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Fulltext Anxiety in Frontline and Non-Frontline Healthcare Providers in Kelantan, Malaysia

Mohd Noor N, Che Yusof R, Yacob MA

Int J Environ Res Public Health, 2021 Jan 20;18(3).
PMID: 33498397 DOI: 10.3390/ijerph18030861

In response to the coronavirus disease 2019 (COVID-19) pandemic, healthcare providers are exposed to psychological and mental health implications, including vicarious traumatization, anxiety, and depression. Gradual increases in the number of COVID-19 cases meant they were inadequately protected from contamination due to a shortage of protective equipment, excessive workloads, emotional exhaustion and frustration. These circumstances affect their work performance in delivering health services. This study aims to compare the levels of anxiety in frontline and non-frontline healthcare providers during the COVID-19 pandemic. This study applied a comparative cross-sectional design between May and July 2020 at the Hospital Raja Perempuan Zainab II. Convenient sampling was applied in the selection of eligible participants. The case report form contained two self-administered questionnaires, namely, The Hospital Anxiety and Depression Scale and Medical Outcome Study Social Support Survey. Descriptive analysis, analysis of variance, and analysis of covariance were conducted using SPSS version 26. The number of participants recruited was 306, including 160 healthcare providers in the frontline group and 146 in the non-frontline group. The non-frontline healthcare providers reported a significantly higher anxiety mean score of 1.7 than the frontline providers after adjusting for gender, duration of employment, and social support. It indicates that non-frontline healthcare providers require psychological support similar to that of frontline healthcare providers during the COVID-19 pandemic.
Fulltext Health-Related Quality of Life and Family Functioning of Primary Caregivers of Children with Cerebral Palsy in Malaysia

Ying K, Rostenberghe HV, Kuan G, Mohd Yusoff MHA, Ali SH, Yaacob NS

Int J Environ Res Public Health, 2021 02 28;18(5).
PMID: 33670850 DOI: 10.3390/ijerph18052351

Caregiving for children with cerebral palsy (CP) has proved to negatively impact on the physical and psychological well-being of their primary caregivers. The aim of the current study was to examine the overall impact of caregiving for children with CP on the primary caregivers' health-related quality of life (HRQOL) and family functioning, and to identify potential factors associated with primary caregivers' HRQOL and family functioning. The cross-sectional study involved a total of 159 primary caregivers of children with CP with a mean age of 42.8 ± 8.4 years. Demographic data and information on the physical and leisure activities of the primary caregivers were collected, and their quality of life (QOL) was measured based on the self-reported Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM). Primary caregivers in the current study have shown good HRQOL and family functioning, with scores of 82.4 and 85.3 out of 100, respectively. Through multiple linear regression analyses, the mother's level of education, family monthly income, sleeping problems in children with CP, and the existence of children with other types of disability have been identified as factors contributing to HRQOL and family functioning. The findings help set out the course for stakeholders to establish action to enhance the QOL of primary caregivers.
Fulltext Interactive Low Back Pain Intervention Module Based on the Back School Program: A Cluster-Randomized Experimental Study Evaluating Its Effectiveness among Nurses in Public Hospitals

Ibrahim MI, Zubair IU, Shafei MN, Ahmad MI, Yaacob NM

Int J Environ Res Public Health, 2020 08 14;17(16).
PMID: 32824040 DOI: 10.3390/ijerph17165916

The prevalence of low back pain (LBP) among nurses is high. The main aim of this study was to evaluate the effectiveness of an interactive LBP module based on the Back School Program in improving Oswestry Disability Scores (ODSs) among nurses in government hospitals in Penang, Malaysia. A cluster-randomized experimental study was conducted within four public hospitals. These hospitals were randomized to intervention and control groups. A total of 284 nurses from the selected hospitals were randomly selected (142 in each group). An interactive LBP intervention module based on the Back School Program was designed and prescribed. Both the intervention and control groups were assessed using the Oswestry Disability Questionnaire at baseline and at the end of the third and sixth weeks. Out of 284 participants, 281 completed this study. A between-group comparison revealed that ODSs were significantly lower in the intervention group than in the control group at the ends of the third (p = 0.006) and sixth weeks (p < 0.001). Within-group changes revealed a significant reduction in ODSs within the intervention group from baseline to the third (p < 0.001) and sixth weeks (p < 0.001) of the intervention. This simple interactive LBP module was effective in reducing symptoms of LBP among nurses as early as three weeks, and this effect was sustained until the sixth week of the intervention.
Fulltext Assessing Patient-Perceived Hospital Service Quality and Sentiment in Malaysian Public Hospitals Using Machine Learning and Facebook Reviews

