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Fulltext Factors Contributing to Sharp Waste Disposal at Health Care Facility Among Diabetic Patients in North-East Peninsular Malaysia

Hasan UA, Mohd Hairon S, Yaacob NM, Daud A, Abdul Hamid A, Hassan N, et al.

Int J Environ Res Public Health, 2019 06 26;16(13).
PMID: 31247892 DOI: 10.3390/ijerph16132251

BACKGROUND: Type 2 diabetic patients are major users of medical sharps in the community. Proper sharp disposal practice among them, however, was reported to be low. The current study was aimed to determine the factors contributing to sharp waste disposal at a health care facility among Type 2 diabetic patients.
METHODS: In this cross-sectional study, Type 2 diabetic patients who were on insulin therapy attending health clinics were randomly selected and interviewed using a validated questionnaire. Binary logistic regression analysis was applied.
RESULTS: Out of 304 respondents, only 11.5% of them brought their used sharps to be disposed at health care facilities. Previous advice on sharp disposal from health care providers, knowledge score, and duration of diabetes were significant contributing factors for sharp waste disposal at health care facilities: (Adj. OR 6.31; 95% CI: 2.63, 15.12; p < 0.001), (Adj. OR 1.05; 95% CI: 1.03, 1.08; p < 0.001), and (Adj. OR 2.51; 95% CI: 1.06, 5.93; p = 0.036), respectively.
CONCLUSION: Continuous education and a locally adapted safe sharp disposal option must be available to increase awareness and facilitate diabetic patients adopting proper sharp disposal behavior.
Fulltext Examining Consumers' Adoption of Wearable Healthcare Technology: The Role of Health Attributes

Cheung ML, Chau KY, Lam MHS, Tse G, Ho KY, Flint SW, et al.

Int J Environ Res Public Health, 2019 Jun 26;16(13).
PMID: 31247962 DOI: 10.3390/ijerph16132257

With the advancement of information technology, wearable healthcare technology has emerged as one of the promising technologies to improve the wellbeing of individuals. However, the adoption of wearable healthcare technology has lagged when compared to other well-established durable technology products, such as smartphones and tablets, because of the inadequate knowledge of the antecedents of adoption intention. The aim of this paper is to address an identified gap in the literature by empirically testing a theoretical model for examining the impact of consumers' health beliefs, health information accuracy, and the privacy protection of wearable healthcare technology on perceived usefulness. Importantly, this study also examines the influences of perceived usefulness, consumer innovativeness, and reference group influence on the adoption intention of wearable healthcare technology. The model seeks to enhance understanding of the influential factors in adopting wearable healthcare technology. Finally, suggestions for future research for the empirical investigation of the model are provided.
Fulltext The Effects of Brain Breaks on Motives of Participation in Physical Activity among Primary School Children in Malaysia

Hajar MS, Rizal H, Kueh YC, Muhamad AS, Kuan G

Int J Environ Res Public Health, 2019 Jul 02;16(13).
PMID: 31269644 DOI: 10.3390/ijerph16132331

Brain breaks is a physical activity (PA) video designed for school settings that is used to stimulate student's health and learning. The purpose of this study is to measure the effects of brain breaks on motives of participation in PA among primary school children in Malaysia. Purposive sampling was used to divide 159 male and 176 female students aged 10 to 11 years old, mean (standard deviation (SD)) = 10.51 (0.50), from two schools in Kelantan, Malaysia into intervention (n = 183) and control (n = 152) groups. Students undertook brain breaks activities on school days (five minutes per session) spread out for a period of four months. Mixed factorial analysis of variance (ANOVA) was used to test the students' motives of participation in PA for pre-, mid-, and post-tests using the Physical Activity and Leisure Motivation Scale-Youth-Malay (PALMS-Y-M). Mixed factorial ANOVA showed significant changes in enjoyment, F(2, 392) = 8.720, p-value (ηp2) = 0.001 (0.043); competitiveness, F(2, 195) = 4.364, p-value (ηp2) = 0.014 (0.043); appearance, F(2, 392) = 5.709, p-value (ηp2) = 0.004 (0.028); and psychological condition, F(2, 392) = 4.376, p-value (ηp2) = 0.013 (0.022), whereas mastery, affiliation, and physical condition were not significant (p < 0.05). Further post-hoc analysis revealed a significant downward trend in the control group (p < 0.05). Brain breaks is successful in maintaining students' motives for PA in four of the seven factors.
Fulltext Effect of MyMAFI-A Newly Developed Mobile App for Field Investigation of Food Poisoning Outbreak on the Timeliness in Reporting: A Randomized Crossover Trial

