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  1. Naing C, Kai YC, Yi CH, Yee NS, Yi LM, Jun LX, et al.
    Int Health, 2013 Sep;5(3):217-22.
    PMID: 24159624 DOI: 10.1093/inthealth/iht019
    BACKGROUND: This study aimed to determine knowledge of medication use, to investigate the treatment-seeking pattern and to identify factors affecting the use of public health clinics among the study population.

    METHODS: A survey was conducted in Mantin Town of Malaysia using a structured questionnaire based on a literature review. Households were recruited through a three-stage sampling technique.

    RESULTS: Of 183 respondents (mean age 44.6 [±16.9] years; 115 [62.8%] women), 157 (85.8%) did not know about the term 'generic name' and 159 (86.9%) were not sure about the difference in price between a generic medicine and a branded medicine. The majority sought healthcare from the public health clinics (102/183; 55.7%). In the multivariate analysis, higher education level of respondents (p = 0.028), good quality of services in public health clinics (p = 0.001) and short distances between their residences and the public health clinics (p<0.001) were the significant variables for predicting the use of a public health clinic.

    CONCLUSION: This study highlights that health education on the use of generic drugs needs to be scaled up. These findings are important to the health policy makers who may need to consider addressing factors such as quality of care and physical distance to the clinic in the design and implementation of health facilities and the selection of the catchment areas.
  2. Wong LP, Wu Q, Hao Y, Chen X, Chen Z, Alias H, et al.
    Int Health, 2021 May 04.
    PMID: 33945613 DOI: 10.1093/inthealth/ihab023
    BACKGROUND: We aimed to investigate the association between institution trust and public responses to the coronavirus disease 2019 (COVID-19) outbreak.

    METHODS: An Internet-based, cross-sectional survey was administered on 29 January 2020. A total of 4393 adults ≥18 y of age and residing or working in the province of Hubei, central China were included in the study.

    RESULTS: The majority of the participants expressed a great degree of trust in the information and preventive instructions provided by the central government compared with the local government. Being under quarantine (adjusted odds ratio [OR] 2.35 [95% confidence interval {CI} 1.80 to 3.08]) and having a high institutional trust score (OR 2.23 [95% CI 1.96 to 2.53]) were both strong and significant determinants of higher preventive practices scores. The majority of study participants (n=3640 [85.7%]) reported that they would seek hospital treatment if they suspected themselves to have been infected with COVID-19. Few of the participants from Wuhan (n=475 [16.6%]) and those participants who were under quarantine (n=550 [13.8%]) expressed an unwillingness to seek hospital treatment.

    CONCLUSIONS: Institutional trust is an important factor influencing adequate preventive behaviour and seeking formal medical care during an outbreak.

  3. Lyons S, Salgaonkar S, Flaherty GT
    Int Health, 2021 Aug 20.
    PMID: 34415026 DOI: 10.1093/inthealth/ihab050
    Stem cell tourism is an emerging area of medical tourism activity. Frustrated by the slow translation of stem cell research into clinical practice, patients with debilitating conditions often seek therapeutic options that are not appropriately regulated. This review summarises recent developments in the field of stem cell tourism and provides clinicians with the information necessary to provide basic pretravel health advice to stem cell tourists. PubMed and Scopus databases were consulted for relevant publications, using combinations of the terms 'stem cell', 'tourism', 'regenerative medicine', 'international', 'travel medicine' and 'environmental health'. The leading countries in the international stem cell tourism market are the USA, China, India, Thailand and Mexico. As the majority of clinics offering stem cell therapies are based in low- and-middle-income countries, stem cell tourists place themselves at risk of receiving an unproven treatment, coupled with the risk of travel-related illnesses. These clinics do not generally provide even basic travel health information on their websites. In addition to often being ineffective, stem cell therapies are associated with complications such as infection, rejection and tumorigenesis. Physicians, researchers, regulatory bodies, advocacy groups and medical educators are encouraged to work together to improve patient and physician education and address current legislative deficiencies.
  4. Tan AKG, Yen ST, Fang X, Chiang FS
    Int Health, 2019 03 01;11(2):150-158.
    PMID: 30321364 DOI: 10.1093/inthealth/ihy072
    BACKGROUND: This study examined the factors associated with body mass index (BMI) categories of Malaysian adolescents by physical activity (PA) status.

    METHODS: Data were obtained from the 2012 Malaysia Global School-based Student Health Survey. Generalized ordered logit regression analysis was conducted on 24 339 adolescents by PA status.

