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Fulltext Electronic Medical Records in Greece and Oman: A Professional's Evaluation of Structure and Value

Koutzampasopoulou Xanthidou O, Shuib L, Xanthidis D, Nicholas D

Int J Environ Res Public Health, 2018 06 01;15(6).
PMID: 29857585 DOI: 10.3390/ijerph15061137

An Electronic Medical Record (EMR) is a patient's database record that can be transmitted securely. There are a diversity of EMR systems for different medical units to choose from. The structure and value of these systems is the focus of this qualitative study, from a medical professional's standpoint, as well as its economic value and whether it should be shared between health organizations. The study took place in the natural setting of the medical units' environments. A purposive sample of 40 professionals in Greece and Oman, was interviewed. The study suggests that: (1) The demographics of the EMR should be divided in categories, not all of them accessible and/or visible by all; (2) The EMR system should follow an open architecture so that more categories and subcategories can be added as needed and following a possible business plan (ERD is suggested); (3) The EMR should be implemented gradually bearing in mind both medical and financial concerns; (4) Sharing should be a patient's decision as the owner of the record. Reaching a certain level of maturity of its implementation and utilization, it is useful to seek the professionals' assessment on the structure and value of such a system.
Fulltext Maternal Serum and Breast Milk Adiponectin: The Association with Infant Adiposity Development

Mohamad M, Loy SL, Lim PY, Wang Y, Soo KL, Mohamed HJJ

Int J Environ Res Public Health, 2018 Jun 12;15(6).
PMID: 29895806 DOI: 10.3390/ijerph15061250

The prevalence of childhood obesity is increasing at an alarming rate in Malaysia. Metabolic changes during pregnancy are critical to the development of infant adiposity, due to imbalanced adipokines production. Hence, we aimed to investigate the association of maternal serum and breast milk adipokines with infant adiposity development. The study was conducted from April 2010 until December 2012. A total of 155 healthy pregnant mothers aged 19 to 40 years were recruited during the first and second trimester in Kelantan, Malaysia. Data consisted of maternal sociodemographic details, anthropometry and clinical biochemistry analysis; and the infant’s anthropometry and feeding patterns. Maternal fasting serum and breast milk samples were analysed for adiponectin and leptin levels. Data collection was performed in the second and third trimester of pregnancy, and continued with follow-up visits at birth, two, six, and 12 months postpartum. Multiple linear regression (MLR) analyses were performed to examine the associations between maternal serum and breast milk adiponectin and leptin and infant adiposity development. MLR models showed that, in the first year, as maternal serum and breast milk adiponectin increased, infant weight, BMI-for-age Z scores and abdominal circumference significantly decreased (p < 0.05). Maternal serum and/or breast milk adiponectin was associated with first-year infant adiposity development.
Fulltext Development of a Strategic Tool for Shared Decision-Making in the Use of Antidepressants among Patients with Major Depressive Disorder: A Focus Group Study

Zaini S, Manivanna Bharathy HA, Sulaiman AH, Singh Gill J, Ong Hui K, Zaman Huri H, et al.

Int J Environ Res Public Health, 2018 07 03;15(7).
PMID: 29970848 DOI: 10.3390/ijerph15071402

Shared decision-making (SDM) has been recognized as an important tool in the mental health field and considered as a crucial component of patient-centered care. Therefore, the purpose of this study was to develop a strategic tool towards the promotion and implementation of SDM in the use of antidepressants among patients with major depressive disorder. Nineteen doctors and 11 major depressive disorder patients who are involved in psychiatric outpatient clinic appointments were purposively selected and recruited to participate in one of six focus groups in a large teaching hospital in Malaysia. Focus groups were transcribed verbatim and analyzed using a thematic approach to identify current views on providing information needed for SDM practice towards its implementation in near future. Patients’ and doctors’ views were organized into six major themes, which are; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacist. The information may be included in the SDM tool which can be useful to inform further research efforts and developments that contribute towards the successful implementation of SDM into clinical practice.