Hamzah FH, Mohd Hairon S, Yaacob NM, Musa KI

Int J Environ Res Public Health, 2019 07 10;16(14).
PMID: 31295907 DOI: 10.3390/ijerph16142453

Prompt investigation of food poisoning outbreak are essential, as it usually involves a short incubation period. Utilizing the advancement in mobile technology, a mobile application named MyMAFI (My Mobile Apps for Field Investigation) was developed with the aim to be an alternative and better tool for current practices of field investigation of food poisoning outbreak. A randomized cross-over trial with two arms and two treatment periods was conducted to assess the effectiveness of the newly developed mobile application as compared to the standard paper-based format approach. Thirty-six public health inspectors from all districts in Kelantan participated in this study and they were randomized into two equal sized groups. Group A started the trial as control group using the paper-format investigation form via simulated outbreaks and group B used the mobile application. After a one-month 'washout period', the group was crossed over. The primary outcome measured was the time taken to complete the outbreak investigation. The treatment effects, the period effects and the period-by-treatment interaction were analyzed using Pkcross command in Stata software. There was a significant treatment effect with mean square 21840.5 and its corresponding F statistic 4.47 (p-value = 0.038), which indicated that the mobile application had significantly improve the reporting timeliness. The results also showed that there was a significant period effect (p-value = 0.025); however, the treatment by period interaction was not significant (p-value = 0.830). The newly developed mobile application-MyMAFI-can improve the timeliness in reporting for investigation of food poisoning outbreak.
Fulltext Unhealthy Lifestyle Associated with Higher Intake of Sugar-Sweetened Beverages among Malaysian School-Aged Adolescents

Gan WY, Mohamed SF, Law LS

Int J Environ Res Public Health, 2019 08 04;16(15).
PMID: 31382672 DOI: 10.3390/ijerph16152785

High consumption of sugar-sweetened beverages (SSBs) among adolescents has turned into a global concern due to its negative impact on health. This cross-sectional study determined the amount of SSB consumption among adolescents and its associated factors. A total of 421 adolescents aged 13.3 ± 1.3 years (41.8% males, 58.2% females) completed a self-administered questionnaire on sociodemographic characteristics, physical activity, screen-viewing behavior, sleep quality, frequency of eating at fast food restaurants, home food availability, peer social pressure, parenting practice, and SSB consumption. Weight and height were measured. Results showed that the mean daily consumption of SSBs among adolescents was 1038.15 ± 725.55 mL. The most commonly consumed SSB was malted drink, while the least commonly consumed SSB was instant coffee. The multiple linear regression results revealed that younger age (β = -0.204, p < 0.001), higher physical activity (β = 0.125, p = 0.022), higher screen time (β = 0.147, p = 0.007), poorer sleep quality (β = 0.228, p < 0.001), and unhealthy home food availability (β = 0.118, p = 0.032) were associated with a higher SSB intake. Therefore, promoting a healthy lifestyle may help to reduce the excessive consumption of SSBs among adolescents.
Fulltext Application of the Theory of Planned Behavior in Environmental Science: A Comprehensive Bibliometric Analysis

Si H, Shi JG, Tang D, Wen S, Miao W, Duan K

Int J Environ Res Public Health, 2019 08 04;16(15).
PMID: 31382712 DOI: 10.3390/ijerph16152788

Since the theory of planned behavior (TPB) was proposed by Ajzen in 1985, it has attracted extensive interest and been widely applied worldwide. Although an increasing number of studies have employed the TPB in the domain of environmental science, there have been no attempts to retrospectively analyze existing articles. The current study aimed to holistically understand the application status of the TPB in environmental science from a knowledge domain visualization perspective. A total of 531 journal articles were obtained through the Scopus database to perform a bibliometric analysis and content analysis. The results showed that waste management, green consumption, climate and environment, saving and conservation, and sustainable transportation are the primary research topics; the United States (U.S.), Mainland China, the United Kingdom (UK), and Malaysia are the most productive countries/regions. Moreover, the cross-disciplinary situations, main source journals, and key articles were revealed. Furthermore, the extended factors, integrated theories, major methods, specific groups, and control variables of environmental science research using the TPB were elaborated and integrated into a comprehensive application framework. Constructive criticisms were ultimately discussed. The findings contribute in several ways to help relevant researchers learn about the application of TPB to environmental science and provide new insights and holistic references for further research on environment-related behavior.
Fulltext The Effects of Annatto Tocotrienol Supplementation on Cartilage and Subchondral Bone in an Animal Model of Osteoarthritis Induced by Monosodium Iodoacetate

Chin KY, Wong SK, Japar Sidik FZ, Abdul Hamid J, Abas NH, Mohd Ramli ES, et al.