    RESULTS: Early- (ages 11-13) and middle-stage (ages 14-16) adolescents were associated with higher overweight and obesity risks than their older peers (ages 17-18). Male adolescents faced higher underweight and obesity likelihoods than females. Hunger due to food shortage at home was associated with higher likelihoods of underweight and normal weight BMI categories. Smokers were more likely to be underweight or normal weight than non-smokers. Segmented-sample analysis by PA status indicated that, while the direction of associations was parallel across PA status, the magnitudes of association between age, hunger and smoking status with BMI status were greater among active than inactive adolescents.

    CONCLUSIONS: Male adolescents faced a dual burden of underweight and obesity. Other sociodemographic and dietary-lifestyle factors were associated with adolescent BMI categories. Segmented-sample analysis by PA status uncovered varying associations between factors that would otherwise be masked in pooled sample analysis. Public health authorities should take these factors into consideration when deliberating programs to ensure healthy adolescent body weight.

  5. Mahdavi F, Sadrebazzaz A, Chahardehi AM, Badali R, Omidian M, Hassanipour S, et al.
    Int Health, 2022 Jan 19;14(1):5-17.
    PMID: 34022771 DOI: 10.1093/inthealth/ihab026
    BACKGROUND: Application of chemotherapeutics in cancer patients may provide an immunosuppressive milieu, favourable for parasitic infections. Giardia duodenalis is an important zoonotic intestinal parasite responsible for diarrhoea in humans worldwide.

    METHODS: The present systematic review and meta-analysis was conducted to estimate the prevalence of G. duodenalis and respective odds ratios (ORs) in cancer patients around the globe. Four online databases-PubMed, Scopus, Web of Science and Google Scholar-were carefully explored for relevant literature without time limitation until 28 November 2020. Meta-analysis was done based on a random effects model to pool the estimations and define 95% confidence intervals (CIs).

    RESULTS: The overall weighted prevalence of G. duodenalis infection in cancer patients was calculated to be 6.9% (95% CI 0.5 to 9.3) globally, based on data from 32 studies. Although not statistically significant, eight case-control studies revealed that cancer patients were 1.24 times (95% CI 0.66 to 2.31; p=0.501) more exposed to G. duodenalis infection than healthy controls. Moreover, the prevalence of infection was not significantly associated with quantitative variables, including publication year (regression coefficient -0.0135, p=0.578), sample size (regression coefficient -0.0007, p=0.074) and human development index (regression coefficient -1.6263, p=0.419). Also, subgroup analysis of the pooled G. duodenalis infection was performed for publication year, World Health Organization regions, countries, continents, cancer types and country income.

    CONCLUSIONS: Altogether, the epidemiology of G. duodenalis infection and its associated risk factors in immunocompromised individuals, especially cancer patients, is still open to question and deserves comprehensive investigations.

  6. Sukeri S, Mirzaei M, Jan S
    Int Health, 2017 01;9(1):29-35.
    PMID: 28028130 DOI: 10.1093/inthealth/ihw054
    BACKGROUND: Malaysia is an upper-middle income country with a tax-based health financing system. Health care is relatively affordable, and safety nets are provided for the needy. The objectives of this study were to determine the out-of-pocket health spending, proportion of catastrophic health spending (out-of-pocket spending >40% of non-food expenditure), economic hardship and financial coping strategies among patients with ischaemic heart disease (IHD) in Malaysia under the present health financing system.

    METHODS: A cross-sectional study was conducted at the National Heart Institute of Malaysia involving 503 patients who were hospitalized during the year prior to the survey.

    RESULTS: The mean annual out-of-pocket health spending for IHD was MYR3045 (at the time US$761). Almost 16% (79/503) suffered from catastrophic health spending (out-of-pocket health spending ≥40% of household non-food expenditures), 29.2% (147/503) were unable to pay for medical bills, 25.0% (126/503) withdrew savings to help meet living expenses, 16.5% (83/503) reduced their monthly food consumption, 12.5% (63/503) were unable to pay utility bills and 9.0% (45/503) borrowed money to help meet living expenses.

    CONCLUSIONS: Overall, the economic impact of IHD on patients in Malaysia was considerable and the prospect of economic hardship likely to persist over the years due to the long-standing nature of IHD. The findings highlight the need to evaluate the present health financing system in Malaysia and to expand its safety net coverage for vulnerable patients.

