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Fulltext Cost-Effectiveness of Colorectal Cancer Genetic Testing

Ramdzan AR, Manaf MRA, Aizuddin AN, Latiff ZA, Teik KW, Ch'ng GS, et al.

Int J Environ Res Public Health, 2021 08 06;18(16).
PMID: 34444091 DOI: 10.3390/ijerph18168330

Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths worldwide. Approximately 3-5% of CRCs are associated with hereditary cancer syndromes. Individuals who harbor germline mutations are at an increased risk of developing early onset CRC, as well as extracolonic tumors. Genetic testing can identify genes that cause these syndromes. Early detection could facilitate the initiation of targeted prevention strategies and surveillance for CRC patients and their families. The aim of this study was to determine the cost-effectiveness of CRC genetic testing. We utilized a cross-sectional design to determine the cost-effectiveness of CRC genetic testing as compared to the usual screening method (iFOBT) from the provider's perspective. Data on costs and health-related quality of life (HRQoL) of 200 CRC patients from three specialist general hospitals were collected. A mixed-methods approach of activity-based costing, top-down costing, and extracted information from a clinical pathway was used to estimate provider costs. Patients and family members' HRQoL were measured using the EQ-5D-5L questionnaire. Data from the Malaysian Study on Cancer Survival (MySCan) were used to calculate patient survival. Cost-effectiveness was measured as cost per life-year (LY) and cost per quality-adjusted life-year (QALY). The provider cost for CRC genetic testing was high as compared to that for the current screening method. The current practice for screening is cost-saving as compared to genetic testing. Using a 10-year survival analysis, the estimated number of LYs gained for CRC patients through genetic testing was 0.92 years, and the number of QALYs gained was 1.53 years. The cost per LY gained and cost per QALY gained were calculated. The incremental cost-effectiveness ratio (ICER) showed that genetic testing dominates iFOBT testing. CRC genetic testing is cost-effective and could be considered as routine CRC screening for clinical practice.
Fulltext Genetic Testing for Cancer Risk: Is the Community Willing to Pay for It?

Aizuddin AN, Ramdzan AR, Syed Omar SA, Mahmud Z, Latiff ZA, Amat S, et al.

Int J Environ Res Public Health, 2021 Aug 19;18(16).
PMID: 34444499 DOI: 10.3390/ijerph18168752

With the increasing number of cancer cases worldwide, genetic testing for familiar cancers seems inevitable, yet little is known on population interest and the monetary value for cancer genetic risk information. The current study aimed to determine the willingness to undergo and pay for cancer genetic testing among the Malaysian population. A self-administered questionnaire was distributed to cancer patients and their family members in the oncology and daycare units in several government hospitals. Of 641 respondents (354 patients, 287 family members), 267 (41.7%) were willing to undergo cancer genetic testing. The median that respondents were willing to pay was USD 48.31 (MYR 200.00) IQR USD 96.91 (MYR 400), while 143 (22.3%) respondents were willing to pay a shared cost with the insurance company. Regression analysis identified independent positive predictors of willingness to pay as respondent's status as a family member, high education level, and willingness to undergo cancer genetic testing in general, while in patients, female gender and high level of education were identified as independent positive predictors. Generally, the population needs more information to undergo and pay for cancer genetic testing. This will increase the utilization of the services offered, and with cost-sharing practices with the provider, it can be implemented population-wide.
Fulltext Breast Cancer Screening in Semi-Rural Malaysia: Utilisation and Barriers

Mohan D, Su TT, Donnelly M, Hoe WMK, Schliemann D, Tan MM, et al.

Int J Environ Res Public Health, 2021 11 23;18(23).
PMID: 34886015 DOI: 10.3390/ijerph182312293

