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Fulltext The Current and Retrospective Intentional Nature Exposure Scales: Development and Factorial Validity

Wood C, Barron D, Smyth N

Int J Environ Res Public Health, 2019 11 12;16(22).
PMID: 31726784 DOI: 10.3390/ijerph16224443

Both nature exposure and green exercise (GE) can improve health. However, there are no scales examining frequency of engagement; or that consider interaction with nature. There are also no scales assessing these variables during childhood. The aim of this study was to develop a modified (NES-II) and retrospective (RNES-II) version of the Nature Exposure Scale to incorporate GE and to examine their factor structure and reliability. Exploratory factor analysis (EFA) explored the factor structure of the scales; followed by confirmatory factor analysis to confirm the model fit. Fit indices for the one factor five item NES-II and RNES-II models identified by EFA were poor. Use of modification indices resulted in a good model fit; NES-II: χ(5, n = 385) = 2.638; χnormed = 0.879; CFI= 1.000; RMSEA < 0.001 with 90%CI = 0.000-0.082; SRMR = 0.009; AIC = 36.638. RNES-II: χ(2, n = 385) = 7.149; χnormed = 3.574; CFI = 0.995; RMSEA = 0.082 with 90%CI = 0.023-0.151; SRMR = 0.015; AIC = 43.149. Both models demonstrated very good reliability (α = 0.84; 89 respectively). These findings indicate that the scales can be used to assess current and retrospective nature exposure. However, due to the removal of item one, the authors recommend that the scales be named the 'intentional nature exposure scale' and 'retrospective intentional nature exposure scale'.
Fulltext Resveratrol Supplementation Protects Against Nicotine-Induced Kidney Injury

Ramalingam A, Santhanathas T, Shaukat Ali S, Zainalabidin S

Int J Environ Res Public Health, 2019 11 12;16(22).
PMID: 31726798 DOI: 10.3390/ijerph16224445

Prolonged exposure to nicotine accelerates onset and progression of renal diseases in habitual cigarette smokers. Exposure to nicotine, either via active or passive smoking is strongly shown to enhance renal oxidative stress and augment kidney failure in various animal models. In this study, we investigated the effects of resveratrol supplementation on nicotine-induced kidney injury and oxidative stress in a rat model. Male Sprague-Dawley rats were given nicotine (0.6 mg/kg, i.p.) alone or in combination with either resveratrol (8 mg/kg, i.p.), or angiotensin II type I receptor blocker, irbesartan (10 mg/kg, p.o.) for 28 days. Upon completion of treatment, kidneys were investigated for changes in structure, kidney injury markers and oxidative stress. Administration of nicotine alone for 28 days resulted in significant renal impairment as shown by marked increase in plasma creatinine, blood urea nitrogen (BUN) and oxidative stress. Co-administration with resveratrol however successfully attenuated these changes, with a concomitant increase in renal antioxidants such as glutathione similar to the conventionally used angiotensin II receptor blocker, irbesartan. These data altogether suggest that targeting renal oxidative stress with resveratrol could alleviate nicotine-induced renal injury. Antioxidants may be clinically important for management of renal function in habitual smokers.
Fulltext Knowledge, Attitude and Practice Related to Vitamin D and Its Relationship with Vitamin D Status among Malay Female Office Workers

Jamil NA, Shahudin NN, Abdul Aziz NS, Jia Qi C, Wan Aminuddin WAA, Mat Ludin AF, et al.

