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Fulltext Food Insecurity: Is It a Threat to University Students' Well-Being and Success?

Ahmad NSS, Sulaiman N, Sabri MF

Int J Environ Res Public Health, 2021 05 25;18(11).
PMID: 34070321 DOI: 10.3390/ijerph18115627

Food insecurity is a growing concern among university students. The high prevalence of food insecurity is a threat to students' health and success. Therefore, this study aims to determine an association between food security status, psychosocial factors, and academic performance among university students. A total of 663 undergraduate students in seven randomly selected faculties in Universiti Putra Malaysia participated in this study. An online survey was conducted to obtain demographic and socioeconomic characteristics, food security status (six-item USDA; food security survey module, FSSM), psychosocial factors (depression, anxiety and stress scale, DASS-21) and academic performance. Among the abovementioned participating students, 32.4% are male. About 62.8% reported to have experienced food insecurity. Binary logistic regression revealed that students whose fathers were working (AOR = 6.446, 95% CI: 1.22, 34.01) came from low- (AOR = 14.314, 95% CI: 1.565, 130.954) and middle-income groups (AOR = 15.687, 95% CI: 1.720, 143.092), and those receiving financial aid (AOR = 2.811, 95% CI: 1.602, 4.932) were associated with food insecurity. Additionally, food insecurity students were less-likely reported, with CGPA ≥ 3.7 (AOR = 0.363, 95% CI: 1.22-34.014). Food insecurity respondents had higher odds for stress (AOR = 1.562, 95% CI: 1.111, 2.192), anxiety (AOR = 3.046, 95% CI: 2.090, 4.441), and depression (AOR = 2.935, 95% CI: 2.074, 4.151). The higher institutions should identify students with food insecurity problems and future intervention programs need to be conducted to combat food insecurity among students, thus yielding benefits to their health and success.
Fulltext Exploring Regional Advanced Manufacturing and Its Driving Factors: A Case Study of the Guangdong-Hong Kong-Macao Greater Bay Area

Dou Z, Sun Y, Wang T, Wan H, Fan S

Int J Environ Res Public Health, 2021 05 28;18(11).
PMID: 34071373 DOI: 10.3390/ijerph18115800

This study aims to analyze the development trend of the manufacturing industry of the Guangdong-Hong Kong-Macao Greater Bay Area (from 2008 to 2018) by constructing an evaluation system. On the basis of push-pull-mooring theory, we analyze these factors by using an entropy and cluster model. The results show the following: (1) Technological development had an obvious spatial distribution pattern of core regional radiation, while others did not. (2) Economic development was based on the city's existing industrial development system, while environmental development depended on governmental policies. (3) Compared with the environmental factor, the development trends of the economic and technological factors were more similar. Lastly, we provide four strategies for the development of the manufacturing industry in different cities.
Fulltext Using Machine Learning Algorithms to Develop a Clinical Decision-Making Tool for COVID-19 Inpatients

Vepa A, Saleem A, Rakhshan K, Daneshkhah A, Sedighi T, Shohaimi S, et al.

Int J Environ Res Public Health, 2021 06 09;18(12).
PMID: 34207560 DOI: 10.3390/ijerph18126228

BACKGROUND: Within the UK, COVID-19 has contributed towards over 103,000 deaths. Although multiple risk factors for COVID-19 have been identified, using this data to improve clinical care has proven challenging. The main aim of this study is to develop a reliable, multivariable predictive model for COVID-19 in-patient outcomes, thus enabling risk-stratification and earlier clinical decision-making.
METHODS: Anonymised data consisting of 44 independent predictor variables from 355 adults diagnosed with COVID-19, at a UK hospital, was manually extracted from electronic patient records for retrospective, case-control analysis. Primary outcomes included inpatient mortality, required ventilatory support, and duration of inpatient treatment. Pulmonary embolism sequala was the only secondary outcome. After balancing data, key variables were feature selected for each outcome using random forests. Predictive models were then learned and constructed using Bayesian networks.
RESULTS: The proposed probabilistic models were able to predict, using feature selected risk factors, the probability of the mentioned outcomes. Overall, our findings demonstrate reliable, multivariable, quantitative predictive models for four outcomes, which utilise readily available clinical information for COVID-19 adult inpatients. Further research is required to externally validate our models and demonstrate their utility as risk stratification and clinical decision-making tools.
Fulltext The Impact of the COVID-19 Self-Isolation Policy on the Occupations of Vulnerable Groups