A Rahim AI, Ibrahim MI, Musa KI, Chua SL, Yaacob NM

Int J Environ Res Public Health, 2021 09 21;18(18).
PMID: 34574835 DOI: 10.3390/ijerph18189912

Social media is emerging as a new avenue for hospitals and patients to solicit input on the quality of care. However, social media data is unstructured and enormous in volume. Moreover, no empirical research on the use of social media data and perceived hospital quality of care based on patient online reviews has been performed in Malaysia. The purpose of this study was to investigate the determinants of positive sentiment expressed in hospital Facebook reviews in Malaysia, as well as the association between hospital accreditation and sentiments expressed in Facebook reviews. From 2017 to 2019, we retrieved comments from 48 official public hospitals' Facebook pages. We used machine learning to build a sentiment analyzer and service quality (SERVQUAL) classifier that automatically classifies the sentiment and SERVQUAL dimensions. We utilized logistic regression analysis to determine our goals. We evaluated a total of 1852 reviews and our machine learning sentiment analyzer detected 72.1% of positive reviews and 27.9% of negative reviews. We classified 240 reviews as tangible, 1257 reviews as trustworthy, 125 reviews as responsive, 356 reviews as assurance, and 1174 reviews as empathy using our machine learning SERVQUAL classifier. After adjusting for hospital characteristics, all SERVQUAL dimensions except Tangible were associated with positive sentiment. However, no significant relationship between hospital accreditation and online sentiment was discovered. Facebook reviews powered by machine learning algorithms provide valuable, real-time data that may be missed by traditional hospital quality assessments. Additionally, online patient reviews offer a hitherto untapped indication of quality that may benefit all healthcare stakeholders. Our results confirm prior studies and support the use of Facebook reviews as an adjunct method for assessing the quality of hospital services in Malaysia.
Fulltext The Effect of Second-Victim-Related Distress and Support on Work-Related Outcomes in Tertiary Care Hospitals in Kelantan, Malaysia

Mohd Kamaruzaman AZ, Ibrahim MI, Mokhtar AM, Mohd Zain M, Satiman SN, Yaacob NM

Int J Environ Res Public Health, 2022 May 26;19(11).
PMID: 35682042 DOI: 10.3390/ijerph19116454

After a patient safety incident, the involved healthcare providers may experience sustained second-victim distress and reduced professional efficacy, with subsequent negative work-related outcomes and the cultivation of resilience. This study aims to investigate the factors affecting negative work-related outcomes and resilience with a hypothetical triad of support as the mediators: colleague, supervisor, and institutional support. This cross-sectional study recruited 733 healthcare providers from three tertiary care hospitals in Kelantan, Malaysia. Three steps of hierarchical linear regression were developed for both outcomes (negative work-related outcomes and resilience). Four multiple mediator models of the support triad were analyzed. Second-victim distress, professional efficacy, and the support triad contributed significantly in all the regression models. Colleague support partially mediated the relationship defining the effects of professional efficacy on negative work-related outcomes and resilience, whereas colleague and supervisor support partially mediated the effects of second-victim distress on negative work-related outcomes. Similar results were found regarding resilience, with all support triads producing similar results. As mediators, the support triads ameliorated the effect of second-victim distress on negative work-related outcomes and resilience, suggesting an important role of having good support, especially after encountering patient safety incidents.
Fulltext Prognostic Factor of Lower Limb Amputation among Diabetic Foot Ulcer Patients in North-East Peninsular Malaysia

Rosedi A, Hairon SM, Abdullah NH, Yaacob NA

Int J Environ Res Public Health, 2022 Oct 31;19(21).
PMID: 36361092 DOI: 10.3390/ijerph192114212