Int J Environ Res Public Health, 2019 11 27;16(23).
PMID: 31783521 DOI: 10.3390/ijerph16234735

This study assessed knowledge, attitude and practice (KAP) related to vitamin D and its relationship with vitamin D status among Malay female office workers. A total of 147 women aged between 20 and 55 years were recruited from a university in Kuala Lumpur. They answered questionnaires related to KAP on vitamin D, sun exposure, dietary vitamin D intake and physical activity. Serum 25-hydroxyvitamin D (25OHD) was analysed using an enzyme-linked immunoassay. Nearly half (45%) of the subjects had good knowledge but moderate attitude (76%) and practice (84%) towards sunlight exposure and dietary vitamin D intake. Median serum 25OHD was 34.1 nmol/L with the majority (91%) had vitamin D insufficiency (25OHD < 50 nmol/L). Knowledge was weakly associated with attitude (r = 0.29, p < 0.001) but no association was found between knowledge and practice (r = 0.08, p = 0.355) nor attitude and practice (r = -0.001, p = 0.994). Serum 25OHD was positively associated with sunlight exposure (r = 0.22, p = 0.008) and dietary vitamin D intake (r = 0.37, p < 0.001). It can be implied that this group is at increased risk of low bone health status, which highlights the needs of public health campaigns to improve their vitamin D status.
Fulltext Distribution of Refractive Errors among Healthy Infants and Young Children between the Age of 6 to 36 Months in Kuala Lumpur, Malaysia-A Pilot Study

Yahya AN, Sharanjeet-Kaur S, Akhir SM

Int J Environ Res Public Health, 2019 11 27;16(23).
PMID: 31783494 DOI: 10.3390/ijerph16234730

Uncorrected refractive error, especially myopia, in young children can cause permanent visual impairment in later life. However, data on the normative development of refractive error in this age group is limited, especially in Malaysia. The aim of this study was to determine the distribution of refractive error in a sample of infants and young children between the ages of 6 to 36 months in a prospective, cross-sectional study. Cycloplegic retinoscopy was conducted on both eyes of 151 children of mean age 18.09 ± 7.95 months. Mean spherical equivalent refractive error for the right and left eyes was +0.85 ± 0.97D and +0.86 ± 0.98D, respectively. The highest prevalence of refractive error was astigmatism (26%), followed by hyperopia (12.7%), myopia (1.3%) and anisometropia (0.7%). There was a reduction of hyperopic refractive error with increasing age. Myopia was seen to emerge at age 24 months. In conclusion, the prevalence of astigmatism and hyperopia in infants and young children was high, but that of myopia and anisometropia was low. There was a significant reduction in hyperopic refractive error towards emmetropia with increasing age. It is recommended that vision screening be conducted early to correct significant refractive error that may cause disruption to clear vision.
Fulltext Reading Performance and Compensatory Head Posture in Infantile Nystagmus after Null Zone Training

Mohamad Fadzil N, Mohammed Z, Mohamad Shahimin M, Saliman NH

Int J Environ Res Public Health, 2019 11 27;16(23).
PMID: 31783492 DOI: 10.3390/ijerph16234728

This study aimed to assess the visual function, reading performance, and compensatory head posture (CHP) in schoolchildren with infantile nystagmus. A total of 18 participants aged between 13 to 18 years old were divided into spectacle (n = 9) and null zone group (n = 9) based on their visual acuity. Visual acuity (LogMAR), contrast sensitivity (Pelli-Robson), reading time and rate (Tobii TX300), and CHP were measured pre and post null zone reading training. Participants in the null zone group received 10 sessions of training (5 weeks). Visual acuity and contrast sensitivity of participants in the spectacle and null zone groups were not significantly different pre and post training. Reading performance, i.e., reading time (z = -1.36; p = 0.173) and reading rate (z = -0.06; p = 0.953), of participants in the spectacle group was not significantly different after 5 weeks. Reading time (z = -2.55; p = 0.011) and reading rate (z = -2.07; p = 0.038 of participants in the null zone group showed significant improvement post training. After 5 weeks, CHP improved in six out of the nine participants (66.7%) of the null zone group and was unchanged in all participants in the spectacle group. Null zone reading training could benefit children with infantile nystagmus in improving reading performance and compensatory head posture.
Fulltext Utilization of a Diet Optimization Model in Ensuring Adequate Intake among Pregnant Women in Selangor, Malaysia

Sawal Hamid ZB, Rajikan R, Elias SM, Jamil NA

Int J Environ Res Public Health, 2019 11 27;16(23).
PMID: 31783474 DOI: 10.3390/ijerph16234720

