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Fulltext The Association of Falls with Instability: An Analysis of Perceptions and Expectations toward the Use of Fall Detection Devices Among Older Adults in Malaysia

Abdul Rahman K, Ahmad SA, Che Soh A, Ashari A, Wada C, Gopalai AA

Front Public Health, 2021;9:612538.
PMID: 33681130 DOI: 10.3389/fpubh.2021.612538

Background: Falls are a significant incident among older adults affecting one in every three individuals aged 65 and over. Fall risk increases with age and other factors, namely instability. Recent studies on the use of fall detection devices in the Malaysian community are scarce, despite the necessity to use them. Therefore, this study aimed to investigate the association between the prevalence of falls with instability. This study also presents a survey that explores older adults' perceptions and expectations toward fall detection devices. Methods: A cross-sectional survey was conducted involving 336 community-dwelling older adults aged 50 years and older; based on randomly selected participants. Data were analyzed using quantitative descriptive analysis. Chi-square test was conducted to investigate the associations between self-reported falls with instability, demographic and walking characteristics. Additionally, older adults' perceptions and expectations concerning the use of fall detection devices in their daily lives were explored. Results: The prevalence of falls was 28.9%, where one-quarter of older adults fell at least once in the past 6 months. Participants aged 70 years and older have a higher fall percentage than other groups. The prevalence of falls was significantly associated with instability, age, and walking characteristics. Around 70% of the participants reported having instability issues, of which over half of them fell at least once within 6 months. Almost 65% of the participants have a definite interest in using a fall detection device. Survey results revealed that the most expected features for a fall detection device include: user-friendly, followed by affordably priced, and accurate. Conclusions: The prevalence of falls in community-dwelling older adults is significantly associated with instability. Positive perceptions and informative expectations will be used to develop an enhanced fall detection incorporating balance monitoring system. Our findings demonstrate the need to extend the fall detection device features aiming for fall prevention intervention.
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 Systematic Review of Potential Occupational Respiratory Hazards Exposure Among Sewage Workers

Muzaini K, Yasin SM, Ismail Z, Ishak AR

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

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

Clément C, Lvovschi VE, Verot E, du Sartz de Vigneulles B, Darlington-Bernard A, Bourgeois D, et al.

Front Public Health, 2023;11:1326771.
PMID: 38179573 DOI: 10.3389/fpubh.2023.1326771

BACKGROUND: Oral health is a fundamental human right and is inseparable and indivisible from overall health and well-being. Oral Health Literacy (OHL) has been proved to be fundamental to promoting oral health and reducing oral health inequalities. To our knowledge, no OHL instrument to evaluate OHL level is currently validated in French language despite the fact it is the fifth most widely spoken languages on the planet. The Oral health literacy Instrument (OHLI) appears to be the most interesting OHL instrument to adapt into French because it is already available in English, Spanish, Russian, Malaysian, and it contains both reading comprehension and numeracy sections. Its psychometric properties have been rated as adequate.
OBJECTIVE: The aim of this study was to translate and adapt cross-culturally the OHLI into French, to evaluate its psychometric properties and to compare its results to oral health knowledge.
METHOD: This study followed and applied well-established processes of translation, cross-cultural adaptation and validation, based on the recommendations of the World Health Organization guidelines and on the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) study design checklist for patient-reported outcomes. Two psychometric assessments were planned, the comparison of OHLI-F scores according to education level and frequency of dental visits, and the test-retest reliability of the OHLI-F.
RESULTS: A total of 284 participants answered the OHLI-F. The OHLI-F scores were significantly different between participants with different levels of education and frequency of dental visits (p
Fulltext Successes and obstacles in implementing social health insurance in developing and middle-income countries: A scoping review of 5-year recent literatures

Jamal MH, Abdul Aziz AF, Aizuddin AN, Aljunid SM

Front Public Health, 2022;10:918188.
PMID: 36388320 DOI: 10.3389/fpubh.2022.918188