Study site: University Malaya Medical Centre (UMMC)
Fulltext Leptospirosis Health Intervention Module Effect on Knowledge, Attitude, Belief, and Practice among Wet Market Workers in Northeastern Malaysia: An Intervention Study

Rahman MHAA, Hairon SM, Hamat RA, Jamaluddin TZMT, Shafei MN, Idris N, et al.

Int J Environ Res Public Health, 2018 07 03;15(7).
PMID: 29970799 DOI: 10.3390/ijerph15071396

Leptospirosis is an infectious disease which can be prevented by increasing awareness and promoting preventive health behaviours among high risk groups including wet market workers. Thus, the aim of this study was to determine the effectiveness of Leptospirosis Health Intervention Program (LHIP) in improving knowledge, attitude, belief and practice towards leptospirosis among wet market workers in Kelantan. This intervention study was conducted in two main wet markets in Kelantan involving 116 participants in each control and intervention groups. The health education intervention was based on Leptospirosis Health Intervention Module. The knowledge, attitude, belief and practice scores were measured before and six weeks after the intervention to examine the effect of the program. The results showed that knowledge (p < 0.001), attitude (p = 0.001), belief (p < 0.001) and practice (p < 0.001) scores changes were significantly higher in the intervention group compared to the control group. The adjusted mean differences were 12.93 (95% CI: 8.47, 17.39) for knowledge, 5.55 (95% CI: 2.28, 8.81) for attitude, 7.21 (95% CI: 3.43, 10.99) for belief and 7.35 (95% CI: 3.64, 11.05) for practice scores. Leptospirosis Health Intervention Program was an effective health educational tools to improve awareness and preventive behaviours among risk groups such as wet market workers.
Fulltext Performance of Osteoporosis Self-Assessment Tool (OST) in predicting osteoporosis - a review

Subramaniam S, Ima-Nirwana S, Chin KY

Int J Environ Res Public Health, 2018 07 09;15(7).
PMID: 29987247 DOI: 10.3390/ijerph15071445

Bone health screening plays a vital role in the early diagnosis and treatment of osteoporosis to prevent fragility fractures among the elderly and high-risk individuals. Dual-energy X-ray absorptiometry (DXA), which detects bone mineral density, is the gold standard in diagnosing osteoporosis but is not suitable for screening. Therefore, many screening tools have been developed to identify individuals at risk for osteoporosis and prioritize them for DXA scanning. The Osteoporosis Self-assessment Tool (OST) is among the first tools established to predict osteoporosis in postmenopausal women. It can identify the population at risk for osteoporosis, but its performance varies according to ethnicity, gender, and age. Thus, these factors should be considered to ensure the optimal use of OST worldwide. Overall, OST is a simple and economical screening tool to predict osteoporosis and it can help to optimize the use of DXA.
Fulltext A review of knowledge, belief and practice regarding osteoporosis among adolescents and young adults

Chan CY, Mohamed N, Ima-Nirwana S, Chin KY

Int J Environ Res Public Health, 2018 08 12;15(8).
PMID: 30103534 DOI: 10.3390/ijerph15081727

Osteoporosis is a major public health problem affecting millions of people worldwide. Increasing knowledge, correcting health belief and promoting osteoprotective practices are effective measures for building and maintaining strong bone throughout ones' life-span. This review aims to summarize the contemporary evidence on the knowledge, beliefs and practice of adolescents and young adults on bone health. We performed literature searches using the PubMed and Scopus databases to identify original studies from 2008 to May 2018 using the search terms "(knowledge OR beliefs OR attitude OR practice OR behaviours OR physical activity OR exercise OR diet OR nutrition) AND (young OR youth OR adolescents OR children OR young adults OR students OR teenager) AND (osteoporosis OR bone health)". Of the 3206 articles found, 34 met the inclusion criteria. Studies showed that most adolescents and young adults had poor knowledge and expressed disinterest in osteoporosis. They believed that other diseases were more serious than osteoporosis, contributing to low perceived susceptibility and seriousness towards this disease. Popular media emerged as a platform to obtain information regarding osteoporosis. The lack of knowledge and misconceptions about osteoporosis led to poor osteoprotective practices. As a conclusion, the current evidence revealed a lack of awareness about osteoporosis among adolescents and young adults. Educational interventions may be useful to improve the awareness of osteoporosis among this population.
Fulltext Poultry Slaughterhouse Wastewater Treatment Using Submerged Fibers in an Attached Growth Sequential Batch Reactor

