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Fulltext Maggot Therapy in Wound Healing: A Systematic Review

Mohd Zubir MZ, Holloway S, Mohd Noor N

Int J Environ Res Public Health, 2020 08 21;17(17).
PMID: 32825736 DOI: 10.3390/ijerph17176103

BACKGROUND: It is estimated that 2% of the population in developing countries suffer from a chronic wound, making it a hidden phenomenon that is increasing as populations age. The ease of access to maggot therapy has made it increasingly attractive for implementation. This study aimed to explore the effectiveness of maggot therapy as compared to hydrogel dressings in the healing of chronic wounds.
METHODS: An electronic literature search until October 2019 was performed using Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature. The eligibility criteria were chronic wound patients with an intervention that involved a comparison of any maggot species with hydrogel dressings.
RESULTS: The full text of five studies, involving 580 patients with chronic wounds, was retrieved. Four studies used the Lucilia sericata species. The maggot therapy facilitated faster and more effective debridement of non-viable tissue. It enabled faster development of granulation tissue and increased reduction in the wound surface area compared to hydrogel dressings. Maggot therapy had no effect on disinfection or complete healing rate for the wound.
CONCLUSION: Maggot therapy should be considered for faster wound debridement, granulation tissue development, and wound surface area reduction as well as in surgical contraindications. This review can be used as a guide to assist clinicians in identifying patients who may benefit from maggot therapy.
Fulltext Courage in Competition: Adaptation of the Sports Courage Scale for American English and Validation of the Factor Structure with Student-Athletes at Clemson University

Konter E, Kueh YC, Kuan G

Int J Environ Res Public Health, 2020 07 04;17(13).
PMID: 32635576 DOI: 10.3390/ijerph17134834

While courage is widely attributed to athletic pursuits, it has received little scientific attention from both researchers and applied practitioners. A reliable measurement is required to examine courage in sports and competitive activities. Therefore, this research aimed to adapt the original Turkish Sports Courage Scale-31 into American English (SCS-AE). The SCS-31 measure was translated from Turkish into the American English language by the Brislin forward and backward translation technique and language validity. Then, the translated SCS-AE was administered to 548 American university college students (Mean age = 19.02, SD = 1.21). All participants played a sport (e.g., football, soccer, basketball, gymnastics). Based on confirmatory factor analyses (CFA), 31 items of SCS-AE were reduced to 24 items with four factors (i.e., assertiveness, determination, mastery, and venturesome). The fit indices were satisfactory (RMSEA = 0.06, CFI = 0.97, SRMR = 0.06, NFI = 0.96 and NNFI = 0.97). The internal consistency measured by Cronbach alpha, ranging from 0.73 to 0.78, were considered acceptable. The convergent validity and discriminant validity of SCS-AE were also achieved. Our findings indicate strong support for research using the four-factor model of the SCS-AE and adequate support for the five-factor model with sufficient caution regarding the internal consistency of the self-sacrifice factor. While cultural differences in courage perception might exist between these countries, the findings showed more similarities than differences in courage. Results indicated that the SCS-AE is usable for research purposes in the suggested format. Future directions are discussed using the SCS-31 and SCS-AE for research.
Fulltext Does It Matter Who Exhibits More Green Purchase Behavior of Cosmetic Products in Asian Culture? A Multi-Group Analysis Approach

Quoquab F, Jaini A, Mohammad J

Int J Environ Res Public Health, 2020 07 21;17(14).
PMID: 32708199 DOI: 10.3390/ijerph17145258

