Displaying publications 161 - 180 of 750 in total

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  1. Fulltext Nigella sativa and Its Active Compound, Thymoquinone, Accelerate Wound Healing in an In Vivo Animal Model: A Comprehensive Review
    Sallehuddin N, Nordin A, Bt Hj Idrus R, Fauzi MB
    Int J Environ Res Public Health, 2020 06 11;17(11).
    PMID: 32545210 DOI: 10.3390/ijerph17114160
    Nigella sativa (NS) has been reported to have a therapeutic effect towards skin wound healing via its anti-inflammatory, tissue growth stimulation, and antioxidative properties. This review examines all the available studies on the association of Nigella sativa (NS) and skin wound healing. The search was performed in Medline via EBSCOhost and Scopus databases to retrieve the related papers released between 1970 and March 2020. The principal inclusion criteria were original article issued in English that stated wound healing criteria of in vivo skin model with topically applied NS. The search discovered 10 related articles that fulfilled the required inclusion criteria. Studies included comprise different types of wounds, namely excisional, burn, and diabetic wounds. Seven studies unravelled positive results associated with NS on skin wound healing. Thymoquinone has anti-inflammatory, antioxidant, and antibacterial properties, which mainly contributed to wound healing process.
  2. Fulltext Associations of Body Mass Index with Demographics, Lifestyle, Food Intake, and Mental Health among Postpartum Women: A Structural Equation Approach
    Salarzadeh Jenatabadi H, Bt Wan Mohamed Radzi CWJ, Samsudin N
    Int J Environ Res Public Health, 2020 07 18;17(14).
    PMID: 32708480 DOI: 10.3390/ijerph17145201
    As postpartum obesity is becoming a global public health challenge, there is a need to apply postpartum obesity modeling to determine the indicators of postpartum obesity using an appropriate statistical technique. This research comprised two phases, namely: (i) development of a previously created postpartum obesity modeling; (ii) construction of a statistical comparison model and introduction of a better estimator for the research framework. The research model displayed the associations and interactions between the variables that were analyzed using the Structural Equation Modeling (SEM) method to determine the body mass index (BMI) levels related to postpartum obesity. The most significant correlations obtained were between BMI and other substantial variables in the SEM analysis. The research framework included two categories of data related to postpartum women: living in urban and rural areas in Iran. The SEM output with the Bayesian estimator was 81.1%, with variations in the postpartum women's BMI, which is related to their demographics, lifestyle, food intake, and mental health. Meanwhile, the variation based on SEM with partial least squares estimator was equal to 70.2%, and SEM with a maximum likelihood estimator was equal to 76.8%. On the other hand, the output of the root mean square error (RMSE), mean absolute error (MSE) and mean absolute percentage error (MPE) for the Bayesian estimator is lower than the maximum likelihood and partial least square estimators. Thus, the predicted values of the SEM with Bayesian estimator are closer to the observed value compared to maximum likelihood and partial least square. In conclusion, the higher values of R-square and lower values of MPE, RMSE, and MSE will produce better goodness of fit for SEM with Bayesian estimators.
  3. Fulltext Development of Nonlaboratory-Based Risk Prediction Models for Cardiovascular Diseases Using Conventional and Machine Learning Approaches
    Sajid MR, Almehmadi BA, Sami W, Alzahrani MK, Muhammad N, Chesneau C, et al.
    Int J Environ Res Public Health, 2021 11 29;18(23).
    PMID: 34886312 DOI: 10.3390/ijerph182312586
    Criticism of the implementation of existing risk prediction models (RPMs) for cardiovascular diseases (CVDs) in new populations motivates researchers to develop regional models. The predominant usage of laboratory features in these RPMs is also causing reproducibility issues in low-middle-income countries (LMICs). Further, conventional logistic regression analysis (LRA) does not consider non-linear associations and interaction terms in developing these RPMs, which might oversimplify the phenomenon. This study aims to develop alternative machine learning (ML)-based RPMs that may perform better at predicting CVD status using nonlaboratory features in comparison to conventional RPMs. The data was based on a case-control study conducted at the Punjab Institute of Cardiology, Pakistan. Data from 460 subjects, aged between 30 and 76 years, with (1:1) gender-based matching, was collected. We tested various ML models to identify the best model/models considering LRA as a baseline RPM. An artificial neural network and a linear support vector machine outperformed the conventional RPM in the majority of performance matrices. The predictive accuracies of the best performed ML-based RPMs were between 80.86 and 81.09% and were found to be higher than 79.56% for the baseline RPM. The discriminating capabilities of the ML-based RPMs were also comparable to baseline RPMs. Further, ML-based RPMs identified substantially different orders of features as compared to baseline RPM. This study concludes that nonlaboratory feature-based RPMs can be a good choice for early risk assessment of CVDs in LMICs. ML-based RPMs can identify better order of features as compared to the conventional approach, which subsequently provided models with improved prognostic capabilities.