Breast cancer (BC) is the commonest cancer in Malaysia. Delayed diagnosis is a significant cause of BC mortality in the country. Early diagnosis and screening are vital strategies in mortality reduction. This study assessed the level of utilisation and barriers for breast self-examination (BSE), clinical breast examination (CBE) and mammogram in a semi-rural population in Malaysia and compared these across the different ethnic groups. This cross-sectional study was conducted among women aged 40 years and above, embedded within a health and demographic surveillance site (HDSS) in Segamat, Malaysia. Trained data collectors collected data on screening and barriers during home visits. Study participants (n = 250) were aged 59.4 ± 10.9 years and represented Malaysia's three major ethnic groups. Practice of regular BSE, CBE uptake (ever) and mammogram (ever) was 23.2%, 36% and 22.4%, respectively. Regular BSE practice was highest in the Malay ethnic group and least among the Chinese. Regular CBE was very low in all ethnic groups (<5%). Mammogram uptake was highest among Chinese (34.4%), followed by Indians (30.4%) and Malays (16.6%). After adjusting for other socio-demographic variables, Malay ethnicity was positively associated with regular BSE (adjusted OR = 5.26, 95% CI 2.05, 13.50) and negatively associated with having had a mammogram (adjusted OR = 0.3, 95% CI 0.15, 0.57). Lower education was negatively associated (adjusted OR = 0.36, 95% CI 0.17, 0.74) with mammogram attendance (ever). Emotional and financial barriers were the most reported types of barriers, specifically, fear of diagnosis (74.8%), cost of diagnosis (69.6%) and fear of losing a breast (66.4%). Malay women more commonly reported most barriers compared to other ethnic groups. Screening uptake was low among semi-rural women in Malaysia. Implementing culturally appropriate interventions that consider ethnic differences is crucial to empowering women to engage in BC screening initiatives in these communities.
Fulltext A Hybrid MCDM Approach Based on Fuzzy-Logic and DEMATEL to Evaluate Adult Obesity

Safaei M, A Sundararajan E, Asadi S, Nilashi M, Ab Aziz MJ, Saravanan MS, et al.

Int J Environ Res Public Health, 2022 Nov 22;19(23).
PMID: 36497509 DOI: 10.3390/ijerph192315432

Obesity and its complications is one of the main issues in today's world and is increasing rapidly. A wide range of non-contagious diseases, for instance, diabetes type 2, cardiovascular, high blood pressure and stroke, numerous types of cancer, and mental health issues are formed following obesity. According to the WHO, Malaysia is the sixth Asian country with an adult population suffering from obesity. Therefore, identifying risk factors associated with obesity among Malaysian adults is necessary. For this purpose, this study strives to investigate and assess the risk factors related to obesity and overweight in this country. A quantitative approach was employed by surveying 26 healthcare professionals by questionnaire. Collected data were analyzed with the DEMATEL and Fuzzy Rule-Based methods. We found that lack of physical activity, insufficient sleep, unhealthy diet, genetics, and perceived stress were the most significant risk factors for obesity.
Fulltext Impact of Safety Culture on Safety Performance; Mediating Role of Psychosocial Hazard: An Integrated Modelling Approach

Naji GMA, Isha ASN, Mohyaldinn ME, Leka S, Saleem MS, Rahman SMNBSA, et al.

Int J Environ Res Public Health, 2021 08 13;18(16).
PMID: 34444314 DOI: 10.3390/ijerph18168568

We conceptualize that safety culture (SC) has a positive impact on employee's safety performance by reducing their psychosocial hazards. A higher level of safety culture environment reduces psychosocial hazards by improving employee's performance toward safety concerns. The purpose of this study was to evaluate how psychosocial hazard mediates the relationship between safety culture and safety performance. Data were collected from 380 production employees in three states of Malaysia from the upstream oil and gas sector. Structural equation modeling was implemented to test the suggested hypotheses. The proposed model was evaluated using structural equation modeling. A stratified sampling with a Likert 5-point scale was used to distribute the questionnaires. Furthermore, the proposed model was tested using the simulation of the structural equation and partial. According to our findings, all hypotheses were significant. A review of prior studies was used to select the items of the dimension for the data collection. Safety culture was assessed with psychosocial hazard to determine its direct and indirect impact on safety performance. Results suggest that to enhance safety performance (leading and lagging), psychosocial concerns in the workplace environments should be taken into consideration by employees. In addition, the findings showed that the psychosocial hazard fully mediates the relationship between safety culture and safety performance.
Fulltext A Survey on Salt Content Labeling of the Processed Food Available in Malaysia

Haron H, Hiew I, Shahar S, Michael V, Ambak R

Int J Environ Res Public Health, 2020 04 04;17(7).
PMID: 32260382 DOI: 10.3390/ijerph17072469

