduce betel quid chewing. A qualitative phenomenological design was used, with five groups of Focus Group Discussions conducted with 15 participants from an Orang Asli village in Johor. The discussions revealed that betel quid chewing is deeply embedded in Orang Asli culture, often beginning in childhood and associated with social and ceremonial occasions. However, awareness of health risks, particularly oral cancer, was inconsistent. Social support and personal motivation were critical in influencing quitting behaviors. These findings highlight the need for culturally tailored cessation programs that address the unique social and environmental factors influencing betel quid use in this population.
Fulltext One-Year Infection Eradication and Clinical Outcomes After Completed Two-Stage Revision for Hip and Knee Periprosthetic Joint Infection: A Retrospective Cohort Study

Rao M, Bin Soldin MAA, Balan M, Abdullah MA

Cureus, 2026 Oct;18(10):e118884.
PMID: 42967026 DOI: 10.7759/cureus.118884

Background Two-stage revision is an established treatment for hip and knee periprosthetic joint infection (PJI). Infection eradication is the primary goal, but reconstruction should also provide acceptable pain relief and function. This study evaluated infection eradication and clinical outcomes approximately one year after completed two-stage revision arthroplasty. Methodology This retrospective, single-center cohort study included adults who completed two-stage revision for hip or knee PJI between January 2019 and December 2024. The index date was second-stage reimplantation. Successful eradication required no persistent or recurrent PJI, no further surgery for infection, and no suppressive antimicrobial therapy for persistent infection at one year. Secondary outcomes were pain score, ambulatory status, and joint-specific range of motion (ROM). Outcomes were compared by eradication status using the Mann-Whitney U test and the Fisher-Freeman-Halton exact test. These comparisons were exploratory. Results Of the 50 patients who underwent second-stage reimplantation, 46 survived and had sufficient follow-up for inclusion in the one-year analysis (24 hip, 22 knee). Successful infection eradication was observed in 41 of these 46 assessed patients (89.1%; 95% confidence interval (CI) = 76.4%-96.4%). The median pain score was 2 (interquartile range (IQR) = 1-2), and 37 (80.4%) patients were independently ambulant at one year. Patients with successful eradication had lower pain scores than those with persistent or recurrent infection (median = 2, IQR = 1-2 vs median = 3, IQR = 2-3; p = 0.012). Ambulatory status also differed between groups (p = 0.002), with independent ambulation in 36 of 41 (87.8%) patients and one of five (20.0%) patients, respectively. No significant differences in hip or knee ROM were detected, although only five patients had persistent or recurrent infection. Conclusions Among the 46 assessed survivors after reimplantation, 41 (89.1%) met the one-year infection-eradication criteria. Successful eradication was associated with less pain and greater independent mobility, while joint-specific ROM differences did not reach statistical significance in the small comparison groups. Assessment of pain and ambulation alongside infection status may provide a more clinically meaningful measure of early recovery after septic revision.
Fulltext A qualitative study on barriers and facilitators of COVID-19 vaccination during pregnancy among pregnant women in Malaysia

Mohamed Pauzi MH, Abdul Kadir A, Muhamad R, Mat Yudin Z

PLoS One, 2025;20(8):e0329895.
PMID: 40779546 DOI: 10.1371/journal.pone.0329895

BACKGROUND: COVID-19 vaccination is crucial for pregnant women to protect against severe complications during pregnancy. However, vaccine hesitancy and refusal can affect acceptance rates among this vulnerable group, posing risks to both maternal and fetal health. This research was conducted to explore the barriers and facilitators influencing COVID-19 vaccination among Malaysian pregnant women.
METHODS: This qualitative study adopted a hermeneutic phenomenological design. Nineteen pregnant women receiving antenatal care at three clinics in Kelantan between February 2024 and June 2024 were purposively selected to participate in in-depth interviews. The interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo software alongside manual coding. Thematic analysis, incorporating both inductive and deductive approaches, was conducted to identify key themes.
RESULTS: Most pregnant women expressed hesitancy toward COVID-19 vaccination during pregnancy due to various concerns. Our findings identified four key themes as barriers to vaccination: (i) Fear of side effects, (ii) Negative social influences, (iii) Perception of returning to normalcy, and (iv) Vaccine scepticism and prejudice. Conversely, three themes emerged as facilitators of vaccine acceptance: (i) Concerns about the effects of COVID-19 infection, (ii) Trust in the vaccine, and (iii) Personal and shared vaccination experiences.
CONCLUSION: This study identified key factors influencing COVID-19 vaccine hesitancy. These findings highlight the importance of addressing both personal and social dimensions of vaccine hesitancy. Public health interventions should focus on building trust, countering misinformation, and leveraging positive community experiences to encourage vaccine uptake, particularly in populations where hesitancy remains a concern.
Utilization of bottom ash waste as a granular column to enhance the lateral load capacity of soft kaolin clay soil

Zaini MSI, Hasan M, Jusoh WNBW

Environ Sci Pollut Res Int, 2025 May;32(22):12951-12977.
PMID: 36826761 DOI: 10.1007/s11356-023-25966-x

Implementation of industrial wastes such as bottom ash in ground improvement can be cost-effective and environment-friendly. Ground improvement is an effective method of mitigation to improve problematic soils including soft kaolin clay soils as the problematic soils always expose to the severe settlements, low shear strength, immoderate plasticity, greater compressibility, dispersivity, bulging, erodibility, and susceptibility to climatic variables. Several studies conducted on the granular column using the bottom ash column. However, only a few studies have reported findings coherent with the statistical analysis. In this study, the lateral load capacity of bottom ash column-kaolin clay has been conducted. Coherently, the reinforced kaolin clay samples were tested via particle size distribution, Atterberg limit test, relative density, compaction test, permeability test, unconfined compression test, and unconsolidated undrained triaxial test with the single and group of encapsulated bottom ash columns with the geotextile encasement and a prediction model was developed. The effect of a number of columns, column diameter, column height, area replacement ratio, height penetration ratio, height-diameter column ratio, volume replacement ratio, and confining pressures on the shear strength of the single and group of encapsulated bottom ash columns have been investigated. The findings showed the effectiveness of using the bottom ash columns at various number of column, column diameter, column height, area replacement ratio, height penetration ratio, height-diameter column ratio, volume replacement ratio, and confining pressures can enhance the shear strength of the soil up to 77.00% at the optimal utilization of single encapsulated bottom ash column of 10-mm diameter and 80-mm height. Therefore, the study proved that the utilization of bottom ash waste as a granular column can significantly enhance the lateral load capacity of soft kaolin clay soil.

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