Int J Environ Res Public Health, 2019 08 13;16(16).
PMID: 31412648 DOI: 10.3390/ijerph16162897

Osteoarthritis is a degenerative joint disease which primarily affects the articular cartilage and subchondral bones. Since there is an underlying localized inflammatory component in the pathogenesis of osteoarthritis, compounds like tocotrienol with anti-inflammatory properties may be able to retard its progression. This study aimed to determine the effects of oral tocotrienol supplementation on the articular cartilage and subchondral bone in a rat model of osteoarthritis induced by monosodium iodoacetate (MIA). Thirty male Sprague-Dawley rats (three-month-old) were randomized into five groups. Four groups were induced with osteoarthritis (single injection of MIA at week 0) and another served as the sham group. Three of the four groups with osteoarthritis were supplemented with annatto tocotrienol at 50, 100 and 150 mg/kg/day orally for five weeks. At week 5, all rats were sacrificed, and their tibial-femoral joints were harvested for analysis. The results indicated that the groups which received annatto tocotrienol at 100 and 150 mg/kg/day had lower histological scores and cartilage remodeling markers. Annatto tocotrienol at 150 mg/kg/day significantly lowered the osteocalcin levels and osteoclast surface of subchondral bone. In conclusion, annatto tocotrienol may potentially retard the progression of osteoarthritis. Future studies to confirm its mechanism of joint protection should be performed.
Fulltext Recent Incidence of Human Malaria Caused by Plasmodium knowlesi in the Villages in Kudat Peninsula, Sabah, Malaysia: Mapping of The Infection Risk Using Remote Sensing Data

Sato S, Tojo B, Hoshi T, Minsong LIF, Kugan OK, Giloi N, et al.

Int J Environ Res Public Health, 2019 08 16;16(16).
PMID: 31426380 DOI: 10.3390/ijerph16162954

Plasmodium knowlesi (Pk) is a malaria parasite that naturally infects macaque monkeys in Southeast Asia. Pk malaria, the zoonosis transmitted from the infected monkeys to the humans by Anopheles mosquito vectors, is now a serious health problem in Malaysian Borneo. To create a strategic plan to control Pk malaria, it is important to estimate the occurrence of the disease correctly. The rise of Pk malaria has been explained as being due to ecological changes, especially deforestation. In this research, we analysed the time-series satellite images of MODIS (MODerate-resolution Imaging Spectroradiometer) of the Kudat Peninsula in Sabah and created the "Pk risk map" on which the Land-Use and Land-Cover (LULC) information was visualised. The case number of Pk malaria of a village appeared to have a correlation with the quantity of two specific LULC classes, the mosaic landscape of oil palm groves and the nearby land-use patches of dense forest, surrounding the village. Applying a Poisson multivariate regression with a generalised linear mixture model (GLMM), the occurrence of Pk malaria cases was estimated from the population and the quantified LULC distribution on the map. The obtained estimations explained the real case numbers well, when the contribution of another risk factor, possibly the occupation of the villagers, is considered. This implies that the occurrence of the Pk malaria cases of a village can be predictable from the population of the village and the LULC distribution shown around it on the map. The Pk risk map will help to assess the Pk malaria risk distributions quantitatively and to discover the hidden key factors behind the spread of this zoonosis.
Fulltext The Effects of Tocotrienol on Bone Peptides in a Rat Model of Osteoporosis Induced by Metabolic Syndrome: The Possible Communication between Bone Cells

Wong SK, Chin KY, Ima-Nirwana S

Int J Environ Res Public Health, 2019 09 09;16(18).
PMID: 31505801 DOI: 10.3390/ijerph16183313

