Displaying publications 141 - 160 of 257 in total

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  1. Mo SY, Lai OM, Chew BH, Ismail R, Bakar SA, Jabbar NA, et al.
    Eur J Nutr, 2019 Aug;58(5):1873-1885.
    PMID: 29872922 DOI: 10.1007/s00394-018-1738-6
    PURPOSE: We aim to investigate the postprandial effects of palm olein (PO) and chemically interesterified palm olein (IPO) with different proportions of palmitic acid at the sn-2 position using high oleic sunflower oil (HOS) as control fat on concentrations of gut hormones, glucose homeostasis, satiety, lipid and inflammatory parameters in type 2 diabetic (T2D) subjects.

    METHODS: Using a randomised double-blind crossover design, 21 (men = 6, women = 15) T2D subjects consumed test meals (3.65 MJ) consisting of a high fat muffin (containing 50 g test fats provided as PO, IPO or HOS) and a milkshake. Postprandial changes in gut hormones, glucose homeostasis, satiety, lipid and inflammatory parameters after meals were analysed. Some of the solid fractions of the IPO were removed and thus the fatty acid composition of the PO and IPO was not entirely equal (PO vs IPO: palmitate 39.8 vs 38.7; oleate 43.6 vs 45.1). PO, IPO and HOS contained 9.7, 38.9 and 0.2 g/100 g total fatty acids of palmitic acid at the sn-2 position, respectively. At 37 °C, IPO contained 4.2% SFC whereas PO and HOS were completely melted.

    RESULTS: Our novel observation shows that the incremental area under curve (iAUC) 0-6 h of plasma GIP concentration was on average 16% lower following IPO meal compared with PO and HOS (P 

  2. Hosseingholi Pourasl A, Ariffin SHS, Ahmadi MT, Ismail R, Gharaei N
    Beilstein J Nanotechnol, 2019;10:644-653.
    PMID: 30931206 DOI: 10.3762/bjnano.10.64
    Nanomaterial-based sensors with high sensitivity, fast response and recovery time, large detection range, and high chemical stability are in immense demand for the detection of hazardous gas molecules. Graphene nanoribbons (GNRs) which have exceptional electrical, physical, and chemical properties can fulfil all of these requirements. The detection of gas molecules using gas sensors, particularly in medical diagnostics and safety applications, is receiving particularly high demand. GNRs exhibit remarkable changes in their electrical characteristics when exposed to different gases through molecular adsorption. In this paper, the adsorption effects of the target gas molecules (CO and NO) on the electrical properties of the armchair graphene nanoribbon (AGNR)-based sensor are analytically modelled. Thus, the energy dispersion relation of AGNR is developed considering the molecular adsorption effect using a tight binding (TB) method. The carrier velocity is calculated based on the density of states (DOS) and carrier concentration (n) to obtain I-V characteristics and to monitor its variation in the presence of the gas molecules. Furthermore, the I-V characteristics and energy band structure of the AGNR sensor are simulated using first principle calculations to investigate the gas adsorption effects on these properties. To ensure the accuracy of the proposed model, the I-V characteristics of the AGNR sensor that are simulated based both on the proposed model and first principles calculations are compared, and an acceptable agreement is achieved.
  3. Ibrahim N, Amit N, Shahar S, Wee LH, Ismail R, Khairuddin R, et al.
    BMC Public Health, 2019 Jun 13;19(Suppl 4):544.
    PMID: 31196033 DOI: 10.1186/s12889-019-6862-6
    BACKGROUND: Mental illness rates among young people is high, yet the frequency of help-seeking is low, especially among those from lower socioeconomic backgrounds. Understanding factors influencing help-seeking, such as mental illness beliefs, stigma and literacy among B40 individuals is important, but past studies are sparse. Hence, we aimed to examine the factors associated with mental help-seeking attitude among students from the B40 income bracket. Differences in beliefs toward mental illness, stigma and help-seeking attitudes among university and secondary school students were also investigated.

    METHODS: University and secondary school students from low-income households (N = 202) were involved in this cross-sectional study. Participants completed the Depression Literacy Questionnaire (D-Lit), General Help Seeking Questionnaire (GHSQ), Mental Help Seeking Attitudes Scale (MHSAS), Self-Stigma of Seeking Help Scale (SSOSH), and Beliefs toward Mental Illness (BMI).