Salt content in processed foods is high, and it is usually used as preservatives, stabilizers, and color enhancers in the products. Increased consumption of processed foods in the modern world has contributed to a high salt intake and thus increased the prevalence of hypertension among Malaysian populations. Therefore, this study aimed to identify and compare salt content in processed food products available in supermarkets and determine the percentage of processed food products exceeding the reference value stated in International Product Criteria (2016). The percentage of processed food products without salt and sodium labeling was determined in this study, in which 76.5% of unlabeled processed food products were made in Malaysia, while 23.5% were imported products. The food group with the highest average salt content was gravy and sauce (3.97 g/100 g), followed by soup (2.95 g/100 g), cheese (2.14 g/100 g), meat (1.37 g/100 g), fish (1.25 g/100 g), chicken (1.20 g/100 g), vegetables (1.18 g/100 g), butter and margarine (1.13 g/100 g), breakfast cereal (0.94 g/100 g), savory snacks (0.90 g/100 g), flatbread (0.86 g/100 g), sweet snacks (0.30 g/100 g), and potato (0.29 g/100 g). In addition, 79.5% of butter and margarine products had an average salt content above the reference value stated in the International Product Criteria, followed by gravy and sauce (79.3%), vegetables (72%), soup (50%), fish (49.2%), breakfast cereal (41%), cheese (36.6%), potato (36%), savory and sweet snacks (29.1), meat (12.5%) and chicken products (2.3%). Most processed food products available in local supermarkets were high in salt content.
Fulltext Relations of Bedtime Mobile Phone Use to Cognitive Functioning, Academic Performance, and Sleep Quality in Undergraduate Students

Ragupathi D, Ibrahim N, Tan KA, Andrew BN

Int J Environ Res Public Health, 2020 09 29;17(19).
PMID: 33003445 DOI: 10.3390/ijerph17197131

The present cross-sectional study examined the relations of bedtime mobile phone use to cognitive functioning, academic performance, and sleep quality in a sample of undergraduate students. Three hundred eighty-five undergraduate students completed a self-administered questionnaire containing sociodemographic variables, bedtime mobile phone use, the Pittsburgh Sleep Quality Index, and the Cambridge Neuropsychological Test Automated Battery (attention and verbal memory). At bivariate level, increased scores in bedtime mobile phone use were significantly correlated with decreased scores in academic performance and sleep quality. Our multivariate findings show that increased scores in bedtime mobile phone use uniquely predicted decreased scores in academic performance and sleep quality, while controlling for gender, age, and ethnicity. Further untangling the relations of bedtime mobile phone use to academic performance and sleep quality may prove complex. Future studies with longitudinal data are needed to examine the bidirectional effect that bedtime mobile phone use may have on academic performance and sleep quality.
Fulltext Risk Assessment of the SME Sector Operations during the COVID-19 Pandemic

Grondys K, Ślusarczyk O, Hussain HI, Androniceanu A

Int J Environ Res Public Health, 2021 04 15;18(8).
PMID: 33920916 DOI: 10.3390/ijerph18084183

The subject matter of the article relates to the assessment of the perception of selected types of risk in economic activities of the SME sector, which change their intensity as a result of the outbreak of the COVID-19 pandemic. The current economic downturn is unprecedented and involves many companies and industries that have faced new, previously unknown challenges and threats. The objective of the article is to identify the most important risks and their resources based on the empirical research carried out in small and medium-sized enterprises in Poland. The formulated objective was accomplished using the data collection method, i.e., the survey and reports on the condition of the SME sector in Poland as well as statistical data analysis methods, i.e., structure index and the analysis of variance, using the SPSS system. The process of primary data collection was carried out by means of an electronic survey among selected enterprises of the SME sector, conducting business activities in Poland. In the study, the employment factor was taken into account as a determinant of the perception and assessment of the intensity of selected risks arising from the economic activity in the Polish market in the conditions of the current economic downturn. On the basis of the obtained results, the impact of market, economic, financial and operational risks, depending on their intensity, on the functioning of micro-, small and medium-sized enterprises was identified. Based on the analysis of variance, the effect of the size of the company on the level of individual risks was also examined. As a result of the observations made, it was established that, during the pandemic, the level and type of risk is similar in all the surveyed enterprises. They are most often threatened by strong competition in the industry, an increase in energy prices and insufficient profit. The overall results of the empirical research indicate the importance and the need to manage the key threats to the Polish SME sector.
Fulltext The Relationships between a Dietary Pattern Linked to Cardiometabolic Risk Factors and Life Satisfaction in Early Adolescence

Appannah G, Emi NA, Gan WY, Mohd Shariff Z, Shamsuddin NH, Anuar Zaini A, et al.