This study attempts to investigate the moderating effect of gender on value-belief-norm relationships. In addition, this study aims to investigate the factors that affect green purchase behavior of cosmetics products. Particularly, this study investigates the causal relationships between values and pro-environmental beliefs, pro-environmental beliefs and personal norms and personal norms and green purchase behavior. An online survey was carried out which yielded 240 usable responses among which 79 responses were obtained from males and 161 from females. Data were analyzed using structural equation modeling, partial least square (PLS-SEM) approach and multi-group analysis (MGA) technique. Results revealed that all direct relationships were supported by the data. It was also found that gender moderates the relationships between altruistic values and pro-environmental beliefs, pro-environmental beliefs and personal norms and personal norms and green purchase behavior. Nevertheless, gender did not moderate the link between hedonic value and pro-environmental beliefs. This study contributes to the existing literature by considering gender as a moderator, which is comparatively new in the green purchase behavior literature. In addition, this study examines few new linkages: more specifically, incorporating hedonic value in value-belief link and adapting value-belief-norm (VBN) theory in measuring consumers' green purchase behavior.
Fulltext Comparative Evaluation of Dental Implant Failure among Healthy and Well-Controlled Diabetic Patients-A 3-Year Retrospective Study

Sghaireen MG, Alduraywish AA, Srivastava KC, Shrivastava D, Patil SR, Al Habib S, et al.

Int J Environ Res Public Health, 2020 07 21;17(14).
PMID: 32708165 DOI: 10.3390/ijerph17145253

Diabetes mellitus is known to compromise the various aspects of homeostasis, including the immune response and the composition of oral microflora. One of the oral manifestations of diabetes mellitus is tooth loss and the survival rate of dental implants chosen as a treatment modality for its rehabilitation is controversial. The current study aims to evaluate and compare the failure rate of dental implants between well-controlled diabetic and healthy patients. A retrospective study of case-control design was conceptualized with 121 well-controlled diabetic and 136 healthy individuals. Records of subjects who had undergone oral rehabilitation with dental implants between the periods of January 2013 to January 2016 were retrieved. Post-operative evaluation was carried out for all patients for about three years to assess the immediate and long-term success of the procedure. From a total of 742 dental implants, 377 were placed in well-controlled diabetic patients (case group) and 365 in healthy subjects (control group). A comparable (9.81%), but non-significant (p = 0.422) failure rate was found in the case group in comparison to the control group (9.04%). A non-significant (p = 0.392) raised number (4.98%) of failure cases were reported among females in comparison to males (4.44%). In respect to arch, the mandibular posterior region was reported as the highest failure cases (3.09%; p = 0.411), with 2.29% of cases reported in the mandibular anterior (p = 0.430) and maxillary posterior (p = 0.983) each. The maxillary anterior region was found to have the least number (1.75%; p = 0.999) of failure cases. More (4.98%; p = 0.361) cases were reported to fail during the functional loading stage in contrast to osseointegration (4.44%; p = 0.365). A well-controlled diabetic status does not impose any additional risk for individuals undergoing dental implant therapy.
Fulltext Correlation of Mortality Burdens of Cerebrovascular Disease and Diabetes Mellitus with Domestic Consumption of Soya and Palm Oils

Ismail M, Alsalahi A, Khaza'ai H, Imam MU, Ooi J, Samsudin MN, et al.

Int J Environ Res Public Health, 2020 07 28;17(15).
PMID: 32731336 DOI: 10.3390/ijerph17155410

BACKGROUND: Cerebrovascular diseases (CBVDs) and diabetes mellitus (DM) are interrelated and cumbersome global health burdens. However, the relationship between edible oils consumption and mortality burdens of CBVDs and DM has not yet been evaluated. This review aims to explore correlations between per capita mortality burdens of CBVDs and DM, as well as food consumption of palm or soya oils in 11 randomly selected countries in 2005, 2010, and 2016.
METHODS: After obtaining data on food consumption of palm and soya oils and mortality burdens of CBVDs and DM, correlations between the consumption of oils and mortality burdens of diseases were explored.
RESULTS: There was a positive correlation between the consumption of soya oil with the mortality burden of CBVDs in Australia, Switzerland, and Indonesia, as well as the mortality burden of DM in the USA. The consumption of palm oil had a positive correlation with the mortality burden of DM in Jordan only.
CONCLUSIONS: Food consumption of soya oil in several countries possibly contributes to the mortality burden of CBVDs or DM more than food consumption of palm oil, which could be a possible risk factor in the mortality burdens of CBVDs and DM.
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 A Systematic Review of the Economic Burden of Type 2 Diabetes in Malaysia

Ganasegeran K, Hor CP, Jamil MFA, Loh HC, Noor JM, Hamid NA, et al.