    RESULTS: Mental help-seeking attitude had a significant relationship with self-stigma on seeking help (r = -.258, p r = .156, p = .027), and age (r = .187, p 

  4. Muthiah YD, Ong CE, Sulaiman SA, Tan SC, Ismail R
    J Pharm Pharmacol, 2012 Dec;64(12):1761-9.
    PMID: 23146039 DOI: 10.1111/j.2042-7158.2012.01551.x
    To investigate the effect of Tualang honey on cytochrome P450 2C8 (CYP2C8) activity in vitro using an amodiaquine N-desethylase assay.
  5. Rosdi RA, Mohd Yusoff N, Ismail R, Soo Choon T, Saleem M, Musa N, et al.
    Ann Hum Biol, 2015 Sep 24.
    PMID: 26402341
    CYP2C9 gene polymorphisms modulate inter-individual variations in the human body's responses to various endogenous and exogenous drug substrates. To date, little is known about the CYP2C9 gene polymorphisms among the aboriginal populations of the world, including those in Malaysia.
  6. Rizal H, Said MA, Abdul Majid H, Su TT, Maw Pin T, Ismail R, et al.
    PLoS One, 2022;17(2):e0263751.
    PMID: 35134086 DOI: 10.1371/journal.pone.0263751
    BACKGROUND: Globally, a lower income is associated with poorer health status and reduced quality of life (QOL). However, more research is needed on how being older may influence QOL in lower-income households, particularly as older age is associated with an increased risk of chronic diseases and care needs. To this end, the current study attempts to determine the health-related QOL (HRQOL) among individuals from lower-income households aged 60 years and over compared to lower-income adults aged less than 60 years.

    METHODS: Participants were identified from the Department of Statistics Malaysia sampling frame. Surveys were carried out with individual households aged 18 years and older through self-administered questionnaires. Information was collected on demographics, household income, employment status, number of diseases, and HRQOL assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) tool.

    RESULTS: Out of a total of 1899 participants, 620 (32.6%) were female and 328 (17.3%) were aged 60 years and above. The mean (SD) age was 45.2 (14.1) and mean (SD) household income was RM2124 (1356). Compared with younger individuals, older respondents were more likely to experience difficulties in mobility (32.1% vs 9.7%, p<0.001), self-care (11.6% vs 3.8%, p<0.001), usual activities (24.5% vs 9.1%, p<0.001), pain/discomfort (38.8% vs 16.5%, p<0.001) and anxiety/depression (21.4% vs 13.5%, p<0.001). The mean (SD) EQ-5D index scores were lower among older respondents, 0.89 (0.16) vs 0.95 (0.13), p = 0.001. After adjusting for covariates, age was a significant influencing factor (p = 0.001) for mobility (OR = 2.038, 95% CI:1.439-2.885), usual activities (OR = 1.957, 95% CI:1.353-2.832) and pain or discomfort (OR = 2.241, 95% CI:1.690-2.972).

    CONCLUSION: Lower-income older adults had poorer HRQOL compared to their younger counterparts. This has important implications concerning intervention strategies that incorporate active ageing concepts on an individual and policy-making level to enhance the QOL and wellbeing, particularly among the older lower-income population.

  7. Nawi AM, Ismail R, Ibrahim F, Hassan MR, Manaf MRA, Amit N, et al.
    BMC Public Health, 2021 Nov 13;21(1):2088.
    PMID: 34774013 DOI: 10.1186/s12889-021-11906-2
    BACKGROUND: Drug abuse is detrimental, and excessive drug usage is a worldwide problem. Drug usage typically begins during adolescence. Factors for drug abuse include a variety of protective and risk factors. Hence, this systematic review aimed to determine the risk and protective factors of drug abuse among adolescents worldwide.

    METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was adopted for the review which utilized three main journal databases, namely PubMed, EBSCOhost, and Web of Science. Tobacco addiction and alcohol abuse were excluded in this review. Retrieved citations were screened, and the data were extracted based on strict inclusion and exclusion criteria. Inclusion criteria include the article being full text, published from the year 2016 until 2020 and provided via open access resource or subscribed to by the institution. Quality assessment was done using Mixed Methods Appraisal Tools (MMAT) version 2018 to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis of the included studies was undertaken.