Amirudin A, Urbański M, Saputra J, Johansyah MD, Latip L, Tarmizi A, et al.

Int J Environ Res Public Health, 2021 Jun 15;18(12).
PMID: 34203631 DOI: 10.3390/ijerph18126452

Today, the spread of the Coronavirus 2019 (COVID-19) pandemic continues to impact on world public health and bring about considerable human suffering partly due to government policies on reducing the spread. COVID-19 has significantly affected human health and it has impacted on the occupation of vulnerable groups such as tour guides, drivers and shop assistants. Of these, the present study aims to investigate the impact of the COVID-19 self-isolation policy on the occupation of vulnerable groups in Semarang City, Indonesia. To achieve this objective, this study uses a qualitative method with an ethnography approach considering a rational or non-rational thinking model. The binary opposition thinking pattern pioneered by Lévi-Strauss was used in the interview process with 25 informants in Semarang City, Indonesia. The data analyzed the response pattern of informants through the taxonomy analysis. Three levels of vulnerability among groups relating to occupation were identified; jobs lost, income decreased, and delayed salary. The result of the analysis found that the group who obeyed self-isolation was categorized as a rational thinking; these groups stay at home, do not go to work, and have no income. Besides that, the group who ignored self-isolation is categorized as non-rational thinking; they work, as usual, get their salary, and believe that the COVID-19 pandemic is a disaster and they pray for their safety to God. In conclusion, COVID-19 brings a significant impact on occupation in the forms of postponing, declining, and missing income besides the health effects among vulnerable groups in Semarang city, Indonesia. In avoiding COVID-19 infection, the circumstances of vulnerable groups are worse when self-isolation is required. Thus, this study suggests that the government needs to assist vulnerable groups by focusing on strategic policies, such as strategies for survival, providing access to basic needs, including health, and offering livelihood plans by providing access to medical services and other source of income.
Fulltext Relationship between Physical Activity and Cardiovascular Risk Factors: A Cross-Sectional Study among Low-Income Housewives in Kuala Lumpur

Mohd Saat NZ, Hanawi SA, M F Farah N, Mohd Amin H, Hanafiah H, Shamsulkamar NS

Int J Environ Res Public Health, 2021 06 04;18(11).
PMID: 34200066 DOI: 10.3390/ijerph18116090

Cardiovascular disease is a significant public health concern worldwide, including in Malaysia. Various attempts have been made to resolve this issue. One of the most important methods of controlling cardiovascular risk factors is physical exercise. However, today's women, especially housewives, are often identified by a lack of physical activity. This is alarming to society, as cardiovascular disease can affect the quality of their life. The aim of this study is to determine the relationship between physical activity and cardiovascular risk factors among low-income housewives in Kuala Lumpur. A total of 63 housewives participated in this cross-sectional study. All participating housewives were asked to fill out a sociodemographic questionnaire and the short version of the International Physical Activity Questionnaire (IPAQ). To evaluate cardiovascular risk factors, anthropometric measurements and blood samples were taken. Findings showed that an average of 70.5 ± 232.4 min/week was spent on moderate-to-vigorous physical activity (MVPA), which indicated a low level of physical activity. Data showed that 90.5% of the subjects had low physical activity, 6.3% were moderate, and 3.2% were considered as having a high level of physical activity. For body mass index (BMI), 58.7% of the respondents were obese, 28.6% were overweight (29.10 ± 5.67 kg m-2), and 81.0% of subjects had a waist circumference (WC) value above the normal range (92.74 ± 16.40 cm). A two-way ANOVA test revealed significant mean differences between systolic blood pressure (mm/Hg) and age groups (p > 0.05). Nevertheless, there was a significant association between MVPA and cardiovascular risk factors using negative binomial regression (p < 0.01). The findings of this study highlight the need for health promotional programs to raise awareness, educate, and engage low-income housewives in lifestyle-enhancing behaviors.
Fulltext The Implementation of Childhood Obesity Related Policy Interventions in Malaysia-A Non Communicable Diseases Scorecard Project