A positive association between metabolic syndrome (MetS) and osteoporosis has been demonstrated in previous animal studies. The mechanisms of MetS in orchestrating the bone remodelling process have traditionally focused on the interactions between mature osteoblasts and osteoclasts, while the role of osteocytes is unexplored. Our earlier studies demonstrated the bone-promoting effects of tocotrienol using a rat model of osteoporosis induced by MetS. This study aimed to investigate the expression of osteocyte-derived peptides in the bone of rats with MetS-induced osteoporosis treated with tocotrienol. Age-matched male Wistar rats (12-week-old; n = 42) were divided into seven experimental groups. Two groups served as the baseline and normal group, respectively. The other five groups were fed with a high-carbohydrate high-fat (HCHF) diet to induce MetS. The five groups of HCHF animals were treated with tocopherol-stripped corn oil (vehicle), annatto tocotrienol (60 and 100 mg/kg), and palm tocotrienol (60 and 100 mg/kg) starting from week 8. At the end of the study, the rats were sacrificed and their right tibias were harvested. Protein was extracted from the metaphyseal region of the proximal right tibia and levels of bone peptides, including osteoprotegerin (OPG), soluble receptor activator of nuclear factor-kappa B ligand (sRANKL), sclerostin (SOST), Dickkopf-related protein 1 (DKK-1), fibroblast growth factor-23 (FGF-23), and parathyroid hormone (PTH), were measured. The vehicle-treated animals displayed higher levels of sRANKL, SOST, DKK-1, FGF-23, and PTH as compared to the normal animals. Oral supplementation of annatto and palm tocotrienol (60 and 100 mg/kg) reduced the levels of sRANKL and FGF-23 in the HCHF animals. Only 100 mg/kg annatto and palm tocotrienol lowered SOST and DKK-1 levels in the HCHF animals. In conclusion, tocotrienol exerts potential skeletal-promoting benefit by modulating the levels of osteocytes-derived bone-related peptides.
Fulltext Effectiveness of Diabetes Community Sharp Disposal Education Module in Primary Care: An Experimental Study in North-East Peninsular Malaysia

Hasan UA, Mohd Hairon S, Yaacob NM, Daud A, Abdul Hamid A, Hassan N, et al.

Int J Environ Res Public Health, 2019 09 11;16(18).
PMID: 31514391 DOI: 10.3390/ijerph16183356

Background: Structured education is needed to cultivate safe sharp disposal behavior among diabetic patients. Thus, this study aimed to assess the effectiveness of the Diabetes Community Sharp Disposal Education Module in improving knowledge and sharp disposal practice among Malaysian Type 2 diabetic patients. Methods: This quasi-experimental study was conducted at primary health clinics in two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. A total of 132 Type 2 diabetic patients on insulin therapy were involved, with 68 participants in each control and intervention group. The health education intervention was based on the validated Diabetes Community Sharp Disposal Education Module. The knowledge and practices were measured using a validated questionnaire at baseline, one month, and three months after the intervention. Results: There was a significant increment in the mean knowledge score for intervention group; from baseline to one month follow up and from baseline to three months follow up [Greenhouse-Geisser; F(1.5, 199.7) = 62.38, p < 0.001; effect size (η2) = 0.318]. Intervention group had significantly higher mean knowledge score as compared to control group; at one month and three months follow up [F(1, 134) = 17.38, p < 0.001; effect size (η2) = 0.115]. There was a statistically significant increment in the proportion of participants in the intervention group who practiced the proper community sharp disposal method over time, X2(2) = 52.061, p < 0.001. Conclusions: The Diabetes Community Sharp Disposal Education Module was an effective health education tool to improve knowledge and encourage Malaysian diabetic patients to engage with proper sharp disposal practices.
Fulltext Prospective Application of Palm Oil Mill Boiler Ash as a Biosorbent: Effect of Microwave Irradiation and Palm Oil Mill Effluent Decolorization by Adsorption

Hamzah MH, Ahmad Asri MF, Che Man H, Mohammed A

Int J Environ Res Public Health, 2019 09 17;16(18).
PMID: 31533308 DOI: 10.3390/ijerph16183453

