Colorectal cancer (CRC)-screening reduces mortality, yet remains underutilized. The use of electronic media (e-media) decision aids improves saliency and fosters informed decision-making. This systematic review aimed to determine the effectiveness of CRC-screening promotion, using e-media decision aids in primary healthcare (PHC) settings. Three databases (MEDLINE, Web of Science, and the Cochrane Library) were searched for eligible studies. Studies that evaluated e-media decision aids compared to usual care or other conditions were selected. Quality was assessed by using Cochrane tools. Their effectiveness was measured by CRC-screening completion rates, and meta-analysis was conducted to calculate the pooled estimates. Ten studies involving 9393 patients were included in this review. Follow-up durations spanned 3-24 months. The two types of decision-aid interventions used were videos and interactive multimedia programs, with durations of 6-15 min. Data from nine feasible studies with low or some risk of bias were synthesized for meta-analysis. A random-effects model revealed that CRC-screening promotion using e-media decision aids were almost twice as likely to have screening completion than their comparisons (OR 1.62, 95% CI: 1.03-2.62, p < 0.05). CRC-screening promotion through e-media has great potential for increasing screening participation in PHC settings. Thus, its development should be prioritized, and it should be integrated into existing programs.
In this review, we have investigated the perceptions, barriers, and enabling factors that were responsible for a dietary salt reduction in the out-of-home sectors. For this purpose, we examined different knowledge databases such as Google Scholar, Ebscohost, MEDLINE (PubMed), Ovid, and Cochrane Library for research articles from September to December 2020. The inclusion criteria for the research articles were that they had to be published in English and had to be a qualitative or quantitative study that was conducted after 2010. These studies also had to report the various enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors. After implementing the inclusion criteria, we successfully screened a total of 440 studies, out of which 65 articles fulfilled all the criteria. The perceived barriers that hindered salt reduction among the out-of-home sectors included lack of menu and food variabilities, loss of sales due to salt reduction, lack of technical skills for implementing the salt reduction processes for cooking or reformulation, and an absence of environmental and systemic support for reducing the salt concentration. Furthermore, the enablers for salt reduction included the intervention programs, easy accessibility to salt substitutes, salt intake measurement, educational availability, and a gradual reduction in the salt levels. With regards to the behavior or perceptions, the effect of organizational and individual characteristics on their salt intake were reported. The majority of the people were not aware of their salt intake or the effect of salt on their health. These people also believed that low salt food was recognized as tasteless. In conclusion, the enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors were multifaceted. Therefore, for the implementation of the strategies, policies, and initiatives for addressing the barriers, the policymakers need to encourage a multisectoral collaboration for reducing the salt intake in the population.
This study aimed to investigate the association between traffic-related air pollution (TRAP) exposure and histone H3 modification among school children in high-traffic (HT) and low-traffic (LT) areas in Malaysia. Respondents' background information and personal exposure to traffic sources were obtained from questionnaires distributed to randomly selected school children. Real-time monitoring instruments were used for 6-h measurements of PM10, PM2.5, PM1, NO2, SO2, O3, CO, and total volatile organic compounds (TVOC). Meanwhile, 24-h measurements of PM2.5-bound black carbon (BC) were performed using air sampling pumps. The salivary histone H3 level was captured using an enzyme-linked immunosorbent assay (ELISA). HT schools had significantly higher PM10, PM2.5, PM1, BC, NO2, SO2, O3, CO, and TVOC than LT schools, all at p < 0.001. Children in the HT area were more likely to get higher histone H3 levels (z = -5.13). There were positive weak correlations between histone H3 level and concentrations of NO2 (r = 0.37), CO (r = 0.36), PM1 (r = 0.35), PM2.5 (r = 0.34), SO2 (r = 0.34), PM10 (r = 0.33), O3 (r = 0.33), TVOC (r = 0.25), and BC (r = 0.19). Overall, this study proposes the possible role of histone H3 modification in interpreting the effects of TRAP exposure via non-genotoxic mechanisms.
There is a paucity of information concerning vital pulp treatment outcomes in the undergraduate teaching setting. This study aimed to determine which type of deciduous molar, arch location, type of vital pulp therapy, and the number of carious surfaces involved had a better prognosis when carried out by undergraduate dental students. The method used was the review of clinical records of 590 patients with 600 deciduous molars, that visited the outpatient undergraduate dental clinics for vital pulp therapy. Statistical analysis used to determine the associations of tooth type, arch location, treatment type, and the number of carious surfaces involved in successful outcomes was logistic regression analysis with significance set at p < 0.05. According to the regression analysis model results, there was a significant association based on tooth type (p < 0.05) and arch location (p = 0.003). In addition, there was a significant association based on the type of treatment performed (p = 0.036). However, there was no significant association in success rates based on the number of carious surfaces involved (p = 0.873). In conclusion, second deciduous molars and maxillary deciduous molars had a better overall prognosis, and indirect pulp therapy was revealed to be more highly associated with successful treatment outcomes in comparison to ferric sulfate pulpotomy in our setting.