Mok WKH, Hairi NN, Chan CMH, Mustapha FI, Saminathan TA, Low WY

Int J Environ Res Public Health, 2021 06 01;18(11).
PMID: 34206056 DOI: 10.3390/ijerph18115950

(1) Background: The prevalence of overweight and obesity among children has increased tremendously in the ASEAN region, including Malaysia. In Malaysia, the National Strategic Plan for Non-Communicable Diseases (2015-2025) provides the overall framework for its response to the non-communicable diseases (NCD) epidemic. Preventing childhood obesity is one of the key strategies for early intervention to prevent NCDs. The objective of this research is to examine the current status of policy interventions in addressing childhood obesity in Malaysia. (2) Methods: A panel of 22 stakeholders and experts from Malaysia, representing the government, industry, academia and non-governmental organizations, were sampled using a modified Delphi technique. Data were collected using a modified NCD scorecard under four domains (governance, risk factors, surveillance and research and health systems response). A heat map was used to measure the success of the four realms of the NCD scorecard. For each domain of the NCD scorecard, the final score was grouped in quintiles. (3) Results: A total of 22 participants responded, comprising of eight (36.4%) males and 14 (63.4%) females. All the domains measured in implementing policies related to childhood obesity were of low progress. Nine governance indicators were reported as 22.5% (low progress), four in the risk factors domain, and two in the surveillance. This shows that timely and accurate monitoring, participatory review and evaluation, and effective remedies are necessary for a country's surveillance system. (4) Conclusion: Although Malaysia has published several key strategic documents relating to childhood obesity and implemented numerous policy interventions, we have identified several gaps that must be addressed to leverage the whole-of-government and whole-of-society approach in addressing childhood obesity in the country.
Development and Validation of Psychometric Properties of the 10 IB Learner Profile Instrument (10IBLP-I): A Combination of the Rasch and Classical Measurement Model

Kamaruddin M, Mohd Matore MEE

Int J Environ Res Public Health, 2021 Jun 15;18(12).
PMID: 34203683 DOI: 10.3390/ijerph18126455

BACKGROUND: The International Baccalaureate Middle Years Programme (IBMYP) aims to produce a holistic transformation with creative and critically minded students. However, very little attention has been paid to the development of an instrument to measure the IB learner profile with good psychometric properties.
PURPOSE: This study aims to develop an instrument with good psychometric properties, based on the Rasch measurement model and confirmatory factor analysis.
METHODS: The study consists of two phases of pilot and field studies involving 597 year four students from IBWS MOE.
RESULTS: The findings from the Rasch measurement model analysis have shown that 54 items meet the criteria of the item fit, unidimensionality, and reliability index. Meanwhile, confirmatory factor analysis found that 44 items have shown a valid item fit index.
CONCLUSIONS: The combination of both analyses has shown the strength of 10IBLP-I psychometric properties that cover the aspects of validity and reliability. The findings also provide an implication to the theory, with empirical evidence that the IB learner profile consists of 10 constructs. Besides, the evidenced 10IBLP-I comprises good psychometric properties, which can be used to measure the level of IB learner profile among IBWS MOE students to assess the effectiveness of the implementation of IBMYP in Malaysia.
A Systematic Review and Meta-Analysis of the Efficacy of Evening Primrose Oil for Mastalgia Treatment