Common conventional biological treatment methods fail to decolorize palm oil mill effluent (POME). The present study focused on using the abundant palm oil mill boiler (POMB) ashes for POME decolorization. The POMB ashes were subjected to microwave irradiation and chemical treatment using H2SO4. The resultant adsorbents were characterized using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), and Brunauer-Emmett-Teller (BET) analyses. The adsorption efficiency was evaluated at various pH levels (2-8.5), adsorption dosages (3-15 g) in 200 mL, and contact times (1-5 h). The microwave-irradiated POMB-retained ash recorded the highest color removal of 92.31%, for which the best conditions were pH 2, 15 g adsorbent dosage in 200 mL, and 5 h of contact time. At these best treatment conditions, the color concentration of the treated effluent was analyzed using the method proposed by the American Dye Manufacturers Institute (ADMI). The color concentration was 19.20 ADMI, which complies with the Malaysia discharge standard class A. The Freundlich isotherm model better fit the experimental data and had a high R2 of 0.9740. Based on these results, it can be deduced that microwave-irradiated POMB-retained ash has potential applications for POME decolorization via a biosorption process.
Fulltext Antibiotic Susceptibility Patterns, Biofilm Formation and esp Gene among Clinical Enterococci: Is There Any Association?

Weng PL, Ramli R, Hamat RA

Int J Environ Res Public Health, 2019 09 17;16(18).
PMID: 31533204 DOI: 10.3390/ijerph16183439

Enterococci are commonly found in humans, animals and environments. Their highly adaptive mechanisms are related to several virulent determinants and their ability to resist antibiotics. Data on the relationship between the esp gene, biofilm formation and antibiotic susceptibility profiles may differ between countries. This cross-sectional study was conducted to determine the proportion of esp gene and biofilm formation among Enterococcus faecalis and Enterococcus faecium clinical isolates. We also investigated the possible association between the esp gene with antibiotic susceptibility patterns and biofilm formation. The isolates were collected from clinical samples and identified using biochemical tests and 16SRNA. Antibiotic susceptibility patterns and a biofilm assay were conducted according to the established guidelines. Molecular detection by PCR was used to identify the esp gene using established primers. In total, 52 and 28 of E. faecalis and E. faecium were identified, respectively. E. faecium exhibited higher resistance rates compared to E. faecalis as follows: piperacillin/tazobactam (100% versus 1.9%), ampicillin (92.8% versus 1.9%), high-level gentamicin resistance (HLGR) (89.3% versus 25.0%) and penicillin (82.1% versus 7.7%). E. faecium produced more biofilms than E. faecalis (59.3% versus 49.0%). E. faecium acquired the esp gene more frequently than E. faecalis (78.6% versus 46.2%). Interestingly, the associations between ampicillin and tazobactam/piperacillin resistance with the esp gene were statistically significant (X2 = 4.581, p = 0.027; and X2 = 6.276, p = 0.012, respectively). Our results demonstrate that E. faecium exhibits high rates of antimicrobial resistance, esp gene acquisition and biofilm formation. These peculiar traits of E. faecium may have implications for the management of enterococcal infections in hospitals. Thus, concerted efforts by all parties in establishing appropriate treatment and effective control measures are warranted in future.
Fulltext Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus

Dhillon H, Nordin RB, Ramadas A

Int J Environ Res Public Health, 2019 09 23;16(19).
PMID: 31547629 DOI: 10.3390/ijerph16193561

Diabetes complications, medication adherence, and psychosocial well-being have been associated with quality of life (QOL) among several Western and Asian populations with diabetes, however, there is little evidence substantiating these relationships among Malaysia's unique and diverse population. Therefore, a cross-sectional study was conducted in a Malaysian public primary care clinic among 150 patients diagnosed with type 2 diabetes mellitus (T2DM). Structured and validated questionnaires were used to investigate the associations between demographic, clinical, and psychological factors with QOL of the study participants. Approximately three-quarters of patients had a good-excellent QOL. Diabetes-related variables that were significantly associated with poor QOL scores included insulin containing treatment regimens, poor glycemic control, inactive lifestyle, retinopathy, neuropathy, abnormal psychosocial well-being, higher diabetes complication severity, and nonadherence (p < 0.05). The main predictors of a good-excellent QOL were HbA1c ≤ 6.5% (aOR = 20.78, 95% CI = 2.5175.9, p = 0.005), normal anxiety levels (aOR = 5.73, 95% CI = 1.8-18.5, p = 0.004), medication adherence (aOR = 3.35, 95% CI = 1.3-8.7, p = 0.012), and an aDCSI score of one and two as compared to those greater than or equal to four (aOR = 7.78, 95% CI = 1.5-39.2, p = 0.013 and aOR = 8.23, 95% CI = 2.1-32.8, p = 0.003), respectively. Medication adherence has also been found to be an effect modifier of relationships between HbA1c, depression, anxiety, disease severity, and QOL. These predictors of QOL are important factors to consider when managing patients with T2DM.
Fulltext Pre-Pregnancy BMI Influences the Association of Dietary Quality and Gestational Weight Gain: The SECOST Study

Yong HY, Mohd Shariff Z, Mohd Yusof BN, Rejali Z, Tee YYS, Bindels J, et al.