Lower limb amputation (LLA) is a common complication of diabetic foot ulcer (DFU), which can lead to a higher 5-year mortality rate compared to all cancers combined. This study aimed to determine the prognostic factors of LLA among DFU patients in Kelantan from 2014 to 2018. A population-based study was conducted using secondary data obtained from the National Diabetic Registry (NDR). There were 362 cases that fulfilled the study criteria and were further analysed. The prognostic factors were determined by Multiple Cox Proportional Hazards Regression. There were 66 (18.2%) DFU patients who underwent LLA in this study, while 296 (81.8%) were censored. The results revealed that the factor leading to a higher risk of LLA was abnormal HDL-cholesterol levels (Adj. HR 2.18; 95% CI: 1.21, 3.92). Factors that led to a lower risk of LLA include DFU in patients aged 60 or more (Adj. HR 0.48; 95% CI: 0.27, 0.89) and obesity (Adj. HR 0.45; 95% CI: 0.22, 0.89). In conclusion, our model showed that abnormal HDL cholesterol was associated with a 2 times higher risk of LLA when adjusted for age and BMI. Any paradoxical phenomena should be addressed carefully to avoid wrong clinical decision making that can harm the patient.
Fulltext Confirmatory Factor Analysis of the Malay Version of the Smartphone Addiction Scale among Medical Students in Malaysia

Hassim SR, Arifin WN, Kueh YC, Yaacob NA

Int J Environ Res Public Health, 2020 May 28;17(11).
PMID: 32481559 DOI: 10.3390/ijerph17113820

BACKGROUND: At present, the validity and reliability evidence of the Malay version of the Smartphone Addiction Scale (SAS-M) is only available by exploratory factor analysis (EFA). The aim of this study is to validate and determine the psychometric properties of the SAS-M by confirmatory factor analysis (CFA).
METHODS: A cross-sectional study was conducted among 323 medical students in Universiti Sains Malaysia. The students were given questionnaire forms consisting of socio-demographic information, the SAS-M and the Malay version of the Internet Addiction Test (MVIAT). The CFA was conducted using robust maximum likelihood estimator. The internal consistency reliability was determined by Raykov's rho coefficient. The concurrent validity was assessed by the Pearson's correlations between the factor scores of the SAS-M and the MVIAT.
RESULTS: The analysis showed the five-factor model of the SAS-M has an acceptable model fit after the inclusion of 12 correlated errors (SRMR = 0.067, RMSEA 0.059 (90% CI: 0.054, 0.065), CFI = 0.895, TLI = 0.882). The factor loadings ranged from 0.320 to 0.875. The internal consistency reliability was good (Raykov's rho = 0.713 to 0.858) and it showed good concurrent validity with the MVIAT.
CONCLUSIONS: The CFA showed that the SAS-M is a valid and reliable self-administered questionnaire to measure the level of smartphone addiction among medical students.
Fulltext Mediating Role of Intra-Team Conflict between Paternalistic Leadership and Decision-Making Quality among China University's CMT during COVID-19

Cheah KSL, Abdullah Z, Xiao M

Int J Environ Res Public Health, 2022 Sep 16;19(18).
PMID: 36141967 DOI: 10.3390/ijerph191811697

Universities across China have set up crisis management teams (CMTS) to deal with the crisis brought on by the COVID-19 pandemic. This study focuses on how the paternalistic leadership practices of a Chinese university CMT influence crisis strategic decisions by managing conflict. These relationships were verified using hierarchical regression analysis on 312 samples from the surveyed university during the pandemic and found the following: benevolent leadership and moral leadership have positive effects on decision quality. However, unlike most studies on paternalistic leadership, in crisis situations, the negative effects of authoritarian leadership disappear under the mediating effect of affective conflict. This means that affective conflict within CMT fully mediates the relationship between authoritarian leadership and decision quality, and partially mediates the relationship between moral leadership and decision quality, while cognitive conflict partially mediates the relationship between benevolent leadership and crisis decision quality. It indicates that a CMT must stimulate and maintain a certain level of cognitive conflict while suppressing affective conflict to achieve high-quality crisis decision-making. This state can be achieved by practicing lower levels of authoritarian leadership and maintaining high levels of moral and benevolent leadership practices.
Fulltext Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery

