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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 A Qualitative Study on Formal and Informal Carers' Perceptions of Dementia Care Provision and Management in Malaysia

Goodson M, McLellan E, Rosli R, Tan MP, Kamaruzzaman S, Robinson L, et al.

Front Public Health, 2021;9:637484.
PMID: 34368037 DOI: 10.3389/fpubh.2021.637484

Background: The number of people living with dementia worldwide is increasing, particularly in low- and middle-income countries (LMICs) where little is known about existing post-diagnostic care and support. This study aimed to better understand healthcare provision for people living with dementia in Malaysia, and to identify priorities for providing timely, quality, and accessible care and support to all. Methods: This is a qualitative interview study on care providers and facilitators (health and community care professionals, paid carers, traditional medicine practitioners, faith healers, community leaders, non-governmental organisations). A topic guide, piloted in Malaysia and peer reviewed by all LMIC partners, elicited the understanding of dementia and dementia care and barriers and facilitators to care for people living with dementia and carers, and perceptions of key priorities for developing efficient, feasible, and sustainable dementia care pathways. Verbatim transcription of audio-recorded interviews was followed by iterative, thematic data analysis. Results: Twenty interviews were conducted (11 healthcare professionals, 4 traditional medicine practitioners, and 5 social support providers). The findings indicate that dementia care and support services exist in Malaysia, but that they are not fully utilised because of variations in infrastructure and facilities across the country. Despite a locally recognised pathway of care being available in an urban area, people with dementia still present to the healthcare system with advanced disease. The interviewees linked this to a public perception that symptoms of dementia, in particular, are normal sequelae of ageing. Earlier detection of dementia is commonly opportunistic when patients present to GPs, government clinic staff, and general physicians with other ailments. Dementia may only be identified by practitioners who have some specialist interest or expertise in it. Workforce factors that hindered early identification and management of dementia included lack of specialists, overburdened clinics, and limited knowledge of dementia and training in guideline use. Post-diagnostic social care was reported to be largely the domain of families, but additional community-based support was reported to be available in some areas. Raising awareness for both the public and medical professionals, prevention, and more support from the government are seen as key priorities to improve dementia management. Conclusions: This qualitative study provides novel insight into the availability, delivery, and use of post-diagnostic care and support in Malaysia from the perspective of care providers. The respondents in this study perceived that while there was a provision for dementia care in the hospital and community settings, the different care sectors are largely unaware of the services each provides. Future work should explore how care provision across different service sectors and providers can be supported to better facilitate patient access and referral between primary, secondary, and social care. The importance of supporting families to understand dementia and its progression, and strategies to help them care for relatives was emphasised. There is also a need for broad workforce training and development, at both the postgraduate and undergraduate levels, as well as improved general awareness in the community to encourage earlier help-seeking for symptoms of dementia. This will enable the use of preventive strategies and access to specialist services to optimise care and quality of life for people living with dementia in Malaysia.
Fulltext Cardiometabolic risk factors among children who are affected by overweight, obesity and severe obesity

Nur Zati Iwani AK, Jalaludin MY, Roslan FA, Mansor F, Md Zain F, Hong JYH, et al.

Front Public Health, 2023;11:1097675.
PMID: 37181686 DOI: 10.3389/fpubh.2023.1097675