Social health insurance (SHI) is a form of health finance mechanism that had been implemented in many countries to achieve universal health care (UHC). To emulate the successes of SHI in many developed countries, many developing and middle-income countries (MICs) have attempted to follow suit. However, the SHI implementation has problems and obstacles. Many more obstacles were observed despite some successes. This scoping review aimed to study the various developments of SHI globally in its uses, implementation, successes, and obstacles within the last 5 years from 2017 to 2021. Using three databases (i.e., PubMed, EBSCO, and Google Scholar), we reviewed all forms of articles on SHI, including gray literature. The PRISMA-ScR protocol was adapted as the guideline. We used the following search terms: social health insurance, national health insurance, and community health insurance. A total of 57,686 articles were screened, and subsequently, 46 articles were included in the final review. Results showed that the majority of SHI studies were in China and African countries, both of which were actively pursuing SHI programs to achieve UHC. China was still regarded as a developing country. There were also recent experiences from other Asian countries, but only a few from South America. Implementing SHI to achieve UHC was desirable but will need to consider several factors and issues. This was especially the case in developing and MICs. Eventually, full UHC would only be possible with a combination of general taxation and SHI.
Fulltext Study Protocol for a Global Survey: Awareness and Preparedness of Hospital Staff Against Coronavirus Disease (COVID-19) Outbreak

Qarawi ATA, Ng SJ, Gad A, Luu MN, Al-Ahdal TMA, Sharma A, et al.

Front Public Health, 2021;9:580427.
PMID: 34277529 DOI: 10.3389/fpubh.2021.580427

Background: The outbreak of Coronavirus disease (COVID-19) caused by a novel coronavirus (named SARS-CoV-2) has gained attention globally and has been recognized as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) due to the rapidly increasing number of deaths and confirmed cases. Health care workers (HCWs) are vulnerable to this crisis as they are the first frontline to receive and manage COVID-19 patients. In this multicenter multinational survey, we aim to assess the level of awareness and preparedness of hospital staff regarding COVID-19 all over the world. Methods: From February to March 2020, the web-based or paper-based survey to gather information about the hospital staff's awareness and preparedness in the participants' countries will be carried out using a structured questionnaire based on the United States Centers for Disease Control and Prevention (CDC) checklist and delivered to participants by the local collaborators for each hospital. As of March 2020, we recruited 374 hospitals from 58 countries that could adhere to this protocol as approved by their Institutional Review Boards (IRB) or Ethics Committees (EC). Discussion: The awareness and preparedness of HCWs against COVID-19 are of utmost importance not only to protect themselves from infection, but also to control the virus transmission in healthcare facilities and to manage the disease, especially in the context of manpower lacking and hospital overload during the pandemic. The results of this survey can be used to inform hospitals about the awareness and preparedness of their health staff regarding COVID-19, so appropriate policies and practice guidelines can be implemented to improve their capabilities of facing this crisis and other future pandemic-prone diseases.
Fulltext Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation

Ahmad Ainuddin H, Romli MH, Hamid TA, Salim MSF, Mackenzie L

Front Public Health, 2021;9:611793.
PMID: 33748063 DOI: 10.3389/fpubh.2021.611793

Background: Research on rehabilitation for falls after stroke is warranted. However, published evidence on fall interventions with stroke survivors is limited and these are mainly international studies that may be less relevant for Southeast Asia. Objective: This review aims to systematically identify literature related to stroke rehabilitation for falls and risk of falls in Southeast Asia. Methods: A scoping review with stakeholders' consultation was implemented. An electronic search was conducted up to December 2020 on 4 databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only original studies conducted in Southeast Asia were selected. Results: The initial search yielded 3,112 articles, however, only 26 were selected in the final analysis. Most of the articles focused on physical rehabilitation and implemented conventional therapies. While the literature may reflect practice in Southeast Asia, stakeholders perceived that the literature was inadequate to show true practice, was not informative and missed several aspects such as functional, cognitive, and psychological interventions in managing falls. Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Majority of the articles were written by physiotherapists while others were from physicians, occupational therapists, and an engineer but few from other healthcare practitioners (i.e., speech therapists, psychologists) or disciplines interested in falls. Conclusions: Falls prevention among stroke survivors has received a lack of attention and is perceived as an indirect goal in stroke rehabilitation in Southeast Asia. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.
Fulltext Stigma, Social Support, Illicit Drug Use, and Other Predictors of Anxiety and Depression Among HIV/AIDS Patients in Pakistan: A Cross-Sectional Study

Ahmed A, Saqlain M, Umair MM, Hashmi FK, Saeed H, Amer M, et al.