Rochmah TN, Wulandari A, Dahlui M, Ernawaty, Wulandari RD

Int J Environ Res Public Health, 2020 08 18;17(16).
PMID: 32824872 DOI: 10.3390/ijerph17166010

Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.
Fulltext Psychometric Evaluation of the Malay Version of the Family Adaptability and Cohesion Evaluation Scale III for Malaysian Adolescents

Cong CW, Tan CS, Noew HS, Wu SL

Int J Environ Res Public Health, 2021 Dec 24;19(1).
PMID: 35010416 DOI: 10.3390/ijerph19010156

The Family Adaptability and Cohesion Scale III (FACES-III) has been widely used to measure an individual's family functioning in terms of cohesion and adaptability. In Malaysia, the FACES-III has been translated into the Malay language for the community, but its psychometric properties in this context remain unknown. Thus, the purpose of this research is to examine the psychometric properties of the Malay version of the FACES-III in 852 adolescents attending secondary schools in Kuala Lumpur, Malaysia. Data were randomly split into two halves: the exploration sample and the validation sample. Exploratory factor analysis was conducted on the exploration sample and a two-factor model was discovered after removing nine items that showed low factor loading. Then, confirmatory factor analysis was conducted on the validation sample to compare the one-factor models, two-factor models, and three-factor models. Results showed that the 11-item two-factor model (FACES-III-M-SF) was superior to the other competing models. Both the exploratory and confirmatory factor analyses replicated the two-factor structure of the original version of FACES-III. The reliability of the overall scale was consistently good, but the subscale results were mixed. This suggests that researchers should use the overall score, but not the subscale scores, in analyses.
Fulltext Perception of Current Educational Environment, Clinical Competency, and Depression among Malaysian Medical Students in Clinical Clerkship: A Cross-Sectional Study

Sudi R, Chang WL, Arshad NH, Zainal Abidin SN, Suderman U, Woon LS

Int J Environ Res Public Health, 2022 Dec 05;19(23).
PMID: 36498345 DOI: 10.3390/ijerph192316274

The COVID-19 pandemic has altered the educational environment of medical students in clinical clerkship, with potential impacts on clinical competency and reported increased prevalence of depression. This study aimed to determine the relationship between the perception of the educational environment, self-perceived clinical competency, and depression among them. Subjects (N = 196) at the National University of Malaysia participated through convenience sampling in an online survey including sociodemographic data, COVID-19-related stressors, Dundee Ready Education Environment Measure (DREEM), self-perceived clinical competency, and Patient Health Questionnaire (PHQ-9). The cut-off point for depression was a PHQ-9 score ≥ 15. Multiple logistic regression followed bivariate analyses to identify factors for depression. The participants (mean age: 23.2 years, SD ± 0.98 years) were mainly female (71.9%) and Malay (59.2%). The prevalence of depression was 17.4% (95% CI: 12.3-23.4%). Most participants perceived the educational environment positively. In logistic regression, ethnicity (Adjusted OR = 3.1, 95% CI: 1.2-8.1) and DREEM score were significantly associated with depression, whereas self-perceived clinical competency was not. A higher DREEM score indicating a better perception of the educational environment was linked to a lower likelihood of depression (p = 0.046). Besides ethnicity, perception of the educational environment emerged as a factor associated with depression. This relationship between the educational environment and mental well-being warrants further exploration.
Fulltext Candida Chorioamnionitis in Mothers with Gestational Diabetes Mellitus: A Report of Two Cases

Shazniza Shaaya E, Halim SAA, Leong KW, Ku KBP, Lim PS, Tan GC, et al.

Int J Environ Res Public Health, 2021 07 13;18(14).
PMID: 34299901 DOI: 10.3390/ijerph18147450