Aziz HA, Puat NNA, Alazaiza MYD, Hung YT

Int J Environ Res Public Health, 2018 08 13;15(8).
PMID: 30104522 DOI: 10.3390/ijerph15081734

In this study, a sequential batch reactor (SBR) with different types of fibers was employed for the treatment of poultry slaughterhouse wastewater. Three types of fibers, namely, juite fiber (JF), bio-fringe fiber (BF), and siliconised conjugated polyester fiber (SCPF), were used. Four SBR experiments were conducted, using the fibers in different reactors, while the fourth reactor used a combination of these fibers. The treatment efficiency of the different reactors with and without fibers on biochemical oxygen demand (BOD), chemical oxygen demand (COD), ammonia-nitrogen (NH₃-N), phosphorus (P), nitrite (NO₂), nitrate (NO₃), total suspended solids (TSS), and oil-grease were evaluated. The removal efficiency for the reactors with fibers was higher than that of the reactor without fibers for all pollutants. The treated effluent had 40 mg/L BOD₅ and 45 mg/L COD with an average removal efficiency of 96% and 93%, respectively, which meet the discharge limits stated in the Environmental Quality Act in Malaysia.
Fulltext Core Symptoms of Major Depressive Disorder among Palliative Care Patients

Huey NS, Guan NC, Gill JS, Hui KO, Sulaiman AH, Kunagasundram S

Int J Environ Res Public Health, 2018 08 16;15(8).
PMID: 30115817 DOI: 10.3390/ijerph15081758

A valid method to diagnose depression in palliative care has not been established. In this study, we aim to determine the prevalence of depression and the discriminant validity of the items of four sets of diagnostic criteria in palliative care. This is a cross-sectional study on 240 palliative care patients where the presence of depression was based on the Diagnostic and Statistical Manual of Mental Disorders, DSM⁻IV Criteria, Modified DSM⁻IV Criteria, Cavanaugh Criteria, and Endicott's Criteria's. Anxiety, depression, and distress were measured with Hospital Anxiety and Depression Scale and Distress Thermometer. The prevalence of depression among the palliative care patients was highest based on the Modified DSM⁻IV Criteria (23.3%), followed by the Endicott's Criteria (13.8%), DSM⁻IV Criteria (9.2%), and Cavanaugh Criteria (5%). There were significant differences (p < 0.05) in the depressive symptoms showed by DSM⁻IV item 1 (dysphoric mood), item 2 (loss of interest or pleasure), and Endicott's criteria item 8 (brooding, self-pity, or pessimism) among the palliative patients, even after adjustment for the anxiety symptoms and distress level. We found that dysphoric mood, loss of interest, and pessimism are the main features of depression in palliative patients. These symptoms should be given more attention in identifying depression in palliative care patients.
Fulltext Technology Evolution of China's Export of Renewable Energy Products

Cao X, Rajarshi A, Tong J

Int J Environ Res Public Health, 2018 08 19;15(8).
PMID: 30126241 DOI: 10.3390/ijerph15081782

