Displaying publications 41 - 58 of 58 in total

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  1. Affandi TYIMS, Wan Mokhtar I, Mohd Yusof MYP, Ahmad MS
    J Int Soc Prev Community Dent, 2023;13(3):256-263.
    PMID: 37564173 DOI: 10.4103/jispcd.JISPCD_228_22
    AIMS AND OBJECTIVES: Special care dentistry (SCD) provides oral health care to disabled individuals in an environmental, cultural or social setting that supports their oral health. This study aimed to analyze the profiles of patients managed at an SCD clinic in a teaching hospital based on their sociodemographic background, medical condition or disability, dental diagnosis and treatment provided.

    MATERIALS AND METHODS: This retrospective audit study included patients seen from the clinic's inception in January 2017 until June 2022, retrieved from the faculty's record management system. The pattern of patients seen was arranged on an Excel sheet and analyzed using SPSS. Quantitative data were analyzed via descriptive analysis (frequency) and chi-square test (P < 0.05).

    RESULTS: A 220% surge in the number of patients treated between January 2017 and June 2022, from two to 91 years old, with more male patients seen. Most patients had an intellectual disability (49.7%), followed by medical compromised (16.4%) and genetic conditions or syndromes (12.0%). 43% of had caries, which is more prevalent in women, and 31.6% had periodontal disease, with the majority being between the ages of 21 and 40. Periodontal treatment accounted for most of the dental treatment (76.1%). Even though only a small percentage of endodontic therapy was performed (2.4%), a significant association was found between the treatment, gender and age group of patients seen in the clinic.

    CONCLUSION: Considering their health profile, oral diagnosis and therapy, this study demonstrated the varied sorts of patients encountered in an SCD specialist clinic. This useful information will be beneficial in the development of a comprehensive care dentistry center for this community.

  2. Mohd Suria TYI, Omar AF, Wan Mokhtar I, Rahman ANAA, Kamaruddin AA, Ahmad MS
    Spec Care Dentist, 2023;43(6):848-855.
    PMID: 37013967 DOI: 10.1111/scd.12857
    OBJECTIVES: This study aims to analyze the impact and students' perceptions of online peer-assisted learning (OPL), developed as an alternative and innovative approach to Special Care Dentistry (SCD) training during the COVID-19 pandemic. Online peer-assisted learning (OPL) is an alternative pedagogical approach that combines online education and peer-assisted teaching.

    METHODS: The OPL session was conducted by two postgraduate students in SCD (as teachers), to final year undergraduate dental students (as learners) (n = 90), supervised by two specialists in SCD-related areas (as supervisors). Vetted online pre- and post-intervention quizzes were conducted before and after the session, respectively, followed by an online validated feedback survey of the students' learning experiences. Meanwhile, a reflective session was conducted between the postgraduate students and supervisors to explore their perceptions of OPL. Quantitative data was analyzed via paired t-test (significance level, P 

  3. Ahmad MS, Asban MA, Mohd Salleh NSA, Mohd Sarmin N', Abd Rahman ANA
    Spec Care Dentist, 2023;43(6):815-823.
    PMID: 36018716 DOI: 10.1111/scd.12770
    INTRODUCTION: Interprofessional education (IPE), which is aimed at improving the quality of patient care and overall health outcome, has been advocated to prepare future healthcare professionals for collaborative practice OBJECTIVES: This study aimed to investigate the perceptions of IPE among clinical healthcare students at a Malaysian institution METHODS: A validated questionnaire, developed from previous studies, was distributed online to selected final year students of 10 clinical programs from medical, dental, pharmacy and health sciences faculties (n = 501). Quantitative data was analyzed via chi-square test (significance value p 
  4. Mohd FN, Said AH, Ahmad MS, Ridzwan AN, Muhammad AI, Mat Naji AS
    J Int Soc Prev Community Dent, 2023;13(6):477-484.
    PMID: 38304533 DOI: 10.4103/jispcd.JISPCD_89_23
    BACKGROUNDS: People with intellectual disabilities (PWID) are often characterized by challenges in learning and difficulties in performing daily activities. These difficulties can have an impact not only on the individuals themselves but also on the people around them, especially their parents, caregivers, and healthcare workers. Therefore, establishing a positive relationship between parents or caregivers and individuals with disabilities is crucial as a key factor in promoting positive healthcare experiences and outcomes.