Achieving nutritional requirements for pregnant women in rural or suburban households while maintaining the intake of local and culture-specific foods can be difficult. Usage of a linear programming approach can effectively generate diet optimization models that incorporate local and culturally acceptable menus. This study aimed to determine whether a realistic and affordable diet that achieves recommended nutrient intakes for pregnant women could be formulated from locally available foods in Malaysia. A cross-sectional study was conducted to assess the dietary intake of 78 pregnant women using a 24-h dietary recall and a 3-day food record. A market survey was also carried out to estimate the cost of raw foods that are frequently consumed. All linear programming analyses were done using Excel Solver to generate optimal dietary patterns. Our findings showed that the menus designed from diet optimization models using locally available foods would improve dietary adequacy for the seven food groups based on the Malaysian Dietary Guidelines 2010 (MDG 2010) and the 14 nutrients based on Recommended Nutrient Intake 2017 (RNI 2017) in pregnant women. However, inadequacies remained for iron and niacin, indicating that these nutrients may require supplementation.
Fulltext Predictors of Caregivers' Satisfaction with the Management of Children with Autism Spectrum Disorder: A Study at Multiple Levels of Health Care

Nik Adib NA, Ibrahim MI, Ab Rahman A, Bakar RS, Yahaya NA, Hussin S, et al.

Int J Environ Res Public Health, 2019 05 14;16(10).
PMID: 31091735 DOI: 10.3390/ijerph16101684

BACKGROUND: Caregivers are the initial gatekeepers in the health care management of children with autism spectrum disorder (ASD).
METHODS: This cross-sectional study aimed to determine the factors associated with caregivers' satisfaction with different levels of health care services in managing children with ASD in Kelantan. The satisfaction scores of 227 main caregivers of confirmed ASD children were assessed with a modified Parent Satisfaction Scale (PSS) questionnaire.
RESULTS: The analysis showed that caregivers who waited longer for a doctor's consultation in primary care had a reduced PSS score, whereas caregivers who were satisfied with the waiting time in primary care had higher PSS scores. At the secondary care level, caregivers who possessed at least a diploma had reduced PSS scores, whereas caregivers who were satisfied with both doctors' consultation times and occupational therapy appointments had higher PSS scores. At the tertiary care level, caregivers with an underlying medical problem and who had children undergoing occupational therapy for two months or more had reduced PSS scores. Nevertheless, the analysis showed that caregivers who were concerned with their children's sleeping problems, who had been informed about parental support, who were satisfied with speech and occupational therapy appointments, who were satisfied with waiting times at tertiary care clinics, and who were satisfied with their doctor's knowledge and experience had higher PSS scores.
CONCLUSIONS: This study elucidated the importance of understanding caregivers' satisfaction in attaining care for their ASD children and highlighted the need to promote factors that would increase caregivers' satisfaction with current ASD services.
Fulltext The Prevalence of Smoking, Determinants and Chance of Psychological Problems among Smokers in an Urban Community Housing Project in Malaysia

Abd Rashid R, Kanagasundram S, Danaee M, Abdul Majid H, Sulaiman AH, Ahmad Zahari MM, et al.

Int J Environ Res Public Health, 2019 05 18;16(10).
PMID: 31109033 DOI: 10.3390/ijerph16101762