Int J Environ Res Public Health, 2020 07 29;17(15).
PMID: 32751389 DOI: 10.3390/ijerph17155489

Little is known about the contribution of dietary patterns of poor quality on life satisfaction among Malaysian children. We evaluated associations between an empirically derived "high sugar, high fibre, high dietary energy dense (DED) and low fat" dietary pattern and life satisfaction score in adolescents. A total of 548 adolescents aged 13 years were recruited from randomly selected public schools located in three southern states of Peninsular Malaysia. Dietary intake was assessed using a validated food frequency questionnaire (FFQ) while life satisfaction was measured using a Multidimensional Students' Life Satisfaction Scale (MSLSS). Z-score for a "high sugar, high fibre, high DED and low fat" dietary pattern was estimated by applying reduced rank regression analysis. Relationships between the dietary pattern and life satisfaction scores were assessed using regression models. Mean and SD of life satisfaction score was higher in girls (70.5 (12.8)) compared to boys (67.6 (15.4)), p < 0.05. The overall life satisfaction score (β = -0.119; 95% CI: -0.125, -0.004) was inversely associated with dietary pattern z-score as well as scores for self (β = -0.13; 95% CI: -0.170, -0.015) and living environment (β = -0.12; 95% CI: -0.163, -0.007) domains in girls. An opposite trend was observed for school domain in boys whereby an increasing dietary pattern score was positively associated with increasing life satisfaction score (β = 0.216; 95% CI: 0.054, 0.36). The finding of this study highlights the role of free sugar and DED particularly, within the framework of whole diet, and target population at risk to improve life satisfaction among adolescents.
Fulltext Health Information Engagement Factors in Malaysia: A Content Analysis of Facebook Use by the Ministry of Health in 2016 and 2017

A Rahim AI, Ibrahim MI, A Salim FN, Ariffin MAI

Int J Environ Res Public Health, 2019 02 18;16(4).
PMID: 30781691 DOI: 10.3390/ijerph16040591

Health organizations have widely adopted social media for health promotion, public health communication conveyance, and organizational promotion activities. However, little published data exists on the factors that facilitate health information diffusion in South East Asia, especially Malaysia compared with Western countries. This study aimed to investigate factors associated with good engagement rates among internet users on the Facebook (FB) page of Ministry of Health Malaysia. In this observational study, 2123 FB posts were randomly selected. Data dated from 1 November 2016 to 31 October 2017 was gathered from the Facebook Insight. The logistic regression model was applied to identify factors associated with good engagement rates. This study found that a FB post with a good engagement rate was significantly associated with a health education post (Adjusted Odd Ratio (AOR): 3.80, 95% Confidence Interval CI: 3.02⁻4.78, p < 0.001), a risk communication post (AOR: 1.77, 95% CI: 1.39⁻2.26, p < 0.001), a post in the afternoon (AOR: 1.76, 95% CI: 1.34⁻2.31, p < 0.001) or in the evening (AOR: 1.48, 95% CI: 1.20⁻1.82, p < 0.001), and a video format (AOR: 3.74, 95% CI: 1.44⁻9.71, p = 0.007). Therefore, we present the first comprehensive analysis of health information engagement among internet users in Malaysia. The growing trends of online health information-seeking behaviors and demand for the availability of validated health information require effective strategies by public health organizations to disseminate health information and achieve better audience engagement on social media.
Fulltext Cross-Cultural Adaptation and Validation of Oral Health Literacy Instrument (OHLI) for Malaysian Adults

Ramlay MZ, Saddki N, Tin-Oo MM, Arifin WN

Int J Environ Res Public Health, 2020 07 28;17(15).
PMID: 32731318 DOI: 10.3390/ijerph17155407

