Objective: To determine the construct validity and the internal consistency of the Medical Student Stressor Questionnaire (MSSQ) among medical students hence in the future it could be used as a valid and reliable instrument to identify stressors among medical students. Methods: The blueprint for the development of MSSQ was developed after a review of literature on the subject and a discussion with experts in the field. It comprised of 40 items
with six hypothetical groups. The face validity of the questionnaire was established through discussion with 141 final year medical students whereas content validity was established through discussion with experts from field of Medical Education and Psychiatry. It was administered to a total of 761 medical students. Data was analysed using Statistical Package Social Sciences (SPSS) version 12. Factor analysis was applied to test construct validity of the MSSQ. Reliability analysis (Cronbach’s alpha and item total correlation) was applied to test internal consistency of the MSSQ. Results: The total Cronbach’s alpha value of the MSSQ was 0.95. All the preliminary 40 items were included in the MSSQ as the items had item total correlation value of more than 0.3. The items were loaded nicely into the six pre-determined hypothetical groups as their factor loading values were more than 0.3.
Conclusion: This study showed that MSSQ had good psychometric value. It is a valid and reliable instrument in identifying stressors among medical students.
Objective: To determine the sensitivity, specificity and internal consistency of the Malay version GHQ-12 among medical student population. This study determined the appropriate GHQ-12 score to detect distressed medical students. Methods: The Malay version of GHQ-12 was derived based on two sources which were the original version GHQ-12 and the validated Malay version 30-items GHQ. The GHQ-12 and the Malay version Beck Depression Inventory-II (BDI-II) were administered to a total of 141 medical students. Distress diagnoses were made based on the Malay version BDI-II. ROC curve analysis was applied to determine the sensitivity and specificity of the GHQ-12 by testing against the BDI-II. Reliability analysis (Cronbach’s alpha and item total correlation) was applied to test internal consistency of the
GHQ-12. The analysis was done using SPSS version 12.Results: The GHQ-12 sensitivity and specificity at cut-off point of 3/4 was 81.3% and 75.3% respectively with positive predictive value (PPV) of 62.9% as well as area under ROC curve more than 0.7. The Cronbach’s alpha value of the GHQ-12 was 0.85.Conclusion: This study showed the Malay version GHQ-12 is a valid and reliable screening tool in detecting distressed medical students. The
GHQ-12 score equal to or more than 4 was considered as significant distress.
Many researchers have emphasized the importance of teaching stress management and self-care skills to medical students as they are vulnerable to develop psychological health problems. The researchers designed a 4-hour intervention based on the DEAL model to address these problems. This study aimed to determine outcomes of the DEAL-based intervention on medical students’ stress, anxiety and depression symptoms. Methods: A randomized controlled trial study was conducted on 171 medical students. Their stress, anxiety and depression symptoms were measured by the 21-item Depression Anxiety Stress Scale at five intervals; at 2 weeks before the intervention, and at 1 week, 8 weeks, 16 weeks and 32 weeks after the intervention. The mixed model ANCOVA was applied to determine the effect of the intervention on the participants’ psychological health at five intervals. Results: A total of 153 medical students (intervention = 73 and control = 80) completed this study. Results showed that the intervention group experienced significantly lower stress and depression symptoms than the control group. Although anxiety scores are consistently lower in the intervention group, no significant differences between groups were found. Conclusion: These results support the favourable outcomes of the intervention on psychological health of medical students. It is a promising intervention to be considered by medical schools as it consumes minimal amount of time, money, training and man power as well can be implemented easily.
Background: One of important educational climate roles is to provide an environment that promotes positive development of medical students' psychological wellbeing during training. Unfortunately, many studies have reported that educational climate in medical education are not favourable to them. Therefore, it is a real need for a simple, valid, reliable and stable tool that will help medical schools to screen psychological wellbeing of their students so that early intervention could be done.
Objective: This study aimed to explore the psychometric properties of the Medical Student Wellbeing Index (MSWBI) to measure psychological wellbeing at different interval of measurements in a cohort of medical students.
Method: A prospective study was done on a cohort of medical students. MSWBI was administered to the medical students at five different intervals. The confirmatory factor analysis, Cronbach's alpha and intra-class correlation analysis were applied to measure construct validity, internal consistency and agreement level at different interval of measurements.
