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Fulltext Effects of a Multi-Component Training Program on Healthy Older Adults' Prospective Memory Performance: Assessing Change Over Time

Farzin A, Ibrahim R, Madon Z, Basri H, Farzin S, Motalebizadeh A

Front Public Health, 2021;9:594953.
PMID: 33968872 DOI: 10.3389/fpubh.2021.594953

Prospective Memory (PM) is a cognitive function affected by aging. PM is the memory of future intentions and is significantly involved in everyday life, especially among older adults. Nevertheless, there are a few studies focused on PM training among healthy older adults and these studies did not report the optimal duration of training regarding improving PM performance among older adults. The present study aimed to determine the effective duration for training PM performance among healthy older adults. The current study was a randomized, controlled, single-blind, within-participants crossover trial including a training program with a duration of 12 h. The sample of 25 older adults aged 55 to 74 years recruited from the active members of the University of the Third Age (U3A), Kuala Lumpur/Selangor, their family members, and friends. The study design ensured some participants would receive the training after baseline while others would wait for 6 weeks after the baseline before receiving the training. All participants were evaluated five times: at baseline, 6, 12, 16, and at 24 weeks post-baseline. Moreover, the training program ensured all participants were assessed after each training session. The minimum number of hours to achieve training effects for this multi-component training program was eight. Results supported the efficacy of the training program in improving PM performance among healthy older adults. Also, the optimal duration for the multicomponent training program on PM performance among healthy older adults was obtained. This trial is registered at isrctn.com (#ISRCTN57600070).
Fulltext Effectiveness of a Community-Based Muscle Strengthening Exercise Program to Increase Muscle Strength Among Pre-frail Older Persons in Malaysia: A Pilot Study

Raja Adnan RNE, Mat Din H, Ashari A, Minhat HS

Front Public Health, 2021;9:610184.
PMID: 33968874 DOI: 10.3389/fpubh.2021.610184

Deterioration in muscle mass and muscle strength is common among the frail older persons, cause functional dependence and decrease in the quality of life. Therefore, the identification of cost-effective interventions to prevent or ameliorate frailty is crucially needed. The aim of this study is to determine the effectiveness of a Community-based Muscle Strengthening Exercise (COME) program to increase muscle strength among pre-frail older persons. This study was a quasi-experimental study. A total of 32 older persons aged 60 years and older with pre-frail symptoms were recruited from the community center. The COME was developed based on the Growing Stronger program and the Otago Home Exercise Program. COME was designed to strengthen all of the major muscle groups in the upper and lower extremities. The exercise program was conducted for 12 weeks and divided into 3 parts; (1) to strengthen the body slowly and gently, using only body weight, (2) to introduce dumbbells and ankle weights to increase strength and (3) to add various new ways to boost strength even more. Functional tests were measured before and after the intervention. The results revealed non-significant p-value for pre- and post-intervention comparison for all study outcomes. Observing the values of mean difference, the study intervention was shown to have slightly improved the time up and go (Mean difference = -0.25), and sit-to-stand duration (Mean difference = -0.41) as well as the handgrip strength (Mean difference = 0.68) among the participants. On the assessment of Cohen ES, all three improvements exhibited small effect sizes. Sit-to-stand duration was shown to have most benefited from the intervention with highest ES among the outcome variables (ES = 0.20). COME intervention program among pre-frail older persons showed favorable trend toward improvement of upper and lower extremities muscle strength. This study should be further tested in randomized control trial to confirm its effectiveness.
Fulltext Study Protocol for a Global Survey: Awareness and Preparedness of Hospital Staff Against Coronavirus Disease (COVID-19) Outbreak

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

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

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

Mohd Hassan NZA, Razali A, Shahari MR, Mohd Nor Sham Kunusagaran MSJ, Halili J, Zaimi NA, et al.