Ahmad Adni LL, Norhayati MN, Mohd Rosli RR, Muhammad J

Int J Environ Res Public Health, 2021 Jun 10;18(12).
PMID: 34200727 DOI: 10.3390/ijerph18126295

Mastalgia, or breast pain, is common among women which can lead to significant impairment in daily living. Hence, finding an effective treatment that can alleviate the symptom is very important. Thus, we carry out this study to determine the efficacy of evening primrose oil (EPO) for mastalgia treatment in women. The review included published randomised clinical trials that evaluated EPO used for treating mastalgia against a placebo or other treatments, irrespective of the blinding procedure, publication status, or sample size. Two independent authors screened the titles and abstracts of the identified trials; full texts of relevant trials were evaluated for eligibility. Two reviewers independently extracted data on the methods, interventions, outcomes, and risk of bias. The random-effects model was used for estimating the risk ratios and mean differences with 95% confidence intervals. Thirteen trials with 1752 randomised patients were included. The results showed that EPO has no difference to reduce breast pain compared to topical NSAIDS, danazol, or vitamin E. The number of patients who achieved pain relief was no different compared to the placebo or other treatments. The EPO does not increase adverse events, such as nausea, abdominal bloating, headache or giddiness, increase weight gain, and altered taste compared to a placebo or other treatments. EPO is a safe medication with similar efficacy for pain control in women with mastalgia compared to a placebo, topical NSAIDS, danazol, or vitamin E.
Vision and Hearing Impairments Affecting Activities of Daily Living among Malaysian Older Adults by Gender

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.
The Influence of Teachers' Self-Efficacy and School Leaders' Transformational Leadership Practices on Teachers' Innovative Behaviour

Zainal MA, Mohd Matore MEE

Int J Environ Res Public Health, 2021 Jun 14;18(12).
PMID: 34198506 DOI: 10.3390/ijerph18126423

BACKGROUND: The current rapid development demands educators to possess innovative behaviour. Presently, in the environment of rapid technological growth and borderless global communication, teachers with innovative behaviour are capable of facing each painful challenge that confronts the education system; therefore, it is essential to understand the factors influencing the innovative behaviour of teachers.
PURPOSE: To identify the influence of teachers' self-efficacy and school administrators' transformational leadership practices on teachers' innovative behaviour.
METHOD: A quantitative approach using a cross-sectional survey design with a sample of 1415 teachers from four states in Malaysia, and the data were statistically analysed using SPSS® version 26.0 for Windows™ (IBM Corporation, New York, NY, USA).
RESULT: Multiple Regression Analysis found that teachers' self-efficacy and school administrators' transformational leadership practices both had a significant influence on teachers' innovative behaviour by contributing 47.0% of the variance in teachers' innovative behaviour.
CONCLUSION: The findings suggested that teachers' self-efficacy and school administrators' transformational leadership practices both play a role in influencing teachers' innovative behaviour. Therefore, the stakeholders need to consider the aspects of self-efficacy and transformational leadership practices of school administrators in drafting policies and related programmes to improve teachers' innovative behaviour.
Fulltext Relationship between Physical Activity, Sedentary Behavior, and Anthropometric Measurements among Saudi Female Adolescents: A Cross-Sectional Study

Ahmad Bahathig A, Abu Saad H, Md Yusop NB, Mohd Shukri NH, El-Din MME

Int J Environ Res Public Health, 2021 08 10;18(16).
PMID: 34444210 DOI: 10.3390/ijerph18168461