Result: A total of 153 (89.5%) medical students responded completely to the MSWBI. The MSWBI showed that the one-factor model had acceptable values for most of the goodness of fit indices signified its construct was stable across multiple measurements. The overall Cronbach's alpha values for the MSWBI at the five measurements ranged between 0.69 and 0.78. The ICC coefficient values for the MSWBI total score was 0.58 to 0.59.
Conclusion: This study found that the MSWBI had stable psychometric properties as a screening tool for measuring psychological wellbeing among medical students at different time and occasions. Continued research is required to refine and verify its psychometric credentials at different educational settings.
Teaching stress management skills for medical students has been echoed as an important educational component in medical education. Discussions about approaches to teaching stress management in medical education context are largely unexplored despite of a large number of articles have emphasized on its importance. This paper describes four elements in a framework as an approach to teaching stress management skills in medical education. As one moves through the framework, it provides a greater degree of insight on stress management ability as is acquired through one's awareness, experience and conscious effort that allow stressful situations to be handled effectively and efficiently. It may provide a useful educational framework for medical teachers to teach and assess stress management skills of medical students. It also may be used as an aid in planning, implementing and evaluating stress management programs in medical schools. The authors discuss about the implications of this framework for future research in medical education.
Timber scaffold boards have been widely utilised in the offshore construction industry. However, technical specifications
and inspection procedure for the application of scaffold boards from a wood material were inadequate. In the development
of the standard requirements, evaluation of actual engineering practices could indicate the level of workplace safety. A
study was conducted to identify risk and safety measures concerning the use of timber scaffold boards in construction.
This article discusses on the occupational risks and ergonomics issues of the scaffolding application based on the physical
and mechanical conditions of tropical timber scaffold boards extracted from offshore oil and gas rigs. The boards were
exposed to a seasonal climate of East Coast monsoon of South China Sea between November and February. The scaffolding
application extended up to 20 m directly above the ocean surface and some boards were completely immersed below
the ocean surface particularly during elevated tidal waves. Some of the boards were installed as the on-deck platforms.
Forty scaffold boards fabricated from tropical timber species were evaluated. Physical characteristics of the boards
were described by natural and man-made factors. A three-point bending test was conducted to determine the maximum
load capacity of each board and the mode of fracture was evaluated. Timber identification test was conducted to identify
the groups of the timber being used. The microscopic observation confirmed the presence of hyphae which indicated the
biological deterioration has happened in some of the boards. Occupational risks were summarised based on the results
of the physical and mechanical assessments
The influence of apolipoprotein (APOE) on neuropsychological outcome was investigated in 19 patients (25.79 ± 7.22 years) with mild-to-moderate traumatic brain injury and 14 matched healthy control subjects (27.43 ± 6.65 years).
In the title complex, [Ni(C(20)H(10)Br(2)Cl(2)N(2)O(2))], the Ni(II) ion is coordinated by two phen-oxy O atoms and two imino N atoms of the tetradentate ligand, forming a slightly distorted square-planar environment. The mol-ecule is essentially planar, with an r.m.s. deviation of 0.088 Å for the mean plane defined by all non-H atoms in the mol-ecule.
This study evaluated the convergent, discriminant, construct, concurrent and discriminative validity of the Medical Student Wellbeing Index (MSWBI) as well as to evaluate its internal consistency and optimal cut-off total scores to detect at least moderate levels of general psychological distress, stress, anxiety and depression symptoms. A cross sectional study was done on 171 medical students. The MSWBI and DASS-21 were administered and returned immediately upon completion. Confirmatory factor analysis, reliability analysis, ROC analysis and Pearson correlation test were applied to assess psychometric properties of the MSWBI. A total of 168 (98.2%) medical students responded. The goodness of fit indices showed the MSWBI had a good construct (χ(2)=6.14, p=0.803, RMSEA<0.001, RMR=0.004, GFI=0.99, AGFI=0.97, CFI=1.00, IFI=1.02, TLI=1.04). The Cronbach's alpha value was 0.69 indicating an acceptable level of internal consistency. Pearson correlation coefficients and ROC analysis suggested each MSWBI's item showed adequate convergent and discriminant validity. Its optimal cut-off scores to detect at least moderate levels of general psychological distress, stress, anxiety, and depression were 1.5, 2.5, 1.5 and 2.5 respectively with sensitivity and specificity ranged from 62 to 80% and the areas under ROC curve ranged from 0.71 to 0.83. This study showed that the MSWBI had good level of psychometric properties. The MSWBI score more than 2 can be considered as having significant psychological distress. The MSWBI is a valid and reliable screening instrument to assess psychological distress of medical students.
