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  1. Ramakreshnan L, Fong CS, Sulaiman NM, Aghamohammadi N
    Sci Total Environ, 2020 Dec 20;749:141457.
    PMID: 33370890 DOI: 10.1016/j.scitotenv.2020.141457
    Recognizing and mainstreaming pertinent walkability elements into the university campus planning is crucial to materialise green mandates of the campus, while enhancing social and economic sustainability. In one of such attempts, this transverse study investigated the walking motivations, built environment factors associated with campus walkability and the relative importance of the studied built environment factors in reference to the sociodemographic attributes from the viewpoint of the campus community in a tropical university campus in Kuala Lumpur, Malaysia. An online survey using a structured questionnaire was conducted between May and September 2019. The built environment factors associated with campus walkability were expressed and ranked as adjusted scores (AS). Meanwhile, multivariable logistic regression was deployed to examine the relative importance of the studied built environment factors in reference to the sociodemographic attributes of the campus community. Among 504 total responses acquired, proximity between complementary land uses (90.7%) was reported as the main motivation for walking. On the other hand, street connectivity and accessibility (AS: 97.62%) was described as the most opted built environment factor, followed by land use (AS: 96.76%), pedestrian infrastructure (AS: 94.25%), walking experience (AS: 87.07%), traffic safety (AS: 85.28%) and campus neighbourhood (AS: 59.62%), respectively. Among the sociodemographic attributes, no regular monthly income (OR = 3.162; 95% CI = 1.165-8.379; p 
  2. Ramakreshnan L, Aghamohammadi N, Fong CS, Sulaiman NM
    Environ Sci Pollut Res Int, 2021 Jan;28(2):1357-1369.
    PMID: 33094458 DOI: 10.1007/s11356-020-11305-x
    This study quantitatively investigated the scientific progress of walkability research landscape and its future prospects using bibliometric indicators to highlight the research hotspots. The results accentuated multifaceted nature of walkability research landscape with a strong association towards public health disciplines. Keyword co-occurrence analysis emphasized that majority of the walkability studies centred on the interactions between walking and other three main factors such as built environment attributes, transportation and obesity. Based on the identified research hotspots, a brief state-of-the-art review of walkability studies was presented. Future prospects based on the unexplored research gaps within the hotspots were also discussed. High correlation (r = 0.99, p 
  3. Aghamohammadi N, Fong CS, Idrus MHM, Ramakreshnan L, Sulaiman NM
    Sci Total Environ, 2021 Aug 15;782:146611.
    PMID: 33838362 DOI: 10.1016/j.scitotenv.2021.146611
    Due to the changing climate, more frequent and prolonged heatwaves are expected to have a catastrophic consequence on urban human settlement. In tropical cities such as Kuala Lumpur (KL), the quality of the urban environment is made worse by urban heat island (UHI) phenomena due to poor urban planning practices. The prolonged exposure to urban heat is hypothesized to influence human health and well-being, especially in tropical urban areas with high population density. Therefore, a study was conducted to understand the association of urban heat stress with physical, psychosomatic and psychological (PPP) health symptoms within a tropical urban setting. Continuous urban microclimate monitoring is conducted using an automated weather station to define the level of heat stress in the study area expressed as Physiological Equivalent Temperature (PET). A cross-sectional approach is used to identify heat-related health symptoms experienced by the urban population. Through exploratory factor analysis, a total of 38 PPP health symptoms are reduced into 8 heat-related health clusters which are sensory organ pain, heat-related illnesses, cardiopulmonary, pain, fatigue, anxiety, somatization, and depression-related symptoms. Heat stress was found to significantly affect psychosomatic pain (p = 0.016) as well as psychological anxiety (p = 0.022) and somatization (p = 0.041) related symptoms. Other health clusters were not significantly associated with heat stress. More studies are needed to unravel the influence of confounding factors and the long-term impact of urban heat on the health and well-being of the urban population in a tropical city.
  4. Wong YJ, Shimizu Y, Kamiya A, Maneechot L, Bharambe KP, Fong CS, et al.
    Environ Monit Assess, 2021 Jun 22;193(7):438.
    PMID: 34159431 DOI: 10.1007/s10661-021-09202-y
    Rivers in Malaysia are classified based on water quality index (WQI) that comprises of six parameters, namely, ammoniacal nitrogen (AN), biochemical oxygen demand (BOD), chemical oxygen demand (COD), dissolved oxygen (DO), pH, and suspended solids (SS). Due to its tropical climate, the impact of seasonal monsoons on river quality is significant, with the increased occurrence of extreme precipitation events; however, there has been little discussion on the application of artificial intelligence models for monsoonal river classification. In light of these, this study had applied artificial neural network (ANN) and support vector machine (SVM) models for monsoonal (dry and wet seasons) river classification using three of the water quality parameters to minimise the cost of river monitoring and associated errors in WQI computation. A structured trial-and-error approach was applied on input parameter selection and hyperparameter optimisation for both models. Accuracy, sensitivity, and precision were selected as the performance criteria. For dry season, BOD-DO-pH was selected as the optimum input combination by both ANN and SVM models, with testing accuracy of 88.7% and 82.1%, respectively. As for wet season, the optimum input combinations of ANN and SVM models were BOD-pH-SS and BOD-DO-pH with testing accuracy of 89.5% and 88.0%, respectively. As a result, both optimised ANN and SVM models have proven their prediction capacities for river classification, which may be deployed as effective and reliable tools in tropical regions. Notably, better learning and higher capacity of the ANN model for dataset characteristics extraction generated better predictability and generalisability than SVM model under imbalanced dataset.
  5. Aghamohammadi N, Ramakreshnan L, Fong CS, Noor RM, Hanif NR, Sulaiman NM
    Sci Total Environ, 2022 Feb 01;806(Pt 1):150331.
    PMID: 34571225 DOI: 10.1016/j.scitotenv.2021.150331
    The stakeholders' perceptions on the impacts of Urban Heat Island (UHI) are critical for reducing exposure and influencing their response to interventions that are aimed at encouraging a behaviour change. A proper understanding of the UHI impacts on the society, economy and environment is deemed an essential motivating factor for the stakeholders to work towards UHI mitigations in the local context. This study adopted an inductive qualitative approach using Stakeholder Dialogue Sessions (SDSs) to assess the perceived impacts of UHI among various stakeholders, comprising policy makers, academicians, developers and Non-Governmental Organizations (NGO), in a tropical metropolitan city. The results revealed five themes such as deterioration of public health, acceleration of urban migration patterns and spending time in cooler areas, reduction of workers' productivity, increased energy consumption by the households and deterioration of environmental quality and natural resources that were categorized into social, economic and environmental impacts. Although most of the stakeholders were quite unfamiliar with the term UHI, they still display a good understanding of the potential impacts of UHI due to their posteriori knowledge and ability to rationalize the physical condition of the environment in which they live. The findings provide useful insights and valuable information to the local authorities to tailor necessary actions and educational campaigns to increase UHI awareness among the stakeholders. Being among the earlier studies to use a qualitative approach to attain the aforementioned objective, the findings are crucial to determine the level of understanding of the stakeholders on the impact of UHI. Through this study, the authors have highlighted the gaps and needs for knowledge improvements aimed at behaviour change among the stakeholders.
  6. Ramakreshnan L, Aghamohammadi N, Fong CS, Bulgiba A, Zaki RA, Wong LP, et al.
    Environ Sci Pollut Res Int, 2018 Jan;25(3):2096-2111.
    PMID: 29209970 DOI: 10.1007/s11356-017-0860-y
    Seasonal haze episodes and the associated inimical health impacts have become a regular crisis among the ASEAN countries. Even though many emerging experimental and epidemiological studies have documented the plausible health effects of the predominating toxic pollutants of haze, the consistency among the reported findings by these studies is poorly understood. By addressing such gap, this review aimed to critically highlight the evidence of physical and psychological health impacts of haze from the available literature in ASEAN countries. Systematic literature survey from six electronic databases across the environmental and medical disciplines was performed, and 20 peer-reviewed studies out of 384 retrieved articles were selected. The evidence pertaining to the health impacts of haze based on field survey, laboratory tests, modelling and time-series analysis were extracted for expert judgement. In specific, no generalization can be made on the reported physical symptoms as no specific symptoms recorded in all the reviewed studies except for throat discomfort. Consistent evidence was found for the increase in respiratory morbidity, especially for asthma, whilst the children and the elderly are deemed to be the vulnerable groups of the haze-induced respiratory ailments. A consensual conclusion on the association between the cardiovascular morbidity and haze is unfeasible as the available studies are scanty and geographically limited albeit of some reported increased cases. A number of modelling and simulation studies demonstrated elevating respiratory mortality rates due to seasonal haze exposures over the years. Besides, evidence on cancer risk is inconsistent where industrial and vehicular emissions are also expected to play more notable roles than mere haze exposure. There are insufficient regional studies to examine the association between the mental health and haze. Limited toxicological studies in ASEAN countries often impede a comprehensive understanding of the biological mechanism of haze-induced toxic pollutants on human physiology. Therefore, the lack of consistent evidence among the reported haze-induced health effects as highlighted in this review calls for more intensive longitudinal and toxicological studies with greater statistical power to disseminate more reliable and congruent findings to empower the institutional health planning among the ASEAN countries.
  7. Carter JL, Abdullah N, Bragg F, Murad NAA, Taylor H, Fong CS, et al.
    Int J Obes (Lond), 2023 Sep;47(9):855-864.
    PMID: 37460680 DOI: 10.1038/s41366-023-01339-9
    BACKGROUND: No large-scale studies have compared associations between body composition and cardiovascular risk factors across multi-ethnic populations.