  4. Fulltext Poor Self-Rated Health and Associated Factors among Older Persons in Malaysia: A Population-Based Study
    Sahril N, Chan YM, Chan YY, Ahmad NA, Kassim MSA, Shahein NA, et al.
    Int J Environ Res Public Health, 2023 Feb 28;20(5).
    PMID: 36901351 DOI: 10.3390/ijerph20054342
    OBJECTIVE: This study aims to determine the prevalence of poor self-rated health (SRH) in Malaysia and its association with sociodemographic characteristics, lifestyle behavior, chronic diseases, depression, and functional limitations in activities of daily living (ADLs) among older persons.

    DESIGN: Cross-sectional. Setting, participants, and outcome measures: We used data from the National Health and Morbidity Survey 2018, a nationwide community-based study. This study was conducted using a two-stage stratified cluster sampling design. Older persons were defined as persons aged 60 years and above. SRH was assessed using the question "How do you rate your general health?" and the answers were "very good", "good", "moderate", "not good", and "very bad". SRH was then grouped into two categories; "Good" (very good and good) and "Poor" (moderate, not good, and very bad). Descriptive and logistic regression analyses were conducted using SPSS version 25.0.

    RESULTS: The prevalence of poor SRH among older persons was 32.6%. Poor SRH was significantly related to physical inactivity, depression, and limitations in activities of daily living (ADLs). Multiple logistic regression revealed that poor SRH was positively associated with those who had depression (aOR 2.92, 95% CI:2.01,4.24), limitations in ADLs (aOR 1.82, 95% CI: 1.31, 2.54), low individual income (aOR 1.66, 95% CI:1.22, 2.26), physical inactivity (aOR 1.40, 95% CI:1.08, 1.82), and hypertension (aOR 1.23, 95% CI:1.02, 1.49).

    CONCLUSIONS: Older persons with depression, limitations in ADLs, low income, physical inactivity, and hypertension were significantly associated with poor SRH. These findings provide information to aid health personnel and policymakers in the development and implementation of health promotion and disease prevention programs, as well as adequate evidence in planning different levels of care for the older population.

  5. Fulltext Adaptation and Psychometric Validation of the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) among Patients with Metabolic Syndrome in Primary Care
    Sahar NH, Badlishah-Sham SF, Ramli AS
    Int J Environ Res Public Health, 2021 09 06;18(17).
    PMID: 34502011 DOI: 10.3390/ijerph18179405
    Self-management support is one of the most important components of the Chronic Care Model (CCM). The EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was developed for patients with Metabolic Syndrome (MetS), inspired by the CCM. Assessing usability of a self-management tool is important in chronic disease management. However, there was no available instrument to assess usability of a self-management booklet, as most instruments were developed to assess usability of mobile application. Therefore, this study aimed to adapt Skala Kebolehgunaan Aplikasi Mudah Alih (SKAMA) into the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) and to determine its validity and reliability in assessing usability of a self-management booklet. A cross-sectional validation study was conducted among patients with MetS attending a university primary care clinic in Selangor, Malaysia. Content validation, adaptation and face validation of E-SUQ were performed according to recommended guidelines. It underwent two rounds of content validation as major revision was required for item 5. Subsequently, the revised E-SUQ was face-validated by 10 participants. Psychometric evaluation was conducted using principal component analysis with varimax rotation to determine the underlying structure of E-SUQ. Internal consistency reliability was assessed using Cronbach's α coefficient and the test-retest reliability was assessed using intraclass correlation coefficient (ICC (2,k)). A total of 205 patients participated in the study. The item-level content-validity-index (I-CVI) for item 5 improved from 0.57 to 1.0 after the second round of content validation. The final S-CVI/Ave value for ESUQ was >0.90. The item-level face-validity-index (I-FVI) ranged between 0.9 and 1.0. Kaiser-Meyer-Olkin value of 0.871 and Bartlett's test of sphericity p-value of <0.05 indicated good sample adequacy for factor analysis. Two factors with eigenvalues of >1 were extracted according to the Kaiser's Criteria. The two extracted factors explained 60.6% of the cumulative percentage of variance. The elbow of the scree plot occurred between the second and third component, suggesting two factors to be retained. The two factors were consistent with "Positive" and "Negative" tone model. The overall Cronbach's α coefficient was 0.77, indicating good internal reliability. The overall ICC was 0.85, indicating good reproducibility. The E-SUQ is shown to be valid, reliable and stable to measure the usability of a self-management booklet among patients with MetS in a university primary care clinic in Malaysia.