Overweight and obesity are becoming increasingly prevalent among children and adolescents in Saudi Arabia and are an emerging cause of non-communicable diseases (NCDs). Lifestyle factors, such as insufficient levels of physical activity and sedentary behaviors, are responsible for the increased prevalence of NCDs. This study aimed to determine the association between physical activity levels, sedentary behaviors, and anthropometric measurements in Saudi female adolescents. A cross-sectional study was carried out among 399 healthy female adolescent students aged 13-14 years in Arar, Saudi Arabia. The participants were randomly selected from different schools and their anthropometric measurements were determined. The Physical Activity Questionnaire for Older Children (PAQ-C) and the Adolescent Sedentary Activity Questionnaire (ASAQ) were used to assess their physical activity levels and sedentary behaviors, and an analysis was conducted using IBM SPSS software version 25. A multiple linear regression model was used to determine the association between the variables. The majority of the participants had a normal body mass index (BMI; 79.4%) and waist circumference (WC; 62.4%). A total of 74.4% had waist to height ratio (WHtR) < 0.5. About 92.7% of the participants were not meeting PA recommendations of 60 min of moderate to vigorous physical activity daily. The overall mean time spent on sedentary activities was high on both weekdays and weekend days at 357.64 ± 86.29 and 470.51 ± 147.64 min/day, respectively. Moreover, anthropometric measurement (BMI) was positively associated with age and negatively associated with sedentary behavior on weekends, while WHtR was positively associated with age. The multiple linear regression analysis also showed that age and sedentary behavior significantly predicted BMI among the study participants (F (2, 396) = 4.346, p < 0.014) and age was the only significant predictor of WHtR (F (1, 397) = 16.191, p ≤ 0.001). This study revealed that most of the female Saudi adolescents undertook low levels of activity and high levels of sedentary behaviors. Sedentary behaviors were significantly associated with their BMI. Accordingly, an intervention program on healthy lifestyles is important to improve Saudi female adolescents' lifestyles.
Fulltext Critical Success Factors of Safety Program Implementation in Construction Projects in Iraq

Buniya MK, Othman I, Sunindijo RY, Kashwani G, Durdyev S, Ismail S, et al.

Int J Environ Res Public Health, 2021 08 11;18(16).
PMID: 34444218 DOI: 10.3390/ijerph18168469

The construction sector is recognized as one of the most dangerous industries in the world. The situation is worsening in Iraq, as a result of a lack of attention to safety in the building industry and the poor implementation of safety programs. This research aims to identify the critical safety factors (CSFs) of safety program implementation in the Iraqi construction industry. The CSFs were first identified from a review of literature before being verified by construction practitioners, using semi-structured interviews. A questionnaire, based on the verified CSFs, was distributed to construction practitioners in Iraq. Exploratory factor analysis (EFA) was used to analyze the quantitative data, and the results show that the CSFs can be categorized into four constructs: worker involvement, safety prevention and control system, safety arrangement, and management commitment. Following that, partial least square structural equation modelling (PLS-SEM) was executed to establish the connection between safety program implementation and overall project success. The result confirms that safety program implementation has a significant, positive impact on project success. This article contributes to knowledge and practice by identifying the CSFs for implementing safety programs in the Iraqi construction industry. The successful implementation of a safety program not only improves safety performance, but also helps to meet other project goals.
Fulltext Cost-Effectiveness of Colorectal Cancer Genetic Testing

Ramdzan AR, Manaf MRA, Aizuddin AN, Latiff ZA, Teik KW, Ch'ng GS, et al.

Int J Environ Res Public Health, 2021 08 06;18(16).
PMID: 34444091 DOI: 10.3390/ijerph18168330

Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths worldwide. Approximately 3-5% of CRCs are associated with hereditary cancer syndromes. Individuals who harbor germline mutations are at an increased risk of developing early onset CRC, as well as extracolonic tumors. Genetic testing can identify genes that cause these syndromes. Early detection could facilitate the initiation of targeted prevention strategies and surveillance for CRC patients and their families. The aim of this study was to determine the cost-effectiveness of CRC genetic testing. We utilized a cross-sectional design to determine the cost-effectiveness of CRC genetic testing as compared to the usual screening method (iFOBT) from the provider's perspective. Data on costs and health-related quality of life (HRQoL) of 200 CRC patients from three specialist general hospitals were collected. A mixed-methods approach of activity-based costing, top-down costing, and extracted information from a clinical pathway was used to estimate provider costs. Patients and family members' HRQoL were measured using the EQ-5D-5L questionnaire. Data from the Malaysian Study on Cancer Survival (MySCan) were used to calculate patient survival. Cost-effectiveness was measured as cost per life-year (LY) and cost per quality-adjusted life-year (QALY). The provider cost for CRC genetic testing was high as compared to that for the current screening method. The current practice for screening is cost-saving as compared to genetic testing. Using a 10-year survival analysis, the estimated number of LYs gained for CRC patients through genetic testing was 0.92 years, and the number of QALYs gained was 1.53 years. The cost per LY gained and cost per QALY gained were calculated. The incremental cost-effectiveness ratio (ICER) showed that genetic testing dominates iFOBT testing. CRC genetic testing is cost-effective and could be considered as routine CRC screening for clinical practice.
Fulltext Behind the Scenes of Parents Nurturing a Child with Autism: A Qualitative Study in Malaysia

Yaacob WNW, Yaacob LH, Muhamad R, Zulkifli MM

Int J Environ Res Public Health, 2021 08 12;18(16).
PMID: 34444280 DOI: 10.3390/ijerph18168532

Many parents have experienced difficulties in parenting children with autism. We, therefore, consider a more in-depth understanding that is necessary to explore the challenges facing parents and families to provide a better outcome for both. We interviewed 21 parents of 24 children with autism spectrum disorder (ASD) to qualitatively explore the challenges they experienced through a phenomenological framework. Four main aspects emerged as challenges to the parents: inadequate knowledge, psychological distress and stigma, lack of support, and barriers to services. These four themes reflect a lack of balance between the needs of caregivers and the services and resources or support available in the community to meet those needs. Our study contributes to an understanding of how parents perceive challenges, making it easier to take necessary action to meet their needs and ease their burden of stress. A concerted effort is needed to coordinate services across all disciplines to address these challenges.
Fulltext Implementation of Kinetic and Kinematic Variables in Ergonomic Risk Assessment Using Motion Capture Simulation: A Review

Yunus MNH, Jaafar MH, Mohamed ASA, Azraai NZ, Hossain MS

Int J Environ Res Public Health, 2021 08 06;18(16).
PMID: 34444087 DOI: 10.3390/ijerph18168342

Work-related musculoskeletal disorders (WMSDs) are among the most common disorders in any work sector and industry. Ergonomic risk assessment can reduce the risk of WMSDs. Motion capture that can provide accurate and real-time quantitative data has been widely used as a tool for ergonomic risk assessment. However, most ergonomic risk assessments that use motion capture still depend on the traditional ergonomic risk assessment method, focusing on qualitative data. Therefore, this article aims to provide a view on the ergonomic risk assessment and apply current motion capture technology to understand classical mechanics of physics that include velocity, acceleration, force, and momentum in ergonomic risk assessment. This review suggests that using motion capture technologies with kinetic and kinematic variables, such as velocity, acceleration, and force, can help avoid inconsistency and develop more reliable results in ergonomic risk assessment. Most studies related to the physical measurement conducted with motion capture prefer to use non-optical motion capture because it is a low-cost system and simple experimental setup. However, the present review reveals that optical motion capture can provide more accurate data.
Fulltext Prevalence and Associated Factors of Psychological Distress and Burnout among Medical Students: Findings from Two Campuses

Arif NMNA, Roslan NS, Ismail SB, Nayak RD, Jamian MR, Mohamad Ali Roshidi AS, et al.

