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  1. Chan YM, Ismail MZH, Khaw WF
    BMC Womens Health, 2023 Jul 25;23(1):389.
    PMID: 37491253 DOI: 10.1186/s12905-023-02553-3
    BACKGROUND: In 2020, cervical cancer ranked fourth in terms of both frequency of diagnosis and the leading cause of cancer-related deaths among women globally. Among Malaysian women, it was the third most prevalent form of cancer. Published data on nationally representative cervical cancer screening in Malaysia have been limited. Therefore, this study aimed to determine the prevalence of receiving a Pap smear test in the past three years, its relationship with socio-demographic factors and physical activity.

    METHODS: Using a subset of survey data from the National Health and Morbidity Survey (NHMS) 2019, a secondary data analysis was performed. Trained research assistants collected data through face-to-face method using a mobile tablet questionnaire system application. Logistic regression analysis was performed to examine the relationship between sociodemographic factors, physical activity, and cervical cancer screening. The analyses were conducted using STATA version 14 (Stata Corp, College Station, Texas, USA), accounting for sample weighs and complex sampling design.

    RESULTS: The analysis included 5,650 female respondents, representing an estimated 10.3 million Malaysian female adults aged 18 and above. Overall, 35.2% (95%CI 33.2, 37.4) respondents had a Pap smear test within the past three years. Respondents who were physically active were 1.41 times more likely to have a Pap smear test. Similarly, respondents aged 35-59 (OR 1.84; 95%CI 1.46, 2.34) and those living in rural localities (OR 1.38; 95%CI 1.13, 1.70) had higher odds of receiving a Pap smear test. Compared to married respondents, single respondents (OR 0.04; 95%CI 0.02, 0.07) and widowed/divorcee respondents (OR 0.72; 95%CI 0.56, 0.82) were less likely to receive a Pap smear test. Educated respondents were more likely to have had a Pap smear test.

    CONCLUSIONS: The overall prevalence of cervical cancer screening in Malaysia remains low (35.2%). Efforts should be made to strengthen health promotion programs and policies in increasing awareness on the significance of cervical cancer screening. These initiatives should specifically target younger women, single women, and widowed/divorced individuals. The higher cervical screening uptake among rural women should be studied further, and the enabling factors in the rural setup should be emulated in urban areas whenever possible.

  2. Chan YM, Sahril N, Chan YY, Ab Wahab NA, Shamsuddin N, Ismail MZH
    Int J Environ Res Public Health, 2021 Jun 10;18(12).
    PMID: 34200564 DOI: 10.3390/ijerph18126271
    Vision and hearing impairments are common among older adults and can cause undesirable health effects. There are limited studies from low- and middle-income countries exploring gender differences between vision and hearing impairment with Activities of Daily Living (ADL) disability. Therefore, this study aimed to investigate gender differences between vision and hearing impairments with ADL disability among older adults in Malaysia. Cross-sectional data from 3977 respondents aged 60 and above from the Malaysian National Health and Morbidity Survey 2018 were used. We used logistic regression analysis to measure associations between vision and hearing impairments with ADL disability, adjusted for covariates. The prevalence of ADL disability was higher among females than males (p < 0.001). The adjusted associations between vision impairment and ADL disability were significant among males (aOR 3.79; 95%CI 2.26, 6.38) and females (aOR 2.66; 95%CI 1.36, 5.21). Similarly, significant adjusted associations were found between hearing impairment and ADL disability among males (aOR 5.76; 95%CI 3.52, 9.40) and females (aOR 3.30; 95%CI 1.17, 9.33). Vision and hearing impairments were significantly associated with ADL disability, with no gender differences identified. Early detection and effective management of vision and hearing impairments are important to prevent ADL disability and improve older adults' level of independence.
  3. Omar ED, Mat H, Abd Karim AZ, Sanaudi R, Ibrahim FH, Omar MA, et al.
    Int J Nephrol Renovasc Dis, 2024;17:197-204.
    PMID: 39070075 DOI: 10.2147/IJNRD.S461028
    PURPOSE: This study aimed to identify the best-performing algorithm for predicting Acute Kidney Injury (AKI) necessitating dialysis following cardiac surgery.

    PATIENTS AND METHODS: The dataset encompassed patient data from a tertiary cardiothoracic center in Malaysia between 2011 and 2015, sourced from electronic health records. Extensive preprocessing and feature selection ensured data quality and relevance. Four machine learning algorithms were applied: Logistic Regression, Gradient Boosted Trees, Support Vector Machine, and Random Forest. The dataset was split into training and validation sets and the hyperparameters were tuned. Accuracy, Area Under the ROC Curve (AUC), precision, F-measure, sensitivity, and specificity were some of the evaluation criteria. Ethical guidelines for data use and patient privacy were rigorously followed throughout the study.