BACKGROUND: The increasing severity of obesity is expected to lead to more serious health effects. However, there is limited information on the prevalence and clinical characteristics of cardiometabolic risk factors in severely children affected by obesity in Malaysia. This baseline study aimed to investigate the prevalence of these factors and their association with obesity status among young children.
METHODS: In this study, a cross-sectional design was employed using the baseline data obtained from the My Body Is Fit and Fabulous at school (MyBFF@school) intervention program involving obese school children. Obesity status was defined using the body mass index (BMI) z-score from the World Health Organization (WHO) growth chart. Cardiometabolic risk factors presented in this study included fasting plasma glucose (FPG), triglycerides (TGs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood pressure, acanthosis nigricans, insulin resistance (IR), and MetS. MetS was defined using the International Diabetes Federation (IDF) 2007 criteria. Descriptive data were presented accordingly. The association between cardiometabolic risk factors, such as obesity status, and acanthosis nigricans with MetS was measured using multivariate logistic regression, which was adjusted for gender, ethnicity, and strata.
RESULTS: Out of 924 children, 38.4% (n = 355) were overweight, 43.6% (n = 403) were obese, and 18% (n = 166) were severely obese. The overall mean age was 9.9 ± 0.8 years. The prevalence of hypertension, high FPG, hypertriglyceridemia, low HDL-C, and the presence of acanthosis nigricans among severely children affected by obesity was 1.8%, 5.4%, 10.2%, 42.8%, and 83.7%, respectively. The prevalence of children affected by obesity who were at risk of MetS in <10-year-old and MetS >10-year-old was observed to be similar at 4.8%. Severely children affected by obesity had higher odds of high FPG [odds ratio (OR) = 3.27; 95% confdence interval (CI) 1.12, 9.55], hypertriglyceridemia (OR = 3.50; 95%CI 1.61, 7.64), low HDL-C (OR = 2.65; 95%CI 1.77, 3.98), acanthosis nigricans (OR = 13.49; 95%CI 8.26, 22.04), IR (OR = 14.35; 95%CI 8.84, 23.30), and MetS (OR = 14.03; 95%CI 3.97, 49.54) compared to overweight and children affected by obesity. The BMI z-score, waist circumference (WC), and percentage body fat showed a significant correlation with triglycerides, HDL-C, the TG: HDL-C ratio, and the homeostatic model assessment for IR (HOMA-IR) index.
CONCLUSIONS: Severely children affected by obesity exhibit a higher prevalence of and are more likely to develop cardiometabolic risk factors compared to overweight and children affected by obesity. This group of children should be monitored closely and screened periodically for obesity-related health problems to institute early and comprehensive intervention.
Fulltext Assessment of Knowledge, Attitude, Practise and Health Literacy (KAPH) Towards COVID-19 in Post-COVID-19 New Reality: The Need and Its Challenges in Malaysia

Dalawi I, Chen XW, Isa MR, Azhar ZI, Mohd Nor F

Front Public Health, 2021;9:704115.
PMID: 34368066 DOI: 10.3389/fpubh.2021.704115
Fulltext Effectiveness of school-based child sexual abuse intervention among school children in the new millennium era: Systematic review and meta-analyses

Che Yusof R, Norhayati MN, Mohd Azman Y

Front Public Health, 2022;10:909254.
PMID: 35937243 DOI: 10.3389/fpubh.2022.909254

INTRODUCTION: School-based child sexual abuse intervention programs were developed to educate the school children to protect them from sexual abuse. The programs were evaluated to make sure the interventions were effective in reducing child sexual abuse cases (CSA). This review aimed to determine the effectiveness of the school-based child sexual abuse intervention programs in the new millennium era (2000-2021) in improving the knowledge, skills, and attitude of school children under 18 years old toward child sexual abuse.
METHODS: A systematic search was conducted through MEDLINE (PubMed), EBSCO, and SCOPUS databases to collect full English articles related to school-based CSA intervention programs published from 2000 to 2021.
RESULTS: A total of 29 studies from randomized control trial and quasi-experimental from several countries was analyzed. Comparisons within group of pre-post intervention for knowledge, skills, and attitude were measured by standardized mean difference (SMD) and 95% CI of -1.06 (95% CI: -1.29, -0.84), -0.91 (95% CI: -1.2, -0.61), and -0.51 (95% CI: -3.61, 0.58), respectively. Meanwhile for between intervention and control group comparisons, the SMD of knowledge was 0.9 (95% CI: 0.63, 1.18), skills was 0.39 (95% CI: 0.07, 0.71), and attitude was 1.76 (95% CI: 0.46, 3.07).
CONCLUSION: The programs were found to be effective in improving the knowledge, skills, and attitude of the students from pre-intervention to post-intervention and between the intervention and control groups.Systematic Review Registration: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022312383, identifier: CRD42022312383.
Fulltext Online Multi-Domain Geriatric Health Screening in Urban Community Dwelling Older Malaysians: A Pilot Study

Alex D, Fauzi AB, Mohan D

Front Public Health, 2020;8:612154.
PMID: 33520920 DOI: 10.3389/fpubh.2020.612154