Objective: This study was conducted to assess the prevalence, pattern of smoking and sociodemographic factors among Kerinchi residents in Kuala Lumpur, as well as to identify the association between smoking, stress, anxiety and depression. Methods: This study was carried out at four community housing projects in the Lembah Pantai area in Kuala Lumpur. Data was collected between 3 February 2012, and 29 November 2012. Data collectors made house visits and used interviewer administered questionnaires containing questions on demographic data and smoking patterns. Depression anxiety stress scale (DASS) was used to assess psychological symptoms. Alcohol smoking and substance involvement screening tool (ASSIST) scale was used to assess nicotine use. Results: Data from 1989 individuals (833 households) showed the age of respondents ranged from 18 to 89 years and the mean age was 39.12 years. There were 316 smokers indicating the prevalence of smoking was 15.85%, with 35.5% among males and 1.8% among females. Further, 86.6% of smokers were Malay and 87% were Muslims. Divorce was associated with smoking. Unemployment and housewives were less associated with smoking. Depression and anxiety were significantly associated with smoking (OR = 1.347. 95% CI: 1.042-1.741) and (OR = 1.401. 95% CI: 1.095-1.793) respectively. Conclusion: Screening for depression and anxiety should be routinely performed in the primary care setting and in population-based health screening to intervene early in patients who smoke.
Fulltext Monitoring Consumption of Common Illicit Drugs in Kuala Lumpur, Malaysia, by Wastewater-Cased Epidemiology

Du P, Liu X, Zhong G, Zhou Z, Thomes MW, Lee CW, et al.

Int J Environ Res Public Health, 2020 01 31;17(3).
PMID: 32023897 DOI: 10.3390/ijerph17030889

Southeast Asian countries including Malaysia play a major role in global drug trade and abuse. Use of amphetamine-type stimulants has increased in the past decade in Malaysia. This study aimed to apply wastewater-based epidemiology for the first time in Kuala Lumpur, Malaysia, to estimate the consumption of common illicit drugs in urban population. Influent wastewater samples were collected from two wastewater treatment plants in Kuala Lumpur in the summer of 2017. Concentrations of twenty-four drug biomarkers were analyzed for estimating drug consumption. Fourteen drug residues were detected with concentrations of up to 1640 ng/L. Among the monitored illicit drugs, 3,4-methylenedioxy-methamphetamine (MDMA) or ecstasy had the highest estimated per capita consumptions. Consumption and dose of amphetamine-type stimulants (methamphetamine and MDMA) were both an order of magnitude higher than those of opioids (heroin and codeine, methadone and tramadol). Amphetamine-type stimulants were the most prevalent drugs, replacing opioids in the drug market. The prevalence trend measured by wastewater-based epidemiology data reflected the shift to amphetamine-type stimulants as reported by the Association of Southeast Asian Nations Narcotics Cooperation Center. Most of the undetected drug residues were new psychoactive substances (NPSs), suggesting a low prevalence of NPSs in the drug market.
Fulltext Malay Version of Exercise Self-Efficacy: A Confirmatory Analysis among Malaysians with Type 2 Diabetes Mellitus

Hidrus A, Kueh YC, Norsa'adah B, Kuan G

Int J Environ Res Public Health, 2020 02 02;17(3).
PMID: 32024257 DOI: 10.3390/ijerph17030922

Exercise self-efficacy (ESE) is one of the psychological constructs in the Transtheoretical Model (TTM). The objective of the present study is to assess the validity and reliability of the Malay version of Exercise self-efficacy scale (ESE-M) among Malaysians with type 2 diabetes mellitus (T2DM). A cross-sectional study design with convenience sampling method using a self-administered questionnaire was carried out. Participants were invited to complete the ESE-M with 18 items. Confirmatory factor analysis (CFA) was conducted and composite reliability (CR) was computed using Mplus 8. A total of 331 Malaysians with T2DM with a mean age of 63 years old (Standard Deviation = 0.57) completed the questionnaire. Most of the participants were male (52%) and Malay (89.4%). Two initial CFA models (single factor and three factors) of ESE-M scale were tested and they did not fit to the data well. Several re-specifications of the models were conducted. The final model for the ESE-M showed improvement on the value of model fit indices for the single factor model (comparative fit index (CFI) = 0.952, Tucker and Lewis index (TLI) = 0.938, standardised root mean square (SRMR) = 0.044, root mean square error of approximation (RMSEA) = 0.054) and three factors model (CFI = 0.891, TLI = 0.863, SRMR = 0.049, RMSEA = 0.081). The CR for the self-efficacy factor was 0.921 (single factor), while CR for internal feelings, competing demands and situational (three factors) were 0.762, 0.818 and 0.864, respectively. The final model of single factor ESE-M showed better fit to the data compared to the three factors ESE-M. This indicated that the single factor ESE-M is more suitable to be adopted for future study among Malaysians with T2DM.
Fulltext Leptospiral Culture without 5'-Fluorouracil Revealed Improved Leptospira Isolation from Febrile Patients in North-Eastern Malaysia