Front Public Health, 2021;9:699735.
PMID: 34322473 DOI: 10.3389/fpubh.2021.699735

Screening of high-risk groups for Tuberculosis (TB) is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia. A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk groups from a provider perspective using secondary data from the year 2016 to 2018. The results are presented in terms of an Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per TB case detected. Deterministic and Probabilistic Sensitivity Analysis was also performed to measure the robustness of the model. TB screening among Person Living with Human Immunodeficiency Virus (PL HIV) was the most cost-effective strategy, with MYR 2,597.00 per TB case detected. This was followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24, and MYR 4,327.76 per one TB case detected, respectively. There was an incremental cost of MYR 2.49 per screening, and 3.4 TB case detection per 1,000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost-effectiveness efficacy among PL HIV. Results of the study suggest prioritization of high-risk group TB screening program by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has a lower cost per TB case detected.
Fulltext Non-communicable Disease Surveillance in Malaysia: An Overview of Existing Systems and Priorities Going Forward

Chandran A, Selva Kumar S, Hairi NN, Low WY, Mustapha FI

Front Public Health, 2021;9:698741.
PMID: 34295873 DOI: 10.3389/fpubh.2021.698741

In 2012, the World Health Organization (WHO) set a comprehensive set of nine global voluntary targets, including the landmark "25 by 25" mortality reduction target, and 25 indicators. WHO has also highlighted the importance of Non-Communicable Disease (NCD) surveillance as a key action by Member States in addressing NCDs. This study aimed to examine the current national NCD surveillance tools, activities and performance in Malaysia based on the WHO Global Monitoring Framework for NCDs and to highlight gaps and priorities moving forward. A desk review was conducted from August to October in 2020, to examine the current national NCD surveillance activities in Malaysia from multiple sources. Policy and program documents relating to NCD surveillance in Malaysia from 2010 to 2020 were identified and analyzed. The findings of this review are presented according to the three major themes of the Global Monitoring Framework: monitoring of exposure/risk factor, monitoring of outcomes and health system capacity/response. Currently, there is a robust monitoring system for NCD Surveillance in Malaysia for indicators that are monitored by the WHO NCD Global Monitoring Framework, particularly for outcome and exposure monitoring. However, Malaysia still lacks data for the surveillance of the health system indicators of the framework. Although Malaysia has an NCD surveillance in place that is adequate for the WHO NCD Global Monitoring Framework, there are areas that require strengthening. The country must also look beyond these set of indicators in view of the increasing burden and impact of the COVID-19 pandemic. This includes incorporating mental health indicators and leveraging on alternate sources of data relating to behaviors.
Fulltext Effectiveness of a Novel Smartphone Health Education Intervention in Enhancing Knowledge, Attitudes, and Practices for the Prevention of Respiratory Tract Infections Among Private Hajj Pilgrims From Malaysia

Goni MD, Naing NN, Hasan H, Wan-Arfah N, Deris ZZ, Arifin WN, et al.

Front Public Health, 2021;9:594204.
PMID: 34277530 DOI: 10.3389/fpubh.2021.594204

This study was aimed to develop and evaluate the efficacy of a health education program for increasing knowledge, changing attitudes, and promoting prevention practices to reduce the incidence of RTIs among Malaysian Hajj pilgrims. A quasi-experimental study was done among 130 Hajj pilgrims attending Hajj orientation course organized by a private Hajj tour companies. Hajj pilgrims assigned to intervention group (n = 65) and control group (n = 65). Data were collected baseline and after return from Hajj using a validated questionnaire. Mixed design repeated measure ANOVA was used to analyse the effect of group, time, and group-time interaction on the dependent variables. There was a significant improvement in knowledge, attitude and practice scores in the intervention group compared to the control group. Based on the findings of the interaction of time and group, there was a significant statistical difference for post intervention for knowledge (p = 0.005), attitude (p = 0.041), and practice (p = 0.002). The newly-established health education intervention smartphone application was effective in improving KAP toward RTIs prevention among pilgrims.
Fulltext Longitudinal Vitamin D Deficiency Among Malaysian Pregnant Women and Its Correlation With Neonatal Serum 25-Hydroxyvitamin D Levels

Mustapa Kamal Basha MA, Abdul Majid H, Razali N, Abd Rashed A, Muhammad H, Yahya A

Front Public Health, 2021;9:654292.
PMID: 34268285 DOI: 10.3389/fpubh.2021.654292