Background:Candida chorioamnionitis is rarely encountered, even though vulvovaginal candidiasis incidence is about 15%. Interestingly, it has characteristic gross and histological findings on the umbilical cord that are not to be missed. Case Report: We report two cases of Candida chorioamnionitis with presence of multiple yellowish and red spots of the surface of the umbilical cord. Microscopically, these consist of microabscesses with evidence of fungal yeasts and pseudohyphae. The yeasts and pseudohyphae were highlighted by periodic acid- Schiff and Grocott methenamine silver histochemical stains. Both cases were associated with a history of gestational diabetes mellitus. Discussion: Peripheral funisitis is a characteristic feature of Candida chorioamnionitis. It is associated with high risk of adverse perinatal and neonatal outcomes, such as preterm delivery, stillbirth and neonatal death. We recommend careful examination of the umbilical cord of mothers with gestational diabetes mellitus.
Fulltext Effect of the COVID-19 Pandemic on Medical Student Career Perceptions: Perspectives from Medical Students in China

Cai CZ, Lin Y, Alias H, Hu Z, Wong LP

Int J Environ Res Public Health, 2021 05 11;18(10).
PMID: 34064814 DOI: 10.3390/ijerph18105071

Our aim was to examine perceived occupational turnover intentions among medical students and the associated factors. A cross-sectional study using a Web-based survey was conducted. A total of 2922 completed responses were received (response rate 55.7%). A total of 58.4% (95% CI 56.6-60.2) reported high turnover intention (score of 7-15). The odds of higher total turnover score among the fifth-year students was nearly four times that of first-year students (OR = 3.88, 95% CI 2.62-5.73). Perception of the medical profession as not being of high social status and reputation significantly influenced high turnover intention scores (OR = 2.26, 95% CI 1.90-2.68). All three dimensions of the multidimensional scale of perceived social support (MSPSS) significantly predict turnover intention. Lower scores in the support from Significant Other (OR = 1.47, 95% CI 1.17-1.84), Family (OR = 1.47, 95% CI 1.18-1.83) and Friend (OR = 1.42, 95% CI 1.14-1.77) subscales were associated with higher turnover intention. Low score in the Brief Resilience Scale (BRS) was also associated with higher turnover intention (OR = 1.44, 95% CI 1.17-1.77). The findings shed light on the importance of changing public attitudes towards respecting the medical profession and improving the implementation of policies to protect the well-being of people in the medical profession.
Fulltext Analysis of newspaper coverage of active aging through the lens of the 2002 World Health Organization Active Ageing Report: A Policy Framework and the 2010 Toronto Charter for Physical Activity: A Global Call for Action

Abdullah B, Wolbring G

Int J Environ Res Public Health, 2013 Dec;10(12):6799-819.
PMID: 24317386 DOI: 10.3390/ijerph10126799

As populations continue to grow older, efforts to support the process of aging well are important goals. Various synonyms are used to cover aging well, such as active aging. The World Health Organization published in 2002 the report Active Ageing: A Policy Framework that according to the call for papers, has brought active ageing to the forefront of international public health awareness. The 2010 Toronto Charter for Physical Activity: A Global Call for Action was singled out in the call for papers as a key document promoting physical activity one goal of the 2002 WHO active aging policy framework. Media are to report to the public topics of importance to them. We investigated the newspaper coverage of aging well and synonymous terms such as active aging through the lens of the 2002 WHO active aging policy framework and the 2010 Toronto Charter for Physical Activity. As sources we used the following newspapers: China Daily, The Star (Malaysia), two UK newspapers (The Guardian, The Times), a database of 300 Canadian newspapers (Canadian Newsstand) and a US newspaper (The New York Times). The study generated data answering the following four research questions: (1) how often are the 2002 WHO active aging policy framework and the 2010 Toronto Charter for Physical Activity mentioned; (2) how often is the topic of active aging and terms conveying similar content (aging well, healthy aging, natural aging and successful aging) discussed; (3) which of the issues flagged as important in the 2002 WHO active aging policy framework and the 2010 Toronto Charter for Physical Activity are covered in the newspaper coverage of active aging and synonymous terms; (4) which social groups were mentioned in the newspapers covered. The study found a total absence of mentioning of the two key documents and a low level of coverage of "active aging" and terms conveying similar content. It found further a lack of engagement with the issues raised in the two key documents and a low level of mentioning of socially disadvantages groups. We posit that reading the newspapers we covered will not expose the reader to the two key documents and the issues linked to aging well including the need to increase physical activity.
Fulltext Exploration of Food-Seeking Behaviour, Food Preparation, and Restrictions to Sufficient Food among the Jahai Sub-Tribe (Indigenous People) in Gerik, Malaysia