Int J Environ Res Public Health, 2019 10 04;16(19).
PMID: 31590213 DOI: 10.3390/ijerph16193735

Poor diet quality in pregnancy could impact gestational weight gain (GWG) and consequently fetal growth and development. But today there is limited data available on gestational diet quality. This study investigated the association between diet quality in each pregnancy trimester and GWG in Malaysian women. Diet quality was assessed using the modified Healthy Eating Index for Malaysians (HEI). Total GWG was defined as the difference between measured weight at last prenatal visit and pre-pregnancy weight. About one-fourth of women (23.3%) had excessive total GWG. There were significant differences in the HEI component score across trimesters, except for fruits. Overall, overweight/obese women had lower total HEI score (51.49-55.40) during pregnancy compared to non-overweight/obese women (53.38-56.50). For non-overweight/obese women, higher total HEI scores in the second and third trimesters were significantly associated with lower risk of inadequate GWG (aOR = 0.97, 95% CI = 0.95-0.99, p = 0.01) and higher risk of excessive GWG (aOR = 1.04, 95% CI = 1.01-1.07, p = 0.03), respectively. Overweight/obese women with higher total HEI scores in the second (aOR = 1.04, 95% CI = 1.01-1.07, p = 0.02) and third trimester (aOR = 1.04, 95% CI = 1.01-1.08, p = 0.02) were significantly at higher risk for excessive GWG. Pregnant women had relatively low diet quality throughout pregnancy. Diet quality and GWG association differed according to pre-pregnancy BMI with excessive GWG more likely to be associated with higher total HEI scores in the third trimester.
Fulltext Predictors of Health-Seeking Behavior for Fever Cases among Caregivers of Under-Five Children in Malaria-Endemic Area of Imo State, Nigeria

Oluchi SE, Manaf RA, Ismail S, Udeani TK

Int J Environ Res Public Health, 2019 10 04;16(19).
PMID: 31590340 DOI: 10.3390/ijerph16193752

Fever is one of the most common symptoms of pediatric illnesses; it is an important early symptom of malaria. Fever had served as the entry point for presumptive treatment of malaria among children in Nigerian. Appropriate HSB is important when seeking treatment for fever among under-five children; this will help for better prognosis because treatment will be initiated early. This study attempted to identify caregiver's HSB for under-five children with fever. A cross-sectional study was conducted in Imo-State, Nigeria. Appropriate HSB was operationally defined as seeking treatment from health facility within 24 h of fever. Data were obtained using pretested self-administered questionnaire. Data were analyzed using SPSS version 22. Simple and multiple logistic regression were used to determine predictors of appropriate HSB. A total of 559 eligible respondents were recruited; 103 (18.6%) caregivers had appropriate HSB. The predictors of HSB are being male child (aOR = 2.760; 95% CI:1.536-4.958), the age of child younger than 27 months (aOR = 2.804; 95% CI:1.485-5.295), employed caregivers (aOR = 1.882; 95% CI:1.014-3.493), number of household members (aOR = 2.504; 95% CI:1.464-4.283), and caregivers who decided to seek treatment at early stage (aOR = 7.060; 95% CI:1.616-30.852). Only 18.6% caregivers practiced appropriate HSB for fever cases among under-five children. It is essential to educate caregivers and emphasise on early treatment of fever and appropriate use of health facilities for fever. The findings will be used to improve intervention at the community level and will be compared with follow-up data to evaluate their effectiveness.
Fulltext Levels of Knowledge, Beliefs, and Practices Regarding Osteoporosis and the Associations with Bone Mineral Density among Populations More Than 40 Years Old in Malaysia

Chan CY, Subramaniam S, Chin KY, Ima-Nirwana S, Muhammad N, Fairus A, et al.