Currently, the availability of a functional oral health literacy instrument in the Malay language is limited. This study aimed to cross-culturally adapt Oral Health Literacy Instrument (OHLI) into the Malay language and to determine its psychometric properties in Malaysian adults. Cross-cultural adaptation of the OHLI into the Malay version (OHLI-M) was conducted according to a guideline, followed by a cross-sectional study among outpatients in a selected health clinic. The psychometric evaluations were the comparison of the OHLI-M scores by education levels and last dental visits, the correlation of the reading comprehension section of OHLI-M with the Malay version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA-M), the correlation of OHLI-M with decayed, missing, and filled teeth (DMFT) and Community Periodontal Index (CPI), and the test-retest reliability of OHLI-M. A total of 195 outpatients participated in this study. The OHLI-M scores were significantly different between participants with different levels of education and timing since last dental visit. Participants with lower secondary school qualification and below, and those whose last dental visit was more than two years ago or never, had significantly lower OHLI-M scores. There was a positive correlation between the reading comprehension scores of the OHLI-M and the S-TOFHLA-M (Spearman's rho = 0.37, p < 0.001). There was no significant correlation between the OHLI-M scores and the DMFT index scores or the CPI scores. The internal consistency was good (Cronbach's alpha = 0.83 to 0.88). The test-retest reliability was excellent (intraclass correlation = 0.80 to 0.86). The OHLI-M showed good validity and reliability among adults in Malaysia.
Fulltext Dietary Patterns and Associated Factors Among Adolescents in Malaysia: Findings from Adolescent Nutrition Survey 2017

Man CS, Salleh R, Ahmad MH, Baharudin A, Koon PB, Aris T

Int J Environ Res Public Health, 2020 05 14;17(10).
PMID: 32423077 DOI: 10.3390/ijerph17103431

Balanced diet in the early stages of life plays a role in optimum growth and maintains good health status of adolescents. Dietary habits that are established during adolescence will sustain till adulthood. Therefore, this present study aims to identify the dietary patterns and to determine factors associated with dietary patterns in terms of socio-demographic characteristics, locality of schools, ethnicity, eating habits, self-perceived weight status, and food label reading habit among adolescents in Malaysia. Data from the Adolescent Nutrition Survey (ANS) 2017 was used for the present study. ANS is a population representative school-based cross-sectional study among school-going adolescents from primary four to secondary five from schools in 13 states and three federal territories registered under the Ministry of Education Malaysia. A self-administrated questionnaire was used to collect information on socio-demographic characteristics, locality of schools, ethnicity, eating habits, self-perceived weight status, and food label reading habit. A pre-tested face-to-face food frequency questionnaire (FFQ) was used to collect information on food group intake frequency. Dietary patterns were identified by using exploratory factor analysis and associated factors, using complex sample general linear model (GLM) analysis. All statistical analyses were carried out at 95% confidence interval or p-value < 0.05. The dietary patterns identified are healthy, unhealthy, and alternative proteins. The healthy dietary pattern was significantly associated with the types of school and ethnicity. The unhealthy dietary pattern was significantly associated with the locality of schools, ethnicity, frequency of snacks intake per week, frequency of eating out per week, self-perceived weight status, and food label reading habit. Significant associations were found between alternative proteins dietary pattern and locality of schools, ethnicity, and types of school. This study found that there is a disparity of dietary patterns between different ethnicity, locality of schools, and types of school. We recommend strategies of specifying ethnicity and geographical area to improve dietary patterns of adolescents in Malaysia.
Fulltext No Interaction Effect between Interleukin-6 Polymorphisms and Acid Ash Diet with Bone Resorption Marker in Postmenopausal Women

Lim SY, Chan YM, Ramachandran V, Shariff ZM, Chin YS, Arumugam M

Int J Environ Res Public Health, 2021 Jan 19;18(2).
PMID: 33478001 DOI: 10.3390/ijerph18020827