    AIM: This study aims to explore the barriers and perceptions toward healthcare services among parents or caretakers of people with intellectual disability, including the challenges and their expectations toward healthcare services.

    MATERIALS AND METHODS: This was a qualitative study using purposive sampling. Thirty participants were contacted at the initial stage and invited to participate in the study. Semi-structured in-depth interviews were done among parents and caretakers of PWID who attended Special Care Dentistry and Paediatric Dentistry clinics in Sultan Ahmad Shah Medical Centre, Kuantan, Pahang. Topic guides were generated from literature review and expert opinions, followed by pilot interviews to refine them. However, after the interviews were done for the first 13 participants, we have reached data saturation, and no new themes emerged. The interviews were recorded, verbatim transcribed, and analyzed using Braun and Clarke's guidelines for thematic analysis.

    RESULTS: The satisfaction of parents or caretakers toward healthcare services for PWID and positive experiences in receiving healthcare services were noted. However, the results revealed several barrier themes in seeking healthcare services: lack of availability of parking, longer waiting time, appointment time, crowded environment, limited information on the availability of the services, and longer travel duration. Furthermore, expectation themes emerged from this study: continuous follow-up, accessibility to healthcare services, and staff attitude.

  5. Aslam MS, Ahmad MS, Mamat AS, Ahmad MZ, Salam F
    PMID: 27528881 DOI: 10.1155/2016/4685246
    Elephantopus scaber and Clinacanthus nutans are traditionally used as wound healing herb. The objective of the present study is to develop a new polyherbal formulation, by comparison, the herbal combination of Elephantopus scaber and Clinacanthus nutans as an in vitro antioxidant activity with their individual herbal activity followed by fractionation of polyherbal formulation for in vivo wound healing activities and identification of bioactive compounds from their active fractions. Antioxidant activity was performed in vitro by DPPH scavenging antioxidant activity followed by in vivo wound healing activities using excision wound model, incision wound model, and burn wound model. Toxicity of the fractions of the polyherbal formulation was performed by a dermal toxicity test. The result showed that Elephantopus scaber crude extract on the basis of EC50 performs a much faster action (15.67 μg/mL) but with less % inhibition (87.66%) as compared to the combination of the new polyherbal formulation of crude extract (30 μg/mL). The polyherbal formulation has the highest % inhibition (89.49%) at the same dose as compared to Elephantopus scaber (87.66%). In comparison among all crude and fractions of new polyherbal formulation, it was found that the ethyl acetate fraction of polyherbal formulation has the fastest activity (EC50 14.83 μg/mL) with % inhibition (89.28%). Furthermore, during evaluation of wound contraction on excision and incision wound model, ethyl acetate fraction possesses the highest activity with (P < 0.001) and (P < 0.0001), respectively. During burn wound model, aqueous fraction (P < 0.001) possesses the highest activity followed by an ethyl acetate fraction (P < 0.0001). LC-MS analysis discovered the presence of several flavonoid-based compounds that work synergistically with sesquiterpene lactone and other bioactive compounds. In conclusion, flavonoid increases the antioxidant activity that surges the rate of wound contraction and works synergistically with other bioactive compounds.
  6. Abbas A, Ahmad MS, Cheng YH, AlFaify S, Choi S, Irfan RM, et al.
    Chemosphere, 2024 Aug 16;364:143083.
    PMID: 39154761 DOI: 10.1016/j.chemosphere.2024.143083
    Chiral drugs play an important role in modern medicine, but obtaining pure enantiomers from racemic mixtures can pose challenges. When a drug is chiral, only one enantiomer (eutomer) typically exhibits the desired pharmacological activity, while the other (distomer) may be biologically inactive or even toxic. Racemic drug formulations introduce additional health risks, as the body must still process the inactive or detrimental enantiomer. Some distomers have also been linked to teratogenic effects and unwanted side effects. Therefore, developing efficient and scalable methods for separating chiral drugs into their pure enantiomers is critically important for improving patient safety and outcomes. Metal-organic frameworks (MOFs) show promise as novel materials for chiral separation due to their highly tunable structures and interactions. This review summarizes recent advancements in using MOFs for chromatographic and spectroscopic resolution of drug enantiomers. Both the opportunities and limitations of MOF-based separation techniques are discussed. A thorough understanding of these methods could aid the continued development of pure enantiomer formulations and help reduce health risks posed by racemic drug mixtures.
  7. Khan W, Khan I, Ullah H, Zain SNM, Panhwar WA, Mehmood SA, et al.
    Braz J Biol, 2021;82:e238665.
    PMID: 33787717 DOI: 10.1590/1519-6984.238665