    RESULTS: Out of 425 articles identified, 22 quantitative articles and one qualitative article were included in the final review. Both the risk and protective factors obtained were categorized into three main domains: individual, family, and community factors. The individual risk factors identified were traits of high impulsivity; rebelliousness; emotional regulation impairment, low religious, pain catastrophic, homework completeness, total screen time and alexithymia; the experience of maltreatment or a negative upbringing; having psychiatric disorders such as conduct problems and major depressive disorder; previous e-cigarette exposure; behavioral addiction; low-perceived risk; high-perceived drug accessibility; and high-attitude to use synthetic drugs. The familial risk factors were prenatal maternal smoking; poor maternal psychological control; low parental education; negligence; poor supervision; uncontrolled pocket money; and the presence of substance-using family members. One community risk factor reported was having peers who abuse drugs. The protective factors determined were individual traits of optimism; a high level of mindfulness; having social phobia; having strong beliefs against substance abuse; the desire to maintain one's health; high paternal awareness of drug abuse; school connectedness; structured activity and having strong religious beliefs.

    CONCLUSION: The outcomes of this review suggest a complex interaction between a multitude of factors influencing adolescent drug abuse. Therefore, successful adolescent drug abuse prevention programs will require extensive work at all levels of domains.

  8. Lau WP, Ng KP, Ganapathy SS, Tah PC, Ismail R, Jalalonmuhali M, et al.
    Transplant Proc, 2022 Feb 03.
    PMID: 35125235 DOI: 10.1016/j.transproceed.2021.12.019
    BACKGROUND: Proteinuria and metabolic acidosis adversely affect long term renal allograft outcome and are highly prevalent in reported studies. The role of dietary intake in influencing proteinuria and metabolic acidosis remained uncertain. This study aims to determine the prevalence rate of proteinuria and metabolic acidosis among kidney transplant recipients (KTRs) and to study their relationship with dietary intake.

    METHODS: We performed a cross-sectional study on KTRs with functioning renal allograft and at least 3 months post transplant. Dietary protein, salt, and dietary acid load were estimated using 24-hour urine collection. Demographic characteristics, concomitant medications, medical history, and laboratory results were obtained from electronic medical records.

    RESULTS: A total of 204 KTRs were recruited with median age of 48 years (interquartile range [IQR], 18 years); male to female ratio was 61:39. A total of 79.9% (n = 163) were living related kidney transplants. The median duration after transplant was 71 months (IQR, 131 months), and median eGFR was 65 mL/min/1.73 m2 (IQR, 25 mL/min/1.73 m2). The prevalence rates of proteinuria (defined as ≥ 0.5 g/d) and metabolic acidosis (defined as at least 2 readings of serum bicarbonate ≤ 22 mmol/L in the past 6 months) were 17.7 % and 6.2%, respectively. High dietary protein of > 1.2 g/kg ideal body weight (adjusted odds ratio, 3.13; 95% CI, 1.35-7.28; P = .008) was significantly associated with proteinuria. Dietary protein, salt, and acid load did not correlate with chronic metabolic acidosis.

    CONCLUSIONS: The prevalence rate of proteinuria is consistent with published literature, but metabolic acidosis rate is extremely low in our cohort. High protein intake (> 1.2 g/kg ideal body weight) is a risk factor of proteinuria and may have negative impact on KTR outcome.