Introduction: With a rapidly aging population, the Malaysian health care system needs to develop solutions to address the lack of resources that are required for the assessment of the older person. The complex nature of geriatric syndromes coupled with the occurrence of multiple comorbid illnesses with aging, make geriatric assessment a resource intensive process. Digital health solutions could play an important role in supporting existing health care systems, especially in low and middle income countries, with limited speciality services in geriatrics. Objective: This is a pilot study aimed at screening for geriatric syndromes through self-administered online surveys in urban community dwelling older Malaysians and assessing the pattern of geriatric syndromes in relation to the frailty status of the study participants. Methods: This is a cross-sectional pilot study conducted between July-September 2020. Community dwelling adults aged 60 years and over were invited to take part in an online survey. Information on sociodemographic variables, comorbidities, and the self-reported results of geriatric syndromes (frailty, sarcopenia, anorexia of aging, urinary incontinence, falls, and cognitive impairment), were collected through the survey. Results: Data was collected for 162 participants over a period of 2 months. The mean (SD) age of the respondents was 66.42 (5.25) years with 64.9% females. Majority of the respondents were of Chinese ethnic origin (67.9%) and had tertiary level of education (75.9%). The average time taken by participants to complete the survey was 16.86 min. Urinary incontinence was the highest reported geriatric syndrome (55.1%) followed by falls (37.6%), anorexia of aging (32.8%), cognitive impairment (27.8%), and sarcopenia (8.3%). Frailty was detected in 4.5% of the study population. Loss of weight in the previous year was the highest reported component of the frailty assessment tool. The presence of sarcopenia, anorexia of aging, poor/fair self-rated health, urinary incontinence, and multimorbidity were significantly higher in older adults who were frail or prefrail. Conclusion: Screening for geriatric syndromes through online surveys is a feasible approach to identify older adults in the community who are likely to benefit from geriatric assessment. However, the demographic profile of the older population that are accessible through such digital platforms is limited.
Fulltext Frequency of Cognitive Impairment Among Malaysian Elderly Patients Following First Ischaemic Stroke-A Case Control Study

Mohamed Fuad Z, Mahadzir H, Syed Zakaria SZ, Mohamed Ibrahim N

Front Public Health, 2020;8:577940.
PMID: 33282811 DOI: 10.3389/fpubh.2020.577940

Background: Stroke is highly prevalent globally and is an important cause of cognitive impairment and dementia. Aims: We determined the frequency of post-stroke cognitive impairment (PSCI) at 1, 3, and 6 months among patients with first clinical ischemic stroke compared to risk and age-matched controls. Methods: This study involved 32 cases and 32 controls, and was conducted over 6 months. Cases were inpatients aged >60 with first clinical ischemic stroke. Controls were age-matched subjects without prior stroke. Montreal Cognitive Assessment (MoCA) was performed in all patients at 1, 3, and 6 month post stroke. A MoCA score of <26 was used for mild PSCI and <22 for moderate PSCI (post stroke dementia). Results: Post-stroke dementia was detected in 12 patients (37.5%) at 1st month, in 13 (40.6%) at 3rd month and 15 (48.4%) at 6th months. Mild PSCI was present in 7 patients (21.6%) at 1 month, 16 patients (50%) at 3 months, and 15 patients (48%) at 6 months. The odds ratio (OR) for post-stroke dementia was 3.2 (95%CI 0.98-10.68; p = 0.05) at 1 month; 3.69(95% CI 1.13-12.11; p = 0.031) at 3 months, and 4.88 (95% CI 1.49-15.99; p = 0.009) at 6 months. Years of education was an independent predictor for dementia (OR 0.60; p = 0.046). The OR for post-stroke dementia at 6th month was 7.23 with education level adjusted (95%CI 1.46-35.86, p = 0.015). Conclusion: The frequency of PSCI was high as early as 1 month after stroke. Stroke alone conferred a 7.2 times risk for post-stroke dementia compared to controls.
Fulltext Factors Associated With Underprivileged E-Learning, Session Jam Phobia, and the Subsequent Mental Distress Among Students Following the Extended University Closure in Bangladesh

Hossain MJ, Ahmmed F, Sarker MMR, Sarwar S, Bari MS, Khan MR, et al.