Int J Environ Res Public Health, 2020 08 07;17(16).
PMID: 32784771 DOI: 10.3390/ijerph17165723

Diabetes causes significant disabilities, reduced quality of life and mortality that imposes huge economic burden on societies and governments worldwide. Malaysia suffers a high diabetes burden in Asia, but the magnitude of healthcare expenditures documented to aid national health policy decision-making is limited. This systematic review aimed to document the economic burden of diabetes in Malaysia, and identify the factors associated with cost burden and the methods used to evaluate costs. Studies conducted between 2000 and 2019 were retrieved using three international databases (PubMed, Scopus, EMBASE) and one local database (MyCite), as well as manual searches. Peer reviewed research articles in English and Malay on economic evaluations of adult type 2 diabetes conducted in Malaysia were included. The review was registered with PROSPERO (CRD42020151857), reported according to PRISMA and used a quality checklist adapted for cost of illness studies. Data were extracted using a data extraction sheet that included study characteristics, total costs, different costing methods and a scoring system to assess the quality of studies reviewed. The review identified twelve eligible studies that conducted cost evaluations of type 2 diabetes in Malaysia. Variation exists in the costs and methods used in these studies. For direct costs, four studies evaluated costs related to complications and drugs, and two studies were related to outpatient and inpatient costs each. Indirect and intangible costs were estimated in one study. Four studies estimated capital and recurrent costs. The estimated total annual cost of diabetes in Malaysia was approximately USD 600 million. Age, type of hospitals or health provider, length of inpatient stay and frequency of outpatient visits were significantly associated with costs. The most frequent epidemiological approach employed was prevalence-based (n = 10), while cost analysis was the most common costing approach used. The current review offers the first documented evidence on cost estimates of diabetes in Malaysia.
Fulltext Bone Marrow Oxidative Stress and Acquired Lineage-Specific Genotoxicity in Hematopoietic Stem/Progenitor Cells Exposed to 1,4-Benzoquinone

Mathialagan RD, Abd Hamid Z, Ng QM, Rajab NF, Shuib S, Binti Abdul Razak SR

Int J Environ Res Public Health, 2020 08 13;17(16).
PMID: 32823552 DOI: 10.3390/ijerph17165865

Hematopoietic stem/progenitor cells (HSPCs) are susceptible to benzene-induced genotoxicity. However, little is known about the mechanism of DNA damage response affecting lineage-committed progenitors for myeloid, erythroid, and lymphoid. Here, we investigated the genotoxicity of a benzene metabolite, 1,4-benzoquinone (1,4-BQ), in HSPCs using oxidative stress and lineage-directed approaches. Mouse bone marrow cells (BMCs) were exposed to 1,4-BQ (1.25-12 μM) for 24 h, followed by oxidative stress and genotoxicity assessments. Then, the genotoxicity of 1,4-BQ in lineage-committed progenitors was evaluated using colony forming cell assay following 7-14 days of culture. 1,4-BQ exposure causes significant decreases (p < 0.05) in glutathione level and superoxide dismutase activity, along with significant increases (p < 0.05) in levels of malondialdehyde and protein carbonyls. 1,4-BQ exposure induces DNA damage in BMCs by significantly (p < 0.05) increased percentages of DNA in tail at 7 and 12 μM and tail moment at 12 μM. We found crucial differences in genotoxic susceptibility based on percentages of DNA in tail between lineage-committed progenitors. Myeloid and pre-B lymphoid progenitors appeared to acquire significant DNA damage as compared with the control starting from a low concentration of 1,4-BQ exposure (2.5 µM). In contrast, the erythroid progenitor showed significant damage as compared with the control starting at 5 µM 1,4-BQ. Meanwhile, a significant (p < 0.05) increase in tail moment was only notable at 7 µM and 12 µM 1,4-BQ exposure for all progenitors. Benzene could mediate hematological disorders by promoting bone marrow oxidative stress and lineage-specific genotoxicity targeting HSPCs.
Fulltext Effectiveness of Health-Led Cognitive Behavioral-Based Group Therapy on Pain, Functional Disability and Psychological Outcomes among Knee Osteoarthritis Patients in Malaysia