Gan WY, Sulaiman N, Law LS, Zalbahar N, Ahmad Fuzi SF, Wilkes MA

Int J Environ Res Public Health, 2020 01 04;17(1).
PMID: 31947907 DOI: 10.3390/ijerph17010348

Access to food has been determined to be a factor that strongly influences the dietary intake and eating habit of indigenous people (Orang Asli, OA). This study explored food acquisition and the barriers in obtaining traditional and market foods among the Jahai subtribe (within the Negrito ethnic group) via a qualitative approach. Twenty-eight OA (14 males and 14 females) from Gerik, Perak, Malaysia participated in four focus group discussions (FGDs; two male-only and two female-only groups; seven informants in each FGD). Thematic analysis was adopted to analyse the gathered data. The results found that the Jahai applied both modern (buying and receiving food assistance) and traditional (gathering, farming, fishing, and hunting) methods in obtaining food. The barriers they faced in gathering sufficient food supply included low purchasing power, high demand for food, high transport costs, depletion of food supplies in their surroundings, threats from wild animals on the farm and during food searching activities, and food sharing. Food preparation methods practiced by the OA include roasting and grilling, frying, simmering (gulai), and boiling. In conclusion, this study enhances our understanding of the dietary behaviour of the Jahai subtribe and highlights restricted food access among the OA, which demands urgent attention.
Fulltext Adaptation and Validation of the Malay Version of the SAVE-9 Viral Epidemic Anxiety Scale for Healthcare Workers

Wasimin FS, Thum SCC, Tseu MWL, Kamu A, Ho CM, Pang NTP, et al.

Int J Environ Res Public Health, 2022 Aug 27;19(17).
PMID: 36078389 DOI: 10.3390/ijerph191710673

Viral epidemics have surfaced frequently over the past quarter-century, with multiple manifestations of psychological distress. This study sought to establish the psychometric properties of the Malay version of SAVE-9 among healthcare workers. A total of 203 healthcare workers across Malaysia participated in the research. The Malay version of SAVE-9 was translated and back-translated using the WHO instrument validation protocols. Classical Test Theory (CTT) and Rasch analysis were used to assess the validity and reliability of the Malay version of the SAVE-9 scale. The analysis was run using IBM SPSS 26.0 and JAPS. Cronbach's alpha was used to measure the internal consistency of SAVE-9, which was found to be satisfactory (Cronbach's α = 0.795). The correlations between the SAVE-9 and other measured scales (GAD-7 and PHQ-9) were statistically significant. A score of 22 was defined as a cut-off point with good sensitivity (0.578) and specificity (0.165). The Malay version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale is valid and reliable after testing among healthcare workers. It is psychometrically suitable to be used in assessing healthcare workers' stress and anxiety specific to viral epidemics.
Fulltext Barriers to and Facilitators of Cervical Cancer Screening among Women in Southeast Asia: A Systematic Review

Chua B, Ma V, Asjes C, Lim A, Mohseni M, Wee HL

Int J Environ Res Public Health, 2021 Apr 26;18(9).
PMID: 33926019 DOI: 10.3390/ijerph18094586

In Southeast Asia, cervical cancer is the second most common cancer in women. Low coverage for cervical cancer screening (CCS) becomes a roadblock to disease detection and treatment. Existing reviews on CCS have limited insights into the barriers and facilitators for SEA. Hence, this study aims to identify key barriers and facilitators among women living in SEA. A systematic literature review was conducted on Pubmed, Embase, PsycINFO, CINAHL, and SCOPUS. Primary qualitative and quantitative studies published in English that reported barriers and facilitators to CCS were included. The Mix Methods Appraisal Tool was used for the quality assessment of the included studies. Among the 93 included studies, pap smears (73.1%) were the most common screening modality. A majority of the studies were from Malaysia (35.5%). No studies were from Timor-Leste and the Philippines. The most common barriers were embarrassment (number of articles, n = 33), time constraints (n = 27), and poor knowledge of screening (n = 27). The most common facilitators were related to age (n = 21), receiving advice from healthcare workers (n = 17), and education status (n = 11). Findings from this review may inform health policy makers in developing effective cervical cancer screening programs in SEA countries.
Fulltext A Deep Learning Approach for Dengue Fever Prediction in Malaysia Using LSTM with Spatial Attention