  6. 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.
  7. Fulltext Pristine and Magnetic Kenaf Fiber Biochar for Cd2+ Adsorption from Aqueous Solution
    Saeed AAH, Harun NY, Sufian S, Bilad MR, Zakaria ZY, Jagaba AH, et al.
    Int J Environ Res Public Health, 2021 Jul 27;18(15).
    PMID: 34360240 DOI: 10.3390/ijerph18157949
    Development of strategies for removing heavy metals from aquatic environments is in high demand. Cadmium is one of the most dangerous metals in the environment, even under extremely low quantities. In this study, kenaf and magnetic biochar composite were prepared for the adsorption of Cd2+. The synthesized biochar was characterized using (a vibrating-sample magnetometer VSM), Scanning electron microscopy (SEM), X-ray powder diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), and X-ray photoelectron spectroscopy (XPS). The adsorption batch study was carried out to investigate the influence of pH, kinetics, isotherm, and thermodynamics on Cd2+ adsorption. The characterization results demonstrated that the biochar contained iron particles that help in improving the textural properties (i.e., surface area and pore volume), increasing the number of oxygen-containing groups, and forming inner-sphere complexes with oxygen-containing groups. The adsorption study results show that optimum adsorption was achieved under pH 5-6. An increase in initial ion concentration and solution temperature resulted in increased adsorption capacity. Surface modification of biochar using iron oxide for imposing magnetic property allowed for easy separation by external magnet and regeneration. The magnetic biochar composite also showed a higher affinity to Cd2+ than the pristine biochar. The adsorption data fit well with the pseudo-second-order and the Langmuir isotherm, with the maximum adsorption capacity of 47.90 mg/g.
  8. 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.
  9. Fulltext Exploring the Relationships of Financial Literacy and Financial Behaviour with Health-Related Quality of Life (HRQOL) among the Low-Income Working Population in Malaysia during the COVID-19 Pandemic
    Sabri MF, Said MA, Magli AS, Pin TM, Rizal H, Thangiah N, et al.
    Int J Environ Res Public Health, 2022 Sep 30;19(19).
    PMID: 36231818 DOI: 10.3390/ijerph191912520
    This cross-sectional study examined the relationships of financial literacy (FL) and financial behaviour (FB) with health-related quality of life (HRQOL) during the COVID-19 pandemic among low-income working population (20-60 years old) in Malaysia. A self-administered questionnaire survey was used with HRQOL data were gathered using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) tool. A generalised linear model was employed to examine the hypothesised relationships between the constructs. From 1186 respondents, the majority were employed (73.9%), had a monthly household income of less than RM 2500 (74.5%), and did not have any chronic medical conditions (74.5%). The mean (SD) values of FL, FB, and EQ-5D-5L were 5.95 (1.48), 22.08 (4.79), and 0.96 (0.10), respectively. The results of the adjusted model revealed lower age group, Malay ethnicity, Indian ethnicity, and increased FB score as significant determinants of higher EQ-5D-5L scores. With the addition of the chronic medical condition factor into the saturated model, the lower age group, ethnicity, and no chronic medical condition were significant determinants of higher HRQOL. The effects of FB on QOL were confounded by chronic diseases, implying that interventions that focus on improving FB for those with chronic medical condition may help to improve the QOL among the low-income working population.
  10. Fulltext Bullying and Its Associated Individual, Peer, Family and School Factors: Evidence from Malaysian National Secondary School Students
    Sabramani V, Idris IB, Ismail H, Nadarajaw T, Zakaria E, Kamaluddin MR
    Int J Environ Res Public Health, 2021 Jul 05;18(13).