  9. Ghani LA, Mahmood NZ, Ismail R, Sa'at SA, Ali N, Mohd Zakuan SA
    Heliyon, 2022 Dec;8(12):e12309.
    PMID: 36619421 DOI: 10.1016/j.heliyon.2022.e12309
    The research on food flow network is unpredictable as the approaches employed are more targeted at specific study points, often excluding spatial and temporal changes. The research questions must still address why and how food flow moves in the entire supply chain system. This study aims to investigate the movement of food flow using national statistics, comprising of four main subsystems: agriculture, nutrition, waste, wastewater management, and the environment by using the Material Flow Analysis (MFA) approach. Comprehensive research using primary and secondary data including literature reviews have successfully bridged the knowledge gap on food supply chain management in Malaysia. This article provides new contributions through the considerations of food safety and the opportunity to understand flow issues that are connected to hotspots, closed flow, and economic circulars. Additionally, this study acts as a simple guide for policymakers to manage the imbalances of food supply in certain areas. From the perspective of food waste management, several important strategies were successfully formulated to combat the leakage of food waste flow and financial burden while highlighting the need for local social actors' involvement to fulfil Malaysia's agenda of Sustainable Development Goals.
  10. Muthiah YD, Lee WL, Teh LK, Ong CE, Salleh MZ, Ismail R
    Clin Chim Acta, 2004 Nov;349(1-2):191-8.
    PMID: 15469873 DOI: 10.1016/j.cccn.2004.06.024
    BACKGROUND: Cytochrome P450 (CYP) 2C8 is a principle enzyme responsible for the metabolism of many clinically important drugs as well as endogenous compounds such as arachidonic acid. The enzyme is genetically polymorphic but a simple method is not available to study its genetic polymorphism. We developed and optimized a variant-specific PCR techniques to detect CYP2C8*2, CYP2C8*3 and CYP2C8*4.
    METHOD: Genomic DNA was extracted from blood using standard extraction methods. A two-step PCR method was developed to detect simultaneously three CYP2C8 variants. In the first PCR (PCR1), specific regions from exons 3, 5 and 8 of the CYP2C8 gene were amplified. The products were used as templates in parallel alleles-specific PCR (PCR2). This method was tested against DNA samples obtained from 57 healthy Malaysian volunteers.
    RESULT: The bands of interest were successfully amplified. This method showed specific and reproducible results when tested on healthy volunteers. DNA sequencing further confirmed genotype results obtained from current method.
    CONCLUSION: We have successfully developed and optimized a multiplex PCR method suitable for use in population studies of CYP2C8 polymorphism.
  11. Ismail R, Ibrahim A, Mohamed HMSH, Mahmood MR, Adnan A
    Data Brief, 2023 Feb;46:108872.
    PMID: 36691557 DOI: 10.1016/j.dib.2022.108872
    Base isolation is a technique installed to absorb any movement or vibration on the structures. The incorporation of nanocomposites into elastomer as the interesting materials especially for the active stiffness and vibration control of structural systems. A base isolator is made up of alternate layers of steel and rubber. The performance of magnetic rubber device is dependent on mechanical and magnetic properties of composite rubber materials. A vibrating sample magnetometer (VSM) is an instrument to detect the magnetic properties. The article provides information on the magnetic properties corresponding to different carbon nanotubes loadings of 0%, 1%, 3% and 5% and different loading of microcarbonyl iron (MCI) i.e. 0% (B0), 10% (B10), 20% (B20) and 30% (B30) in natural rubber compound. The magnetic properties dataset described the data from compression test.
  12. Thangiah G, Johar H, Ismail R, Reininghaus U, Bärnighausen T, Thurairajasingam S, et al.
    Int J Environ Res Public Health, 2022 Aug 14;19(16).
    PMID: 36011650 DOI: 10.3390/ijerph191610015
    Diabetes mellitus (DM) management imposes a tremendous psychological burden on patients. The study investigates the association between DM treatment with blood glucose (BG) control and common mental health conditions. A cross-sectional study was conducted among 1821 individuals with DM in a community-based survey conducted in 2013. Information on respondents’ sociodemographic, mental health, DM treatment, and BG levels was collected. Multinomial logistic regression was employed to examine the association of diabetes treatment with controlled BG levels (<11.1 mmol/L) (42.5%, n = 774) or uncontrolled BG levels (34.3%, n = 625) compared with those not undergoing treatment (23.2%, n = 422) on depression anxiety, and stress. Having DM treatment and controlled BG was associated with high depressive symptoms (Relative Risk Ratio, RRR: 2.42; 95% CI 1.33−4.41) and high anxiety symptoms (1.66; 1.08−2.56) but not with perceived stress. However, treated DM with uncontrolled BG was associated with anxiety (high: 1.64; 1.05−2.56; low: 2.59; 1.10−6.09) but not depression or perceived stress. Our results suggest that being treated for DM, regardless of glucose control status, was associated with anxiety symptoms, whereas being treated with controlled BG was associated with high depressive symptoms. This situation highlights the need for integrative, multidisciplinary care for DM patients with mental health comorbidities.
  13. Salway R, Su TT, Ismail R, Glynis Armstrong ME, Foster C, Johnson L
    J Glob Health, 2021;11:05029.
    PMID: 35003716 DOI: 10.7189/jogh.11.05029
    BACKGROUND: The COVID-19 pandemic prompted movement restrictions in countries worldwide, impacting on physical activity (PA), a major non-communicable disease risk factor, and thus may have unintentional long-term health implications. In semi-rural areas of low-middle-income-countries (LMICs), where occupational activity is the main source of PA, changes in PA associated with COVID-19 restrictions are unknown. We investigated the impact of Movement Control Order (MCO) restrictions in a semi-rural region of Malaysia.

    METHODS: The South East Asia Community Observatory (SEACO) is a dynamic prospective community cohort. We contacted a random sample of 1007 adults (18+) who had previously provided PA data in 2018. We asked about PA during the MCO (March-May 2020) and at the time of interview (June 2020).

