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  1. 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.
  2. Fulltext The Validation and Improvement of a Food Literacy Behavior Checklist for Food Literacy Programs
    Paynter E, Begley A, Butcher LM, Dhaliwal SS
    Int J Environ Res Public Health, 2021 12 16;18(24).
    PMID: 34948890 DOI: 10.3390/ijerph182413282
    Food literacy is a multidimensional construct required to achieve diet quality. The Food Sensations® for Adults (FSA) program aims to improve the food literacy of low to middle-income adults living in Western Australia and is funded by the Western Australian Department of Health. The original published behavior checklist used to measure change in food literacy has been revised based on experience of the facilitators and the iterative development of the program. This research sought to assess the validity and reliability of the improved food literacy behavior checklist. A total of 1,359 participants completed the checklist over an 18-month period. Content, face, and construct validity were considered in the re-development of the checklist. An exploratory factor analysis of the checklist identified three factors: (1) Plan and Manage, (2) Selection, and (3) Preparation. Cronbach's alpha coefficients of 0.883, 0.760, and 0.868 were found for each of the three factors respectively. These coefficients indicated good internal consistency and were higher than those found in the original checklist analysis. An external validation was undertaken with the original food literacy behavior checklist, and a strong positive relationship between the two tools was found. In addition to being used to evaluate FSA, this revised and extensively validated tool could provide guidance to others evaluating similar food literacy programs and contribute to international measurement research.
  3. Fulltext Does a Person-Environment-Fit Promote the Academic Achievement of Hearing-Impaired Students in Malaysian Polytechnics? The Mediating Effects of Satisfaction and Adjustment
    Azizan CR, Roslan S, Abdullah MC, Asimiran S, Zaremohzzabieh Z, Ahrari S
    Int J Environ Res Public Health, 2021 12 19;18(24).
    PMID: 34948990 DOI: 10.3390/ijerph182413381
    (1) This study investigates the influence of a person-environment-fit on academic achievement and examines mediating effects of adjustment and satisfaction on this relationship; (2) Methods: Data were collected from a sample of 195 hearing-impaired students from five polytechnics in Malaysia that offered the Special Skills Certificate program; (3) Results: Results revealed that the two constructs of the person-environment approach: personality-major fit and needs-supplies fit were positively associated with academic achievement. The adjustment was found to mediate this relationship. Taken together, these results signal that the person-environment constructs contribute to the academic achievement of hearing-impaired students and that adjustment is instrumental in elucidating this relationship; (4) Conclusions: The finding adds to the data, indicating that the person-environment-fit is a possible model of inclusion for hearing-impaired students and also provides initial data about the functioning of hearing-impaired students in Malaysian polytechnics.
  4. 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.
  5. Fulltext Breast Cancer Screening in Semi-Rural Malaysia: Utilisation and Barriers
    Mohan D, Su TT, Donnelly M, Hoe WMK, Schliemann D, Tan MM, et al.
    Int J Environ Res Public Health, 2021 11 23;18(23).
    PMID: 34886015 DOI: 10.3390/ijerph182312293
    Breast cancer (BC) is the commonest cancer in Malaysia. Delayed diagnosis is a significant cause of BC mortality in the country. Early diagnosis and screening are vital strategies in mortality reduction. This study assessed the level of utilisation and barriers for breast self-examination (BSE), clinical breast examination (CBE) and mammogram in a semi-rural population in Malaysia and compared these across the different ethnic groups. This cross-sectional study was conducted among women aged 40 years and above, embedded within a health and demographic surveillance site (HDSS) in Segamat, Malaysia. Trained data collectors collected data on screening and barriers during home visits. Study participants (n = 250) were aged 59.4 ± 10.9 years and represented Malaysia's three major ethnic groups. Practice of regular BSE, CBE uptake (ever) and mammogram (ever) was 23.2%, 36% and 22.4%, respectively. Regular BSE practice was highest in the Malay ethnic group and least among the Chinese. Regular CBE was very low in all ethnic groups (<5%). Mammogram uptake was highest among Chinese (34.4%), followed by Indians (30.4%) and Malays (16.6%). After adjusting for other socio-demographic variables, Malay ethnicity was positively associated with regular BSE (adjusted OR = 5.26, 95% CI 2.05, 13.50) and negatively associated with having had a mammogram (adjusted OR = 0.3, 95% CI 0.15, 0.57). Lower education was negatively associated (adjusted OR = 0.36, 95% CI 0.17, 0.74) with mammogram attendance (ever). Emotional and financial barriers were the most reported types of barriers, specifically, fear of diagnosis (74.8%), cost of diagnosis (69.6%) and fear of losing a breast (66.4%). Malay women more commonly reported most barriers compared to other ethnic groups. Screening uptake was low among semi-rural women in Malaysia. Implementing culturally appropriate interventions that consider ethnic differences is crucial to empowering women to engage in BC screening initiatives in these communities.