With the increasing scarcity of traditional energy sources, global warming and environmental degradation, the increased use of renewable energy (RE) has become an effective path for sustainable development. Therefore, countries are paying more and more attention to the development of the RE industry, and the world trade in renewable energy products (REPs) is developing rapidly. First of all, this paper defines REPs, refines the scope of REPs, and proposes the "Equalization Technology Classification" method for the technology classification of REPs. Second, based on the United Nations Comtrade (COMTRADE) data, the export technology structure of China's REPs from 2007 to 2016 was empirically measured. Finally, a comparative study was conducted on the renewable energy product (REP) export technologies of major REP exporting countries (or regions) in the world. We found that (1) China's exports of REPs are mainly medium-high and medium technical complexity products, and that there are few high technical complexity products; (2) the export technology structure of China's REPs is deteriorating, and its overall technical level is in the middle of the global industrial value chain. The export technology of China's REPs has a gap compared with that of Denmark, Hong Kong China, and Singapore; (3) the technological competition of the world's REPs is becoming increasingly fierce. The growth rates of REP technologies in South Korea, Japan, and Malaysia's REPs are significantly higher than that of China.
Fulltext The Effects of Vitamin E from Elaeis guineensis (Oil Palm) in a Rat Model of Bone Loss Due to Metabolic Syndrome

Wong SK, Chin KY, Suhaimi FH, Ahmad F, Ima-Nirwana S

Int J Environ Res Public Health, 2018 08 24;15(9).
PMID: 30149518 DOI: 10.3390/ijerph15091828

The beneficial effects of vitamin E in improving components of MetS or bone loss have been established. This study aimed to investigate the potential of palm vitamin E (PVE) as a single agent, targeting MetS and bone loss concurrently, using a MetS animal model. Twelve-week-old male Wistar rats were divided into five groups. The baseline group was sacrificed upon arrival. The normal group was given standard rat chow. The remaining three groups were fed with high-carbohydrate high-fat (HCHF) diet and treated with tocopherol-stripped corn oil (vehicle), 60 mg/kg or 100 mg/kg PVE. At the end of the study, the rats were evaluated for MetS parameters and bone density. After euthanasia, blood and femurs were harvested for the evaluation of lipid profile, bone histomorphometric analysis, and remodeling markers. PVE improved blood pressure, glycemic status, and lipid profile; increased osteoblast surface, osteoid surface, bone volume, and trabecular thickness, as well as decreased eroded surface and single-labeled surface. Administration of PVE also significantly reduced leptin level in the HCHF rats. PVE is a potential agent in concurrently preventing MetS and protecting bone loss. This may be, in part, achieved by reducing the leptin level and modulating the bone remodeling activity in male rats.
Fulltext The Sensitivity, Specificity and Accuracy of Warning Signs in Predicting Severe Dengue, the Severe Dengue Prevalence and Its Associated Factors

Ahmad MH, Ibrahim MI, Mohamed Z, Ismail N, Abdullah MA, Shueb RH, et al.

Int J Environ Res Public Health, 2018 09 15;15(9).
PMID: 30223572 DOI: 10.3390/ijerph15092018

Objectives: To study Malaysian dengue clinical practice guideline (CPG) warning signs (WS) in predicting severe dengue (SD) and its associated factors among confirmed cases presented to a teaching hospital in north-eastern Malaysia in 2014. Methods: A cross-sectional study was performed in February 2015 using secondary data acquired from the hospital records. There were 2607 confirmed dengue cases presented to Hospital Universiti Sains Malaysia (HUSM) in 2014. Seven hundred patients were selected after proportionate stratified random sampling conducted according to the number of cases in 12 different months in 2014. Data were collected and analysed using SPSS version 22.0. Results: Severe dengue outcomes represented 4.9% of cases. The prevalence of any of WS in SD was 91.2%. The most common WSs prior to SD were persistent vomiting (55.9%), and abdominal pain/tenderness (52.9%). The most sensitive warning sign in detecting SD was abdominal pain (59%). Specificity of individual WS were generally good, especially of clinical fluid accumulation (99%), hepatomegaly (98%) and mucosal bleeding (93%). Factors associated with SD were persistent vomiting (Adjusted odds ratio (aOR)): 2.41), mucosal bleeding (aOR: 4.73) and haematocrit rise with rapid platelet drop (aOR: 2.74). Conclusion: A focus on sensitivity, specificity, predictive values and association of a number of particular WS should be emphasized in order to better predict severe dengue outcomes.
Fulltext Health Risk of Polonium 210 Ingestion via Drinking Water: An Experience of Malaysia