Mohamad Safiee AW, Ali MRM, Fauzi MH, Besari AM, Yean CY, Neela VK, et al.

Int J Environ Res Public Health, 2020 02 18;17(4).
PMID: 32085530 DOI: 10.3390/ijerph17041307

Objectives: Isolation of Leptospira by culture represents a definitive growth and confirmation of the disease, yet it is hampered with its nature of slow growth. With slight modification of culture method, the study aims to isolate and characterize Leptospira spp. from patients with acute febrile illness. Methods: A total of 109 blood samples were collected from patients with acute febrile illness that presented at the Emergency Department of Hospital Universiti Sains Malaysia, Malaysia. Clinical samples were subjected to Leptospira IgM Rapid test, microscopic agglutination test (MAT), isolation by culture method, and direct real-time PCR test. For leptospiral isolation, the samples (whole blood and deposit from spun plasma) were cultured into modified Ellinghausen McCullough Johnson Harris (EMJH) media with and without 5'-fluorouracil (5-FU). In every culture positive sample, partial 16S rRNA gene sequencing was performed for molecular identification of the isolates. Phylogenetic analysis was carried out to determine the genetic relatedness among the isolates. An inhibition of 5-FU study was performed on Leptospirainterrogans serovar Canicola with different concentrations to compare the growth detection of the tested Leptospira with or without 5-FU within 7 days of incubation. Results: Leptospirosis was diagnosed in 14.7% of patients with acute febrile illness. Two Leptospira spp. (n = 2/109, 1.85%) were successfully isolated from whole blood and deposit from spun plasma samples. B004 and B208 samples were positive at day 11 and day 7, respectively, in EMJH media without addition of 5-FU. Sample B004 was identified as Leptospira interrogans and B208 as Leptospira weilli. Phylogenetic analysis confirmed that both of them were within pathogenic group and they were not related. The 5-FU inhibition study revealed that additional of 5-FU at final concentration of 200 µg/mL to EMJH media demonstrated an inhibitory effect on the growth of the tested strain Conclusion: Isolation of Leptospira spp. using EMJH media without addition of 5'-fluorouracil resulted in a better outcome. Two pathogenic Leptospira isolates were successfully cultivated from patients with acute febrile illness that were genetically not related.
Fulltext Awareness, Knowledge, Attitude and Preventive Practice of Leptospirosis Among Healthy Malaysian and Non-Malaysian Wet Market Workers in Selected Urban Areas in Selangor, Malaysia

Samsudin S, Saudi SNS, Masri NS, Ithnin NR, T Z M T J, Hamat RA, et al.

Int J Environ Res Public Health, 2020 02 19;17(4).
PMID: 32093098 DOI: 10.3390/ijerph17041346