Front Public Health, 2021;9:745545.
PMID: 34660521 DOI: 10.3389/fpubh.2021.745545

Introduction: Anxiety and depression in people living with HIV/AIDS (PLWHA) can lead to non-adherence to antiretroviral therapy (ART), morbidity, and mortality. Therefore, assessing the stigma, social support, and other determinants of anxiety and depression in PLWHA are important for developing further interventions. Methods: An institution-based cross-sectional study was conducted in 505 PLWHA, approached through systematic sampling, who paid routine visits to the ART center, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Data was collected by pretested validated hospital anxiety and depression scale (HADS). Version 26 of the SPSS was used to apply Logistic regression analysis to identify determinants, and the 95% confidence interval (CI) adjusted odds ratio (AOR) was calculated to assess the magnitude of the relationships. Results: In PLWHA, the prevalence of co-morbid depression and anxiety was 80%. Separately, 89.9% had depression, and 80.3% had anxiety. Use of illicit drugs [AOR = 1.87, 95% CI (1.01, 3.27)], low social support [AOR = 1.21, 95% CI (1.02, 2.25)], being male [AOR = 2.21, 95% CI (1.11, 5.49)], and HIV related stigma [AOR = 2.48, 95% CI (1.25, 6.02)] were significant predictors of depression. Having detectable viral load [AOR = 3.04, 95% CI (1.04, 8.86)], young age [AOR = 5.31, 95% CI (1.19, 29.39)], no formal education [AOR = 21.78, 95% CI (4.03, 117.62)], low [AOR = 1.70, 95% CI (1.12, 6.93)] or moderate [AOR = 2.20, 95% CI (1.79, 6.09)] social support, illicit drugs addiction [AOR = 1.17, 95% CI (1.03, 2.55)], and HIV stigma [AOR = 54.3, 95% CI (21.20, 139.32)] had a remarkable association with anxiety. Conclusions: Given the high prevalence of anxiety and depression among PLWHA, the Pakistan Ministry of Health should focus more on monitoring mental health, expanding mental health services, and developing interventions based on identified factors to treat depression and anxiety among PLWHA.
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 Social media use in higher education: Building a structural equation model for student satisfaction and performance

Al-Rahmi AM, Shamsuddin A, Wahab E, Al-Rahmi WM, Alyoussef IY, Crawford J

Front Public Health, 2022;10:1003007.
PMID: 36203665 DOI: 10.3389/fpubh.2022.1003007

Social media utilization at the student-level has become more prevalent contemporary higher education. Hence, this study is aimed at developing a specific model, along with the behavioral intention to use, to explore educational quality, actual social media use, and task-technology fit that affects student satisfaction and performance impact through examining the synergies of constructivism, user acceptance and usage of information technology, and technology acceptance. To test, a survey was administered to 430 students across five Malaysian universities. Through structural equation modeling, findings indicate that to improve student satisfaction and student performance through embedded social media, students need to have opportunities to collaborate on learning, have easy access to social media, perceive such use to be easy, and have aligned expectation on performance and effort. Interestingly, the actual social media use, was the only variable in the model that did not predict student satisfaction, despite its role in predicting student performance. The study highlights that constructivist learning, as well as task-technology fit over social media, enhances the students' learning experience and enables knowledge sharing and dissemination. The effect of using social media on student satisfaction and academic performance highlights that all students think that it is adequate for their instructors to improve their usage of social media tools. Therefore, we advocate learners and students employing social media for academic purposes with the help of lecturers at higher teaching organizations and institutions.
Fulltext Social Determinants Predicting the Knowledge, Attitudes, and Practices of Women Toward Zika Virus Infection