Foo CN, Arumugam M, Lekhraj R, Lye MS, Mohd-Sidik S, Jamil Osman Z

Int J Environ Res Public Health, 2020 08 26;17(17).
PMID: 32858791 DOI: 10.3390/ijerph17176179

BACKGROUND: Psychosocial interventions for patients with osteoarthritis (OA) of the knee to reduce pain and improve physical and psychological functioning are still lacking in Malaysia.
METHODS: A parallel-group unblinded randomized controlled trial involving 300 patients was conducted in two hospital orthopedics clinics in Malaysia. Patients were randomly assigned to receive cognitive behavioral-based group therapy (n = 150) or no further intervention (n = 150). The primary outcome was the change from baseline in knee pain as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 months. The data collected were analyzed by covariate-adjusted mixed design repeated measures analysis of variance. All analyses were performed under the terms of intention-to-treat.
RESULTS: At 6 months, mean change from baseline in the KOOS knee pain score was 0.6 points (95% CI -1.73 to 2.94) in the control group and 8.9 points (95% CI 6.62 to 11.23) (denoting less knee pain intensity) in the intervention group (significant treatment effect p < 0.0001). Patients treated with such an approach also experienced significant improvement in functional ability when performing activities of daily living and had improved ability to cope with depression, anxiety and pain catastrophizing.
CONCLUSION: The intervention module delivered by healthcare professionals had a sustained effect on knee OA pain and functionality over 6 months, thereby leading to an overall improvement in psychological well-being, thus benefitting most of the Malaysian knee OA patients.
Fulltext Age-Friendly Environments in ASEAN Plus Three: Case Studies from Japan, Malaysia, Myanmar, Vietnam, and Thailand

Tiraphat S, Buntup D, Munisamy M, Nguyen TH, Yuasa M, Nyein Aung M, et al.

Int J Environ Res Public Health, 2020 06 23;17(12).
PMID: 32586034 DOI: 10.3390/ijerph17124523

Promoting age-friendly environment is one of the appropriate approaches to support quality of life toward ageing populations. However, the information regarding age-friendly environments in the Association of Southeast Asian Nations (ASEAN) Plus Three countries is still limited. This study aimed to survey the perceived age-friendly environments among ASEAN Plus Three older populations. This study employed cross-sectional quantitative research using multistage cluster sampling to select a sample of older adults in the capital cities of Japan, Malaysia, Myanmar, Vietnam and Thailand. The final sample was composed of 2171 older adults aged 55 years and over, including 140 Japanese, 510 Thai, 537 Malaysian, 487 Myanmarese, and 497 Vietnamese older adults. Data collection was conducted using a quantitative questionnaire with 20 items of perceived age-friendly environments with the rating scale based on the World Health Organization (WHO) standard. The score from the 20 items were analyzed and examined high-risk groups of "bad perception level" age-friendly environments using ordinal logistic regression. The research indicated the five highest inadequacies of age-friendly environments including: (1) participating in an emergency-response training session or drill which addressed the needs of older residents; (2) enrolling in any form of education or training, either formal or non-formal in any subject; (3) having opportunities for paid employment; (4) involvement in decision making about important political, economic and social issues in the community; and (5) having personal care or assistance needs met in the older adult's home setting by government/private care services. Information regarding the inadequacy of age-friendliness by region was evidenced to guide policy makers in providing the right interventions towards older adults' needs.
Fulltext Landslide Susceptibility Mapping Using Machine Learning Algorithms and Remote Sensing Data in a Tropical Environment

Nhu VH, Mohammadi A, Shahabi H, Ahmad BB, Al-Ansari N, Shirzadi A, et al.