Ahmed MF, Alam L, Mohamed CAR, Mokhtar MB, Ta GC

Int J Environ Res Public Health, 2018 09 20;15(10).
PMID: 30241360 DOI: 10.3390/ijerph15102056

The presence of toxic polonium-210 (Po-210) in the environment is due to the decay of primordial uranium-238. Meanwhile, several studies have reported elevated Po-210 radioactivity in the rivers around the world due to both natural and anthropogenic factors. However, the primary source of Po-210 in Langat River, Malaysia might be the natural weathering of granite rock along with mining, agriculture and industrial activities. Hence, this is the first study to determine the Po-210 activity in the drinking water supply chain in the Langat River Basin to simultaneously predict the human health risks of Po-210 ingestion. Therefore, water samples were collected in 2015⁻2016 from the four stages of the water supply chain to analyze by Alpha Spectrometry. Determined Po-210 activity, along with the influence of environmental parameters such as time-series rainfall, flood incidents and water flow data (2005⁻2015), was well within the maximum limit for drinking water quality standard proposed by the Ministry of Health Malaysia and World Health Organization. Moreover, the annual effective dose of Po-210 ingestion via drinking water supply chain indicates an acceptable carcinogenic risk for the populations in the Langat Basin at 95% confidence level; however, the estimated annual effective dose at the basin is higher than in many countries. Although several studies assume the carcinogenic risk of Po-210 ingestion to humans for a long time even at low activity, however, there is no significant causal study which links Po-210 ingestion via drinking water and cancer risk of the human. Since the conventional coagulation method is unable to remove Po-210 entirely from the treated water, introducing a two-layer water filtration system at the basin can be useful to achieve SDG target 6.1 of achieving safe drinking water supplies well before 2030, which might also be significant for other countries.
Fulltext The Pertinence of Microwave Irradiated Coconut Shell Bio-Sorbent for Wastewater Decolourization: Structural Morphology and Adsorption Optimization Using the Response Surface Method (RSM)

Abdulsalam M, Che Man H, Isma Idris A, Zainal Abidin Z, Faezah Yunos K

Int J Environ Res Public Health, 2018 10 09;15(10).
PMID: 30304814 DOI: 10.3390/ijerph15102200

Palm oil mill effluent contains carcinogenic coloured compounds that are difficult to separate due to their aromatic structure. Though colour treatment using adsorption processes at lower pH (<4) have been reported effectual, due to its acidity the remediated effluent poses an environmental hazard as a result. Thus, the current study focused on achieving decolourization at neutral pH by enhancing the morphology of the coconut shell activated carbon (CSAC) using N₂ as activating-agent with microwave irradiation heating. The microwave pretreated and non-pretreated CSAC were characterized using scanned electron microscopy (SEM), energy dispersive X-ray (EDX) and Brunauer-Emmett-Teller (BET) analysis. A significant modification in the porous structure with a 66.62% increase in the specific surface area was achieved after the pretreatment. The adsorption experimental matrix was developed using the central composite design to investigate the colour adsorption performance under varied pH (6⁻7), dosage (2⁻6 g) and contact time (10⁻100 min). At optimum conditions of neutral pH (7), 3.208 g dosage and contact time of 35 min, the percentage of colour removal was 96.29% with negligible differences compared with the predicted value, 95.855%. The adsorption equilibrium capacity of 1430.1 ADMI × mL/g was attained at the initial colour concentration of 2025 ADMI at 27 °C. The experimental data fitted better with the Freundlich isotherm model with R² 0.9851.
Fulltext Effect of Organic Loading Rate on Anaerobic Digestion Performance of Mesophilic (UASB) Reactor Using Cattle Slaughterhouse Wastewater as Substrate