We report successful treatment of syphilitic uveitis in a case series of three Human immunodeficiency virus (HIV)-positive patients at Malaysia's Selayang Hospital eye clinic. All three patients with syphilitic uveitis were male, aged from 23 to 35 years old, with a history of high-risk behaviors. Of the patients, two presented with blurring of vision and only one patient presented with floaters in the affected eye. Ocular examination revealed intermediate uveitis (case 1 and case 3) and panuveitis (case 2). Each patient showed a high Venereal Disease Research Laboratory (VDRL) titer at presentation and they were also newly diagnosed as HIV positive with variable CD4 counts. All three patients responded well to a neurosyphilis regimen of intravenous penicillin G. At 3 months posttreatment, there was reduction in VDRL titer with improvement of vision in the affected eye. Diagnosis of syphilis needs to be ruled out in all cases of uveitis. All syphilitic uveitis cases should have HIV screening and vice versa, as syphilis is one of the most common infectious diseases associated with HIV-positive patients. Early detection and treatment are important for a good visual outcome.
Being in medical school has always been regarded as highly stressful. Excessive stress causes physical and mental health problems. Persistent stress can impair students' academic achievement and personal or professional development. The aim of this study is to explore the nature of stress among medical students by determining the prevalence, sources and pattern of stress and the factors affecting it.
The aim of this study was to determine the incidence and associated risk factors of postpartum depression among Malay women in Beris Kubor Besar, Bachok, Kelantan The study was conducted between February to August 1998. A two-stage population survey approach was employed. Firstly, all the women who delivered between the months of February and May 1998 in the catchment area were identified. In stage 1, the 30 items GHQ was used as the screening instrument at 6 to 8 weeks postpartum. All the potential cases (scoring above 6 on the questionnaire) were later interviewed using the CIS in stage 2 of the study. Diagnosis of postpartum depression was only made if the women fulfilled required criteria. Of the 174 women who were recruited, 17 of them fulfilled the criteria for postpartum depression yielding an incidence rate of 9.8 %. The condition was found to be significantly linked to low income or socioeconomic status, having marital problems (mainly financial in nature) and not breast - feeding.
Lactobacilli are well-documented probiotics that exert health benefits on their host. They exhibit characteristics that make them potential alternative treatments to address the antimicrobial resistance conundrum and diseases. Their mechanism of action varies with strain and species. Five lactobacilli strains previously isolated from the anogenital region were subjected to several assessments highlighted in the FAO/WHO document, ‘Guidelines for the Evaluation of Probiotics in Food’ to determine its suitability as potential probiotics. Methods: The five lactobacilli strains were subcultured onto Man de Rogosa agar (MRS). Their ability to auto- and co-aggregate was determined spectrophotometrically. Simultaneously, the cell surface hydrophobic properties of these strains towards xylene and toluene were evaluated using the microbial adhesion to hydrocarbon (MATH) test. The lactobacilli strains were also tested for their ability to withstand acid, bile and spermicide to determine their level of tolerance. Results: Lact. reuteri 29A, L. delbrueckii 45E and L. reuteri 29B exhibited the highest degree of auto- and co-aggregation properties. These lactobacilli strains also demonstrated high cell surface hydrophobicity, with the exception of L. delbrueckii 45E. Further tests to evaluate the isolated lactobacilli tolerance identified L. reuteri 29B as the most tolerant strain towards low pH (pH 2.5 for 4 h), high bile concentration (0.5% for 4 h) and high spermicides concentration (up to 10%). Conclusion: Out of the five lactobacilli strains which possessed high antimicrobial activities, L. reuteri 29B portrayed the best probiotic qualities with good auto- and co-aggregation abilities and high tolerance against acid, bile and spermicide.