Maharajan MK, Rajiah K, Belotindos JS, Basa MS

Front Public Health, 2020;8:170.
PMID: 32582602 DOI: 10.3389/fpubh.2020.00170

Objective: To investigate the factors predicting knowledge, attitude, and practices (KAP) toward Zika virus infection among women population in Cebu City, Philippines. Study Design: A cross-sectional survey was conducted from March 2018 to May 2018. Ethical practices were followed. A total of 702 women was approached and finally 516 completed the survey. Methods: Descriptive analysis was undertaken for the participants' characteristics. Kolmogorov-Smirnov test was applied to declare the nature of data distribution. To determine the role of socio-demographic characteristics on KAP, differences in socio-demographic status were compared with the KAP scores using the one-way analysis of variance or Kruskal-Wallis test with p < 0.05 as significant. Logistic regression analysis was used to determine the predictors of each KAP domain (good and poor). Results: There was a significant positive correlation between level of education and KAP scores. Also, there was a significant positive correlation between employment and KAP scores. Knowledge score was a significant predictor of practice score (b = 1.261, p = 0.024), and attitude score was also a significant predictor of practice score (b = 0.183, p = 0.039). However, knowledge score was not a significant predictor of attitude score (b = 0.316, p = 0.247). Conclusions: The present findings provided an overall view of KAP on Zika virus infection among females in Philippines and the socio-demographic factors that affected their KAP. Women with postgraduate education and being in higher profession were the predictors influencing the KAP scores of this female population. Women with postgraduate education was the strongest predictor.
Fulltext Short-Term Forecasting of Daily Confirmed COVID-19 Cases in Malaysia Using RF-SSA Model

Shaharudin SM, Ismail S, Hassan NA, Tan ML, Sulaiman NAF

Front Public Health, 2021;9:604093.
PMID: 34195166 DOI: 10.3389/fpubh.2021.604093

Novel coronavirus (COVID-19) was discovered in Wuhan, China in December 2019, and has affected millions of lives worldwide. On 29th April 2020, Malaysia reported more than 5,000 COVID-19 cases; the second highest in the Southeast Asian region after Singapore. Recently, a forecasting model was developed to measure and predict COVID-19 cases in Malaysia on daily basis for the next 10 days using previously-confirmed cases. A Recurrent Forecasting-Singular Spectrum Analysis (RF-SSA) is proposed by establishing L and ET parameters via several tests. The advantage of using this forecasting model is it would discriminate noise in a time series trend and produce significant forecasting results. The RF-SSA model assessment was based on the official COVID-19 data released by the World Health Organization (WHO) to predict daily confirmed cases between 30th April and 31st May, 2020. These results revealed that parameter L = 5 (T/20) for the RF-SSA model was indeed suitable for short-time series outbreak data, while the appropriate number of eigentriples was integral as it influenced the forecasting results. Evidently, the RF-SSA had over-forecasted the cases by 0.36%. This signifies the competence of RF-SSA in predicting the impending number of COVID-19 cases. Nonetheless, an enhanced RF-SSA algorithm should be developed for higher effectivity of capturing any extreme data changes.
Fulltext Self-medication in Chinese residents and the related factors of whether or not they would take suggestions from medical staff as an important consideration during self-medication

Ge P, Li Q, Dong M, Niu Y, Han X, Xiong P, et al.

Front Public Health, 2022;10:1074559.
PMID: 36620260 DOI: 10.3389/fpubh.2022.1074559

OBJECTIVE: To investigate the status of Chinese residents' self-medication behavior and the important factors to consider when purchasing OTC drugs, and to explore the related factors of the possibility that Chinese residents take medical staff's suggestions as important factors to consider when purchasing OTC drugs.
STUDY DESIGN: A cross-sectional survey.
METHODS: A questionnaire was developed for exploring the sociodemographic characteristics of the respondents, their self-medication status, and important considerations. The questionnaire includes several scales including Health Literacy Scale-Short Form (HLS-SF), EQ-5D Visual Analog Scale (EQ-5D-VAS), Big Five Inventary-10 Items (BFI-10), and New General Self Efficacy Scale (NGSES). After carrying out a multi-stage sampling method, the questionnaire was conducted nationwide from July 10 to September 15, 2021. Next, descriptive statistics were conducted to analyze the general features. Logistic regression was then used to analyze the related factors of the possibility that the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs.
RESULTS: Nine thousand two hundred fifty-six qualified questionnaires were received. 99.06% of Chinese adults had self-medication behaviors. The types of OTC drugs purchased most by the respondents were NSAIDs (5,421/9,256 people, 58.57%) and vitamins/minerals (4,851/9,256 people, 52.41%). 86.2% of the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs. The results of multi-factor logistic regression showed that women, those living in the central and western regions of China, those suffering from chronic diseases, those with high agreeableness, high conscientiousness, high neuroticism and openness, high health literacy, high EQ-5D-VAS, and those with high self-efficacy are more likely to take medical staff's suggestions as important factors to consider.
CONCLUSION: The vast majority of Chinese adults have self-medication behavior. Important considerations when purchasing OTC drugs include medical staff's suggestions, drug safety and drug efficacy. Whether residents take the suggestions of medical staff as an important consideration is related to their sociological characteristics, agreeableness, conscientiousness, neuroticism, openness, health literacy, self-assessment health status, and self-efficacy. When purchasing and using OTC drugs, residents should carefully listen to the suggestions from medical staff. They should also carefully consider their own conditions before buying OTC drugs.
Fulltext School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol

Mohammadi S, Su TT, Jalaludin MY, Dahlui M, Azmi Mohamed MN, Papadaki A, et al.