Musa MA, Idrus S, Hasfalina CM, Daud NNN

Int J Environ Res Public Health, 2018 10 11;15(10).
PMID: 30314290 DOI: 10.3390/ijerph15102220

In this study, the performance of a laboratory scale upflow anaerobic sludge blanket (UASB) reactor operating at mesophilic temperature (35 °C) was examined. Cattle slaughterhouse wastewater (CSWW) was used as the main substrate. The total and effective volumes of the reactor were 8 L and 6 L, respectively. Twelve different organic loading rates (OLR) were applied and the performance was evaluated. The chemical oxygen demand (COD) removal efficiency was more than 90% during batch study. In the continuous study, COD removal was also approximately 90% at OLR 0.4 g/L d-1 which subsequently dropped to below 50% when the loading rate increased to 15 g/L d-1. Approximately 5 L/d of biogas was obtained with high methane concentration at stages VI and XI corresponding to OLR of 2 and 10 g/L d-1, respectively. It was observed that the concentration of volatile fatty acids was low and that the alkalinity of the wastewater was sufficient to avoid acidification. Specific methane yields of 0.36 and 0.38 LCH₄/g COD added were achieved at OLR 7 and 10 g/L d-1. A hydraulic retention time (HRT) of 1 day was sufficient to remove greater than 70% of COD which correspond to 89% methane concentration. Parameters like soluble COD, NH₃-N, pH, alkalinity, total suspended solid (TSS), fats, oil, and grease were also investigated. The results show that the UASB reactor could serve as a good alternative for anaerobic treatment of CSWW and methane production.
Fulltext Prevalence of Anaemia and Iron Deficiency among Primary Schoolchildren in Malaysia

Nik Shanita S, Siti Hanisa A, Noor Afifah AR, Lee ST, Chong KH, George P, et al.

Int J Environ Res Public Health, 2018 10 23;15(11).
PMID: 30360488 DOI: 10.3390/ijerph15112332

The present study aimed to report the prevalence of anaemia and iron deficiency (ID) and to explore the associations among socio-demographic characteristics, nutritional status and inflammation status in the occurrence of anaemia and ID in a nationally representative sample of Malaysian primary schoolchildren. Using data from the South East Asian Nutrition Surveys (SEANUTS), 544 Malaysian children aged 7 to 12 years were included in this secondary analysis. Blood samples were drawn for haemoglobin and serum ferritin analysis while C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) were measured to detect inflammation. Prevalence of anaemia and ID were 4.0% and 5.2%, respectively. There were significantly more anaemic indigenous bumiputra children (9.9%) than Chinese children (0.6%). Correction for inflammation did not change the prevalence of ID. More overweight/obese children than thin/normal weight children were found to have elevated acute phase protein (APP). Children with elevated inflammatory markers had significantly higher ferritin level than children without inflammation. Periodic health assessments of anaemia and ID at the population level to monitor and clarify the epidemiology of health problems are required to inform public health policies and strategies.
Fulltext Wound Healing Properties of Selected Natural Products

Ibrahim N', Wong SK, Mohamed IN, Mohamed N, Chin KY, Ima-Nirwana S, et al.