  6. Fulltext Behavioral theory-based framework for prediabetes self-care system-design perspectives and validation results
    Subramaniam S, Dhillon JS, Wan Ahmad WF
    Int J Environ Res Public Health, 2021 08 31;18(17).
    PMID: 34501750 DOI: 10.3390/ijerph18179160
    Type 2 diabetes (T2D) is a chronic condition that can lead to many life-threatening diseases. Prediabetes is defined as a state in which blood glucose levels are elevated but not high enough to be diagnosed as diabetes. This stage can be reversible with appropriate lifestyle and dietary modifications. Existing solutions are mostly developed to deal with T2D instead of preventing it in the first place. In this study, we propose a framework to aid in the development of self-care systems to prevent T2D, which integrates behavioral change theories and techniques and offers features, such as goal setting, activity planning, and health monitoring. We then assessed the feasibility of a prediabetes self-care system designed based on the proposed framework. Quantitative and qualitative methods were adopted in evaluating i-PreventDiabetes, a prototype. Numerous aspects of the prototype were evaluated, including (1) its effectiveness in assisting individuals with prediabetes in improving their health management behaviors, (2) its effect on users' attitudes toward diabetes prevention, (3) users' motivation levels, (4) user acceptability of the system, and (5) user experience. Users viewed i-PreventDiabetes positively and experienced a positive change in their attitude toward their health. Diabetes prevention systems, such as i-PreventDiabetes, have the potential to increase self-care behaviors among individuals with prediabetes, enabling them to manage their lifestyle and nutrition more effectively to avert a variety of potentially fatal conditions.
  7. Fulltext Environmental Remediation Potential of Ferrous Sulfate Waste as an Eco-Friendly Coagulant for the Removal of NH3-N and COD from the Rubber Processing Effluent
    Mohammad Ilias MK, Hossain MS, Ngteni R, Al-Gheethi A, Ahmad H, Omar FM, et al.
    Int J Environ Res Public Health, 2021 11 25;18(23).
    PMID: 34886153 DOI: 10.3390/ijerph182312427
    The present study was conducted to determine the potential of utilizing the FeSO4·7H2O waste from the titanium manufacturing industry as an effective coagulant for treating industrial effluent. In this study, the secondary rubber processing effluent (SRPE) was treated using ferrous sulfate (FeSO4·7H2O) waste from the titanium oxide manufacturing industry. The FeSO4·7H2O waste coagulation efficiency was evaluated on the elimination of ammoniacal nitrogen (NH3-N) and chemical oxygen demand (COD) from SRPE. The central composite design (CCD) of experiments was employed to design the coagulation experiments with varying coagulation time, coagulant doses, and temperature. The coagulation experiments were optimized on the optimal elimination of NH3-N and COD using response surface methodology (RSM). Results showed that coagulant doses and temperature significantly influenced NH3-N and COD elimination from SRPE. The highest NH3-N and COD removal obtained were 98.19% and 93.86%, respectively, at the optimized coagulation experimental conditions of coagulation time 70 min, coagulant doses 900 mg/L, and temperature 62 °C. The residual NH3-N and COD in treated SPRE were found below the specified industrial effluent discharge limits set by DoE, Malaysia. Additionally, the sludge generated after coagulation of SRPE contains essential plant nutrients. The present study's finding showed that FeSO4·7H2O waste generated as an industrial byproduct in a titanium oxide manufacturing industry could be utilized as an eco-friendly coagulant in treating industrial effluent.