Int J Environ Res Public Health, 2021 08 10;18(16).
PMID: 34444193 DOI: 10.3390/ijerph18168446

Medical training is intensive and predisposes students to psychological distress and burnout. Unaddressed burnout in medical training may persist in the internship phase and impact the quality of patient care. While some associations have been established, the link between some individual factors and training characteristics with distress and burnout in medical training remained unclear. In this study, we aim to examine the prevalence of psychological distress and burnout, and its association with gender, training phase, funding status, cumulative grade points average (CGPA), and coping strategies among medical students. The study applied a multicenter cross-sectional study design and convenience sampling on medical students from two medical schools from Malaysia and India. We used a self-reporting instrument that includes demographic details, the 12-item General Health Questionnaire (GHQ), the Copenhagen Burnout Inventory (CBI), and the Brief Coping Orientation to Problems Experienced (Brief COPE). A total of 748 medical students participated in the study. The prevalence of psychological distress, personal-related, work-related, and patient-related burnout were 33.0%, 56.1%, 35.0%, and 26.2%, respectively. Being male, clinical year, self-funded, and having a CGPA of more than 3.50 predicted psychological distress and burnout with mixed results. Maladaptive coping mechanisms consistently predicted the risk of psychological distress and burnout by more than two times. The findings indicate that primary and secondary mental health interventions have a role in medical training. A systematic intervention should incorporate coping skills training alongside institutional-targeted intervention.
Fulltext Understanding the Impact of Perfluorinated Compounds on Cardiovascular Diseases and Their Risk Factors: A Meta-Analysis Study

Abdullah Soheimi SS, Abdul Rahman A, Abd Latip N, Ibrahim E, Sheikh Abdul Kadir SH

Int J Environ Res Public Health, 2021 08 06;18(16).
PMID: 34444092 DOI: 10.3390/ijerph18168345

Perfluorinated compounds (PFCs) are non-biodegradable synthetic chemical compounds that are widely used in manufacturing many household products. Many studies have reported the association between PFCs exposure with the risk of developing cardiovascular diseases (CVDs). However, those reports are still debatable, due to their findings. Thus, this review paper aimed to analyse the association of PFCs compound with CVDs and their risk factors in humans by systematic review and meta-analysis. Google Scholar, PubMed and ScienceDirect were searched for PFCs studies on CVDs and their risk from 2009 until present. The association of PFCs exposure with the prevalence of CVDs and their risk factors were assessed by calculating the quality criteria, odds ratios (ORs), and 95% confidence intervals (CIs). CVDs risk factors were divided into serum lipid profile (main risk factor) and other known risk factors. The meta-analysis was then used to derive a combined OR test for heterogeneity in findings between studies. Twenty-nine articles were included. Our meta-analysis indicated that PFCs exposure could be associated with CVDs (Test for overall effect: z = 2.2, p = 0.02; Test for heterogeneity: I2 = 91.6%, CI = 0.92-1.58, p < 0.0001) and their risk factors (Test for overall effect: z = 4.03, p < 0.0001; Test for heterogeneity: I2 = 85.8%, CI = 1.00-1.14, p < 0.0001). In serum lipids, total cholesterol levels are frequently reported associated with the exposure of PFCs. Among PFCs, perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) exposure increased the risk of CVDs than other types of PFCs. Although the risk of PFOA and PFOS were positively associated with CVDs and their risk factors, more observational studies shall be carried out to identify the long-term effects of these contaminants in premature CVDs development in patients.
Fulltext Older Adults with Hypertension: Prevalence of Falls and Their Associated Factors

Abu Bakar AA, Abdul Kadir A, Idris NS, Mohd Nawi SN

Int J Environ Res Public Health, 2021 08 04;18(16).
PMID: 34444005 DOI: 10.3390/ijerph18168257