BACKGROUND: Evidence is growing that a high-acid diet might accelerate the rate of bone loss, and gene polymorphisms such as Interleukin 6 (IL6) -174G/C and -572G/C are related to bone deterioration. However, no study of the interaction between diet and IL6 polymorphisms has been conducted among Asians. Thus, the objective of this study was to determine whether IL6 gene polymorphisms modified the association between dietary acidity and the rate of bone resorption.
METHODS: This cross-sectional study recruited 203 postmenopausal women (age ranged from 51 to 85 years old) in community settings. The dietary intakes of the participants were assessed using a validated interviewer-administered semi-quantitative food frequency questionnaire (FFQ), while dietary acid load (DAL) was estimated using net endogenous acid production (NEAP). Agena® MassARRAY genotyping analysis and serum collagen type 1 cross-linked C-telopeptide (CTX1) were used to identify the IL6 genotype and as a bone resorption marker, respectively. The interactions between diet and single-nucleotide polymorphisms (SNPs) were assessed using linear regressions.
RESULTS: A total of 203 healthy postmenopausal women aged between 51 and 85 years participated in this study. The mean BMI of the participants was 24.3 kg/m2. In IL6 -174 G/C, all the participants carried the GG genotype, while the C allele was absent. Approximately 40% of the participants had a high dietary acid load. Dietary acid load (B = 0.15, p = 0.031) and the IL6 -572 CC genotype group (B = 0.14, p = 0.044) were positively associated with a higher bone resorption. However, there was no moderating effect of the IL6 genetic polymorphism on the relationship between and acid ash diet and bone resorption markers among the postmenopausal women (p = 0.79).
CONCLUSION: High consumption of an acid ash diet and the IL6 -572 C allele seem to attribute to high bone resorption among postmenopausal women. However, our finding does not support the interaction effect of dietary acidity and IL6 (-174G/C and -572G/C) polymorphisms on the rate of bone resorption. Taken together, these results have given scientific research other candidate genes to focus on which may interact with DAL on bone resorption, to enhance planning for preventing or delaying the onset of osteoporosis among postmenopausal women.
Fulltext Occurrence of Aflatoxins in Edible Vegetable Seeds and Oil Samples Available in Pakistani Retail Markets and Estimation of Dietary Intake in Consumers

Waqas M, Iqbal SZ, Abdull Razis AF, Pervaiz W, Ahmad T, Usman S, et al.

Int J Environ Res Public Health, 2021 07 29;18(15).
PMID: 34360308 DOI: 10.3390/ijerph18158015

Aflatoxins (AFs) are secondary metabolites toxic to humans as well as animals. The environmental conditions, conventional agricultural practices, and illiteracy are the main factors which favor the production of AFs in food and feed. In the current study 744 samples of vegetable seeds and oils (soybean, sunflower, canola, olive, corn, and mustard) were collected and tested for the presence of aflatoxin B1 (AFB1) and total AFs. Liquid-liquid extraction was employed for the extraction of AFs from seeds and oil samples. Reverse phase high performance liquid chromatography equipped with fluorescence detection was used for the analysis. The results have shown that 92 (56.7%) samples of imported and 108 (57.0%) samples of local edible seeds were observed to be contaminated with AFs. All samples of edible seeds have AFB1 levels greater than the proposed limit set by the European Union (EU, 2 µg/kg) and 12 (7.40%) samples of imported seeds and 14 (7.40%) samples of local seeds were found in the range ≥ 50 µg/kg. About 78 (43.3%) samples of imported edible oil and 103 (48.3%) sample of local edible oil were observed to be positive for AFs. Furthermore, 16 (8.88%) and six (3.33%) samples of imported vegetable oil have levels of total AFs in a range (21-50 µg/kg) and greater than 50 µg/kg, respectively. The findings indicate significant differences in AFs levels between imported and local vegetable oil samples (t = 22.27 and p = 0.009) at α = 0.05 and a significant difference in AFs levels were found between vegetable seeds and oil samples (t = -17.75, p = 0.009) at α = 0.05. The highest dietary intake was found for a local sunflower oil sample (0.90 µg/kg/day) in female individuals (16-22 age group). The results have shown considerably high levels of AFB1 and total AFs in seeds and oil samples and emphasise the need to monitor carefully the levels of these toxic substances in food and feed on regular basis.
Fulltext Assessment of Deoxynivalenol in Wheat, Corn and Its Products and Estimation of Dietary Intake

Iqbal SZ, Usman S, Razis AFA, Basheir Ali N, Saif T, Asi MR

Int J Environ Res Public Health, 2020 Aug 03;17(15).
PMID: 32756472 DOI: 10.3390/ijerph17155602