    Malakand region is an endemic area for cutaneous leishmaniasis (CL). However, there are limited number of studies of this disease in Pakistan. Therefore, a study was conducted to understand the level of awareness attitude and practice among the residents of Makaland towards CL and the disease vectors. This study adopted a cross-sectional approach with a total of 400 respondents (n=93 rural and n= 307 urban). Overall, the population in Malakand region (61.2%) were well-informed in the role of sand fly in transmitting diseases, but most lack knowledge on the vector's behavior and almost a quarter (24.5%) were unable to provide knowledge on proper control measures. Alarmingly, the practice and attitudes of the general population was not satisfactory as close to half (49.8%) of the population did adopt any control method. This study calls for increase in awareness through health education campaign to reduce the risk of cutaneous leishmaniasis outbreaks in the future.
  8. Ahmad MS, Cheng CK, Singh S, Ong HR, Abdullah H, Hong CS, et al.
    J Nanosci Nanotechnol, 2020 09 01;20(9):5916-5927.
    PMID: 32331197 DOI: 10.1166/jnn.2020.18549
    Glycerol electro-oxidation offers a green route to produce the high value added chemicals. Here in, we report the glycerol electro-oxidation over a series of multi walled carbon nano tubes supported monometallic (Pt/CNT and Pd/CNT) and bimetallic (Pt-Pd/CNT) catalysts in alkaline medium. The cyclic voltammetry, linear sweep voltammetry and chronoamperometry measurements were used to evaluate the activity and stability of the catalysts. The Pt-Pd/CNT electrocatalyst exhibited the highest activity in terms of higher current density (129.25 A/m²) and electrochemical surface area (382 m²/g). The glycerol electro-oxidation products formed at a potential of 0.013 V were analyzed systematically by high performance liquid chromatography. Overall, six compounds were found including mesoxalic acid, 1,3-dihydroxyacetone, glyceraldehyde, glyceric acid, tartronic acid and oxalic acid. A highest mesoxalic acid selectivity of 86.42% was obtained for Pt-Pd/CNT catalyst while a maximum tartronic acid selectivity of 50.17% and 46.02% was achieved for Pd/CNT and Pt/CNT respectively. It was found that the introduction of Pd into Pt/CNT lattice facilitated the formation of C3 products in terms of maximum selectivity achieved (86.42%) while the monometallic catalysts (Pd/CNT and Pt/CNT) showed a poor performance in comparison to their counterpart.
  9. Ahmad MS, Mehmood MA, Al Ayed OS, Ye G, Luo H, Ibrahim M, et al.
    Bioresour Technol, 2017 Jan;224:708-713.
    PMID: 27838316 DOI: 10.1016/j.biortech.2016.10.090
    The biomass of Urochloa mutica was subjected to thermal degradation analyses to understand its pyrolytic behavior for bioenergy production. Thermal degradation experiments were performed at three different heating rates, 10, 30 and 50°Cmin-1 using simultaneous thermogravimetric-differential scanning calorimetric analyzer, under an inert environment. The kinetic analyses were performed using isoconversional models of Kissenger-Akahira-Sunose (KAS) and Flynn-Wall-Ozawa (FWO). The high heating value was calculated as 15.04MJmol-1. The activation energy (E) values were shown to be ranging from 103 through 233 kJmol-1. Pre-exponential factors (A) indicated the reaction to follow first order kinetics. Gibbs free energy (ΔG) was measured to be ranging from 169 to 173kJmol-1 and 168 to 172kJmol-1, calculated by KAS and FWO methods, respectively. We have shown that Para grass biomass has considerable bioenergy potential comparable to established bioenergy crops such as switchgrass and miscanthus.
  10. Ibrahim NI, Ahmad MS, Zulfarina MS, Zaris SNASM, Mohamed IN, Mohamed N, et al.
    PMID: 29772744 DOI: 10.3390/ijerph15051002
    Fracture is a type of musculoskeletal injury that contributes to an inability to perform daily activities. The objective of this study was to evaluate activities of daily living (ADL) of older adult patients with lower body fracture and to determine factors influencing ADL. Patient's ADL was assessed at pre-fracture, ward admission and post-discharge phases using the Katz ADL questionnaire. There were 129 subjects at pre-fracture and ward phases and 89 subjects at discharge phase. There were four independent variables; age, gender, type of fracture and ability to walk before fracture. Logistic regression models showed that 'age' and 'ability to walk before fracture' were the determinant factors of dependent for 'bathing', 'dressing' and 'toileting'. The 'ability to walk before fracture' was the determinant factor of dependent for 'transferring'. 'Age' and 'gender' were the determinant factors of dependent for 'continence', while 'age' was the determinant factor of dependent for 'feeding'. The ADL score changes were significant across the phases with a reduction in ADL score in the ward admission phase and partial increment during the post-discharge phase. There were improvements in the health outcomes of subjects aged more than 50 years old after 3 months of being discharged from the hospital. In conclusion, age, being female, having a hip fracture and using a walking aid before fracture were the determinants identified in this study.
  11. Lin GSS, Ng YS, Hashim H, Foong CC, Yahya NA, Halil MHM, et al.
    BMC Oral Health, 2024 Jul 04;24(1):762.
    PMID: 38965533 DOI: 10.1186/s12903-024-04532-y
    BACKGROUND: Interprofessional education (IPE) is essential to foster collaboration among healthcare professionals for holistic patient care. However, Malaysian dental education remains discipline-centric, hindering multidisciplinary learning approaches. Hence, this study aimed to explore Malaysian undergraduate dental students' perceptions of IPE.