    RESULTS: During the MCO, PA reduced by a mean of 6.7 hours/week (95% confidence interval (CI) = 5.3, 8.0) compared to 2018, with the largest reductions among those in employment. By June, PA was 3.4 hours/week (95% CI = 2.0, 4.8) less than 2018, leaving 34% of adults currently inactive (20% in 2018). Reductions in occupational PA were not replaced with active travel or activity at home. Despite these observed reductions, most participants did not think the MCO had affected their PA.

    CONCLUSIONS: Movement restrictions are associated with lower PA lasting beyond the period of strict restrictions; such longer-term reductions in PA may have a detrimental impact on health. Future MCOs should encourage people to be active, but may additionally need targeted messaging for those who don't necessarily realise they are at risk. In particular, policies developed in more affluent countries may not easily translate to LMICs.

  14. Romli F, Alitheen NB, Hamid M, Ismail R, Abd Rahman NM
    J Cell Biochem, 2013 Jun;114(6):1230-7.
    PMID: 23239017 DOI: 10.1002/jcb.24477
    The first successful attempt to reprogram somatic cell into embryonic-like stem cell was achieved on 2006. Since then, it had sparked a race against time to bring this wonderful invention from bench to bedside but it is not easily achieved due to severe problems in term of epigenetic and genomic. With each problem arise, new technique and protocol will be constructed to try to overcome it. This review addresses the various techniques made available to create iPSC with problems hogging down the technique.
  15. Ngow HA, Wan Khairina WM, Teh LK, Lee WL, Harun R, Ismail R, et al.
    Singapore Med J, 2009 May;50(5):490-3.
    PMID: 19495518
    Genetic polymorphisms of CYP2C9 among different populations in different geographical regions could be different. CYP2C9 has been reported to be the enzyme responsible for the metabolism of many drugs, including warfarin and other drugs with a narrow therapeutic index. Realising the importance of inter-individual differences in the genetic profile in determining the outcome of a drug therapy, this study was conducted to explore the types and frequencies of CYP2C9 alleles in healthy and warfarin-treated Malays and Chinese, the two major ethnic groups in Malaysia. We aimed to evaluate the prevalence of the types and frequencies of common CYP2C9 alleles (*1, *2, *3 and *4) among the healthy unrelated individuals and diseased patients prescribed with warfarin.
  16. Mahat NA, Muktar NK, Ismail R, Abdul Razak FI, Abdul Wahab R, Abdul Keyon AS
    Environ Sci Pollut Res Int, 2018 Oct;25(30):30224-30235.
    PMID: 30155632 DOI: 10.1007/s11356-018-3033-8
    Contamination of toxic metals in P. viridis mussels has been prevalently reported; hence, health risk assessment for consuming this aquaculture product as well as the surrounding surface seawater at its harvesting sites appears relevant. Since Kampung Pasir Puteh, Pasir Gudang is the major harvesting site in Malaysia, and because the last heavy metal assessment was done in 2009, its current status remains unclear. Herein, flame atomic absorption spectrometry and flow injection mercury/hydride system were used to determine the concentrations of Pb, Cd, Cu and total Hg in P. viridis mussels and surface seawater (January-March 2015), respectively. Significantly higher concentrations of these metals were found in P. viridis mussels (p r = 0.787) observed between Pb concentration in P. viridis mussel with the surface seawater indicates its possible application for inferring Pb concentrations in the mussel. Since both the calculated target hazard quotient and hazard index for Pb and Cd exceeded 1, the possible detrimental health impacts on human for consuming P. viridis mussels from this rearing site cannot be ignored. Hence, promoting continuous monitoring programmes and developing efficient toxic metal removal techniques prior to entering the market are required.
  17. Ali HM, Sitinjak C, Md Said MH, Hassim JZ, Ismail R, Simic V
    Front Public Health, 2022;10:1093732.
    PMID: 36743182 DOI: 10.3389/fpubh.2022.1093732
    Effective management of end-of-life vehicles (ELVs) represents a sound strategy to mitigate global climate change. ELVs are contaminants that pollute water, air, soil, and landscape. This waste flow must be adequately treated, but no proper rule oversees the disposal of ELV waste in Malaysia. This study aims to determine the extent of implementing the ELV policy and the social readiness in implementing environmentally friendly ELV disposal in Malaysia. The questionnaire seeks public input on critical ELV concerns such as public perception of the phenomena, environmental and safety standards, and recycling and treatment facilities. This research uses a cross-sectional design with 448 respondents in the survey. Fit models in structural equation modeling are evaluated using a variety of goodness-of-fit indicators to ensure an actual hypothesis. This study's advantages include the availability of representative samples and allowing for comparable and generalizable conclusions to larger communities throughout Malaysia. It is found that personal experience is significantly correlated with social readiness. The cause of ELV vehicles knowledge was the vital mediator, along with recycling costs knowledge. Thus, knowledge regarding ELV management costs is the most decisive mediation variable to predict public acceptance. The recommended strategy to reduce resentment and rejection of ELV policy is to disseminate information about the negative ELV impact on environmental and social sustainability.
  18. Murugiah L, Ismail R, Taib HM, Applanaidu SD, Long MNHBH
    MethodsX, 2023 Dec;11:102383.
    PMID: 37767158 DOI: 10.1016/j.mex.2023.102383
    Financial literacy is an essential lifelong skill that should be taught to children at any age. It holds the key to develop a generation of adults who are knowledgeable about money and the economy. Additionally, OECD (2018) suggests that using digital tools could significantly enhance financial literacy and well-being. Therefore, this paper aims to:(i)assess the financial literacy level of primary school children in the northern region of Malaysia and(ii)explore interactive and engaging methods for teaching financial literacy.The sample size was determined using Krejcie and Morgan's (1970) approach, resulting in 419 primary school students aged 7 to 12 and their parents. An online questionnaire was employed, and multi-regression analysis was conducted. The findings highlighted those primary students displayed a high level of financial literacy, scoring above 80 % on the questionnaire. Furthermore, parents expressed a preference for their children to enroll in personal finance subjects offered by schools, have financial assignments or activities at school, and engage in online financial games. The study emphasized the crucial roles of schools, teachers, and active parental involvements to enhance financial literacy. This study recommends incorporating interactive and attractive teaching methods through in-class and online activities at the school level.
  19. Ibrahim N, Chu SY, Siau CS, Amit N, Ismail R, Abdul Gafor AH
    BMJ Open, 2022 Jun 03;12(6):e059305.
    PMID: 36691236 DOI: 10.1136/bmjopen-2021-059305
    INTRODUCTION: The number of patients in Malaysia requiring dialysis is expected to rise substantially in the future due to the ageing population and increasing prevalence of diabetes mellitus and hypertension. Hence, more individuals will be expected to adopt the role of caregivers in the future. The upward trend of end-stage renal disease (ESRD) and caregiving for dialysis patients has detrimental consequences for both patients and caregivers in terms of their psychological well-being and quality of life. Despite the current circumstances, there are very few studies in Malaysia that have explored the psychosocial factors, specifically on the economic impact of the management of ESRD.