  7. Azizan NA, Thangiah N, Su TT, Majid HA
    Int Health, 2018 03 01;10(2):108-115.
    PMID: 29462331 DOI: 10.1093/inthealth/ihy001
    Background: The purpose of this study was to identify the unhealthy dietary habits and practices in a low-income community in an urban area and determine the associated factors.

    Methods: A cross-sectional survey was conducted in a low-income housing area in Kuala Lumpur, Malaysia. Data were collected using a questionnaire via face-to-face interviews by trained enumerators in order to obtain details on sociodemographic characteristics and dietary practices.

    Results: Descriptive statistics showed that 86.7% of the respondents in the low-income community consumed fruit and vegetables less than five times per day, 11.7% consumed carbonated and sweetened drinks more than twice per day and about 25% consumed fast food more than four times per month. In total, 65.2% (n=945) did not have healthy dietary practices. Binary logistic regression showed that age, education and ethnicity were significant predictors of unhealthy dietary practices among the low-income community. Those in the 30-59 years age group had higher odds (odds ratio 1.65, p=0.04) of practising an unhealthy diet as compared with those older than 60 years of age.

    Conclusion: Unhealthy dietary practices were found to be common among the low-income group living in an urban area. Healthy lifestyle intervention should be highlighted so that it can be adopted in the low-income group.

  8. Baha Raja D, Abdul Taib NA, Teo AKJ, Jayaraj VJ, Ting CY
    Int Health, 2023 Jan 03;15(1):37-46.
    PMID: 35265998 DOI: 10.1093/inthealth/ihac005
    BACKGROUND: The computer simulation presented in this study aimed to investigate the effect of contact tracing on coronavirus disease 2019 (COVID-19) transmission and infection in the context of rising vaccination rates.

    METHODS: This study proposed a deterministic, compartmental model with contact tracing and vaccination components. We defined contact tracing effectiveness as the proportion of contacts of a positive case that was successfully traced and the vaccination rate as the proportion of daily doses administered per population in Malaysia. Sensitivity analyses on the untraced and infectious populations were conducted.

    RESULTS: At a vaccination rate of 1.4%, contact tracing with an effectiveness of 70% could delay the peak of untraced asymptomatic cases by 17 d and reduce it by 70% compared with 30% contact tracing effectiveness. A similar trend was observed for symptomatic cases when a similar experiment setting was used. We also performed sensitivity analyses by using different combinations of contact tracing effectiveness and vaccination rates. In all scenarios, the effect of contact tracing on COVID-19 incidence persisted for both asymptomatic and symptomatic cases.

    CONCLUSIONS: While vaccines are progressively rolled out, efficient contact tracing must be rapidly implemented concurrently to reach, find, test, isolate and support the affected populations to bring COVID-19 under control.

  9. Borhanuddin B, Ahmad N, Shah SA, Murad NAA, Zakaria SZS, Kamaruddin MA, et al.
    Int Health, 2018 Sep 01;10(5):382-390.
    PMID: 29462329 DOI: 10.1093/inthealth/ihx075
    BACKGROUND: The investigation of risk factors of cardiovascular disease (e.g., major endocrine, nutritional and metabolic diseases) across job sectors is useful for targeted public health intervention. This study examined the occurrence of type 2 diabetes mellitus (T2DM), hypercholesterolemia and obesity in 21 job sectors in the general population.

    METHODS: A baseline cross-sectional analysis of the Malaysian Cohort was conducted, which included 105 391 adults. Multiple logistic regression analyses were conducted for these three diseases across 20 job sectors compared with the unemployed/homemaker sector.

    RESULTS: The prevalence of T2DM, hypercholesterolemia and obesity was 16.7%, 38.8% and 33.3%, respectively. The Accommodation & Food Service Activities and Transportation & Storage sectors had significantly higher odds for T2DM (adjusted [adj.] prevalence odds ratio [POR] 1.18, p=0.007 and adj. POR 1.15, p=0.008, respectively). No job sector had significantly higher odds for hypercholesterolemia compared with the unemployed/homemaker sector. Only the Accommodation & Food Service Activities sector had significantly higher odds for obesity (adj. POR 1.17, p≤0.001).

    CONCLUSIONS: Many job sectors were significantly associated with lower odds of having these three diseases when compared with the unemployed/homemaker sector. These differing associations between diverse job sectors and these diseases are important for public health intervention initiatives and prioritization.

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