    METHODS: The present cross-sectional study employed convenience sampling to survey undergraduate dental students from four Malaysian institutions using a modified questionnaire with 20 close-ended and 2 open-ended questions. The questionnaire covered three domains (effectiveness, preference, importance) to assess students' perceptions using a five-point Likert scale. Psychometric validation was performed to assure validity and reliability of the modified questionnaire. Quantitative analysis (descriptive and inferential statistics), and qualitative analysis (content analysis) were subsequently performed.

    RESULTS: 397 students responded, and positive perceptions were generally noted with mean scores ranging from 4.13 to 4.35 across all domains. Questions 2 and 3, assessing the improvement in understanding the roles and responsibilities, and communication among healthcare professionals, received the highest mean scores. Meanwhile, Question 15 concerning the incorporation of IPE into educational goals received the lowest mean score. Regression analysis identified gender and clinical phase as significant factors, with females and preclinical students exhibiting more favourable perceptions. Motivators for IPE included a keen interest in diverse perspectives and recognising the importance of teamwork, while barriers encompassed tightly packed schedules, lack of understanding about IPE, misconceptions regarding dental education, and students' nervousness and fear of participation.

    CONCLUSION: This study produced a valid and reliable instrument to measure undergraduate dental students' perceptions towards IPE. Strategic planning, such as overcoming logistical challenges, improving awareness, and creating a supportive learning environment are crucial for successful IPE integration into existing curricula, especially in resource-constrained developing countries like Malaysia.

  12. Niven TCS, Azhany Y, Rohana AJ, Karunakar TVN, Thayanithi S, Jelinar Noor MN, et al.
    J Glaucoma, 2019 01;28(1):7-13.
    PMID: 30461551 DOI: 10.1097/IJG.0000000000001120
    PURPOSE: The purpose of this study was to determine the association between cigarette smoking and the severity of primary angle closure glaucoma (PACG) in Malay patients residing in Malaysia.

    METHODS: A cross-sectional study was conducted involving 150 Malay PACG patients between April 2014 and August 2016. Ocular examination was performed including Humphrey visual field (HVF) 24-2 analysis assessment. On the basis of the 2 consecutive reliable HVFs, the severity of glaucoma was scored according to modified Advanced Glaucoma Intervention Study (AGIS) by 2 masked investigators and classified as mild, moderate, and severe. Those with retinal diseases, neurological diseases, memory problem, and myopia ≥4 diopters were excluded. Their smoking status and details were obtained by validated questionnaire from Singapore Malay Eye Study (SiMES). The duration of smoking, number of cigarettes per day, and pack/year was also documented. Multiple linear regression analysis was conducted.

    RESULTS: There was a significant association between education level and severity of PACG (P=0.001). However, there was no significant association between cigarette smoking and severity of glaucoma (P=0.080). On the basis of multivariate analysis, a linear association was identified between cigarette smoked per day (adjusted b=0.73; 95% CI: 0.54, 1.45; P<0.001) and body mass index (adjusted b=0.32; 95% CI: 0.07, 1.35; P=0.032) with AGIS score.