    PMID: 34281145 DOI: 10.3390/ijerph18137208
    Adolescents involved in bullying can be at risk of developing behavioural problems, physical health problems and suicidal ideation. In view of this, a quantitative research design using a cross-sectional study was conducted to determine the prevalence of bullying and associated individual, peer, family and school factors. The study involved 4469 Malaysian public-school students who made up the response rate of 89.4%. The students were selected using a randomized multilevel sampling method. The study found that 79.1% of student respondents were involved in bullying as perpetrators (14.4%), victims (16.3%), or bully-victims (48.4%). In a multivariate analysis, the individual domain showed a significant association between students' bullying involvement and age (OR = 1.38; 95% CI 1.12-1.70), gender (OR = 1.73; 95% CI 1.47-0.91), ethnicity (OR = 0.66; 95% CI 0.47-0.91), duration of time spent on social media during the weekends (OR = 1.43; 95% CI 1.09-1.87) and psychological distress level (OR = 2.55; 95% CI 1.94-3.34). In the peer domain, the significantly associated factors were the number of peers (OR = 0.69; 95% CI 0.56-0.86) and frequency of quarrels or fights with peers (OR = 2.12; 95% CI 1.24-3.26). Among the items in the school domain, the significantly associated factors were students being mischievous in classrooms (OR = 1.52; 95% CI 1.06-2.06), student's affection towards their teachers (OR = 1.53; 95% CI 1.06-2.20), frequency of appraisal from teachers (OR = 1.49; 95% CI 1.16-1.94), frequency of friends being helpful in classrooms (OR = 1.92; 95% CI 1.09-3.38) and frequency of deliberately skipping class (OR = 2.91; 95% CI 2.90-1.72). As a conclusion, the study revealed high levels and widespread bullying involvement among students in Malaysia. As such, timely bullying preventions and interventions are essential, especially in terms of enhancing their mental health capacity, which substantially influences the reduction in the prevalence rates of bullying involvement among students in Malaysia.
  11. Fulltext Anxiety among Adolescents and Young Adults during COVID-19 Pandemic: A Multi-Country Survey
    Sabbagh HJ, Abdelaziz W, Alghamdi W, Quritum M, AlKhateeb NA, Abourdan J, et al.
    Int J Environ Res Public Health, 2022 Aug 24;19(17).
    PMID: 36078253 DOI: 10.3390/ijerph191710538
    (1) Background: Adolescents-and-young-adults (AYA) are prone to anxiety. This study assessed AYA's level of anxiety during the COVID-19 pandemic; and determined if anxiety levels were associated with country-income and region, socio-demographic profile and medical history of individuals. (2) Methods: A survey collected data from participants in 25 countries. Dependent-variables included general-anxiety level, and independent-variables included medical problems, COVID-19 infection, age, sex, education, and country-income-level and region. A multilevel-multinomial-logistic regression analysis was conducted to determine the association between dependent, and independent-variables. (3) Results: Of the 6989 respondents, 2964 (42.4%) had normal-anxiety, and 2621 (37.5%), 900 (12.9%) and 504 (7.2%) had mild, moderate and severe-anxiety, respectively. Participants from the African region (AFR) had lower odds of mild, moderate and severe than normal-anxiety compared to those from the Eastern-Mediterranean-region (EMR). Also, participants from lower-middle-income-countries (LMICs) had higher odds of mild and moderate than normal-anxiety compared to those from low-income-countries (LICs). Females, older-adolescents, with medical-problems, suspected-but-not-tested-for-COVID-19, and those with friends/family-infected with COVID-19 had significantly greater odds of different anxiety-levels. (4) Conclusions: One-in-five AYA had moderate to severe-anxiety during the COVID-19-pandemic. There were differences in anxiety-levels among AYAs by region and income-level, emphasizing the need for targeted public health interventions based on nationally-identified priorities.
  12. Fulltext Factors Influencing Visual Improvement after Phacoemulsification Surgery among Malaysian Cataract Patients
    Sa'at N, Ghazali AK, Yaacob NM, Salowi MA
    Int J Environ Res Public Health, 2022 Sep 13;19(18).