Objective: This study aimed to investigate the longitudinal relationship between maternal vitamin D concentrations during pregnancy and neonatal vitamin D concentrations at birth. Materials and Methods: A prospective cohort of 236 healthy pregnant women from various ethnicity in early pregnancy (≤20 weeks of pregnancy) was followed at late pregnancy (28-40 weeks of pregnancy) and birth. Maternal serum 25-hydroxyvitamin D (25(OH)D) was assessed at early pregnancy (baseline) and late pregnancy, while neonatal cord serum 25(OH)D at birth. General estimating equations (GEE) were used to analyze the longitudinal association of maternal serum 25(OH)D levels during pregnancy and neonatal cord serum 25(OH)D levels at birth with adjusting for the time exposure, maternal weight gain, ethnicity, and skin type. Results: The results showed that the prevalence of vitamin D deficiency (25(OH)D <50 nmol/L) was at 89.9, 92.2, and 96.1% in early, late pregnancy and in neonatal cord serum, respectively. The GEE analysis showed a trend that longitudinal vitamin D deficiency during pregnancy leads to lower vitamin D concentrations in neonatal cord blood (RR = 1.17; 95% CI (1.05-1.36); p = 0.04). Conclusion: Longitudinal vitamin D deficiency during pregnancy leads to vitamin D deficiency in neonates at birth. A further trial is needed to affirm this association.
Fulltext Short-Term Forecasting of Daily Confirmed COVID-19 Cases in Malaysia Using RF-SSA Model

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

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

Novel coronavirus (COVID-19) was discovered in Wuhan, China in December 2019, and has affected millions of lives worldwide. On 29th April 2020, Malaysia reported more than 5,000 COVID-19 cases; the second highest in the Southeast Asian region after Singapore. Recently, a forecasting model was developed to measure and predict COVID-19 cases in Malaysia on daily basis for the next 10 days using previously-confirmed cases. A Recurrent Forecasting-Singular Spectrum Analysis (RF-SSA) is proposed by establishing L and ET parameters via several tests. The advantage of using this forecasting model is it would discriminate noise in a time series trend and produce significant forecasting results. The RF-SSA model assessment was based on the official COVID-19 data released by the World Health Organization (WHO) to predict daily confirmed cases between 30th April and 31st May, 2020. These results revealed that parameter L = 5 (T/20) for the RF-SSA model was indeed suitable for short-time series outbreak data, while the appropriate number of eigentriples was integral as it influenced the forecasting results. Evidently, the RF-SSA had over-forecasted the cases by 0.36%. This signifies the competence of RF-SSA in predicting the impending number of COVID-19 cases. Nonetheless, an enhanced RF-SSA algorithm should be developed for higher effectivity of capturing any extreme data changes.
Fulltext Muscles Affecting Minimum Toe Clearance

Perera CK, Gopalai AA, Ahmad SA, Gouwanda D

Front Public Health, 2021;9:612064.
PMID: 34136448 DOI: 10.3389/fpubh.2021.612064

The aim of this study was to investigate how the anterior and posterior muscles in the shank (Tibialis Anterior, Gastrocnemius Lateralis and Medialis), influence the level of minimum toe clearance (MTC). With aging, MTC deteriorates thus, greatly increasing the probability of falling or tripping. This could result in injury or even death. For this study, muscle activity retention taping (MART) was used on young adults, which is an accepted method of simulating a poor MTC-found in elderly gait. The subject's muscle activation was measured using surface electromyography (SEMG), and the kinematic parameters (MTC, knee and ankle joint angles) were measured using an optical motion capture system. Our results indicate that MART produces significant reductions in MTC (P < α), knee flexion (P < α) and ankle dorsiflexion (P < α), as expected. However, the muscle activity increased significantly, contrary to the expected result (elderly individuals should have lower muscle activity). This was due to the subject's muscle conditions (healthy and strong), hence the muscles worked harder to counteract the external restriction. Yet, the significant change in muscle activity (due to MART) proves that the shank muscles do play an important role in determining the level of MTC. The Tibialis Anterior had the highest overall muscle activation, making it the primary muscle active during the swing phase. With aging, the shank muscles (specifically the Tibialis Anterior) would weaken and stiffen, coupled with a reduced joint range of motion. Thus, ankle-drop would increase-leading to a reduction in MTC.
Fulltext Consumers' Knowledge, Attitudes, and Practices Toward Medicine Price Transparency at Private Healthcare Setting in Malaysia

Ahmad NS, Hatah E, Jalil MR, Makmor-Bakry M

Front Public Health, 2021;9:589734.
PMID: 34504820 DOI: 10.3389/fpubh.2021.589734