    RESULTS: With the highest accuracy (88.66%), AUC (94.61%), and sensitivity (91.30%), Gradient Boosted Trees emerged as the top performance. Random Forest displayed strong AUC (94.78%) and accuracy (87.39%). In contrast, the Support Vector Machine showed higher sensitivity (98.57%) with lower specificity (59.55%), but lower accuracy (79.02%) and precision (70.81%). Sensitivity (87.70%) and specificity (87.05%) were maintained in balance via Logistic Regression.

    CONCLUSION: These findings imply that Gradient Boosted Trees and Random Forest might be an effective method for identifying patients who would develop AKI following heart surgery. However specific goals, sensitivity/specificity trade-offs, and consideration of the practical ramifications should all be considered when choosing an algorithm.

  4. Yusof NA, Idris NA, Abdul Aziz A, Naing NN, Oo SS, Aung MMT, et al.
    Med J Malaysia, 2025 Mar;80(2):212-220.
    PMID: 40145165
    INTRODUCTION: Prediabetes is a critical stage preceding diabetes mellitus (DM) which is also associated with an elevated risk of developing DM and related complications. Addressing predictors that influence the progression or regression of glycaemic outcomes in prediabetic individuals can enhance intervention strategies. This study aims to identify key predictors of glycaemic progression among adults with prediabetes in Terengganu, Malaysia.

    MATERIALS AND METHODS: A retrospective cohort study was conducted involving 592 prediabetic adults from 28 health clinics in Terengganu between January 2019 and June 2023. Participants were selected based on oral glucose tolerance test (OGTT) results indicating prediabetes. Sociodemographic, medical background, and clinical data, including body mass index (BMI), blood pressure, fasting blood sugar (FBS), and lipid profiles, were extracted from medical records. Glycaemic outcomes were classified into three categories: reversion to normoglyacemia, persistent prediabetes, or progression to DM, based on glycated haemoglobin (HbA1c) levels taken within two years of follow-up. Ordinal logistic regression analysis was used to identify the significant predictors influencing these outcomes.

    RESULTS: Analysis showed age, BMI, underlying dyslipidaemia, FBS, and triglyceride levels as significant predictors of glycaemic progression. Specifically, each additional year of age and each one-unit increase in BMI raised the likelihood of progression to DM by 3% and 6%, respectively. Participants with dyslipidaemia were noted to have a 67% higher risk of worsening glycaemic status, while increases in FBS and triglyceride levels were associated with 65% and 34% greater odds of diabetic progression, respectively.

    CONCLUSION: This study identifies critical predictors of glycaemic outcomes in prediabetic adults, emphasizing the role of age, BMI, dyslipidaemia, FBS, and triglycerides in the disease progression. These findings support the development of targeted interventions that address these risk factors to curb diabetes progression in high-risk individuals, contributing valuable insights into diabetes prevention strategies tailored for Malaysian populations.

  5. Nordin MNB, Jayaraj VJ, Ismail MZH, Omar ED, Seman Z, Yusoff YM, et al.
    Cureus, 2025 Jan;17(1):e77342.
    PMID: 39944445 DOI: 10.7759/cureus.77342
    OBJECTIVE: This study explores machine learning (ML) for automating unstructured textual data translation into structured International Classification of Diseases (ICD)-10 codes, aiming to identify algorithms that enhance mortality data accuracy and reliability for public health decisions.

    METHODS: This study analyzed death records from January 2017 to June 2022, sourced from Malaysia's Health Informatics Centre, coded into ICD-10. Data anonymization adhered to ethical standards, with 387,650 death registrations included after quality checks. The dataset, limited to three-digit ICD-10 codes, underwent cleaning and an 80:20 training-testing split. Preprocessing involved HTML tag removal and tokenization. ML approaches, including BERT (Bidirectional Encoder Representations from Transformers), Gzip+KNN (K-Nearest Neighbors), XGBoost (Extreme Gradient Boosting), TensorFlow, SVM (Support Vector Machine), and Naive Bayes, were evaluated for automated ICD-10 coding. Models were fine-tuned and assessed across accuracy, F1-score, precision, recall, specificity, and precision-recall curves using Amazon SageMaker (Amazon Web Services, Seattle, WA). Sensitivity analysis addressed unbalanced data scenarios, enhancing model robustness.

    RESULTS: In assessing ICD-10 coding with ML, Gzip+KNN had the longest training time at 10 hours, with BERT leading in memory use. BERT performed best for the F1-score (0.71) and accuracy (0.82), closely followed by Gzip+KNN. TensorFlow excelled in recall, whereas SVM had the highest specificity but lower overall performance. XGBoost was notably less effective across metrics. Precision-recall analysis showed Gzip+KNN's superiority. On an unbalanced dataset, BERT and Gzip+KNN demonstrated consistent accuracy.

    CONCLUSION: Our study highlights that BERT and Gzip+KNN optimize ICD-10 coding, balancing efficiency, resource use, and accuracy. BERT excels in precision with higher memory demands, while Gzip+KNN offers robust accuracy and recall. This suggests significant potential for improving healthcare analytics and decision-making through advanced ML models.

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