Int J Environ Res Public Health, 2020 07 08;17(14).
PMID: 32650595 DOI: 10.3390/ijerph17144933

We used AdaBoost (AB), alternating decision tree (ADTree), and their combination as an ensemble model (AB-ADTree) to spatially predict landslides in the Cameron Highlands, Malaysia. The models were trained with a database of 152 landslides compiled using Synthetic Aperture Radar Interferometry, Google Earth images, and field surveys, and 17 conditioning factors (slope, aspect, elevation, distance to road, distance to river, proximity to fault, road density, river density, normalized difference vegetation index, rainfall, land cover, lithology, soil types, curvature, profile curvature, stream power index, and topographic wetness index). We carried out the validation process using the area under the receiver operating characteristic curve (AUC) and several parametric and non-parametric performance metrics, including positive predictive value, negative predictive value, sensitivity, specificity, accuracy, root mean square error, and the Friedman and Wilcoxon sign rank tests. The AB model (AUC = 0.96) performed better than the ensemble AB-ADTree model (AUC = 0.94) and successfully outperformed the ADTree model (AUC = 0.59) in predicting landslide susceptibility. Our findings provide insights into the development of more efficient and accurate landslide predictive models that can be used by decision makers and land-use managers to mitigate landslide hazards.
Fulltext Perception of Health Conditions and Test Availability as Predictors of Adults' Mental Health during the COVID-19 Pandemic: A Survey Study of Adults in Malaysia

Dai H, Zhang SX, Looi KH, Su R, Li J

Int J Environ Res Public Health, 2020 07 30;17(15).
PMID: 32751459 DOI: 10.3390/ijerph17155498

Research identifying adults' mental health during the coronavirus disease 2019 (COVID-19) pandemic relies solely on demographic predictors without examining adults' health condition as a potential predictor. This study aims to examine individuals' perception of health conditions and test availability as potential predictors of mental health-insomnia, anxiety, depression, and distress-during the COVID-19 pandemic. An online survey of 669 adults in Malaysia was conducted during 2-8 May 2020, six weeks after the Movement Control Order (MCO) was issued. We found adults' perception of health conditions had curvilinear relationships (horizontally reversed J-shaped) with insomnia, anxiety, depression, and distress. Perceived test availability for COVID-19 also had curvilinear relationships (horizontally reversed J-shaped) with anxiety and depression. Younger adults reported worse mental health, but people from various religions and ethnic groups did not differ significantly in reported mental health. The results indicated that adults with worse health conditions had more mental health problems, and the worse degree deepened for unhealthy people. Perceived test availability negatively predicted anxiety and depression, especially for adults perceiving COVID-19 test unavailability. The significant predictions of perceived health condition and perceived COVID-19 test availability suggest a new direction for the literature to identify the psychiatric risk factors directly from health-related variables during a pandemic.
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 Developing an Ensemble Predictive Safety Risk Assessment Model: Case of Malaysian Construction Projects

Sadeghi H, Mohandes SR, Hosseini MR, Banihashemi S, Mahdiyar A, Abdullah A

Int J Environ Res Public Health, 2020 11 13;17(22).
PMID: 33202768 DOI: 10.3390/ijerph17228395