The co-occurrence of multiple modifiable risk factors increases the risk of cardiovascular disease (CVD) morbidity or mortality. This study examines the prevalence and clustering of self-reported modifiable CVD risk factors among older adults in Malaysia. A total of 7117 adults aged ≥50 years participated in the National Health and Morbidity Survey (NHMS) 2018: Elderly Health, a community-based cross-sectional survey. Data were collected using a standardized structured questionnaire. Multivariable logistic regression was used to determine the factors associated with the clustering of self-reported modifiable CVD risk factors. The prevalence of self-reported diabetes, hypertension, hypercholesterolemia, overweight/obesity, and current smoking was 23.3%, 42.2%, 35.6%, 58.4%, and 17.5%, respectively. Overall, the prevalence of clustering of ≥1, ≥2, and ≥3 modifiable CVD risk factors was 83.3%, 75.4%, and 62.6%, respectively. Multivariable logistic regression analysis showed that men, 60-69 age group, urban dwellers, having no formal education, unemployed/retirees/homemakers, and being physically inactive were independently associated with self-reported modifiable CVD risk factors clustering. There are also ethnic differences in self-reported modifiable CVD risk factors clustering. Our findings underscore the necessity of targeted interventions and integrated strategies for early detection and treatment of modifiable CVD risk factors among older adults, considering age, sex, ethnicity, and socioeconomic status.
Aflatoxins (AFs) are secondary metabolites toxic to humans as well as animals. The environmental conditions, conventional agricultural practices, and illiteracy are the main factors which favor the production of AFs in food and feed. In the current study 744 samples of vegetable seeds and oils (soybean, sunflower, canola, olive, corn, and mustard) were collected and tested for the presence of aflatoxin B1 (AFB1) and total AFs. Liquid-liquid extraction was employed for the extraction of AFs from seeds and oil samples. Reverse phase high performance liquid chromatography equipped with fluorescence detection was used for the analysis. The results have shown that 92 (56.7%) samples of imported and 108 (57.0%) samples of local edible seeds were observed to be contaminated with AFs. All samples of edible seeds have AFB1 levels greater than the proposed limit set by the European Union (EU, 2 µg/kg) and 12 (7.40%) samples of imported seeds and 14 (7.40%) samples of local seeds were found in the range ≥ 50 µg/kg. About 78 (43.3%) samples of imported edible oil and 103 (48.3%) sample of local edible oil were observed to be positive for AFs. Furthermore, 16 (8.88%) and six (3.33%) samples of imported vegetable oil have levels of total AFs in a range (21-50 µg/kg) and greater than 50 µg/kg, respectively. The findings indicate significant differences in AFs levels between imported and local vegetable oil samples (t = 22.27 and p = 0.009) at α = 0.05 and a significant difference in AFs levels were found between vegetable seeds and oil samples (t = -17.75, p = 0.009) at α = 0.05. The highest dietary intake was found for a local sunflower oil sample (0.90 µg/kg/day) in female individuals (16-22 age group). The results have shown considerably high levels of AFB1 and total AFs in seeds and oil samples and emphasise the need to monitor carefully the levels of these toxic substances in food and feed on regular basis.
The aim of this study was to evaluate the performance of a set of sociodemographic and habits measures on estimating periodontal disease among south Indian adults. This cross-sectional study was carried out among 288 individuals above 18 years old in Tamil Nadu, India. The outcome of the study was periodontal disease, measured by WHO criteria. The covariates were age, ethnicity, smoking and alcohol habit. The assessment of factors predicting periodontal disease was carried out by multiple logistic regression analysis using R version 3.6.1. The demographic factors like age group (AOR = 3.56; 95% CI 1.69-7.85), ethnicity (AOR = 6.07; 95% CI 2.27-18.37), non-alcoholic (AOR = 0.31; 95% CI 0.13-0.64) and non-smoking (AOR = 0.33; 95% CI 0.15-0.67) were found to be associated with the outcome. The maximum log likelihood estimate value was -30.5 and AIC was 385 for the final model, respectively. Receiver operating characteristic (ROC) curve for the periodontal disease was 0.737. We can conclude that sociodemographic factors and habits were useful for predicting periodontal diseases.
Rice straw is commonly burned openly after harvesting in Malaysia and many other Asian countries where rice is the main crop. This operation emits a significant amount of air pollution, which can have severe consequences for indoor air quality, public health, and climate change. Therefore, this study focuses on determining the compositions of trace elements and the morphological properties of fine particles. Furthermore, the species of bacteria found in bioaerosol from rice burning activities were discovered in this study. For morphological observation of fine particles, FESEM-EDX was used in this study. Two main categories of particles were found, which were natural particles and anthropogenic particles. The zinc element was found during the morphological observation and was assumed to come from the fertilizer used by the farmers. ICP-OES identifies the concentration of trace elements in the fine particle samples. A cultured method was used in this study by using nutrient agar. From this study, several bacteria were identified: Exiguobavterium indicum, Bacillus amyloliquefaciens, Desulfonema limicola str. Jadabusan, Exiguobacterium acetylicum, Lysinibacillus macrolides, and Bacillus proteolyticus. This study is important, especially for human health, and further research on the biological composition of aerosols should be conducted to understand the effect of microorganisms on human health.