Front Public Health, 2021;9:807474.
PMID: 35223762 DOI: 10.3389/fpubh.2021.807474

Severe session jam phobia (SJP), the extent of underprivileged online education, and subsequent mental health disorders among students have emerged as distinguished global problems due to the overwhelming effects of coronavirus disease 2019 (COVID-19). The purpose of this research was to evaluate the impact of extended COVID-19 lockdown and its mediating factors on current e-Learning activities, the prevalence of severe SJP and psychological distress among university students in Bangladesh. A web-based cross-sectional study was conducted to assemble responses through Google Form by applying a simple snowball sampling technique among university students aged 18 years or above in Bangladesh. All ethical considerations were maintained, and univariate, bivariate, and multivariate analyses were employed to analyze the acquired data set. Among the total analyzed data (n = 1,122), the male and female ratio was almost 1:1, and a remarkable segment (63.7%) was aged between 21-24 years. Alarmingly, around 50-60% of the students were suffering from severe SJP, prevailing underprivileged education in the e-Learning platform, and severe mental distress. Logistic regression analyses demonstrated that the students from public universities, lower- and mid-income families, lower-aged, and junior years education groups were significantly (p < 0.05) more underprivileged than their counter groups. Besides, the monthly family income and university type significantly influenced the extent of severe SJP. Finally, the students who were female, rustic, come from low-income families (below 25,000 BDT), who had academic uncertainty, job insecurity, online exam phobia, and dissatisfaction with e-Learning education, were significantly suffering from moderate to severe mental distress. The current evidence demonstrates that a substantial number of Bangladeshi university students are struggling with extreme session jam phobia, underprivileged e-Learning education, and subsequent psychological distress, which need to be immediately addressed through concerted efforts by the government, parents, and university authorities.
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 Physicians' Perspective on Prescribing Patterns and Knowledge on Antimicrobial Use and Resistance in Penang, Malaysia: A Qualitative Study

Akhtar A, Khan AH, Zainal H, Ahmad Hassali MA, Ali I, Ming LC

Front Public Health, 2020;8:601961.
PMID: 33324603 DOI: 10.3389/fpubh.2020.601961

Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system. Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis. Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance. Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.
Fulltext Clinical Characteristics and Diagnostic Challenges of COVID-19: An Update From the Global Perspective

Israfil SMH, Sarker MMR, Rashid PT, Talukder AA, Kawsar KA, Khan F, et al.

Front Public Health, 2020;8:567395.
PMID: 33505949 DOI: 10.3389/fpubh.2020.567395

Clinical characteristics are essential for the correct diagnosis of diseases. The current review aimed to summarize the global clinical characteristics of the COVID-19 patients systematically and identify their diagnostic challenges to help the medical practitioners properly diagnose and for better management of COVID-19 patients. We conducted a systematic search in PubMed, Web of Science, Scopus, Science Direct, and Google Scholar databases for original articles containing clinical information of COVID-19 published up to 7th May 2020. Two researchers independently searched the databases to extract eligible articles. A total of 34 studies from 8 different countries with 10889 case-patients were included for clinical characteristics. The most common clinical symptoms were cough 59.6, fever 46.9, fatigue 27.8, and dyspnea 20.23%. The prominent laboratory findings were lymphocytopenia 55.9, elevated levels of CRP 61.9, aspartate aminotransferase 53.3, LDH 40.8, ESR 72.99, serum ferritin 63, IL-6 52, and prothrombin time 35.47%, and decreased levels of platelets 17.26, eosinophils 59.0, hemoglobin 29, and albumin 38.4%. CT scan of the chest showed an abnormality in 93.50% cases with bilateral lungs 71.1%, ground-glass opacity 48%, lesion in lungs 78.3%, and enlargement of lymph node 50.7%. Common comorbidities were hypertension, diabetes, obesity, and cardiovascular diseases. The estimated median incubation period was 5.36 days, and the overall case fatality rate was 16.9% (Global case fatality outside China was 22.24%: USA 21.24%, Italy 25.61%, and others 0%; whereas the case fatality inside the Hubei Province of China was found to be 11.71%). Global features on the clinical characteristics of COVID-19 obtained from laboratory tests and CT scan results will provide useful information to the physicians to diagnose the disease and for better management of the patients as well as to address the diagnostic challenges to control the infection.
Fulltext Let There Be Light-Digital Eye Strain (DES) in Children as a Shadow Pandemic in the Era of COVID-19: A Mini Review

Bhattacharya S, Heidler P, Saleem SM, Marzo RR

Front Public Health, 2022;10:945082.
PMID: 36033797 DOI: 10.3389/fpubh.2022.945082