  8. Fulltext Sustainability of Heating, Ventilation and Air-Conditioning (HVAC) Systems in Buildings-An Overview
    Asim N, Badiei M, Mohammad M, Razali H, Rajabi A, Chin Haw L, et al.
    Int J Environ Res Public Health, 2022 Jan 17;19(2).
    PMID: 35055838 DOI: 10.3390/ijerph19021016
    Increasing demand on heating, ventilation, and air-conditioning (HVAC) systems and their importance, as the respiratory system of buildings, in developing and spreading various microbial contaminations and diseases with their huge global energy consumption share have forced researchers, industries, and policymakers to focus on improving the sustainability of HVAC systems. Understanding and considering various parameters related to the sustainability of new and existing HVAC systems as the respiratory system of buildings are vital to providing healthy, energy-efficient, and economical options for various building types. However, the greatest opportunities for improving the sustainability of HVAC systems exist at the design stage of new facilities and the retrofitting of existing equipment. Considering the high available percentage of existing HVAC systems globally reveals the importance of their retrofitting. The attempt has been made to gather all important parameters that affect decision-making to select the optimum HVAC system development considerations among the various opportunities that are available for sustainability improvement.
  9. Fulltext Bioaccessibility of Polycyclic Aromatic Hydrocarbons (PAHs) in Grilled Meat: The Effects of Meat Doneness and Fat Content
    Hamidi EN, Hajeb P, Selamat J, Lee SY, Abdull Razis AF
    Int J Environ Res Public Health, 2022 Jan 10;19(2).
    PMID: 35055557 DOI: 10.3390/ijerph19020736
    Exposure to polycyclic aromatic hydrocarbons (PAHs) through diet is gaining concern due to the risk it poses to human health. This study evaluated the bioaccessibility of PAHs contained in charcoal-grilled beef and chicken in different segments of the gastrointestinal tract (GIT) with regard to the degree of doneness and fat content of the meats. The levels of 15 PAHs in the grilled meat samples and bioaccessible fractions were determined using high-performance liquid chromatography (HPLC) equipped with PAH column, and UV and fluorescence detectors. Total PAHs were found in beef (30.73 ng/g) and chicken (70.93 ng/g) before its digestion, and different PAHs' bioaccessibility were observed in the different segments of GIT, with the highest in the stomach followed by the small intestine, despite the relatively higher bioaccessibility of individual PAHs in grilled beef as compared to those in grilled chicken. Additionally, the PAHs' bioaccessibility increased with the increase in the degree of doneness. Positive linear correlation was observed for the PAHs' bioaccessibility and the fat contents of grilled meat. Overall, this study highlights the influence of meat doneness (cooking time) and fat contents on the bioaccessibility and bioaccumulation of PAHs.
  10. Fulltext Malaysian Health Literacy: Scorecard Performance from a National Survey
    Jaafar N, Perialathan K, Krishnan M, Juatan N, Ahmad M, Mien TYS, et al.
    Int J Environ Res Public Health, 2021 05 28;18(11).
    PMID: 34071455 DOI: 10.3390/ijerph18115813
    Health literacy is an indicator of a society's ability to make better health judgements for themselves and the people around them. This study investigated the prevalence of health literacy among Malaysian adults and provided an overall picture of the society's current health literacy status, which has not been previously assessed. The study also highlighted socio-demographic markers of communities with limited health literacy that may warrant future intervention. A population-based self-administered survey using the Health Literacy Survey Malaysian Questionnaire18 (HLS-M-Q18) instrument was conducted as part of the National Health Morbidity Survey 2019 in Malaysia. The nationwide survey utilized a two-staged stratified random sampling method. A sample of 9478 individuals aged 18 and above, drawn from the living quarter list, participated in the study. The health literacy score was divided into three levels; limited, sufficient, and excellent. Findings showed a majority of the Malaysian population had a sufficient health literacy level in all three domains-healthcare, diseases prevention and health promotion (49.1%, 44.2%, and 47.5%, respectively)-albeit leaning towards the lower end of the category with an average score of 35.5. The limited health literacy groups were prevalent among respondents with older age (68%), lower education level (64.8%), and lower household income (49.5%). The overall health literacy status for Malaysia was categorized at a lower sufficiency level. Future health literacy improvements should focus on communities with a limited health literacy level to improve the overall score.