Int J Environ Res Public Health, 2019 Oct 25;16(21).
PMID: 31731507 DOI: 10.3390/ijerph16214115

Osteoporosis is a skeletal disorder commonly found among the elderly, in which the bones become weak, brittle, and more susceptible to fracture. Adequate knowledge and positive attitude towards the disease and osteoprotective activities may prevent osteoporosis, but comprehensive studies to verify this hypothesis are limited in Malaysia. This study aims to bridge the research gap by determining the levels of knowledge, beliefs, and practices regarding osteoporosis and their associations with bone mineral density (BMD) among men and women ≥ 40 years in Klang Valley, Malaysia. In this cross-sectional study, 786 Malaysians (382 men, 404 women) completed a questionnaire on knowledge, beliefs, and osteoprotective practices, and underwent BMD scan using a dual-energy X-ray absorptiometry device. The current study found moderate levels of knowledge and beliefs regarding osteoporosis but poor osteoprotective practices. Osteoporosis knowledge, beliefs, and practices were significantly different based on subjects' demographic characteristics (p < 0.05). Osteoporosis knowledge and beliefs were correlated significantly with osteoprotective practices (p < 0.05). Bone health status of the subjects was associated positively with calcium supplement intake, and negatively with exercise barriers and smoking status of the subjects (p < 0.05). However, no significant correlation was noted between osteoporosis knowledge and bone health (p > 0.05). Conclusively, despite some correlations between individual components, the detachment between bone health knowledge and beliefs, and osteoprotective practices among Malaysians is apparent. Integrating all three components into a comprehensive osteoporosis prevention program is warranted.
Fulltext Low Back Pain and Its Associated Factors among Nurses in Public Hospitals of Penang, Malaysia

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

Int J Environ Res Public Health, 2019 11 01;16(21).
PMID: 31683911 DOI: 10.3390/ijerph16214254

OBJECTIVES: To determine the prevalence of low back pain (LBP) and its associated factors among the nurses working in the public hospitals of Penang, Malaysia.
METHODS: A cross-sectional study was conducted on nurses, aged 25-60 years, who had been working for at least three months at six public hospitals of Penang. A proportionate stratified random sampling method was applied to select 1292 respondents. The Malay-validated BACKS Tool questionnaire using a 5-point Likert scale was used to obtain data. Simple and multiple logistic regression analyses were performed.
RESULTS: A total of 989 (76.5%) nurses suffered from LBP at a point of time. The factors significantly associated with LBP among the nurses included working more than seven hours [adjusted odds ratio (AOR) (95% confidence interval (CI)) 1.48 (1.06, 1.98)], twisting of the body while working [AOR (95% CI) 1.60 (1.13, 2.26)], manual handling of patients in wards [AOR (95% CI) 1.44 (1.08, 2.07)], and fatigue [AOR (95% CI) 2.63 (1.94, 3.58)].
CONCLUSION: The prevalence of LBP among the nurses in the public hospitals of Penang was relatively high. The factors predicting LBP included working more than seven hours a day, twisting of the body while working, manual handling, and fatigue. The findings from this study may better enable policymakers to devote resources to minimize low back pain among nurses. The nurses should be encouraged to comply with safe working procedures.
Fulltext Health-Seeking Behavior for Erectile Dysfunction in Methadone Maintenance Treatment Patients

Ramli FF, Shuid AN, Pakri Mohamed RM, Tg Abu Bakar Sidik TMI, Naina Mohamed I

Int J Environ Res Public Health, 2019 11 01;16(21).
PMID: 31683816 DOI: 10.3390/ijerph16214249

Background: Erectile dysfunction (ED) is commonly associated with methadone usage. However, little data is known regarding the health-seeking behavior for ED in the methadone maintenance treatment (MMT) population. This study aimed to determine the health-seeking behavior of MMT patients with ED who perceived themselves as having ED. We aimed to assess the attitudes and health-seeking behavior, the effectiveness of the treatment and the factors associated with treatment-seeking behavior. Methods: This was an observational questionnaire-based study. Patients were first screened for ED (n = 154) using the International Index of Erectile Function-5 (IIEF-5). Fifty patients with ED were evaluated for health-seeking behavior for ED. Results: More than half of the patients who thought they had ED (78%) believed their sex life was affected. Most patients (48%) did not seek any information regarding ED. Education level (p = 0.017) and marital status (p = 0.008) were predictive factors of health-seeking behavior. Conclusions: The health-seeking rate among MMT patients with ED needs to be improved. Measures to increase awareness of ED in MMT patients should be taken to overcome the barrier to health-seeking behavior. Health practitioners should take action to screen ED in this population to increase the detection rate and offer appropriate management according to the patients' needs.
Fulltext The Effect of Brain Breaks on Physical Activity Behaviour among Primary School Children: A Transtheoretical Perspective