Picrasma quassioides is a member of the Simaroubaceae family commonly grown in the regions of Asia, the Himalayas, and India and has been used as a traditional herbal medicine to treat various illnesses such as fever, gastric discomfort, and pediculosis. This study aims to critically review the presence of phytochemicals in P. quassioides and correlate their pharmacological activities with the significance of its use as traditional medicine. Data were collected by reviewing numerous scientific articles from several journal databases on the pharmacological activities of P. quassioides using certain keywords. As a result, approximately 94 phytochemicals extracted from P. quassioides were found to be associated with quassinoids, β-carbolines and canthinones. These molecules exhibited various pharmacological benefits such as anti-inflammatory, antioxidant, anti-cancer, anti-microbial, and anti-parasitic activities which help to treat different diseases. However, P. quassioides were also found to have several toxicity effects in high doses, although the evidence regarding these effects is limited in proving its safe use and efficacy as herbal medicine. Accordingly, while it can be concluded that P. quassioides may have many potential pharmacological benefits with more phytochemistry discoveries, further research is required to determine its real value in terms of quality, safety, and efficacy of use.
Objective: The Fuzzy Delphi Method (FDM) is one of the phases in Design and Development Research (DDR). It is a systematic method for tool development and validation. This article aims to validate an occupational zoonotic disease questionnaire using this technique. DDR is applied going through phase 1 (needs analysis), phase 2 (development and design), and phase 3 (usability).Method: In phase 1, information about safe work practices and occupational zoonotic exposure was obtained from discussions to verify predetermined domains as stated in The National Park Service survey on zoonotic disease exposure and risk. In phase 2, agreement from 14 experts about the domains was obtained using the FDM. In phase 3, a cognitive debriefing was performed to determine its usability for future studies. A total of five superior domains were verified, and their items were adapted. All domains and their items were submitted to experts to obtain consensus agreement.Results: A total of 31 (96.9%) passed the Triangle of Fuzzy Numbers and Defuzzification process with acceptable consensus agreement (78.8-91.9%) and threshold d value (0.07-0.14). Only four veterinarians were needed for cognitive debriefing to achieve the point of saturation.Conclusion: FDM in DDR is suitable to be applied by various professions for tool validation, as it is doable and cost and time effective. The Occupational Zoonotic Disease Questionnaire is now ready to be used for future studies in Malaysia.
Calixarene framework functionalized bio-polymeric magnetic composites (MSp-TDI-calix) were synthesized and utilized as magnetic solid-phase extraction (MSPE) sorbent for the extraction of non-steroidal anti-inflammatory drugs (NSAIDs), namely indoprofen (INP), ketoprofen (KTP), ibuprofen (IBP) and fenoprofen (FNP), from environmental water samples. MSp-TDI-calix was characterized by FT-IR, XRD, FESEM, EDX, VSM and BET analysis, and the results were compared with Sp-TDI and Sp-TDI-calix. To maximize the extraction performance of MSp-TDI-calix decisive MSPE affective parameters such as sorbent amount, extraction time, sample volume, type of organic eluent, volume of organic eluent, desorption time and pH were comprehensively optimized prior to HPLC-DAD determination. The analytical validity of the proposed MSPE method was evaluated under optimized conditions and the following figures of merit were acquired: linearity with good determination coefficient (R2 ≥ 0.991) over the concentration range of 0.5-500 µg/L, limits of detection (LODs) ranged from 0.06-0.26 µg/L and limits of quantitation (LOQ) between 0.20-0.89 µg/L. Excellent reproducibility and repeatability under harsh environment with inter-day and intra-day relative standard deviations were obtained in the range of 2.5-3.2% and 2.4-3.9% respectively. The proposed method was successfully applied for analysis of NSAIDs in tap water, drinking water and river water with recovery efficiency ranging from 88.1-115.8% with %RSD of 1.6-4.6%.