    PMID: 36141761 DOI: 10.3390/ijerph191811485
    Blindness and visual impairment are part of the global burden of eye disease, with cataract being one of the leading causes of blindness. This study aimed to determine the factors affecting visual acuity (VA) improvement among cataract patients after phacoemulsification surgery in Malaysia. Cataract patients aged over 18 who underwent phacoemulsification surgery between January 2014 and December 2018 were included in this retrospective cohort study. Patients' sociodemographic, comorbidities, surgical, and related complication factors were extracted from the National Eye Database. The outcome was measured by the difference in visual acuity before and after the operation and was categorized as "improved", "no change", and "worse". A total of 180,776 patients were included in the final analysis. Multinomial logistic regression analysis showed "no changes in VA" was significantly higher in patients aged less than 40 years old (OR: 1.66; 95% CI: 1.22, 2.26), patients with ocular comorbidities (OR: 1.65; 95% CI: 1.53, 1.77), patients who had undergone surgery lasting more than 60 min (OR: 1.39; 95% CI: 1.14, 1.69), patients who had surgery without an intraocular lens (IOL) (OR: 1.64; 95% CI: 1.20, 2.26), and patients with postoperative complications (OR: 8.76; 95% CI: 8.13, 9.45). Worsening VA was significantly higher among male patients (OR: 1.11; 95% CI: 1.01, 1.22), patients who had ocular comorbidities (OR: 1.76; 95% CI: 1.59, 1.96), patients who had undergone surgery lasting more than 60 min (OR: 1.94; 95% CI: 1.57, 2.41), patients who had surgery without an IOL (OR: 2.03; 95% CI: 1.48, 2.80), and patients with postoperative complications (OR: 21.46; 95% CI: 19.35, 23.80). The factors impacting "no changes" in and "worsening" of VA after cataract surgery were the following: older age, male gender, ethnicity, ocular comorbidities, surgeon grade, absence of IOL, intraoperative complication, and postoperative problems.
  13. Fulltext Bio-Optimization of Chemical Parameters and Earthworm Biomass for Efficient Vermicomposting of Different Palm Oil Mill Waste Mixtures
    Rupani PF, Alkarkhi AFM, Shahadat M, Embrandiri A, El-Mesery HS, Wang H, et al.
    Int J Environ Res Public Health, 2019 06 13;16(12).
    PMID: 31200470 DOI: 10.3390/ijerph16122092
    The present study reports mathematical modelling of palm oil mill effluent and palm-pressed fiber mixtures (0% to 100%) during vermicomposting process. The effects of different mixtures with respect to pH, C:N ratio and earthworms have been optimized using the modelling parameters. The results of analysis of variance have established effect of different mixtures of palm oil mill effluent plus palm press fiber and time, under selected physicochemical responses (pH, C:N ratio and earthworm numbers). Among all mixtures, 60% mixture was achieved optimal growth at pH 7.1 using 16.29 C:N ratio in 15 days of vermicomposting. The relationship between responses, time and different palm oil mill waste mixtures have been summarized in terms of regression models. The obtained results of mathematical modeling suggest that these findings have potential to serve a platform for further studies in terms of kinetic behavior and degradation of the biowastes via vermicomposting.
  14. Fulltext Viral Pandemics of the Last Four Decades: Pathophysiology, Health Impacts and Perspectives
    Roychoudhury S, Das A, Sengupta P, Dutta S, Roychoudhury S, Choudhury AP, et al.
    Int J Environ Res Public Health, 2020 12 15;17(24).
    PMID: 33333995 DOI: 10.3390/ijerph17249411
    The twenty-first century has witnessed some of the deadliest viral pandemics with far-reaching consequences. These include the Human Immunodeficiency Virus (HIV) (1981), Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (2002), Influenza A virus subtype H1N1 (A/H1N1) (2009), Middle East Respiratory Syndrome Coronavirus (MERS-CoV) (2012) and Ebola virus (2013) and the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (2019-present). Age- and gender-based characterizations suggest that SARS-CoV-2 resembles SARS-CoV and MERS-CoV with regard tohigher fatality rates in males, and in the older population with comorbidities. The invasion-mechanism of SARS-CoV-2 and SARS-CoV, involves binding of its spike protein with angiotensin-converting enzyme 2 (ACE2) receptors; MERS-CoV utilizes dipeptidyl peptidase 4 (DPP4), whereas H1N1 influenza is equipped with hemagglutinin protein. The viral infections-mediated immunomodulation, and progressive inflammatory state may affect the functions of several other organs. Although no effective commercial vaccine is available for any of the viruses, those against SARS-CoV-2 are being developed at an unprecedented speed. Until now, only Pfizer/BioNTech's vaccine has received temporary authorization from the UK Medicines and Healthcare products Regulatory Agency. Given the frequent emergence of viral pandemics in the 21st century, proper understanding of their characteristics and modes of action are essential to address the immediate and long-term health consequences.