Background: Medicine price transparency refers to the practice of making prices available to consumers for them to identify, compare, and select the medicine that provides the desired value. This study aimed to evaluate consumer knowledge, attitudes, and practices regarding Malaysia's medicine price transparency initiative, as well as factors that may influence related good consumer practices in private healthcare settings. Methods: A cross-sectional, self-administered survey was conducted between May and July 2019 among consumers attending private healthcare institutions in Malaysia. The self-developed and validated survey consisted of four sections on the following: respondents' demographics, and 28 close-ended and graded Likert scale answer options on knowledge, attitudes, and practices toward medicine price transparency. Factors influencing good consumer practices toward the transparency initiative were modeled using binary logistic regression. Results: A total of 679 respondents were part of the study. The mean age of respondents was 38 ± 13.3, with the majority (n = 420, 61.9%) being female. The respondents' mean score of knowledge and attitudes toward the price transparency initiative was 5.6 ± 1.5 of the total score of 8 and 31.9 ± 4.0 of the total score of 40, respectively. The respondents had the lowest score in the practice of price transparency, with a mean score of 31.5 ± 5.6 of the total score of 60. Male gender, Chinese ethnicity, high score on knowledge and attitudes, and high expenses on medicines influenced respondents' good practices of medicine price transparency. Conclusion: Respondents had good knowledge and attitudes, but their usage and implementation of the medicine price transparency initiative was still inadequate. A number of factors influence this inadequacy, including gender, race, consumers' out-of-pocket spending on medication, and knowledge of and attitudes toward price transparency practices. Consumer-driven market price control would be impossible to achieve without the good consumer practices of medicine price transparency.
Fulltext Risk Factors of Candida parapsilosis Catheter-Related Bloodstream Infection

Yamin DH, Husin A, Harun A

Front Public Health, 2021;9:631865.
PMID: 34458217 DOI: 10.3389/fpubh.2021.631865

Catheter-related bloodstream infection (CRBSI) is an important healthcare-associated infection caused by various nosocomial pathogens. Candida parapsilosis has emerged as a crucial causative agent for the CRBSI in the last two decades. Many factors have been associated with the development of CRBSI including, demography, pre-maturity, comorbidities (diabetes mellitus, hypertension, heart diseases, neuropathy, respiratory diseases, renal dysfunction, hematological and solid organ malignancies, and intestinal dysfunction), intensive care unit (ICU) admission, mechanical ventilation (MV), total parenteral nutrition (TPN), prior antibiotic and/or antifungal therapy, neutropenia, prior surgery, immunosuppressant, and type, site, number, and duration of catheters. This study aims to determine C. parapsilosis CRBSI risk factors. A retrospective study has been performed in an 853-bedded tertiary-care hospital in north-eastern Malaysia. All inpatients with C. parapsilosis positive blood cultures from January 2006 to December 2018 were included, and their medical records were reviewed using a standardized checklist. Out of 208 candidemia episodes, 177 had at least one catheter during admission, and 31 cases had not been catheterized and were excluded. Among the 177 cases, 30 CRBSI cases were compared to 147 non-CRBSI cases [81 bloodstream infections (BSIs), 66 catheter colonizers]. The significance of different risk factors was calculated using multivariate analysis. Multivariate analysis of potential risk factors shows that ICU admission was significantly associated with non-CRBSI as compared to CRBSI [OR, 0.242; 95% CI (0.080-0.734); p = 0.012], and TPN was significantly positively associated with CRBSI than non-CRBSI [OR, 3.079; 95%CI (1.125-8.429); p = 0.029], while other risk factors were not associated significantly. Patients admitted in ICU were less likely to develop C. parapsilosis CRBSI while patients receiving TPN were more likely to have C. parapsilosis CRBSI when compared to the non-CRBSI group.
Fulltext A Qualitative Study Exploring Community Pharmacists' Experiences and Views About Weight Management Interventions and Services in Klang Valley, Malaysia

Verma RK, Chong WW, Taha NA, Paraidathathu T

Front Public Health, 2021;9:720928.
PMID: 34540789 DOI: 10.3389/fpubh.2021.720928