Int J Environ Res Public Health, 2018 10 25;15(11).
PMID: 30366427 DOI: 10.3390/ijerph15112360

Wound healing is a complex process of recovering the forms and functions of injured tissues. The process is tightly regulated by multiple growth factors and cytokines released at the wound site. Any alterations that disrupt the healing processes would worsen the tissue damage and prolong repair process. Various conditions may contribute to impaired wound healing, including infections, underlying diseases and medications. Numerous studies on the potential of natural products with anti-inflammatory, antioxidant, antibacterial and pro-collagen synthesis properties as wound healing agents have been performed. Their medicinal properties can be contributed by the content of bioactive phytochemical constituents such as alkaloids, essential oils, flavonoids, tannins, saponins, and phenolic compounds in the natural products. This review highlights the in vitro, in vivo and clinical studies on wound healing promotions by the selected natural products and the mechanisms involved.
Fulltext Knowledge, Attitudes, Practices and Health Beliefs toward Leptospirosis among Urban and Rural Communities in Northeastern Malaysia

A P, Bd A, Wm Z, S MN, S S, Tj TZ, et al.

Int J Environ Res Public Health, 2018 11 01;15(11).
PMID: 30388737 DOI: 10.3390/ijerph15112425

BACKGROUND: Leptospirosis is a zoonotic disease with a worldwide distribution, especially in developing countries such as Malaysia. This study was designed to explore the knowledge, attitudes, beliefs and practices (KABP) toward leptospirosis among the communities in northeastern Malaysia and to determine the sociodemographic factors associated with the KABP toward leptospirosis. A cross-sectional study using a stratified sampling method was conducted among 214 individuals in four locales in northeastern Malaysia.
METHODS: A cross-sectional study was conducted among 214 respondents in northeastern Malaysia using a multi-stage stratified random sampling method. The study population was divided into two groups based on geographical locations: urban and rural. All data were entered and analyzed using the IBM Statistics for Social Sciences (SPSS) version 22.0 software for Windows (IBM, Armonk, NY, USA). The continuous variables were presented using mean and standard deviation (SD), whereas the categorical variables were described using frequency and percentage. Multiple logistic regression was performed to determine the associated factors for good KABP toward leptospirosis among the respondents.
RESULTS: It was found that 52.8% of respondents had good knowledge, 84.6% had positive attitudes, 59.8% had positive beliefs, and 53.7% had satisfactory practices. There were no significant sociodemographic factors associated with knowledge and practice, except for educational status, which was significant in the attitude and belief domains. Those with higher education exhibited better attitudes (Odds Ratio (OR) 3.329; 95% Coefficient Interval (CI): 1.140, 9.723; p = 0.028) and beliefs (OR 3.748; 95% CI: 1.485, 9.459; p = 0.005). The communities in northeastern Malaysia generally have good knowledge and a high level of positive attitude; however, this attitude cannot be transformed into practice as the number of people with satisfactory practice habits is much lower compared to those with positive attitudes. As for the belief domain, the communities must have positive beliefs to perceive the threat of the disease.
CONCLUSIONS: Our current health program on preventing leptospirosis is good in creating awareness and a positive attitude among the communities, but is not sufficient in promoting satisfactory practice habits. In conclusion, more attention needs to be paid to promoting satisfactory practice habits among the communities, as they already possess good knowledge and positive attitudes and beliefs.
Fulltext Translation and Validation of the Malay Version of the Parents' Satisfaction Scale (PSS-M) for Assessment of Caregivers' Satisfaction with Health Care Services for Children with Autism Spectrum Disorder

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

Int J Environ Res Public Health, 2018 11 04;15(11).
PMID: 30400357 DOI: 10.3390/ijerph15112455