  15. Fulltext Challenges and Research Priorities for Dementia Care in Malaysia from the Perspective of Health and Allied Health Professionals
    Rosli R, Goodson M, Tan MP, Mohan D, Reidpath D, Allotey P, et al.
    Int J Environ Res Public Health, 2021 10 20;18(21).
    PMID: 34769530 DOI: 10.3390/ijerph182111010
    Few studies to date have evaluated dementia care in Malaysia, and the focus of studies has primarily been on epidemiological and laboratory research. In this study, we aimed to identify potential challenges for the delivery of dementia care in Malaysia and priorities for research and enhancing existing dementia care. This study used thematic analysis to evaluate the open and focus group workshop discussions guided by semi-structured questions. Triangulation of the collected data (sticky notes, collated field notes, and transcripts of discussions) was achieved through stakeholder consensus agreement during a workshop held in 2017. Five main themes as priorities for dementia care were identified: (1) availability of a valued multi-disciplinary care service, (2) accessibility of training to provide awareness, (3) the functionality of the governance in establishing regulation and policy to empower care services, (4) perceived availability and accessibility of research data, and (5) influence of cultural uniqueness. The findings of this study seek to enhance existing dementia care in Malaysia but have potential application for other low and middle-income countries with a similar social and health care set up. The constructed relationship between themes also tries to tackle the challenges in a more efficient and effective manner, as none of these aforementioned issues are standalone challenges. In addition, we demonstrated how a carefully constructed workshop with defined aims and objectives can provide a useful analysis tool to evaluate health and social care challenges in a multidisciplinary forum.
  16. Fulltext What Are the Common Themes of Physician Resilience? A Meta-Synthesis of Qualitative Studies
    Roslan NS, Yusoff MSB, Morgan K, Ab Razak A, Ahmad Shauki NI
    Int J Environ Res Public Health, 2022 Jan 01;19(1).
    PMID: 35010729 DOI: 10.3390/ijerph19010469
    In the practice of medicine, resilience has gained attention as on of the ways to address burnout. Qualitative studies have explored the concept of physician resilience in several contexts. However, individual qualitative studies have limited generalizability, making it difficult to understand the resilience concept in a wider context. This study aims to develop a concept of resilience in the context of physicians' experience through a meta-synthesis of relevant qualitative studies. Using a predetermined search strategy, we identified nine qualitative studies among 450 participants that reported themes of resilience in developed and developing countries, various specialties, and stages of training. We utilized the meta-ethnography method to generate themes and a line-of-argument synthesis. We identified six key themes of resilience: tenacity, resources, reflective ability, coping skills, control, and growth. The line-of-argument synthesis identified resilient physicians as individuals who are determined in their undertakings, have control in their professional lives, reflect on adversity, utilize adaptive coping strategies, and believe that adversity provides an opportunity for growth. Resilient physicians are supported by individual and organizational resources that include nurturing work culture, teamwork, and support from the medical community and at home. Our findings suggest that resilience in physicians is dynamic and must be supported not only by physician-directed interventions but also by organization-directed interventions.
  17. Fulltext Maternal Mental Health following Ultrasonographic Detection of Fetal Structural Anomaly in the Midst of the COVID-19 Pandemic
    Roslan NR, Mohd Fauzi MF, Wan Teng L, Nur Azurah AG
    Int J Environ Res Public Health, 2021 12 07;18(24).