Falls are prominent health issues among older adults. Among hypertensive older adults, falls may have a detrimental effect on their health and wellbeing. The purpose of this study is to determine the prevalence of falls among hypertensive older adults and to identify the associated factors that contribute to their falls. This was a cross-sectional study conducted among two hundred and sixty-nine hypertensive older adults who were selected via systematic random sampling in two primary health clinics in Kuala Terengganu, Malaysia. Data on their socio-demographic details, their history of falls, medication history and clinical characteristics were collected. Balance and gait were assessed using the Performance Oriented Mobility Assessment (POMA). It was found that 32.2% of participants reported falls within a year. Polypharmacy (adjusted OR 2.513, 95% CI 1.339, 4.718) and diuretics (adjusted OR 2.803, 95% CI 1.418, 5.544) were associated with an increased risk of falls. Meanwhile, a higher POMA score (adjusted OR 0.940, 95% CI 0.886, 0.996) and the number of antihypertensives (adjusted OR 0.473, 95% CI 0.319, 0.700) were associated with a low incidence of falling among hypertensive older adults. Falls are common among hypertensive older adults. Older adults who are taking diuretics and have a polypharmacy treatment plan have a higher incidence of falls. However, older adults taking a higher number of anti-hypertensive medications specifically were not associated with an increased prevalence of falls.
Fulltext Active Aging in ASEAN Countries: Influences from Age-Friendly Environments, Lifestyles, and Socio-Demographic Factors

Tiraphat S, Kasemsup V, Buntup D, Munisamy M, Nguyen TH, Hpone Myint A

Int J Environ Res Public Health, 2021 08 05;18(16).
PMID: 34444040 DOI: 10.3390/ijerph18168290

Active aging is a challenging issue to promote older population health; still, there is little clarity on research investigating the determinants of active aging in developing countries. Therefore, this research aimed to examine the factors associated with the active aging of the older populations in ASEAN's low and middle-income countries by focusing on Malaysia, Myanmar, Vietnam, and Thailand. The study is a cross-sectional quantitative research study using multi-stage cluster sampling to randomize the sample. The sample consists of 2031 older people aged 55 years and over, including 510 Thai, 537 Malaysian, 487 Myanmar, and 497 Vietnamese. We collected a quantitative questionnaire of age-friendly environmental scale and active aging scale based on the World Health Organization (WHO) concept. The predictors of active aging include age-friendly environments, lifestyles, and socioeconomic factors; the data are analyzed by using multiple logistic regression. After adjusting for other factors, we found that older people living in a community with higher levels of age-friendly environments are 5.52 times more active than those in lower levels of age-friendly environments. Moreover, the older population with healthy lifestyles such as good dietary intake and high physical activity will be 4.93 times more active than those with unhealthy lifestyles. Additionally, older adults with partners, higher education, and aged between 55 and 64 years will be 1.70, 2.61, and 1.63 times more active than those with separate/divorce/widow, primary education, and age at 75 years or higher, respectively. Our results contribute considerable evidence for ASEAN policy-making to promote active aging in this region.
Fulltext Smartphone Addiction and Sleep Quality on Academic Performance of University Students: An Exploratory Research

Rathakrishnan B, Bikar Singh SS, Kamaluddin MR, Yahaya A, Mohd Nasir MA, Ibrahim F, et al.

Int J Environ Res Public Health, 2021 08 05;18(16).
PMID: 34444042 DOI: 10.3390/ijerph18168291

This study was conducted to examine the relationship between smartphone addiction, sleep quality, and academic performance. The study presented quantitative research on 323 students in a public university in Sabah to explore the relationship between smartphone addiction, sleep quality, and academic performance. A simple random sampling was used in the study. The Smartphone Addiction Scale Short Version (SAS-SV) and the Pittsburgh Sleep Quality Index (PSQI) were used in this study. SPSS was used as a tool of analysis for descriptive and inferential analysis. Pearson correlation was involved to test the hypothesis of the study. The result indicated that the greater the smartphone addiction, the lower the academic performance of university students. The finding also proved that students with poor sleep quality might exhibit low academic performance. Smartphone addiction was found to be associated with sleep quality where overusing smartphones was related to poor sleep quality in university students. On this basis, the problem of smartphone addiction and sleep quality should be tackled in order to improve the academic performance of university students and their overall health.

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