Leptospirosis has been reported as an endemic in most tropical countries. Among high risk occupations, leptospirosis includes workers in agriculture and domestic animal industries. Environmental hygiene in the wet market has established a link between the presence of rodents with probability of leptospirosis infection. This study was aimed to compare the level of knowledge, attitude and preventive practice against leptospirosis between healthy Malaysian and non-Malaysian wet market workers in selected wet markets in urban areas of Selangor. A cross-sectional study in the determined area was conducted with the participation of 147 respondents. The respondents were randomly chosen from the list provided by the state agency that regulates these markets. A self-administered bilingual validated questionnaire (English and Bahasa Melayu) was distributed to the selected respondents. There were 68 (48.3%) Malaysian respondents and 79 (53.7%) non-Malaysian respondents. The majority of them were males, who attained formal education and were less than 40 years old. Meanwhile, the respondents earned less than RM3000. Among the Malaysian respondents, 80.9% were aware of leptospirosis as compared to 17.7% of the non-Malaysian colleagues (p < 0.05). All items of knowledge showed that the Malaysian respondents scored higher as compared to non-Malaysian respondents. On attitude towards infection prevention, most Malaysian respondents had a positive attitude, while most non-Malaysian respondents had undecided perception on the majority of crucial attitude items. In practicing preventive measures, there was a marked significant difference in proportion between Malaysian and non-Malaysian respondents for items on "Specific Protection and Isolation at Source." There was a significant gap on knowledge, attitude and preventive practice among Malaysian workers as compared to non-Malaysian workers. Therefore, it was highly recommended the health promotion implementation should also provide specific focus on non-Malaysian workers.
Fulltext Making Health Services Adolescent-Friendly in Northeastern Peninsular Malaysia: A Mixed-Methods Study

Awang H, Ab Rahman A, Sukeri S, Hashim N, Nik Abdul Rashid NR

Int J Environ Res Public Health, 2020 02 19;17(4).
PMID: 32093018 DOI: 10.3390/ijerph17041341

A mixed-methods study was conducted in a Malaysian state beginning with a cross-sectional quantitative study to determine the relationship between clinic characteristics and clinic score of adolescent-friendliness. Subsequently, perceptions of healthcare providers on the facilitating factors for the provision of adolescent-friendly health services were explored qualitatively to support the quantitative findings. Availability of trained healthcare providers, adequate privacy, dedicated adolescent health services team, and adolescent health promotional activities were the clinic characteristics that significantly (p < 0.05) related with clinics' scores of adolescent-friendliness. The facilitating factors required for adolescent-friendly health services were (1) healthcare providers' commitment and prioritization towards adolescent-friendly health services; (2) organizational supports; (3) appropriate clinic settings; and (4) external supports for adolescent health promotional activities. The qualitative findings reaffirmed those of the quantitative study on the significant clinic characteristics required for adolescent-friendly health services. This study provides valuable insight for the Ministry of Health to elicit the required facilitating factors to further improve the quality of adolescent health services in Malaysia.
Fulltext The Environmental and Bitter Taste Endophenotype Determinants of Picky Eating in Australian School-Aged Children 7-12 years-A Cross-Sectional Pilot Study Protocol

Jani R, Byrne R, Love P, Agarwal C, Peng F, Yew YW, et al.

Int J Environ Res Public Health, 2020 02 29;17(5).
PMID: 32121357 DOI: 10.3390/ijerph17051573

Caregivers' perceptions of children's pickiness are relatively scarce in relation to the five core food groups and their importance in providing a nutritionally balanced diet. Furthermore, there is no validated questionnaire that examines child-reported food preferences in an age-appropriate manner, and the use of terms such as a "picky eater" can be attributed to environmental and genetic factors. Despite potential links between children's food preferences and endophenotype bitter taste, associations between bitter taste sensitivity and picky eating is relatively unexplored. The proposed cross-sectional study aims to develop and validate a parent-reported core-food Picky Eating Questionnaire (PEQ) and child-reported Food Preference Questionnaire (C-FPQ) and simultaneously investigate environmental and phenotype determinants of picky eating. The study will be conducted in three stages: Phase 1, piloting PEQ and C-FPQ questionnaires (15-20 primary caregivers and their children aged 7-12 years); Phase 2 and 3, validating the revised questionnaires and evaluating the 6-n-propylthiouracil (PROP) bitter taste sensitivity to examine perception to bitter taste (369 primary caregivers and their children). Study findings will generate new validated tools (PEQ, C-FPQ) for use in evidence-based practice and research and explore picky eating as a behavioural issue via the potential genetic-phenotype basis of bitter taste sensitivity.
Fulltext Patterns of Use and Knowledge about Contact Lens Wear amongst Teenagers in Rural Areas in Malaysia