INTRODUCTION: Digital eye strain, which is often ignored by the public, has emerged as a "Shadow Pandemic" in the era of the COVID-19 pandemic.
AIM: The current paper is aimed at discussing the ill effect of digital screens on eyes in the wake of the COVID-19 pandemic.
METHODOLOGY: A literature search was done using "PubMed," "Google scholar", and "Scopus" using key terms like "Digital Eye Strain," "Eyestrain," or "Computer Vision Syndrome." Relevant articles were identified and included to support the argument for this narrative review.
RESULTS: Studies conducted in the UK reported that 68% of children extensively use computers, while 54% undertake online activities after the age of 3. Similar studies estimated 4 h and 45 min per day of screen exposure time among adults in the UK. Indian studies reveal that the prevalence of DES is 69% in adults and 50% in children respectively. Indian ophthalmologists found that computer-using and specialized ophthalmologists were more informed of symptoms and diagnostic signs but were misinformed about treatment modalities. The use of social media and multitasking is particularly prominent among younger adults, with 87% of individuals aged 20-29 years reporting the use of two or more digital devices simultaneously. It has been observed that the use of computer glasses corrects refractive errors and helps in the reduction of symptoms, while precision spectral filters help in reducing symptoms of micro-fluctuation of accommodation.
CONCLUSION: We concluded that DES is emerging globally as a "Shadow Pandemic" and it is high time to respond. Community ophthalmologists, public health authorities, and educational sectors especially should be involved to prevent this.
Domain and perception on community resilience: comparison between two countries

Irasanti SN, Respati T, Januarita R, Yuniarti Y, Chen HWJ, Marzo RR

Front Public Health, 2023;11:1157837.
PMID: 37529438 DOI: 10.3389/fpubh.2023.1157837

The COVID-19 outbreak demonstrates how unprepared the world is for a different type of crisis, especially non-physical calamities. Revitalizing community involvement in disaster management is essential for making a community resilient. Due to differing sociocultural contexts, the resilience perceptions of communities in different parts of the world may vary. This study aims to understand community resilience factors after the COVID-19 disaster in Indonesia and Malaysia. Data from 2034 questionnaires using 5-interrelated domains in the Communities Advancing Resilience (CART) Toolkit Survey were collected. This study was conducted across Indonesia and Malaysia from March to April 2022. A quantitative-based cross-sectional study design and convenience sampling were applied. Respondents for this study were Indonesian and Malaysian citizens above 18 years of age who met the inclusion criteria. A total of 2034 respondents, 715 from Indonesia and 1,315 from Malaysia responded to the survey. The results suggest that Indonesian and Malaysian communities' Transformative Potential and Informative-Communication domains differ significantly. Indonesian communities demonstrated a higher mean value on Transformative Potential domains than Malaysian communities did, while Malaysian communities indicated a higher mean value on Informative-Communication domains. This study concludes that compared to Malaysian communities, Indonesian communities have a more significant potential for transformation because they can frame collective experiences, gather, and analyze pertinent data, evaluate community performance, and develop resilience-building abilities. On the other hand, Malaysian communities are more resilient in providing information and communication. We found the need to develop a community resilience model that incorporates specific cultural and local requirements. Cooperation between the two countries would open many possibilities to emphasize the capability to bounce back sooner after a catastrophe such as the COVID-19 pandemic and achieve Sustainable Development Goals.
Fulltext A Non-severe Coronavirus Disease 2019 Patient With Persistently High Interleukin-6 Level

Hambali NL, Mohd Noh M, Paramasivam S, Chua TH, Hayati F, Payus AO, et al.

Front Public Health, 2020;8:584552.
PMID: 33304877 DOI: 10.3389/fpubh.2020.584552

Interleukin 6 (IL-6) is one of the markers of immune system activation indicating existent infection and inflammation. We present here a case of a 55-year-old male COVID-19 patient with an unusual high level of interleukin 6 (IL-6). Further investigation revealed he had hepatocellular carcinoma (HCC) with underlying hepatitis B. He did not present with respiratory symptoms although a baseline chest x-ray showed changes, and the patient was categorized as Class 3A of COVID-19. Routine investigations proceeded with high-resolution computed tomography and IL-6 to monitor for progression to severe COVID-19. Notably, there was a high IL-6 level but other parameters did not show he was in severe COVID-19. In this report, we conclude that elevated IL-6 level in a COVID-19 patient is not necessarily associated with severe COVID-19.
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 Predicting the Mass Adoption of eDoctor Apps During COVID-19 in China Using Hybrid SEM-Neural Network Analysis