  11. Fulltext Associations between health literacy and sociodemographic factors: A cross-sectional study in Malaysia utilising the HLS-M-Q18
    Azlan AA, Hamzah MR, Tham JS, Ayub SH, Ahmad AL, Mohamad E
    Int J Environ Res Public Health, 2021 05 02;18(9).
    PMID: 34063294 DOI: 10.3390/ijerph18094860
    Health literacy is progressively seen as an indicator to describe a nation's health status. To improve health literacy, countries need to address health inequalities by examining different social demographic factors across the population. This assessment is crucial to identify and evaluate the strengths and limitations of a country in addressing health issues. By addressing these health inequalities, a country would be better informed to take necessary steps to improve the nation's health literacy. This study examines health literacy levels in Malaysia and analyses socio-demographic factors that are associated with health literacy. A cross-sectional survey was carried out using the HLS-M-Q18 instrument, which was validated for the Malaysian population. Multi-stage random sampling strategy was used in this study, utilising several sampling techniques including quota sampling, cluster sampling, and simple random sampling to allow random data collection. A total of 855 respondents were sampled. Our results showed that there were significant associations between health literacy and age, health status, and health problems. Our findings also suggest that lower health literacy levels were associated with the younger generation. This study's findings have provided baseline data on Malaysians' health literacy and provide evidence showing potential areas of intervention.
  12. Fulltext Family Caregivers' Experiences and Coping Strategies in Managing Stroke Patients during the COVID-19 Pandemic: A Qualitative Exploration Study
    Haji Mukhti MI, Ibrahim MI, Tengku Ismail TA, Nadal IP, Kamalakannan S, Kinra S, et al.
    Int J Environ Res Public Health, 2022 01 14;19(2).
    PMID: 35055764 DOI: 10.3390/ijerph19020942
    BACKGROUND: Stroke is a chronic disease that requires stroke survivors to be supported long-term by their families. This is especially because of the inaccessibility to post-stroke rehabilitation outside hospitals. The Corona Virus Disease 2019 (COVID-19) crisis and the pandemic restrictions in Malaysia are expected to exponentially increase the demand from family caregivers in supporting stroke survivors. Thus, this study aims to explore the burden, experience, and coping mechanism of the family caregivers supporting stroke survivors during the COVID-19 pandemic.

    METHODOLOGY: A phenomenological qualitative study was conducted from November 2020 to June 2021 in Malaysia. A total of 13 respondents were recruited from two public rehabilitation centers in Kota Bharu, Kelantan. In-depth interviews were conducted with the participants. Comprehensive representation of perspectives from the respondents was achieved through purposive sampling. The interviews were conducted in the Kelantanese dialect, recorded, transcribed, and analyzed using thematic analysis.

    RESULTS: Three themes on burdens and experiences were identified. They were worsening pre-existing issues, emerging new issues, and fewer burdens and challenges. Two themes on coping strategies were also identified. They were problem-focused engagement and emotion-focused engagement.

    CONCLUSIONS: The COVID-19 pandemic has changed the entire system of stroke management. While family caregivers mostly faced the extra burden through different experiences, they also encountered some positive impacts from the pandemic. The integrated healthcare system, especially in the era of digitalization, is an important element to establish the collaborative commitment of multiple stakeholders to compensate burden and sustain the healthcare of stroke survivors during the pandemic.

  13. Fulltext Validation and Measurement Invariance of the Body Appreciation Scale-2 between Genders in a Malaysian Sample
    Tan CS, Cheng SM, Cong CW, Abu Bakar ARB, Michael E, Mohd Wazir MIB, et al.
    Int J Environ Res Public Health, 2021 11 05;18(21).