Objective: To qualitatively explore the perspectives of community pharmacists in Malaysia on their roles in weight management, and the barriers and facilitators in the expansion of these roles. Methods: A purposive sampling method was used to recruit community pharmacists in Klang Valley, Malaysia. Semi-structured individual interviews were conducted with community pharmacists, with an interview guide, from May 2018 to January 2019. The interviews were conducted in person (face-to-face). All interviews were audio-recorded with consent and transcribed verbatim. The interview transcripts were analyzed thematically, whereby emerging themes were coded and grouped into categories. Results: Twenty-four community pharmacists were recruited, with years of experience in pharmacy practice ranging from 2 to 40 years. Participants described their perceptions on the different weight management interventions where they emphasized the importance of a comprehensive lifestyle intervention and viewed that it should be the first-line intervention. Participants regarded their weight management service as easily accessible or approachable since community pharmacies are often the first point of call for patients seeking advice for their conditions before consulting doctors. Barriers identified by community pharmacists were mainly organizational in nature, which included lack of private consultation rooms, lack of time, and lack of qualified staff. Participants also described the need for training in weight management. Conclusion: Community pharmacists in Malaysia believed that they can positively contribute to the area of weight management. They cited multiple roles that they could play in weight management interventions and services. The roles cited include provision of education and advice, including on lifestyle modifications, drug therapy, weight loss products and supplements, and monitoring and providing referrals to other healthcare professionals. However, barriers would need to be addressed, including through pharmacist training, to strengthen and improve community pharmacists' roles and contributions in weight management service.
Fulltext Impact of an Educational Training Program on the Knowledge, Attitude, and Perceived Barriers of Community Pharmacists Towards Obesity and Overweight Management in Malaysia

Verma RK, Chong WW, Taha NA, Paraidathathu T

Front Public Health, 2021;9:720939.
PMID: 34540790 DOI: 10.3389/fpubh.2021.720939

Objective: To evaluate the impact of an educational training program on the knowledge, attitude and perceived barriers of community pharmacists (CPs) towards obesity and overweight management. Methods: This interventional study, which consisted of an educational training program, was conducted on a single cohort of Malaysian CPs. Thirty CPs attended the educational training program. The educational training program was delivered through didactic lectures, case studies and small group discussions, and consisted of various sessions covering different topics related to weight management. A validated questionnaire was used to assess the impact of the intervention on the CPs' knowledge, attitude, and perceived barriers. Results: The overall mean knowledge score increased both immediately after (14.93 ± 1.62) and 30 days following the intervention (17.04 ± 2.51), and the increment was statistically significant 30 days following the intervention (p = 0.001) compared to both pre-intervention and immediate-post intervention stages. After the intervention, the participants had a more positive attitude towards the provision of weight management service (WMS) in community pharmacies. They had significantly stronger perceptions about the importance of their role to manage overweight and obesity and their professional competence to treat obese patients. In addition, the barrier of not having space in pharmacy to perform proper counselling for weight management and the barrier of not having training sessions in the area of obesity management were perceived to be significantly less important post-intervention. Conclusion: This study showed the potential positive impact of an educational training program on CPs knowledge, attitudes and perceived barriers towards WMS.
Fulltext Female Community Health Workers and Health System Navigation in a Conflict Zone: The Case of Afghanistan

Parray AA, Dash S, Ullah MIK, Inam ZM, Kaufman S

Front Public Health, 2021;9:704811.
PMID: 34458226 DOI: 10.3389/fpubh.2021.704811

Afghanistan ranked 171st among 188 countries in the Gender Inequality Index of 2011 and has only 16% of its women participating in the labor force. The country has been mired in violence for decades which has resulted in the destruction of the social infrastructure including the health sector. Recently, Afghanistan has deployed community health workers (CHW) who make up majority of the health workforce in the remote areas of this country. This paper aims to bring the plight of the CHWs to the forefront of discussion and shed light on the challenges they face as they attempt to bring basic healthcare to people living in a conflict zone. The paper discusses the motivations of Afghani women to become CHWs, their status in the community and within the health system, the threatening situations under which they operate, and the challenges they face as working women in a deeply patriarchal society within a conflict zone. The paper argues that female CHWs should be provided proper accreditation for their work, should be allowed and encouraged to progress in their careers, and should be instilled at the heart of healthcare program planning because they have the field experience to make the most effective and community oriented programmatic decisions.
Fulltext A Systematic Review of Medical Equipment Reliability Assessment in Improving the Quality of Healthcare Services