Yang Q, Al Mamun A, Hayat N, Md Salleh MF, Salameh AA, Makhbul ZKM

Front Public Health, 2022;10:889410.
PMID: 35570961 DOI: 10.3389/fpubh.2022.889410

Technology plays an increasingly important role in our daily lives. The use of technology-based healthcare apps facilitates and empowers users to use such apps and saves the burden on the public healthcare system during COVID-19. Through technology-based healthcare apps, patients can be virtually connected to doctors for medical services. This study explored users' intention and adoption of eDoctor apps in relation to their health behaviors and healthcare technology attributes among Chinese adults. Cross-sectional data were collected through social media, resulting in a total of 961 valid responses for analysis. The hybrid analysis technique of partial least squares structural equation modeling (PLS-SEM) and artificial neural network (ANN) analysis was applied. The obtained results revealed the significant influence of eDoctor apps in terms of usefulness, compatibility, accuracy, and privacy on users' intention to use eDoctor apps. Intention and product value were also found to suggestively promote the adoption of eDoctor apps. This study offered practical recommendations for the suppliers and developers of eHealth apps to make every attempt of informing and building awareness to nurture users' intention and usage of healthcare technology. Users' weak health consciousness and motivation are notable barriers that restrict their intention and adoption of the apps. Mass adoption of eDoctor apps can also be achieved through the integration of the right technology features that build the product value and adoption of eDoctor apps. The limitations of the current study and recommendations for future research are presented at the end of this paper.
Fulltext School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol

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

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

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

Thangiah N, Chinna K, Su TT, Jalaludin MY, Al-Sadat N, Majid HA

Front Public Health, 2020;8:69.
PMID: 32257989 DOI: 10.3389/fpubh.2020.00069

Background: Cardiovascular disease (CVD) risk factors tend to cluster and progress from adolescence to young adulthood. Reliable and meaningful clustering of CVD risk factors is essential to circumvent loss of information. Tracking adverse and high-risk profiles of adolescents is hoped to curb CVD progression later in life. The study aims to investigate the clustering of biological CVD risk factor among adolescents in Malaysia and the transitions between clusters over time. Method: The Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs) examined school students aged 13 in 2012 and re-examined them in 2014 and 2016. In a two-stage stratified cluster sampling, 1,361 students were recruited, of which, 1,320 had complete data. In the follow-up, there were 881 and 637 students in 2014 and in 2016, respectively. Pearson's correlation coefficients were used to identify and remove highly correlated CVD risk factors. All risk factors were standardized into z-scores. The hierarchical and non-hierarchical (k-means) cluster analyses were used to classify students into high, medium and low risk clusters in each screening year. The tracking and stability of cluster transitions through cross-classification were enumerated with Pearson's inter-age correlations and percentages. Results: Three significant clusters of high, medium and low risk groups were derived from the clustering of eight biological CVD risk factors. The transitions between risk clusters from one screening year to the other were categorized as either stagnant, improved or adverse. The number of students who had adverse transitions increased from 15.5% (13-15 year) to 19.5% (15-17 year), 13.8 to 18.2% among the girls and 19.9 to 22.8% among the boys. For girls, the number of them who remained at high risk over the two transition periods were about the same (13.6 vs. 13.8%) whereas for boys, the percentage reduced from 14.6 to 12.3%. Conclusion: Over time, more than 12% of adolescents remained in the high risk cluster. There were sizable adverse transitions over time as more adolescents appear to be shifting toward an increased risk of having CVD. Collaborative and constant measures should be taken by parents, school, health promotion boards and policy makers to curb the multiplicative effect of clustering CVD risk factors among adolescents.
Fulltext Prevalence, maternal characteristics, and birth outcomes of preeclampsia: A cross-sectional study in a single tertiary healthcare center in greater Kuala Lumpur Malaysia

Sutan R, Aminuddin NA, Mahdy ZA

Front Public Health, 2022;10:973271.
PMID: 36324467 DOI: 10.3389/fpubh.2022.973271