Mohd-Ali B, Tan XL

Int J Environ Res Public Health, 2019 12 17;16(24).
PMID: 31861174 DOI: 10.3390/ijerph16245161

BACKGROUND: Contact lenses (CLs) are more popular than spectacles for vision correction amongst the youth. Knowledge about the risks of wearing CLs is critical especially for those with poor access to public health education. This study investigates the patterns of use and level of knowledge about CL wear amongst teenagers living in rural areas in Selangor, Malaysia using a set of validated questionnaires.
METHODS: A total of 8500 self-administered questionnaires were distributed in eight selected secondary schools. The results were analysed using descriptive statistics.
RESULTS: A total of 2474 (29%) completed questionnaires were collected. The mean age of the respondents was 14.8 ± 1.5 years, and approximately 7.2% were CL wearers. The majority of the wearers were females (76.0%) and wore soft CLs (92.2%). Cosmetic purposes (58.1%) and comfort (24.6%) were the main reasons for wearing CLs. Many of the respondents purchased their lenses from optical shops (50.1%) and beauty accessory shops (15.6%), and approximately 10% did not disinfect their lenses properly. Regarding knowledge about CL care, approximately 56% of the respondents responded correctly.
CONCLUSION: Half of the respondents do not have sufficient knowledge about the risks of wearing CLs. Thus, aggressive public health education aimed at teenagers is needed to prevent improper CL usage.
Fulltext Space-Time Clustering Characteristics of Tuberculosis in Khyber Pakhtunkhwa Province, Pakistan, 2015-2019

Ullah S, Daud H, Dass SC, Fanaee-T H, Kausarian H, Khalil A

Int J Environ Res Public Health, 2020 02 21;17(4).
PMID: 32098247 DOI: 10.3390/ijerph17041413

The number of tuberculosis (TB) cases in Pakistan ranks fifth in the world. The National TB Control Program (NTP) has recently reported more than 462,920 TB patients in Khyber Pakhtunkhwa province, Pakistan from 2002 to 2017. This study aims to identify spatial and space-time clusters of TB cases in Khyber Pakhtunkhwa province Pakistan during 2015-2019 to design effective interventions. The spatial and space-time cluster analyses were conducted at the district-level based on the reported TB cases from January 2015 to April 2019 using space-time scan statistics (SaTScan). The most likely spatial and space-time clusters were detected in the northern rural part of the province. Additionally, two districts in the west were detected as the secondary space-time clusters. The most likely space-time cluster shows a tendency of spread toward the neighboring districts in the central part, and the most likely spatial cluster shows a tendency of spread toward the neighboring districts in the south. Most of the space-time clusters were detected at the start of the study period 2015-2016. The potential TB clusters in the remote rural part might be associated to the dry-cool climate and lack of access to the healthcare centers in the remote areas.
Fulltext Fractional Multi-Step Differential Transformed Method for Approximating a Fractional Stochastic SIS Epidemic Model with Imperfect Vaccination

Abuasad S, Yildirim A, Hashim I, Abdul Karim SA, Gómez-Aguilar JF

Int J Environ Res Public Health, 2019 03 18;16(6).
PMID: 30889889 DOI: 10.3390/ijerph16060973

In this paper, we applied a fractional multi-step differential transformed method, which is a generalization of the multi-step differential transformed method, to find approximate solutions to one of the most important epidemiology and mathematical ecology, fractional stochastic SIS epidemic model with imperfect vaccination, subject to appropriate initial conditions. The fractional derivatives are described in the Caputo sense. Numerical results coupled with graphical representations indicate that the proposed method is robust and precise which can give new interpretations for various types of dynamical systems.
Fulltext Determinants of Diet and Physical Activity in Malaysian Adolescents: A Systematic Review

Mohammadi S, Jalaludin MY, Su TT, Dahlui M, Azmi Mohamed MN, Abdul Majid H

Int J Environ Res Public Health, 2019 02 19;16(4).
PMID: 30791423 DOI: 10.3390/ijerph16040603