Zamzam AH, Abdul Wahab AK, Azizan MM, Satapathy SC, Lai KW, Hasikin K

Front Public Health, 2021;9:753951.
PMID: 34646808 DOI: 10.3389/fpubh.2021.753951

Medical equipment highly contributes to the effectiveness of healthcare services quality. Generally, healthcare institutions experience malfunctioning and unavailability of medical equipment that affects the healthcare services delivery to the public. The problems are frequently due to a deficiency in managing and maintaining the medical equipment condition by the responsible party. The assessment of the medical equipment condition is an important activity during the maintenance and management of the equipment life cycle to increase availability, performance, and safety. The study aimed to perform a systematic review in extracting and categorising the input parameters applied in assessing the medical equipment condition. A systematic searching was undertaken in several databases, including Web of Science, Scopus, PubMed, Science Direct, IEEE Xplore, Emerald, Springer, Medline, and Dimensions, from 2000 to 2020. The searching processes were conducted in January 2020. A total of 16 articles were included in this study by adopting Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The review managed to classify eight categories of medical equipment reliability attributes, namely equipment features, function, maintenance requirement, performance, risk and safety, availability and readiness, utilisation, and cost. Applying the eight attributes extracted from computerised asset maintenance management system will assist the clinical engineers in assessing the reliability of medical equipment utilised in healthcare institution. The reliability assessment done in these eight attributes will aid clinical engineers in executing a strategic maintenance action, which can increase the equipment's availability, upkeep the performance, optimise the resources, and eventually contributes in providing effective healthcare service to the community. Finally, the recommendations for future works are presented at the end of this study.
Fulltext Brain Tumour Temporal Monitoring of Interval Change Using Digital Image Subtraction Technique

Khalil A, Rahimi A, Luthfi A, Azizan MM, Satapathy SC, Hasikin K, et al.

Front Public Health, 2021;9:752509.
PMID: 34621723 DOI: 10.3389/fpubh.2021.752509

A process that involves the registration of two brain Magnetic Resonance Imaging (MRI) acquisitions is proposed for the subtraction between previous and current images at two different follow-up (FU) time points. Brain tumours can be non-cancerous (benign) or cancerous (malignant). Treatment choices for these conditions rely on the type of brain tumour as well as its size and location. Brain cancer is a fast-spreading tumour that must be treated in time. MRI is commonly used in the detection of early signs of abnormality in the brain area because it provides clear details. Abnormalities include the presence of cysts, haematomas or tumour cells. A sequence of images can be used to detect the progression of such abnormalities. A previous study on conventional (CONV) visual reading reported low accuracy and speed in the early detection of abnormalities, specifically in brain images. It can affect the proper diagnosis and treatment of the patient. A digital subtraction technique that involves two images acquired at two interval time points and their subtraction for the detection of the progression of abnormalities in the brain image was proposed in this study. MRI datasets of five patients, including a series of brain images, were retrieved retrospectively in this study. All methods were carried out using the MATLAB programming platform. ROI volume and diameter for both regions were recorded to analyse progression details, location, shape variations and size alteration of tumours. This study promotes the use of digital subtraction techniques on brain MRIs to track any abnormality and achieve early diagnosis and accuracy whilst reducing reading time. Thus, improving the diagnostic information for physicians can enhance the treatment plan for patients.
Fulltext Promoting Mental Health During the COVID-19 Pandemic: A Hybrid, Innovative Approach in Malaysia

Mat Ruzlin AN, Chen XW, Yunus RM, Samsudin EZ, Selamat MI, Ismail Z

Front Public Health, 2021;9:747953.
PMID: 34692630 DOI: 10.3389/fpubh.2021.747953