    PMID: 34770142 DOI: 10.3390/ijerph182111628
    The 10-item Body Appreciation Scale-2 (BAS-2) is a measurement for individuals to self-report the extent to which they accept and respect their bodies. Although the BAS-2 has been translated into the Malay language and found to have promising qualities, the psychometric characteristics of the English version of BAS-2 remain unknown in the Malaysian context. The present study thus administered the English version BAS-2 and selfie-editing frequency scale to 797 individuals aged 18 to 56 years old in Malaysia. The dataset that was randomly divided into two halves were submitted to exploratory factor analysis and confirmatory factor analysis respectively. Both of the factor analyses consistently support a one-factor model. The Cronbach's alpha and McDonald omega coefficients were greater than 0.90, indicating that the BAS-2 has good internal consistency. The incremental validity is also evident. A hierarchical multiple regression showed that the BAS-2 score had a positive relationship with selfie-editing frequency after controlling for age and gender. Moreover, the measurement invariance test supported scalar invariance between genders, and an analysis of covariance did not find significant gender differences. Overall, the findings replicate past findings and regularly support the usability of the BAS-2 in the Malaysian context. The implications of the BAS-2 and future directions are also discussed.
  14. Fulltext Optimization of Micro-Pollutants' Removal from Wastewater Using Agricultural Waste-Derived Sustainable Adsorbent
    Alhothali A, Haneef T, Mustafa MRU, Moria KM, Rashid U, Rasool K, et al.
    Int J Environ Res Public Health, 2021 11 01;18(21).
    PMID: 34770021 DOI: 10.3390/ijerph182111506
    Water pollution due to the discharge of untreated industrial effluents is a serious environmental and public health issue. The presence of organic pollutants such as polycyclic aromatic hydrocarbons (PAHs) causes worldwide concern because of their mutagenic and carcinogenic effects on aquatic life, human beings, and the environment. PAHs are pervasive atmospheric compounds that cause nervous system damage, mental retardation, cancer, and renal kidney diseases. This research presents the first usage of palm kernel shell biochar (PKSB) (obtained from agricultural waste) for PAH removal from industrial wastewater (oil and gas wastewater/produced water). A batch scale study was conducted for the remediation of PAHs and chemical oxygen demand (COD) from produced water. The influence of operating parameters such as biochar dosage, pH, and contact time was optimized and validated using a response surface methodology (RSM). Under optimized conditions, i.e., biochar dosage 2.99 g L-1, pH 4.0, and contact time 208.89 min, 93.16% of PAHs and 97.84% of COD were predicted. However, under optimized conditions of independent variables, 95.34% of PAH and 98.21% of COD removal was obtained in the laboratory. The experimental data were fitted to the empirical second-order model of a suitable degree for the maximum removal of PAHs and COD by the biochar. ANOVA analysis showed a high coefficient of determination value (R2 = 0.97) and a reasonable second-order regression prediction. Additionally, the study also showed a comparative analysis of PKSB with previously used agricultural waste biochar for PAH and COD removal. The PKSB showed significantly higher removal efficiency than other types of biochar. The study also provides analysis on the reusability of PKSB for up to four cycles using two different methods. The methods reflected a significantly good performance for PAH and COD removal for up to two cycles. Hence, the study demonstrated a successful application of PKSB as a potential sustainable adsorbent for the removal of micro-pollutants from produced water.
  15. Fulltext Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19
    Ramli FF, Ali A, Syed Hashim SA, Kamisah Y, Ibrahim N
    Int J Environ Res Public Health, 2021 10 27;18(21).
    PMID: 34769806 DOI: 10.3390/ijerph182111289
    Despite its severe adverse effects, such as agranulocytosis, clozapine is the primary treatment for treatment-resistant schizophrenia. The established clozapine monitoring system has contributed to reducing agranulocytosis incidence and mortality rates. However, the pandemic coronavirus disease 2019 (COVID-19) has caused changes in the monitoring system. This review aimed to assess the current evidence on the neutrophil changes in the patient on clozapine treatment and infected with COVID-19. Individual cases reported various absolute neutrophil count (ANC) levels, normal, reduced, or elevated. No agranulocytosis case was reported. One case had a borderline moderate-severe ANC level, but the patient was in the 18-week period of clozapine treatment. A cumulative analysis of case the series initially reported inconclusive results. However, a more recent study with a larger sample size reported a significant reduction in the ANC during COVID-19 infection. Nevertheless, this effect is transient as no significant difference was found between the baseline and the post-infection period in ANC levels. In conclusion, COVID-19 is associated with a temporary reduction in ANC levels. The results supported the recommendation to reduce the frequency of clozapine monitoring in the eligible candidates. However, more data are required to confirm the current findings given the limitations, including study design, sample size, and statistical analysis.