The increased prevalence of unhealthy eating habits and sedentary lifestyles among Malaysian adolescents has become a public health concern. The aim of this systematic review was to summarize evidence from observational studies related to diet and physical activity (PA) among Malaysian adolescents (13⁻18 years) and to recognize the associations between determinants of diet and PA and diet and PA behaviours. A systematic search for observational studies published from August 1990 through August 2017 was conducted via PubMed, Science Direct, Cochrane and Web of Science. A total of 18 studies met the inclusion criteria; these were independently extracted by two reviewers. Gender and ethnicity were the most commonly studied correlates of diet and PA; males were more physically active and they tended to have poorer diet quality and higher energy and macronutrient intakes in comparison to females; Malay adolescents had a lower diet quality and Chinese adolescents spent less time in PA compared to other ethnicities. However, the significance of these associations was often small or inconsistent. This review highlights the lack of longitudinal observational studies but summarizes the best available evidence for policymakers and public health practitioners to improve the diet and the level of PA in Malaysian adolescents.
Fulltext Development and Validation of Positive Smoker Identity Questionnaire (PSmoQi): A New Instrument for Smoking Cessation Correlates

Ahmad MH, Ibrahim MI, Ab Rahman A, Musa KI, Mohd Zin F, Mohd Zain R, et al.

Int J Environ Res Public Health, 2019 01 26;16(3).
PMID: 30691181 DOI: 10.3390/ijerph16030351

Background: The positive smoker identity construct, which was based on West's PRIME Theory, affected the smoking prevalence, quit attempts and cessation success. A validated questionnaire which could measure this rich and complex construct may facilitate prediction models of successful cessation. We aimed to develop and validate a questionnaire that assesses positive smoker identity based on West's PRIME Theory. Method: The initial item pool was developed based on a theoretical framework, empirical literature, existing scales and expert review. The questionnaire was conveniently distributed to 100 smokers. Exploratory factor analysis was utilized to explore domains in the questionnaire. Construct and criterion validity, internal consistency and reliability of the domains were analyzed. Results: The final positive smoker identity questionnaire (PSmoQi) has 26 items under four internally-consistent and reliable domains: Contributory factors, contextual and temporal patterning, identity related to smoking, and behaviour in relation to smoking. The full scale demonstrated good internal consistency (∝ = 0.78), acceptable convergent and divergent validity, and good concurrent validity with the smoker self-concept scale. Conclusion: The current study provides fundamental evidence for the PSmoQi as a valid instrument in research related to smoking cessation and interventional strategy. The PSmoQi contained validated domains which could measure almost a full spectrum of smoking cessation components.
Fulltext A Deep Learning Model for Automated Sleep Stages Classification Using PSG Signals

Yildirim O, Baloglu UB, Acharya UR

Int J Environ Res Public Health, 2019 02 19;16(4).
PMID: 30791379 DOI: 10.3390/ijerph16040599

Sleep disorder is a symptom of many neurological diseases that may significantly affect the quality of daily life. Traditional methods are time-consuming and involve the manual scoring of polysomnogram (PSG) signals obtained in a laboratory environment. However, the automated monitoring of sleep stages can help detect neurological disorders accurately as well. In this study, a flexible deep learning model is proposed using raw PSG signals. A one-dimensional convolutional neural network (1D-CNN) is developed using electroencephalogram (EEG) and electrooculogram (EOG) signals for the classification of sleep stages. The performance of the system is evaluated using two public databases (sleep-edf and sleep-edfx). The developed model yielded the highest accuracies of 98.06%, 94.64%, 92.36%, 91.22%, and 91.00% for two to six sleep classes, respectively, using the sleep-edf database. Further, the proposed model obtained the highest accuracies of 97.62%, 94.34%, 92.33%, 90.98%, and 89.54%, respectively for the same two to six sleep classes using the sleep-edfx dataset. The developed deep learning model is ready for clinical usage, and can be tested with big PSG data.

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