    PMID: 34948508 DOI: 10.3390/ijerph182412900
    Prenatal ultrasonographic detection of fetal structural anomaly may adversely affect maternal mental health throughout pregnancy, particularly in the current COVID-19 pandemic. This study aims to prospectively assess maternal stress, anxiety, and depression following ultrasonographic detection of fetal structural anomaly from diagnosis until delivery during the COVID-19 pandemic. A total of 141 pregnant women at a tertiary hospital who underwent detailed scans between 16 and 24 gestational weeks were included and categorized into the study (anomaly finding, n = 65) and comparison (normal finding, n = 76) groups. Self-administered questionnaires of 10-item Perceived Stress Scale (PSS-10) and Hospital Anxiety and Depression Scale (HADS) were used to assess maternal stress, anxiety, and depression at prior detection (T1), two-to-four weeks post-detection (T2), one-to-two weeks prior to delivery (T3), and one-to-two weeks post-delivery (T4). Repeated measures of analysis of variance (ANOVA) were conducted to assess time-, between-group, and time-group interaction effect. In general, maternal stress improved, but anxiety worsened, while depression persisted, over the time from T1 to T4. The average maternal stress and anxiety levels were significantly higher among groups with fetal anomaly. The maternal stress and anxiety level were significantly affected within one-to-two weeks post-detection of fetal structural anomaly. In conclusion, maternal mental health parameters were affected differently during the COVID-19 pandemic, with higher vulnerability of stress and anxiety among pregnant women with fetal structural anomaly particularly within one-to-two weeks post-detection.
  18. Fulltext Prognostic Factor of Lower Limb Amputation among Diabetic Foot Ulcer Patients in North-East Peninsular Malaysia
    Rosedi A, Hairon SM, Abdullah NH, Yaacob NA
    Int J Environ Res Public Health, 2022 Oct 31;19(21).
    PMID: 36361092 DOI: 10.3390/ijerph192114212
    Lower limb amputation (LLA) is a common complication of diabetic foot ulcer (DFU), which can lead to a higher 5-year mortality rate compared to all cancers combined. This study aimed to determine the prognostic factors of LLA among DFU patients in Kelantan from 2014 to 2018. A population-based study was conducted using secondary data obtained from the National Diabetic Registry (NDR). There were 362 cases that fulfilled the study criteria and were further analysed. The prognostic factors were determined by Multiple Cox Proportional Hazards Regression. There were 66 (18.2%) DFU patients who underwent LLA in this study, while 296 (81.8%) were censored. The results revealed that the factor leading to a higher risk of LLA was abnormal HDL-cholesterol levels (Adj. HR 2.18; 95% CI: 1.21, 3.92). Factors that led to a lower risk of LLA include DFU in patients aged 60 or more (Adj. HR 0.48; 95% CI: 0.27, 0.89) and obesity (Adj. HR 0.45; 95% CI: 0.22, 0.89). In conclusion, our model showed that abnormal HDL cholesterol was associated with a 2 times higher risk of LLA when adjusted for age and BMI. Any paradoxical phenomena should be addressed carefully to avoid wrong clinical decision making that can harm the patient.
  19. Fulltext Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery
    Rochmah TN, Wulandari A, Dahlui M, Ernawaty, Wulandari RD
    Int J Environ Res Public Health, 2020 08 18;17(16).
    PMID: 32824872 DOI: 10.3390/ijerph17166010
    Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.
  20. Fulltext Economic Burden of Stroke Disease: A Systematic Review
    Rochmah TN, Rahmawati IT, Dahlui M, Budiarto W, Bilqis N
    Int J Environ Res Public Health, 2021 07 15;18(14).
    PMID: 34299999 DOI: 10.3390/ijerph18147552
    Globally, one of the main causes of non-communicable disease as a cause of death every year is stroke. The objective of this study was to analyze the burden in consequence of stroke. This research used a systematic review method. Furthermore, a search for articles was carried out in June-July 2020. Four databases were used to search articles from 2015 to 2020. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were prospective cost studies, retrospective cost studies, database analysis, mathematical models, surveys, and COI studies that assess burden of stroke in primary and referral healthcare (hospital-based). The results showed that from four databases, 9270 articles were obtained, and 13 articles were qualified. A total of 9270 articles had the identified search keywords, but only 13 articles met the set criteria for inclusion. The criteria for inclusion were stroke patients, the economic burden of stroke disease based on cost of illness method, which is approximately equal to USD 1809.51-325,108.84 (direct costs 86.2%, and indirect costs 13.8%). Those that used the health expenditure method did not present the total cost; instead, only either direct or indirect cost of health expenditure were reported. For most hospital admissions due to stroke, LOS (length of stay) was the dominant cost. The high economic burden to manage stroke justifies the promotion and preventive efforts by the policymakers and motivates the practice of healthy lifestyles by the people.
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