BACKGROUND: Preeclampsia is associated with an increased risk of adverse maternal and perinatal outcomes. This study aimed to assess preeclampsia prevalence in a Malaysian referral maternity hospital and the association between preeclampsia and maternal characteristics and outcomes.
METHODS: A cross-sectional study was conducted between January 2010 and December 2020 using secondary data from a single tertiary healthcare center in Greater Kuala Lumpur, Malaysia. A total of 40,212 deliveries were included for analysis to investigate the association between conditions (maternal characteristics and adverse birth outcomes) and preeclampsia. Multivariable logistic regression was conducted to assess the association between multiple independent variables and the outcome variable (preeclampsia).
RESULTS: The reported prevalence of preeclampsia was 1.6%. Pregnant women with preeclampsia had a higher risk of preterm delivery (67.7%), instrumental and cesarean delivery (74.7%), neonatal low birth weight (48.5%), neonatal 5-min Apgar score <7 (18.1%), and neonatal intensive care unit (NICU) admission (19.8%). There were significantly higher odds of developing preeclampsia among nullipara [adjusted odd ratio (adjOR) 1.792, 95% CI: 1.518-2.115], women with a previous history of preeclampsia (adjOR 5.345, 95% CI: 2.670-10.698) and women with multiple pregnancies (adjOR 1.658, 95% CI: 1.071-2.566). However, there is a significant association between maternal characteristic variables. There was a significant association when a combination of variables for risk assessment: the presence of anemia and gestational hypertension effect on preeclampsia (OR 26.344, 95% CI: 9.775-70.993, p < 0.002) and gestational hypertension without anemia on preeclampsia (OR 3.084, 95% CI: 2.240-4.245, p < 0.001). Similarly, an association was seen between chronic hypertension and younger age (<35 years old) on preeclampsia (OR 14.490, 95% CI: 9.988-21.021, p < 0.001), and having chronic hypertension with advanced maternal age (≥35 years old) on preeclampsia (OR 5.174, 95% CI: 3.267-8.195, p < 0.001). Both conditions had increased odds of preeclampsia, in varying magnitudes. Overall, the significant interaction effects suggest that a history of chronic or gestational hypertension has a different relationship to the incidence of preeclampsia depending on the maternal age and anemia status. Pregnant women with preeclampsia had significantly higher odds for preterm delivery (adjOR 6.214, 95% CI: 5.244-7.364), instrumental and cesarean delivery (adjOR 4.320, 95% CI: 3.587-5.202), neonatal low birth weight (adjOR 7.873, 95% CI: 6.687-9.271), 5-min Apgar score <7 (adjOR 3.158, 95% CI: 2.130-4.683), and NICU admission (adjOR 8.778, 95% CI: 7.115-10.830).
CONCLUSIONS: Nulliparity, previous history of preeclampsia, and multiple pregnancies were associated with an increased risk of preeclampsia. The presence of different underlying conditions, such as chronic hypertension, anemia, and extremes of maternal age played an important role in increasing preeclampsia risk in the considered study. Larger samples are needed to validate such findings.
Fulltext Acceptance of medical drone technology and its determinant factors among public and healthcare personnel in a Malaysian urban environment: knowledge, attitude, and perception

Za'im Sahul Hameed M, Nordin R, Ismail A, Zulkifley MA, Sham ASH, Sabudin RZAR, et al.

Front Public Health, 2023;11:1199234.
PMID: 38045974 DOI: 10.3389/fpubh.2023.1199234

INTRODUCTION: Unmanned aerial vehicles (UAVs) are used for commercial, medical, public safety, and scientific research purposes in various countries.
METHODS: This study aimed to explore the acceptance of medical delivery drones among medical practitioners as well as the public community in Malaysia using a knowledge, attitude, and perception (KAP) model and statistical analysis to decrease uncertainty. Bivariate and multivariate analyses of the results were performed in SPSS.
RESULTS: A total of 639 respondents took part in the survey, of which 557 complete responses were finally analyzed. The results showed that the overall acceptance rate for medical delivery drones was positive. The acceptance rate was significantly correlated with knowledge, attitude, and perception scores but not with sociodemographic factors.
DISCUSSION: Raising awareness and educating the medical as well as public communities regarding the potential role and benefits of drones are therefore important in garnering support for drone usage for medical purposes.

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