The main goal of the present research was to explore the seasonal variation of deoxynivalenol (DON) in wheat, corn, and their products, collected during 2018-2019. Samples of 449 of wheat and products and 270 samples of corn and their products were examined using reverse-phase liquid chromatography with a UV detector. The findings of the present work showed that 104 (44.8%) samples of wheat and products from the summer season, and 91 (41.9%) samples from winter season were contaminated with DON (concentration limit of detections (LOD) to 2145 µg/kg and LOD to 2050 µg/kg), from summer and winter seasons, respectively. In corn and products, 87 (61.2%) samples from summer and 57 (44.5%) samples from winter season were polluted with DON with levels ranging from LOD to 2967 µg/kg and LOD to 2490 µg/kg, from the summer and winter season, respectively. The highest dietary intake of DON was determined in wheat flour 8.84 µg/kg body weight/day from the summer season, and 7.21 µg/kg body weight/day from the winter season. The findings of the work argued the need to implement stringent guidelines and create awareness among farmers, stakeholders, and traders of the harmful effect of DON. It is mostly observed that cereal crops are transported and stockpiled in jute bags, which may absorb moisture from the environment and produce favorable conditions for fungal growth. Therefore, these crops must store in polyethylene bags during transportation and storage, and moisture should be controlled. It is highly desirable to use those varieties that are more resistant to fungi attack. Humidity and moisture levels need to be controlled during storage and transportation.
Fulltext Seasonal Variation in Aflatoxin Levels in Edible Seeds, Estimation of Its Dietary Intake and Vitamin E Levels in Southern Areas of Punjab, Pakistan

Razis AFA, Shehzad MM, Usman S, Ali NB, Iqbal SZ, Naheed N, et al.

Int J Environ Res Public Health, 2020 12 02;17(23).
PMID: 33276517 DOI: 10.3390/ijerph17238964

A total of 779 samples of edible nuts (melon seeds, watermelon seeds, pumpkin seeds, and cantaloupe seeds) from Southern Punjab (Pakistan), were collected during the summer and the winter seasons. The natural occurrence of aflatoxins (AFs) and vitamin E (tocopherols) levels were investigated using HPLC. The results have shown that 180 (43.4%) of samples from the winter season and 122 (33.4%) samples from the summer season were found positive for AFs. Elevated average levels of total AFs (20.9 ± 3.10 μg/kg, dry weight) were observed in watermelon seeds without shell, and the lowest average amount (15.9 ± 3.60 μg/kg) were documented in melon seeds without shell samples from the winter season. An elevated average amount of total AFs 17.3 ± 1.50 μg/kg was found in pumpkin seeds available without a shell. The results have documented a significant difference in total AFs levels in edible seeds available with shells versus without shells (α = 0.05 & 0.01). The highest dietary intake of 6.30 μg/kg/day was found in female individuals from consuming pumpkin seeds (without shell) in the winter season. A value of 3.00 μg/kg/day was found in pumpkin seed without shell in the summer season in female individuals. The highest total tocopherol levels were 22.2 ± 7.70 ng/100 g in pumpkin seeds samples from the winter season and 14.5 ± 5.50 mg/100 g in melon seed samples from the summer season. The variation of total tocopherol levels in edible seeds among the winter and summer seasons showed a significant difference (p ≤ 0.0054), except watermelon seeds samples with non-significant differences (p ≥ 0.183).
Fulltext The Alchemy of Coaching: Psychological Capital as HERO within Coaches' Selves

Burhanuddin NAN, Ahmad NA, Said RR, Asimiran S

Int J Environ Res Public Health, 2022 Sep 23;19(19).
PMID: 36231322 DOI: 10.3390/ijerph191912020