Occupational Health and Safety (OHS)-related injuries are vexing problems for construction projects in developing countries, mostly due to poor managerial-, governmental-, and technical safety-related issues. Though some studies have been conducted on OHS-associated issues in developing countries, research on this topic remains scarce. A review of the literature shows that presenting a predictive assessment framework through machine learning techniques can add much to the field. As for Malaysia, despite the ongoing growth of the construction sector, there has not been any study focused on OHS assessment of workers involved in construction activities. To fill these gaps, an Ensemble Predictive Safety Risk Assessment Model (EPSRAM) is developed in this paper as an effective tool to assess the OHS risks related to workers on construction sites. The developed EPSRAM is based on the integration of neural networks with fuzzy inference systems. To show the effectiveness of the EPSRAM developed, it is applied to several Malaysian construction case projects. This paper contributes to the field in several ways, through: (1) identifying major potential safety risks, (2) determining crucial factors that affect the safety assessment for construction workers, (3) predicting the magnitude of identified safety risks accurately, and (4) predicting the evaluation strategies applicable to the identified risks. It is demonstrated how EPSRAM can provide safety professionals and inspectors concerned with well-being of workers with valuable information, leading to improving the working environment of construction crew members.
Fulltext Improvement of Ficin-Based Inhibitive Enzyme Assay for Toxic Metals Using Response Surface Methodology and Its Application for Near Real-Time Monitoring of Mercury in Marine Waters

Uba G, Manogaran M, Gunasekaran B, Halmi MIE, Shukor MYA

Int J Environ Res Public Health, 2020 11 19;17(22).
PMID: 33227985 DOI: 10.3390/ijerph17228585

Potentially toxic metals pollution in the Straits of Malacca warrants the development of rapid, simple and sensitive assays. Enzyme-based assays are excellent preliminary screening tools with near real-time potential. The heavy-metal assay based on the protease ficin was optimized for mercury detection using response surface methodology. The inhibitive assay is based on ficin action on the substrate casein and residual casein is determined using the Coomassie dye-binding assay. Toxic metals strongly inhibit this hydrolysis. A central composite design (CCD) was utilized to optimize the detection of toxic metals. The results show a marked improvement for the concentration causing 50% inhibition (IC50) for mercury, silver and copper. Compared to one-factor-at-a-time (OFAT) optimization, RSM gave an improvement of IC50 (mg/L) from 0.060 (95% CI, 0.030-0.080) to 0.017 (95% CI, 0.016-0.019), from 0.098 (95% CI, 0.077-0.127) to 0.028 (95% CI, 0.022-0.037) and from 0.040 (95% CI, 0.035-0.045) to 0.023 (95% CI, 0.020-0.027), for mercury, silver and copper, respectively. A near-real time monitoring of mercury concentration in the Straits of Malacca at one location in Port Klang was carried out over a 4 h interval for a total of 24 h and validated by instrumental analysis, with the result revealing an absence of mercury pollution in the sampling site.
Fulltext Double Eyelid Tape Wear Affects Anterior Ocular Health among Young Adult Women with Single Eyelids

Yong PT, Arif N, Sharanjeet-Kaur S, Hairol MI

Int J Environ Res Public Health, 2020 10 22;17(21).
PMID: 33105550 DOI: 10.3390/ijerph17217701

Many East Asians apply double eyelid tape to create the double eyelid effect temporarily as a means of increasing their beauty. This study evaluated the effects of four-week wear of double eyelid tape on anterior ocular health in young adult women with single eyelids. Twenty-nine participants who met the inclusion criteria were recruited. The participants' anterior ocular health was examined including blinking characteristics (blink pattern and blink rate), ocular surface health (presence of corneal abrasion, corneal staining, conjunctival staining, corneal curvatures, meibomian gland dysfunction), tear break up time, intraocular pressure, and subjective comfort level. Participants were required to apply the double eyelid tape for at least eight hours a day and five days a week for four weeks. The parameters were re-measured at the end of each week. There was a significant increase in conjunctival staining, corneal staining, and meibomian gland dysfunction, with a significant reduction in tear break-up time and intraocular pressure. By week 3, all participants had incomplete blinks. There was no significant change in symptoms and subjective comfort level reported. Therefore, patients and eye care practitioners should be aware of the potential implications of double eyelid tape wear on ocular health, with no significant change in subjective comfort.
Fulltext Attitudes Toward Patient Safety among Medical Students in Malaysia