Rizal H, Hajar MS, Muhamad AS, Kueh YC, Kuan G

Int J Environ Res Public Health, 2019 11 04;16(21).
PMID: 31690004 DOI: 10.3390/ijerph16214283

Brain Breaks Physical Activity Solutions (BBPAS) is a web-based structured physical activity (PA) video that is specifically designed for school settings and can stimulate a student's health and learning. The purpose of this study is to measure the effect of BBPAS on the stages of change, decisional balance, processes of change, self-efficacy and leisure-time exercise among Malay ethnic primary school children. A validated Malay version of three of the five constructs was derived with sound validity and was used in the present study. A total of 159 male and 163 female children aged 10 to 11 years old, mean (SD) = 10.53 (0.50), were recruited from two schools in Kelantan, Malaysia. Purposive sampling was used to divide the children into intervention (n = 177) and control (n = 145) groups. Children in the intervention group underwent BBPAS activity for an accumulated 30 min per week, while children in the control group were not involved in the BBPAS intervention. Mixed factorial analysis of variance (ANOVA) was used to examine the effect of BBPAS on the study variables. A mixed ANOVA showed significant changes (time effect) on cognitive process, F(1, 320) = 5.768, p-value = 0.017; behavioural process, F(1, 313) = 5.736, p-value = 0.017; and internal feeling, F(1, 312) = 6.050, p-value = 0.014. There was also a significant difference between groups on cons, F(1, 316) = 7.504, p-value = 0.007. A significant interaction effect was observed for stages of change, F(1, 319) = 7.861, p-value = 0.005; pros, F(1, 316) = 31.311, p-value = 0.001; internal feeling, F(1, 312) = 4.692, p-value = 0.031; and behavioural process, F(1, 313) = 7.312, p-value = 0.007. In conclusion, BBPAS was successful in improving four of the five constructs, and thus, should be recommended to be used in schools throughout Malaysia.
Fulltext Development and Validation of an Evaluation Tool to Measure the Effectiveness of a Smoking Cessation Training among Healthcare Providers in Malaysia: The Providers' Smoking Cessation Training Evaluation (ProSCiTE)

Hasan SI, Mohd Hairi F, Amer Nordin AS, Danaee M

Int J Environ Res Public Health, 2019 11 05;16(21).
PMID: 31694286 DOI: 10.3390/ijerph16214297

Background: In line with Article 14 of the Framework Convention for Tobacco Control, we have witnessed vast developments in smoking cessation training for healthcare providers, offering help for smokers. However, there is no specific evaluation tool to monitor and evaluate the effectiveness of these programs for future enhancement and sustainability. Objective: To develop and validate a new tool for evaluating smoking cessation training programs for healthcare providers called the Providers' Smoking Cessation Training Evaluation (ProSCiTE). Methods: The 74-item ProSCiTE tool was developed based on a review of the literature and an expert panel review. The tool was validated in a sample of 403 healthcare providers using a cross-sectional study design from July to December 2016. Content validity was assessed by the Scale-Content Validity Index (S-CVI). The construct validity of the ProSCiTE was analyzed using exploratory factor analysis (EFA) to confirm psychometric properties. Internal consistency reliability was determined using Cronbach's alpha. Results: The content validity showed that the S-CVI ranged from 0.82 to 1.00 for consistency, representativeness, relevancy, and the clarity of each construct, resulting in 67 items for the questionnaire. The construct validity of the ProSCiTE (based on eigenvalues and factor loadings to confirm the four-factor structure (attitude, self-efficacy, behavior, and barriers) with 54.74% total variance) was acceptable (Kaiser-Mayer-Olkin = 0.923; Bartlett's test of sphericity was significant, p < 0.001). The internal consistency reliability of the four-factor structure was very good, with Cronbach's alpha values at 0.89, 0.94, 0.95, and 0.90, respectively. Conclusions: This study showed that 67 items of the ProSCiTE demonstrated good content and construct validity, as well as a high internal consistency reliability for the measurement of knowledge, attitudes, self-efficacy, behavior, and barriers to smoking cessation interventions among healthcare providers. Therefore, the ProSCiTE is a valid and reliable research tool with which to evaluate the effectiveness of smoking cessation training programs.

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