Majeed MA, Shafri HZM, Zulkafli Z, Wayayok A

Int J Environ Res Public Health, 2023 Feb 25;20(5).
PMID: 36901139 DOI: 10.3390/ijerph20054130

This research aims to predict dengue fever cases in Malaysia using machine learning techniques. A dataset consisting of weekly dengue cases at the state level in Malaysia from 2010 to 2016 was obtained from the Malaysia Open Data website and includes variables such as climate, geography, and demographics. Six different long short-term memory (LSTM) models were developed and compared for dengue prediction in Malaysia: LSTM, stacked LSTM (S-LSTM), LSTM with temporal attention (TA-LSTM), S-LSTM with temporal attention (STA-LSTM), LSTM with spatial attention (SA-LSTM), and S-LSTM with spatial attention (SSA-LSTM). The models were trained and evaluated on a dataset of monthly dengue cases in Malaysia from 2010 to 2016, with the task of predicting the number of dengue cases based on various climate, topographic, demographic, and land-use variables. The SSA-LSTM model, which used both stacked LSTM layers and spatial attention, performed the best, with an average root mean squared error (RMSE) of 3.17 across all lookback periods. When compared to three benchmark models (SVM, DT, ANN), the SSA-LSTM model had a significantly lower average RMSE. The SSA-LSTM model also performed well in different states in Malaysia, with RMSE values ranging from 2.91 to 4.55. When comparing temporal and spatial attention models, the spatial models generally performed better at predicting dengue cases. The SSA-LSTM model was also found to perform well at different prediction horizons, with the lowest RMSE at 4- and 5-month lookback periods. Overall, the results suggest that the SSA-LSTM model is effective at predicting dengue cases in Malaysia.
Fulltext Perceived Threat of COVID-19 Contagion and Frontline Paramedics' Agonistic Behaviour: Employing a Stressor-Strain-Outcome Perspective

Shahzad F, Du J, Khan I, Fateh A, Shahbaz M, Abbas A, et al.

Int J Environ Res Public Health, 2020 Jul 15;17(14).
PMID: 32679748 DOI: 10.3390/ijerph17145102

Historically, infectious diseases have been the leading cause of human psychosomatic strain and death tolls. This research investigated the recent threat of COVID-19 contagion, especially its impact among frontline paramedics treating patients with COVID-19, and their perception of self-infection, which ultimately increases their agonistic behaviour. Based on the stressor-strain-outcome paradigm, a research model was proposed and investigated using survey-based data through a structured questionnaire. The results found that the perceived threat of COVID-19 contagion (emotional and cognitive threat) was positively correlated with physiological anxiety, depression, and emotional exhaustion, which led toward agonistic behaviour. Further, perceived social support was a key moderator that negatively affected the relationships between agonistic behaviour and physiological anxiety, depression, and emotional exhaustion. These findings significantly contributed to the current literature concerning COVID-19 and pandemic-related effects on human behaviour. This study also theorized the concept of human agonistic behaviour, which has key implications for future researchers.
Fulltext Factors Affecting the Manufacturing Industry Transformation and Upgrading: A Case Study of Guangdong-Hong Kong-Macao Greater Bay Area

Yang F, Sun Y, Zhang Y, Wang T

Int J Environ Res Public Health, 2021 07 04;18(13).
PMID: 34281094 DOI: 10.3390/ijerph18137157

This study aims to analyze the development trend of the manufacturing industry transformation and upgrading in the Guangdong-Hong Kong-Macao Greater Bay Area (2008-2018). On the basis of synergetics, the order parameter method of factor analysis is used to study these factors. The results show that: (1) There are five slow variable factors, such as intelligent manufacturing industry, technological innovation, scale agglomeration, market demand, and fixed asset investment, which are important power sources of the transformation and upgrading of the manufacturing industry in Greater Bay Area. The development of these factors is relatively mature, and they cooperate with each other. (2) Similar to a fast variable of manufacturing development ecology, green development is an important coordinating factor in removing bottlenecks. Finally, suggestions for the development of the transformation and upgrading of the manufacturing industry are put forward.

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