Front Public Health, 2020;8:549637.
PMID: 33072694 DOI: 10.3389/fpubh.2020.549637

Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention. Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling "red flag" foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell "green flag" food and drinks, such as fruits and vegetables. Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.
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 Risk Factors Associated With Medication Errors Among Patients Suffering From Chronic Disorders

Rasool MF, Rehman AU, Imran I, Abbas S, Shah S, Abbas G, et al.

Front Public Health, 2020;8:531038.
PMID: 33330300 DOI: 10.3389/fpubh.2020.531038

Introduction: Medication error is unintentional and can be reduced by reducing the risk factors. Patients suffering from chronic diseases are at an increased risk of medication errors. Objective: This work aims to assess the risk factors associated with medication errors among patients suffering from chronic disorders in hospitals of South Punjab, Pakistan. Methodology: Multiple logistic regression analysis was used to assess the impact of different risk factors on the prevalence of medication errors in patients suffering from chronic diseases. Results: A greater risk for the occurrence of medication errors was associated with age ≥60 years (odds ratio, OR = 1.9; 95% CI = 1.3-3.1; p = 0.001), overburdened healthcare system (OR = 2.2; 95% CI = 1.64-3.56; p < 0.000), number of prescribed drugs ≥5 (OR = 1.74; 95% CI = 1.02-2.64; p < 0.000), comorbidities (OR = 2.6; 95% CI = 1.72-3.6; p = 0.003), Charlson comorbidity index (OR = 1.31; 95% CI = 0.49-1.84; p = 0.004), and multiple prescribers to one patient (OR = 1.12; 95% CI = 0.64-1.76; p = 0.001). Conclusion: Older age, overburdened healthcare system, number of prescribed drugs, comorbidities, Charlson comorbidity index, and multiple prescribers to one patient are significant risk factors for the occurrence of medication errors.
Fulltext Reliability and Accuracy of 2D Photogrammetry: A Comparison With Direct Measurement

Lim YC, Abdul Shakor AS, Shaharudin R

Front Public Health, 2021;9:813058.
PMID: 35155360 DOI: 10.3389/fpubh.2021.813058

Objective: Facial anthropometric data is important for the design of respirators. Two-dimensional (2D) photogrammetry has replaced direct anthropometric method, but the reliability and accuracy of 2D photogrammetry has not been quantified. This study aimed to assess inter-rater reliability of 2D photogrammetry and to examine the reliability and accuracy of 2D photogrammetry with direct measurement.
Design: A cross-sectional study.
Setting: Malaysia.
Participants: A subset of 96 participants aged 18 and above.
Primary and secondary outcomes: Ten facial dimensions were measured using direct measurement and 2D photogrammetry. An assessment of inter-rater reliability was performed using intra-class correlation (ICC) of the 2D images. In addition, ICC and Bland-Altman analyses were used to assess the reliability and agreement of 2D photogrammetry with direct measurement.
Results: Except for head breadth and bigonial breadth, which were also found to have low inter-rater reliability, there was no significant difference in the inter-rater mean value of the 2D photogrammetry. The mean measurements derived from direct measurement and 2D photogrammetry were mostly similar. However, statistical differences were noted for two facial dimensions, i.e., bizygomatic breadth and bigonial breadth, and clinically the magnitude of difference was also significant. There were no statistical differences in respect to the remaining eight facial dimensions, where the smallest mean difference was 0.3 mm and biggest mean difference was 1.0 mm. The ICC showed head breadth had poor reliability, whilst Bland-Altman analyses showed seven out of 10 facial dimensions using 2D photogrammetry were accurate, as compared to direct measurement.
Conclusion: Only certain facial measurements can be reliably and accurately measured using 2D photogrammetry, thus it is important to conduct a reliability and validation study before the use of any measurement methods in anthropometric studies. The results of this study also suggest that 2D photogrammetry can be used to supplement direct measurement for certain facial dimensions.
Fulltext Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future

Godman B, Haque M, Islam S, Iqbal S, Urmi UL, Kamal ZM, et al.