The complex nature of coaching challenges instructional coaches (ICs) professionally as it requires them to deal with not only teachers' resistance, acceptance and expectation but also adhere to the complex and multifaceted roles that they are bearing. Psychological capital (PsyCap) has been upheld as an effective construct for defending against stress, negative emotions and burnout among educators. This phenomenological study explores ways in which PsyCap was experienced by Malaysian instructional coaches (ICs). Data were gathered from face-to-face interviews with seven instructional coaches purposefully selected from six different District Education Offices (DEOs) throughout Malaysia. Extracted from participants' own words and through the exploration performed, PsyCap was experienced by the participants through a sense of responsibility, positive resources and work commitment. This study highlights the importance of PsyCap as inner positive psychological resources that aided instructional coaches in their practice of coaching. In addition, this study suggests future research recommendations towards implementing PsyCap developmental training with another group of instructional coaches.
Fulltext Validation and Measurement Invariance of the Body Appreciation Scale-2 between Genders in a Malaysian Sample

Tan CS, Cheng SM, Cong CW, Abu Bakar ARB, Michael E, Mohd Wazir MIB, et al.

Int J Environ Res Public Health, 2021 11 05;18(21).
PMID: 34770142 DOI: 10.3390/ijerph182111628

The 10-item Body Appreciation Scale-2 (BAS-2) is a measurement for individuals to self-report the extent to which they accept and respect their bodies. Although the BAS-2 has been translated into the Malay language and found to have promising qualities, the psychometric characteristics of the English version of BAS-2 remain unknown in the Malaysian context. The present study thus administered the English version BAS-2 and selfie-editing frequency scale to 797 individuals aged 18 to 56 years old in Malaysia. The dataset that was randomly divided into two halves were submitted to exploratory factor analysis and confirmatory factor analysis respectively. Both of the factor analyses consistently support a one-factor model. The Cronbach's alpha and McDonald omega coefficients were greater than 0.90, indicating that the BAS-2 has good internal consistency. The incremental validity is also evident. A hierarchical multiple regression showed that the BAS-2 score had a positive relationship with selfie-editing frequency after controlling for age and gender. Moreover, the measurement invariance test supported scalar invariance between genders, and an analysis of covariance did not find significant gender differences. Overall, the findings replicate past findings and regularly support the usability of the BAS-2 in the Malaysian context. The implications of the BAS-2 and future directions are also discussed.
Fulltext Knowledge, Attitudes, Practices and Health Beliefs toward Leptospirosis among Urban and Rural Communities in Northeastern Malaysia

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

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

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

Nozmi N, Samsudin S, Sukeri S, Shafei MN, Wan Mohd WMZ, Idris Z, et al.

Int J Environ Res Public Health, 2018 04 06;15(4).
PMID: 29642390 DOI: 10.3390/ijerph15040693

Little is known on the knowledge, attitudes and preventive practices (KAP) of leptospirosis worldwide. This study embarked on assessing the KAP of leptospirosis among rural communities in Malaysia. A total of 444 participants (223 male; 221 female) aged between 18 and 81 years old were surveyed by using a self-administered questionnaire. A majority of participants had poor knowledge level (57.0%), unacceptable attitudes (90.3%) and unacceptable preventive practices (69.1%) on leptospirosis, and only 29.7% knew "rat-urine disease" as leptospirosis. Only 34.2% of the participants knew the bacteria could enter via wound lesions. Ethnicity and income were strongly associated with knowledge level and preventive practices, respectively (p-values < 0.05). As for attitudes, ethnicity, income and education type were significantly associated (p-values < 0.05). Only 36.5% of the participants were willing to see a doctor and did not mind if their house or surrounding area is dirty (59.7%). Surprisingly, only 32.9% had used rubber boots during floods. By logistic regression analysis, ethnicity was the only significant predictor for both knowledge level (an odds ratio (AOR) = 0.39, 95% confidence interval (CI) = 0.222-0.680) and preventive practices (AOR = 1.81, 95% CI = 1.204-2.734). Ethnicity (AOR = 0.40, 95% CI = 0.239-0.665), income (AOR = 1.58, 95% CI = 1.041-2.385) and education type (AOR = 3.69, 95% CI = 1.237-10.986) were strong predictors for attitudes. Among the KAP variables, attitude (AOR = 4.357, 95% CI = 2.613-7.264) was the only predictor for the preventive practices by logistic regression analysis. The KAP elements on leptospirosis are still lacking and poor health seeking behavior and attitudes are of our utmost concern. Thus, effective strategies should be planned to impart knowledge, and develop proactive approaches and good preventive modules on leptospirosis to this leptospirosis-prone community.

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