  16. Fulltext Influence of a Survival Swimming Training Programme on Water Safety Knowledge, Attitudes and Skills: A Randomized Controlled Trial among Young Adults in Sri Lanka
    Ekanayaka J, Geok CK, Matthews B, Dharmaratne SD
    Int J Environ Res Public Health, 2021 10 30;18(21).
    PMID: 34769944 DOI: 10.3390/ijerph182111428
    Drowning among young adults is high in Sri Lanka. Water safety education is a recommended strategy for drowning prevention but is often overlooked for young adults. This study aimed to evaluate the effectiveness of an adapted educational intervention, "Swim for Safety" on improving water safety knowledge, attitudes and survival swimming skills among undergraduates (19-28 years) in Sri Lanka. This study employed a parallel-group, two-arm randomized controlled trial design. The intervention group (n = 78) received a face-to-face, 12-lesson education programme, and the control group (n = 78) received a brochure and weekly mobile phone messages for six consecutive weeks. Baseline, post-intervention and three-month follow-up knowledge, attitudes and skills were evaluated. Knowledge and attitudes were assessed using a self-administered questionnaire and skills were evaluated following a skills assessment protocol. In total 116 participants, 60 intervention group and 56 control group, completed the study. At baseline there were no differences between groups in median scores of water safety knowledge, attitudes and survival swimming skills. The intervention group demonstrated statistically significant increases in median water safety knowledge, attitudes and survival swimming skill scores compared with the control group, following the intervention and maintained at three-month follow-up (p < 0.05). The adapted Swim for Safety programme significantly improved water safety knowledge, attitudes, and survival swimming skills among young adults in Sri Lanka. Therefore, it is recommended that the SfS programme be implemented widely to prevent drowning in young adults.
  17. Fulltext Malaysia's Health Systems Response to COVID-19
    Ang ZY, Cheah KY, Shakirah MS, Fun WH, Anis-Syakira J, Kong YL, et al.
    Int J Environ Res Public Health, 2021 Oct 22;18(21).
    PMID: 34769629 DOI: 10.3390/ijerph182111109
    This study aimed to highlight the COVID-19 response by the Ministry of Health (MOH) and the Government of Malaysia in order to share Malaysia's lessons and to improve future pandemic preparedness. The team conducted a rapid review using publicly available information from MOH, PubMed, and World Health Organisation (WHO) Global Research on Coronavirus Disease Database to compile Malaysia's responses during the COVID-19 pandemic. Measures taken between 31 December 2019 and 3 June 2020 were classified into domains as well as the pillars described in the WHO COVID-19 Strategic Preparedness and Response Plan (WHO SPRP). Malaysia's response incorporated all pillars in the WHO SPRP and consisted of five domains, (i) whole-of-government, (ii) cordon sanitaire/lockdown, (iii) equity of access to services and supports, (iv) quarantine and isolation systems, and (v) legislation and enforcement. Some crucial measures taken were activation of a centralised multi-ministerial coordination council where MOH acted as an advisor, with collaboration from non-government organisations and private sectors which enabled an effective targeted screening approach, provision of subsidised COVID-19 treatment and screening, isolation or quarantine of all confirmed cases, close contacts and persons under investigation, with all strategies applied irrespective of citizenship. This was provided for by way of the Prevention and Control of Infectious Diseases Act 1988. A combination of these measures enabled the nation to contain the COVID-19 outbreak by the end of June 2020.
  18. Fulltext Smoking a Dangerous Addiction: A Systematic Review on an Underrated Risk Factor for Oral Diseases
    Ahmed N, Arshad S, Basheer SN, Karobari MI, Marya A, Marya CM, et al.
    Int J Environ Res Public Health, 2021 10 20;18(21).