    CONCLUSIONS: There was no significant association between cigarette smoking and severity of PACG. Cigarette smoked per day among the smokers was associated with severity of PACG. However, because of the detrimental effect of smoking, cessation of smoking should be advocated to PACG patients.

  13. Yulkifli Y, Yandes WP, Isa IM, Hashim N, Ulianas A, Sharif SNM, et al.
    Sensors (Basel), 2023 Oct 10;23(20).
    PMID: 37896460 DOI: 10.3390/s23208366
    The fabrication of a zinc hydroxide nitrate-sodium dodecylsulfate bispyribac modified with multi-walled carbon nanotube (ZHN-SDS-BP/MWCNT) paste electrode for uric acid and bisphenol A detection was presented in this study. Electrochemical impedance spectroscopy, chronocoulometry, square-wave voltammetry, and cyclic voltammetry were all used to examine the electrocatalytic activities of modified paste electrodes. The modified electrode's sensitivity and selectivity have been considered in terms of the composition of the modifier in percentages, the types of supporting electrolytes used, the pH of the electrolyte, and square-wave voltammetry parameters like frequency, pulse size, and step increment. Square-wave voltammetry is performed by applying a small amplitude square-wave voltage to a scanning potential from -0.3 V to +1.0 V, demonstrating a quick response time and high sensitivity. The ZHN-SDS-BP/MWCNT sensor demonstrated a linear range for uric acid and bisphenol A from 5.0 µM to 0.7 mM, with a limit of detection of 0.4 µM and 0.8 µM, respectively, with good reproducibility, repeatability, and stability as well. The modified paste electrode was successfully used in the determination of uric acid and bisphenol A in samples of human urine and lake water.
  14. Oglat AA, Matjafri MZ, Suardi N, Oqlat MA, Abdelrahman MA, Oqlat AA, et al.
    J Med Ultrasound, 2018;26(3):123-127.
    PMID: 30283197 DOI: 10.4103/JMU.JMU_13_17
    The wall-less flow phantoms with recognized acoustic features (attenuation and speed of sound), interior properties, and dimensions of tissue were prepared, calibrated, and characterized of Doppler ultrasound scanning demands tissue-mimicking materials (TMMs). TMM phantoms are commercially available and ready-made for medical ultrasound applications. Furthermore, the commercial TMM phantoms are proper for ultrasound purpose or estimation of diagnostic imaging techniques according to the chemical materials used for its preparation. However, preparing a desirable TMM for wall-less flow phantom using a specific chemical material according to the specific applications is required for different flow. In this review, TMM and wall-less flow phantoms prepared using different chemical materials and methods were described. The chemical materials used in Doppler ultrasound TMM and wall-less flow phantoms fabricated over the previous decades were of high interest in this review.
  15. Ibrahim NI, Ahmad MS, Szulfarina M, Sayed Mohd Zaris SNA, Zainal Abidin NA, Mohamed IN, et al.
    Iran J Public Health, 2021 Feb;50(2):415-417.
    PMID: 33748009 DOI: 10.18502/ijph.v50i2.5364
  16. Li J, Fong DYT, Lok KYW, Wong JYH, Man Ho M, Choi EPH, et al.
    J Glob Health, 2023 Aug 11;13:06031.
    PMID: 37565394 DOI: 10.7189/jogh.13.06031
    BACKGROUND: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic.

    METHODS: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels.

    RESULTS: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised.

    CONCLUSIONS: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.

  17. Li J, Fong DYT, Lok KYW, Wong JYH, Ho MM, Choi EPH, et al.
    J Glob Health, 2023 Oct 20;13:04125.
    PMID: 37861130 DOI: 10.7189/jogh.13.04125
    BACKGROUND: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences.

    METHODS: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic.

    RESULTS: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction).

    CONCLUSIONS: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

  18. Li J, Fong DYT, Lok KYW, Wong JYH, Man Ho M, Choi EPH, et al.
    J Glob Health, 2024 Apr 12;14:04068.
    PMID: 38606605 DOI: 10.7189/jogh-14-04068
    BACKGROUND: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements.

    METHODS: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test.

    FINDINGS: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P 

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