    METHODS: Population-based surveys included 30,721 Malay, 10,865 Indian and 25,296 Chinese adults from The Malaysian Cohort, and 413,737 White adults from UK Biobank. Sex-specific linear regression models estimated associations of anthropometry and body composition (body mass index [BMI], waist circumference [WC], fat mass, appendicular lean mass) with systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), triglycerides and HbA1c.

    RESULTS: Compared to Malay and Indian participants, Chinese adults had lower BMI and fat mass while White participants were taller with more appendicular lean mass. For BMI and fat mass, positive associations with SBP and HbA1c were strongest among the Chinese and Malay and weaker in White participants. Associations with triglycerides were considerably weaker in those of Indian ethnicity (eg 0.09 [0.02] mmol/L per 5 kg/m2 BMI in men, vs 0.38 [0.02] in Chinese). For appendicular lean mass, there were weak associations among men; but stronger positive associations with SBP, triglycerides, and HbA1c, and inverse associations with LDL-C, among Malay and Indian women. Associations between WC and risk factors were generally strongest in Chinese and weakest in Indian ethnicities, although this pattern was reversed for HbA1c.

    CONCLUSION: There were distinct patterns of adiposity and body composition and cardiovascular risk factors across ethnic groups. We need to better understand the mechanisms relating body composition with cardiovascular risk to attenuate the increasing global burden of obesity-related disease.

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