BACKGROUND: A Malay version of Parent Satisfaction Scale (PSS-M) is needed to investigate the factors contributing to the Malay caregivers' satisfaction with health care management for children with autism spectrum disorder (ASD). The aim of the study is to translate and validate the questionnaire to assess the caregivers' satisfaction on health care services.
METHODS: A cross-sectional study was conducted among 110 caregivers of children with ASD aged between 2 and 17 years old that received treatment at two tertiary care centres in Kelantan. Permission to use the original version of the PSS questionnaire was obtained. The original English version of the PSS was translated into a Malay version following the 10 steps proposed by an established guideline. Pre-testing of the PSS was carried out with 30 caregivers before confirmatory factor analysis (CFA) was established using 110 caregivers. They were asked to assess their understanding of the questionnaire. The one-dimensional questionnaire consists of 11 items, including staff attitudes, availability of staff, supportiveness, and helpfulness. The 5-point Likert scale provided ratings from 1 (strongly disagree) to 5 (strongly agree). Confirmatory factor analysis was performed using a robust maximum likelihood estimator.
RESULTS: The analysis showed model fit data with good reliability.
CONCLUSION: The PSS-M shows overall model fitness based on specific indices, with good construct validity and excellent absolute reliability to determine the satisfaction level of caregivers of children with ASD with respect to health care services.
Fulltext Differing Contributions of Classical Risk Factors to Type 2 Diabetes in Multi-Ethnic Malaysian Populations

Abdullah N, Murad NAA, Attia J, Oldmeadow C, Kamaruddin MA, Jalal NA, et al.

Int J Environ Res Public Health, 2018 Dec 10;15(12).
PMID: 30544761 DOI: 10.3390/ijerph15122813

The prevalence of type 2 diabetes is escalating rapidly in Asian countries, with the rapid increase likely attributable to a combination of genetic and lifestyle factors. Recent research suggests that common genetic risk variants contribute minimally to the rapidly rising prevalence. Rather, recent changes in dietary patterns and physical activity may be more important. This nested case-control study assessed the association and predictive utility of type 2 diabetes lifestyle risk factors in participants from Malaysia, an understudied Asian population with comparatively high disease prevalence. The study sample comprised 4077 participants from The Malaysian Cohort project and included sub-samples from the three major ancestral groups: Malay (n = 1323), Chinese (n = 1344) and Indian (n = 1410). Association of lifestyle factors with type 2 diabetes was assessed within and across ancestral groups using logistic regression. Predictive utility was quantified and compared between groups using the Area Under the Receiver-Operating Characteristic Curve (AUC). In predictive models including age, gender, waist-to-hip ratio, physical activity, location, family history of diabetes and average sleep duration, the AUC ranged from 0.76 to 0.85 across groups and was significantly higher in Chinese than Malays or Indians, likely reflecting anthropometric differences. This study suggests that obesity, advancing age, a family history of diabetes and living in a rural area are important drivers of the escalating prevalence of type 2 diabetes in Malaysia.
Fulltext Treatment of Wastewater Using Seaweed: A Review

Arumugam N, Chelliapan S, Kamyab H, Thirugnana S, Othman N, Nasri NS

Int J Environ Res Public Health, 2018 12 13;15(12).
PMID: 30551682 DOI: 10.3390/ijerph15122851

Inadequately treated or untreated wastewater greatly contribute to the release of unwanted toxic contaminants into water bodies. Some of these contaminants are persistent and bioaccumulative, becoming a great concern as they are released into the environment. Despite the abundance of wastewater treatment technologies, the adsorption method overall has proven to be an excellent way to treat wastewater from multiple industry sources. Because of its significant benefits, i.e., easy availability, handling, and higher efficiency with a low cost relative to other treatments, adsorption is opted as the best method to be used. However, biosorption using naturally found seaweeds has been proven to have promising results in removing pollutants, such as dyes from textile, paper, and the printing industry, nitrogen, and phosphorous and phenolic compounds, as well as heavy metals from various sources. Due to its ecofriendly nature together with the availability and inexpensiveness of raw materials, biosorption via seaweed has become an alternative to the existing technologies in removing these pollutants from wastewater effectively. In this article, the use of low-cost adsorbent (seaweed) for the removal of pollutants from wastewater has been reviewed. An extensive table summarises the applicability of seaweed in treating wastewater. Literature reported that the majority of research used simulated wastewater and minor attention has been given to biosorption using seaweed in the treatment of real wastewater.

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