Background: The COVID-19 pandemic has had monumental effects on the mental health of populations worldwide. Previous research indicated that programs and interventions using social networks can play a positive role in promoting mental health. Nevertheless, current evidence is largely derived from high-income regions, reflecting an urgent need for more studies in low- and middle-income settings. Objectives: This paper aims to (a) describe the potential value of a hybrid health carnival in promoting mental health and increasing access to screening services; (b) assess the level of community engagement with the digital platform. Methods: A mental health carnival was conducted with the theme of "Mind Your Mental Health" (Cakna Kesihatan Mental) in conjunction with the World Mental Health Day in Malaysia. This was a hybrid carnival that combined elements of face-to-face interactions and virtual learning. Free online therapy sessions were offered to high-risk groups identified during the screening process. Social media metrics were utilized to report the levels of community engagement and participants completed pre-and post-assessments to measure the program's impact on their knowledge. Results: The carnival was attended by 515 participants (78.8% virtual participants). Social media metrics reported more than 5,585 reaches on Facebook for all the activities held throughout the event. Results from pre-and post-assessments showed significant improvement in the mean knowledge scores (p < 0.05). Conclusion: This digital approach will continue to evolve by releasing new features and tools as a new frontier for high-risk populations and all individuals seeking mental health support and treatment.
Fulltext Elucidating the Macroeconomic Determinants of Undernourishment in South Asian Countries: Building the Framework for Action

Aziz N, He J, Raza A, Sui H, Yue W

Front Public Health, 2021;9:696789.
PMID: 34458224 DOI: 10.3389/fpubh.2021.696789

Undernourishment is a big challenge for humanity across the world. Considering the significance of reducing undernourishment, the current study focuses on exploring the macroeconomic determinants of undernourishment in the South Asian panel. The study employed econometric models that are more robust to underpin cross-sectional dependency and heterogeneity in a panel data set. The overall findings reveal that an increase in food production increases undernourishment and infer that food availability at the national level is insufficient to reduce undernourishment unless poor people also had economic and physical access to food. In the case of economic growth and governance, the results are negatively significant in some countries. The results infer that GDP and quality of governance are nuanced in declining the rate of undernourishment in some countries, while in other countries where the results are found insignificant, the government should seek other interventions to curtail the prevalence of undernourishment. Unexpectedly, an increase in food prices lessens the undernourishment in developing countries that reflect that food prices might transform the dietary patterns of poor people from nutrient-rich foods to nutrient-poor staples, thus lead to undernourishment reduction but trigger overweight and obesity alongside. In conclusion, the results depict that policymakers should devise strategies keeping in view fundamental aspects of the country to reduce undernourishment.
Fulltext Reliability and Accuracy of 2D Photogrammetry: A Comparison With Direct Measurement

Lim YC, Abdul Shakor AS, Shaharudin R

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

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

Zamzam AH, Al-Ani AKI, Wahab AKA, Lai KW, Satapathy SC, Khalil A, et al.

Front Public Health, 2021;9:782203.
PMID: 34869194 DOI: 10.3389/fpubh.2021.782203

The advancement of technology in medical equipment has significantly improved healthcare services. However, failures in upkeeping reliability, availability, and safety affect the healthcare services quality and significant impact can be observed in operations' expenses. The effective and comprehensive medical equipment assessment and monitoring throughout the maintenance phase of the asset life cycle can enhance the equipment reliability, availability, and safety. The study aims to develop the prioritisation assessment and predictive systems that measure the priority of medical equipment's preventive maintenance, corrective maintenance, and replacement programmes. The proposed predictive model is constructed by analysing features of 13,352 medical equipment used in public healthcare clinics in Malaysia. The proposed system comprises three stages: prioritisation analysis, model training, and predictive model development. In this study, we proposed 16 combinations of novel features to be used for prioritisation assessment and prediction of preventive maintenance, corrective maintenance, and replacement programme. The modified k-Means algorithm is proposed during the prioritisation analysis to automatically distinguish raw data into three main clusters of prioritisation assessment. Subsequently, these clusters are fed into and tested with six machine learning algorithms for the predictive prioritisation system. The best predictive models for medical equipment's preventive maintenance, corrective maintenance, and replacement programmes are selected among the tested machine learning algorithms. Findings indicate that the Support Vector Machine performs the best in preventive maintenance and replacement programme prioritisation predictive systems with the highest accuracy of 99.42 and 99.80%, respectively. Meanwhile, K-Nearest Neighbour yielded the highest accuracy in corrective maintenance prioritisation predictive systems with 98.93%. Based on the promising results, clinical engineers and healthcare providers can widely adopt the proposed prioritisation assessment and predictive systems in managing expenses, reporting, scheduling, materials, and workforce.

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