Nadarajan SP, Karuthan SR, Rajasingam J, Chinna K

Int J Environ Res Public Health, 2020 10 22;17(21).
PMID: 33105745 DOI: 10.3390/ijerph17217721

The biggest challenge in moving toward a safer healthcare system is patient safety culture-that is, the prevention of harm to patients. Safe medical practices can prevent doing harm to the patients. For this, healthcare professionals must have good attitudes toward patient safety. Medical education plays an important role in promoting patient safety and patient safety attitudes. A study was conducted among medical students in Malaysia to assess their perceptions toward patient safety, using the 26-items Attitudes Toward Patient Safety Questionnaire (APSQ-III). In the analysis, the average percentage of positive responses (APPR) were computed for each domain, and APPR values of ≥75 were used as an indicator of positive perception. Out of the nine domains of APSQ, the students' attitude was positive in six-Safety Training (85.2%), Error Reporting (76.3%), Working Hours (89.5%), Error Inevitability (86.1%), Team Functioning (94.6%), and Patient Involvement (80.1%). The desired level of positive attitude was not met in Disclosure Responsibility (68.5%), Professional Incompetence (70.0%), and Safety Curriculum (71.1%). APRR for disclosure responsibility was high among the first-year students, but, generally, the effect wore off over the years of study. The results support the need to enhance perception on Disclosure Responsibility, Professional Incompetence, and Safety Curriculum among the medical students in Malaysia.
Fulltext Global Prevalence of Macroprolactinemia among Patients with Hyperprolactinemia: A Systematic Review and Meta-Analysis

Che Soh NAA, Yaacob NM, Omar J, Mohammed Jelani A, Shafii N, Tuan Ismail TS, et al.

Int J Environ Res Public Health, 2020 11 06;17(21).
PMID: 33171973 DOI: 10.3390/ijerph17218199

Hyperprolactinemia (hPRL) often poses a diagnostic dilemma due to the presence of macroprolactin. Understanding the prevalence of macroprolactinemia (mPRL) has an important implication in managing patients with hPRL. The primary aim of this study was to determine the prevalence of mPRL globally and to explore selected factors influencing the prevalence estimate. Studies with original data related to the prevalence of mPRL among patients with hPRL from inception to March 2020 were identified, and a random effects meta-analysis was performed. Of the 3770 records identified, 67 eligible studies from 27 countries were included. The overall global prevalence estimate was 18.9% (95% CI: 15.8%, 22.1%) with a substantial statistical heterogeneity (I2 = 95.7%). The highest random effects pooled prevalence was observed in the African region (30.3%), followed by Region of the Americas (29.1%), European (17.5%), Eastern Mediterranean (13.9%), South-East Asian (12.7%), and Western Pacific Region (12.6%). Lower prevalence was observed in studies involving both sexes as compared to studies involving only female participants (17.1% vs. 25.4%) and in more recent studies (16.4%, 20.4%, and 26.5% in studies conducted after 2009, between 2000 and 2009, and before 2000, respectively). The prevalence estimate does not vary according to the age group of study participants, sample size, and types of polyethylene glycol (PEG) used for detection of macroprolactin (PEG 6000 or PEG 8000). With macroprolactin causing nearly one-fifth of hPRL cases, screening for mPRL should be made a routine before an investigation of other causes of hPRL.
Fulltext Prevalence of Alpha(α)-Thalassemia in Southeast Asia (2010-2020): A Meta-Analysis Involving 83,674 Subjects