Front Public Health, 2020;8:585832.
PMID: 33381485 DOI: 10.3389/fpubh.2020.585832

Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.
Fulltext Quality of life among health care workers in Arab countries 2 years after COVID-19 pandemic

Ghazy RM, Abubakar Fiidow O, Abdullah FSA, Elbarazi I, Ismail II, Alqutub ST, et al.

Front Public Health, 2022;10:917128.
PMID: 36408035 DOI: 10.3389/fpubh.2022.917128

Background: Assessment of the quality of life (QoL) among healthcare workers (HCWs) is vital for better healthcare and is an essential indicator for competent health service delivery. Since the coronavirus disease 2019 (COVID-19) pandemic strike, the frontline position of HCWs subjected them to tremendous mental and psychological burden with a high risk of virus acquisition.
Aim: This study evaluated the QoL and its influencing factors among HCWs residing in the Arab countries.
Methods: This was a cross-sectional study using a self-administered online questionnaire based on the World Health Organization QoL-BREF instrument with additional questions related to COVID-19. The study was conducted in three different languages (Arabic, English, and French) across 19 Arab countries between February 22 and March 24, 2022.
Results: A total of 3,170 HCWs were included in the survey. The majority were females (75.3%), aged 18-40 years (76.4%), urban residents (90.4%), married (54.5%), and were living in middle-income countries (72.0%). The mean scores of general health and general QoL were 3.7 ± 1.0 and 3.7 ± 0.9, respectively. Those who attained average physical, psychological, social, and environmental QoL were 40.8, 15.4, 26.2, and 22.3%, respectively. The income per capita and country income affected the mean scores of all QoL domains. Previous COVID-19 infection, having relatives who died of COVID-19, and being vaccinated against COVID-19 significantly affected the mean scores of different domains.
Conclusion: A large proportion of the Arab HCWs evaluated in this study had an overall poor QoL. More attention should be directed to this vulnerable group to ensure their productivity and service provision.
Fulltext Public Knowledge and Practices Regarding Coronavirus Disease 2019: A Cross-Sectional Survey From Pakistan

Saqlain M, Ahmed A, Nabi I, Gulzar A, Naz S, Munir MM, et al.

Front Public Health, 2021;9:629015.
PMID: 34026708 DOI: 10.3389/fpubh.2021.629015

Objectives: Effective mitigation of coronavirus diseases (COVID-19) pandemic requires true adoption of precautionary measures by the masses, that primarily depends upon their knowledge and practices behaviors. The current study aimed to assess the knowledge; practices of Pakistani residents regarding COVID-19 and factors associated with adequate knowledge and positive practices. Material and Methods: A cross-sectional online survey was conducted from 15-April 2020 to 20 May 2020 among 689 Pakistanis by using a validated self-administered questionnaire (Cronbach's alpha 0.77). The questionnaire included questions on the assessment of demographics, the source of information, knowledge, and practice of COVID-19 on google forms and shared links with the WhatsApp groups, Facebook pages and other online platforms. Regression analysis was applied to find potential predictors of knowledge and practices. Results: Of 689 participants, 431 (62.6%) were male, 64.3% (n = 443) were aged <30 years, and\328 (47.6%) of participants were married. 48.19% (n = 332) had adequate knowledge; 81% (n = 555) had positive practices regarding COVID-19 and majority (66.62%, n = 459) seek knowledge from social media. Knowledge was significantly higher (OR > 1.00, p < 0.05) among educated and higher income participants. Positive practices were significantly (OR > 1.00, p < 0.05) related to the older age (≥50 years), higher education, higher income and good knowledge regarding COVID-19. Conclusion: The study concluded that Pakistani residents had average knowledge and good practices toward COVID-19 yet there are gaps in specific aspects of knowledge, and practice that should be focused in future awareness and educational campaigns. The study recommends the ministry of health authorities to promote all precautionary and preventive measures of COVID-19-consisting of a better-organized approach to all strata of society: less privileged people, older ones and less educated people, in order to have equilibrium of knowledge about COVID-19; hence effective implementation of precautionary measures.

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