    METHODS AND ANALYSIS: This two-phase sequential explanatory mixed-methods design, incorporating a quantitative design (phase I) and a qualitative study (phase II), is to be conducted in 4 government hospitals and 10 other non-governmental organisations or private dialysis centres within Klang Valley, Malaysia. A cross-sectional survey (phase I) will include 236 patient-caregiver dyads, while focus group discussions (phase II) will include 30 participants. The participants for both phases will be recruited purposively. Descriptive statistics, independent sample t-tests and multiple regression analysis will be used for analyses in phase I, and thematic analysis will be used in phase II.

    ETHICS AND DISSEMINATION: Approval for the study has been obtained from the National Medical Research and Ethics Committee (MREC) (NMRR-21-1012-59714) and the Research Ethics Committee of Hospital Canselor Tuanku Muhriz UKM (UKM PPI/111/8/JEP-2021-078) and University of Malaya Medical Centre (MREC ID NO: 2 02 178-10346). Informed consent of the participants will be obtained beforehand, and no personal identifiers will be obtained from the participants to protect their anonymity. The findings will be published in peer-reviewed scientific journals and presented at national or international conferences with minimal anonymised data.

  20. Sapari H, Selamat MI, Isa MR, Ismail R, Wan Mahiyuddin WR
    JMIR Res Protoc, 2023 Oct 16;12:e44702.
    PMID: 37843898 DOI: 10.2196/44702
    BACKGROUND: Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce.

    OBJECTIVE: This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs.

    METHODS: We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity.

    RESULTS: This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs.

    CONCLUSIONS: The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities.

    TRIAL REGISTRATION: PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=365471.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44702.

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