    PMID: 34769523 DOI: 10.3390/ijerph182111003
    Despite growing knowledge of the adverse effects of cigarette smoking on general health, smoking is one of the most widely prevalent addictions around the world. Globally, about 1.1 billion smokers and over 8 million people die each year because of cigarette smoking. Smoking acts as a source for a variety of oral and systemic diseases. Various periodontal issues such as increased pocket depth, loss of alveolar bone, tooth mobility, oral lesions, ulcerations, halitosis, and stained teeth are more common among smokers. This systematic review was conducted according to the guidelines from PRISMA, and research articles were retrieved from the Web database sources on 31 May 2021. The quality of research articles was ensured by the type of evidence from combined schema incorporating as schema-13 evidence type description, Cochrane health promotion and public health field (CHPPHF), and the health gains notation framework-14 screening question for quality assessment of qualitative and quantitative studies. Smokers have been found to have bleeding on probing, periodontal pockets, and clinical attachment loss compared to nonsmokers. Oral and respiratory cancers are among the most lethal known diseases caused by cigarette smoking and other commonly occurring sequelae such as stained teeth, periodontal diseases, etc.
  19. Fulltext Blood Transfusion Knowledge among Nurses in Malaysia: A University Hospital Experience
    Mohd Noor NH, Saad NH, Khan M, Hassan MN, Ramli M, Bahar R, et al.
    Int J Environ Res Public Health, 2021 10 25;18(21).
    PMID: 34769712 DOI: 10.3390/ijerph182111194
    Blood transfusion is a fundamental and life-saving procedure where the consequence of errors can be fatal. Nurses' knowledge plays an essential role in ensuring quality and safety in blood transfusion. The objective of this study was to assess blood transfusion-associated knowledge of tertiary hospital nurses on the east coast of Malaysia. This was a cross-sectional study with 200 registered nurses involved in blood transfusion procedures at Hospital Universiti Sains Malaysia. The knowledge of the nurses was evaluated by using the routine blood transfusion knowledge questionnaire based on five parts, and <50%, 50-74%, or ≥75% of the knowledge was considered as poor, moderate, or high, respectively. Based on the scoring system, the overall knowledge of blood transfusion among Malaysian nurses (33.2 ± 8.4 years) was estimated to be 54.9 ± 7.6%. In individual items, the scoring was 81.0%, 45.4%, 49.2%, 63.0%, and 90.0% in knowledge prior to blood transfusion, on pre-transfusion, on post-transfusion, on complications, and on transfusion policy, respectively. The findings of this study indicated that most of the nurses' overall knowledge of blood transfusion was at a moderate level; therefore, training courses and continuous medical education are warranted to improve knowledge and skills of the nurses to ensure good practices of blood transfusion.
  20. Fulltext Naturally Occurring Radioactive Materials in Bracelets and Necklaces: Radiological Risk Evaluation
    Hassan HJ, Hashim S, Abu Hanifah NZH, Ghoshal SK, Sanusi MSM, Binti Suhailin FH, et al.
    Int J Environ Res Public Health, 2021 10 24;18(21).
    PMID: 34769689 DOI: 10.3390/ijerph182111170
    A particular category of jewelry is one involving bracelets and necklaces that are deliberately made to contain naturally occurring radioactive material (NORM)-purveyors making unsubstantiated claims for health benefits from the release of negative ions. Conversely, within the bounds of the linear no-threshold model, long-term use presents a radiological risk to wearers. Evaluation is conducted herein of the radiological risk arising from wearing these products and gamma-ray spectrometry is used to determine the radioactivity levels and annual effective dose of 15 commercially available bracelets (samples B1 to B15) and five necklaces (samples N16 to N20). Various use scenarios are considered; a Geant4 Monte Carlo (Geant4 MC) simulation is also performed to validate the experimental results. The dose conversion coefficient for external radiation and skin equivalent doses were also evaluated. Among the necklaces, sample N16 showed the greatest levels of radioactivity, at 246 ± 35, 1682 ± 118, and 221 ± 40 Bq, for 238U, 232Th, and 40K, respectively. For the bracelets, for 238U and 232Th, sample B15 displayed the greatest level of radioactivity, at 146 ± 21 and 980 ± 71 Bq, respectively. N16 offered the greatest percentage concentrations of U and Th, with means of 0.073 ± 0.0002% and 1.51 ± 0.0015%, respectively, giving rise to an estimated annual effective dose exposure of 1.22 mSv, substantially in excess of the ICRP recommended limit of 1 mSv/year.
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