Goh LPW, Chong ETJ, Lee PC

Int J Environ Res Public Health, 2020 10 09;17(20).
PMID: 33050119 DOI: 10.3390/ijerph17207354

Alpha(α)-thalassemia is a blood disorder caused by many types of inheritable α-globin gene mutations which causes no-to-severe clinical symptoms, such as Hb Bart's hydrops fetalis that leads to early foetal death. Therefore, the aim of this meta-analysis was to provide an update from year 2010 to 2020 on the prevalence of α-thalassemia in Southeast Asia. A systematic literature search was performed using PubMed and SCOPUS databases for related studies published from 2010 to 2020, based on specified inclusion and exclusion criteria. Heterogeneity of included studies was examined with the I2 index and Q-test. Funnel plots and Egger's tests were performed in order to determine publication bias in this meta-analysis. Twenty-nine studies with 83,674 subjects were included and pooled prevalence rates in this meta-analysis were calculated using random effect models based on high observed heterogeneity (I2 > 99.5, p-value < 0.1). Overall, the prevalence of α-thalassemia is 22.6%. The highest α-thalassemia prevalence was observed in Vietnam (51.5%) followed by Cambodia (39.5%), Laos (26.8%), Thailand (20.1%), and Malaysia (17.3%). No publication bias was detected. Conclusions: This meta-analysis suggested that a high prevalence of α-thalassemia occurred in selected Southeast Asia countries. This meta-analysis data are useful for designing thalassemia screening programs and improve the disease management.
Fulltext Assessing the Prevalence and Association of Pulp Stones with Cardiovascular Diseases and Diabetes Mellitus in the Saudi Arabian Population-A CBCT Based Study

Srivastava KC, Shrivastava D, Nagarajappa AK, Khan ZA, Alzoubi IA, Mousa MA, et al.

Int J Environ Res Public Health, 2020 12 11;17(24).
PMID: 33322604 DOI: 10.3390/ijerph17249293

The detection of pulp stone in a patient suffering from undiagnosed systemic diseases can be an early diagnostic indicator. Thus, the aim of the study was to assess the prevalence of pulp stones in the Saudi Arabian population with cardiovascular diseases and diabetes mellitus. In a retrospective study, we included cone-beam computed tomography (CBCT) scans of 73 patients with cardiovascular disease and 76 patients with diabetes mellitus as group I and II, respectively. Group III comprised of CBCT scan of 80 healthy controls. From a total of 229 scans, 4807 teeth were screened for pulp stones throughout the arches. A chi-square test was used for comparing the prevalence of pulp stones among the groups. Univariable and multivariable analysis was done to evaluate the independent risk indicators for pulp stones. The tooth-wise prevalence of pulp stones in group I, II, and III was found to be 16.65%, 9.01%, and 3.86%, respectively. Patient-wise (p < 0.01) and tooth-wise (p < 0.01) prevalence was recorded significantly highest in the cardiovascular group followed by the diabetic group. The control group had the least prevalence. Significantly (p < 0.01) higher number of pulp stones were found in cardiovascular patients with age > 50 years compared to other groups. Similarly, a significantly increased number of pulp stones were seen in the 1st molar (p < 0.05) and the maxillary jaw (p < 0.05) of patients with cardiovascular diseases. Subjects with cardiovascular disease and diabetes were found to have 2.94 times (p < 0.001; CI 1.54-3.10) and 1.81 times (p < 0.01; CI 0.48-2.06) higher risk of having pulp stones in comparison to healthy subjects. The first molar has 2.20 times (p < 0.001; CI 0.84-2.45) increased the risk of having pulp stones compared to other tooth types. Systemic disease such as cardiovascular disease and diabetes mellitus poses a higher risk for the development of pulp stones. Among the systemic disease group, patients in the cardiovascular group showed a higher risk for pulp stones and also reported the maximum number of pulp stones compared to the diabetic and healthy subjects.

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