Flashover on transmission line insulators is one of the major causes of line outages due to contamination from the environment or ageing. Power utility companies practicing predictive maintenance are currently exploring novel non-contact methods to monitor insulator surface discharge activities to prevent flashover. This paper presents an investigation on the UV pulse signals detected using UV pulse sensor due to the discharges on the insulator surfaces under varying contamination levels and insulator ages. Unaged and naturally aged insulators (0 to >20 years) were artificially contaminated (none, light to heavy contamination). The electrical stresses on the insulator surfaces were varied to generate varying discharge intensity levels on the surfaces of the insulator. The DC and harmonic components of UV pulse signals detected during surface discharges were recorded and analysed. Results show a positive correlation between the discharge intensity level of contaminated and aged transmission insulators with the DC and harmonic components of the UV pulse signals. Furthermore, the study revealed that under dry insulator surface conditions, insulator ageing has a more profound effect during discharges than contamination level. The findings from this study suggest that the use of UV pulse sensors to monitor UV pulse signals emitted during insulator surface discharges can be another novel non-contact method of monitoring transmission line insulator surface conditions.
We report a case of acalvaria diagnosed prenatally via ultrasound and MRI. Acalvaria is a rare, fatal congenital condition characterized by the absence of flat bones of the cranial vault, dura mater, and its associated muscles with an intact central nervous system. A 41-year-old gravida 5, para 2 + 2A, presented to us at 26 weeks gestation age (GA) with ultrasound findings of a fragile and hypomineralized skull in the fetus. The patient was not keen on whole-axon sequencing. Fetus magnetic resonance imaging (MRI) revealed large cutaneous/skull nonvisualization of the fetus skull, possibly acrania without anencephaly. She delivered via cesarean section at 37 weeks because of two previous cesarean sections. A female infant weighing 2650 g was born with an intact sac to minimize excessive external pressure to the brain tissue. A diagnosis of acalvaria with bilateral lateral cleft lip and palate was made postdelivery. The infant was managed conservatively per multidisciplinary discussion and expired 3 weeks later.
Acute infectious gastroenteritis (AGE) is among the leading causes of mortality in children less than 5 years of age worldwide. There are many causative agents that lead to this infection, with rotavirus being the commonest pathogen in the past decade. However, this trend is now being progressively replaced by another agent, which is the norovirus. Apart from the viruses, bacteria such as Salmonella and Escherichia coli and parasites such as Entamoeba histolytica also contribute to AGE. These agents can be recognised by their respective biological markers, which are mainly the specific antigens or genes to determine the causative pathogen. In conjunction to that, omics technologies are currently providing crucial insights into the diagnosis of acute infectious gastroenteritis at the molecular level. Recent advancement in omics technologies could be an important tool to further elucidate the potential causative agents for AGE. This review will explore the current available biomarkers and antigens available for the diagnosis and management of the different causative agents of AGE. Despite the high-priced multi-omics approaches, the idea for utilization of these technologies is to allow more robust discovery of novel antigens and biomarkers related to management AGE, which eventually can be developed using easier and cheaper detection methods for future clinical setting. Thus, prediction of prognosis, virulence and drug susceptibility for active infections can be obtained. Case management, risk prediction for hospital-acquired infections, outbreak detection, and antimicrobial accountability are aimed for further improvement by integrating these capabilities into a new clinical workflow.
Introduction: The refeeding programme in government hospitals is aimed at
improving the nutritional status of malnourished children with weight-for-height
z-score (WHZ) below -2.0, using special therapeutic food. However, there is a lack of
data on the nutritional status of indigenous (Orang Asli) children when they return
to the community after hospital discharge. Case presentation: A 3-year-old Temiar
boy residing in a tribal village in Hulu Perak was visited to determine his nutritional
status following discharge from a refeeding programme in a government hospital.
He was admitted to the hospital with a weight of 10.0 kg, height of 85.5 cm and
WHZ of -2.09. The boy was later discharged weighing 11.0 kg, and with height
unchanged at 85.5 cm and WHZ of -0.87. During our visit to the child’s home
three months after discharge, his weight was 9.5 kg, height 86.0 cm, and WHZ
–2.91. Discussion: The management of the case in the hospital was based on
the Malnourished Orang Asli Protocols of the hospital. Household food insecurity,
feeding and care practices, unhealthy household environment and the lack of
communication between hospital and community health services were all identified
as risk factors for malnutrition. Conclusion: The recurrence of malnutrition in this
child, after successful improvement during hospital stay, highlights the importance
of identifying factors that may affect nutritional status after hospital discharge. This
knowledge will be beneficial in planning specific interventions, especially for Orang
Asli children, living in remote villages.