Chemical pollution in the transboundary Langat River in Malaysia is common both from point and non-point sources. Therefore, the water treatment plants (WTPS) at the Langat River Basin have experienced frequent shutdown incidents. However, the Langat River is one of the main sources of drinking water to almost one-third of the population in Selangor state. Meanwhile, several studies have reported a high concentration of Arsenic (As) in the Langat River that is toxic if ingested via drinking water. However, this is a pioneer study that predicts the As concentration in the Langat River based on time-series data from 2005-2014 to estimate the health risk associated with As ingestion via drinking water at the Langat River Basin. Several time-series prediction models were tested and Gradient Boosted Tree (GBT) gained the best result. This GBT model also fits better to predict the As concentration until December 2024. The mean concentration of As in the Langat River for both 2014 and 2024, as well as the carcinogenic and non-carcinogenic health risks of As ingestion via drinking water, were within the drinking water quality standards proposed by the World Health Organization and Ministry of Health Malaysia. However, the ingestion of trace amounts of As over a long period might be detrimental to human health because of its non-biodegradable characteristics. Therefore, it is important to manage the drinking water sources to minimise As exposure risks to human health.
According to continuity theory, successful aging is promoted when older people are able to continue familiar activities as a way to maintain self-identity. The purpose of this study was to examine the importance of both external resources provided by Taipei city and older adults' internal resources in internal and external continuity and life satisfaction. The data were from the 2019 Taipei City Senior Citizen Condition Survey acquired through face-to-face interviews. Only the community-based sample without disability was included in the analysis (n = 1494). Structural equation modeling was used for the analysis. Both internal and external resources significantly promoted internal continuity (physical activity, Internet use, and lifelong learning) and external continuity (work, social connectedness, and social participation), and the effects of personal resources were larger. External continuity was positively related to life satisfaction. The effects of external resources on continuity and life satisfaction were stronger in older women than in older men. Age-friendly cities may provide support for activity continuity and promote well-being for older people. Policy suggestions are discussed.
The impact of happiness on creativity is well-established. However, little is known about the effect of creativity on well-being. Two studies were thus conducted to examine the impact of creativity on subjective well-being. In the first study, 256 undergraduate students (Study 1a) and 291 working adults (Study 1b) self-reported their creativity, stress, and subjective well-being. Hierarchical multiple regression analysis showed a positive relationship between creativity and subjective well-being after controlling the effect of self-perceived stress and demographics in both samples. Study 2 then employed an experimental design to examine the causal relationship between creativity and subjective well-being. Half of the 68 undergraduates underwent a creativity priming task followed by a divergent thinking test as well as self-reported stress and subjective well-being. The priming task was found to boost creative performance in the pilot study (Study 2a) and the actual study (Study 2b). Moreover, after controlling the effect of self-perceived stress, ANCOVA analysis showed that participants receiving the priming reported higher subjective well-being scores than their counterparts in the control group. The overall findings not only shed light on the facilitative effect of creativity on subjective well-being but also highlight the necessity of considering the reciprocal relationship of the two constructs in future research.
Nowadays, the issue of teachers' psychological well-being causes serious concern, especially in Malaysia. Many studies related to psychological well-being have focused on students rather than on the health and well-being of teachers. Thus, the current study investigated the determinants of psychological well-being (depression, anxiety and stress) from the psychosocial work environment (job control, job demands and social support), and examined the moderating role of job control and social support in the relationship between job demands and psychological well-being among teachers. The design of this study was quantitative research through a survey questionnaire. The sample consisted of 335 high school teachers (23.3%-male; 76.7%-female) who responded to measuring scales of job demands, job control, social support, depression, anxiety and stress, and socio-demographic profile. The data were analyzed using two statistical methods, namely descriptive and inferential statistics. The hierarchical linear regression model was used to analyze the data by assisting the statistical software, i.e., SPSS-23. The results showed that job demands, job control and social support significantly predicted teachers' psychological well-being. Furthermore, the effect of job demands on teachers' depression and anxiety was partially moderated by job control and social support. In conclusion, this study has successfully identified the significant predictors of teachers' psychological well-being and the role of job control and social support as a moderating variable to teachers' psychological well-being in Malaysia. The result provides insights and contributes to the literature of teachers' psychological well-being determinants and involves Malaysian respondents with a collectivistic eastern culture.
This review provided a systematic overview of the questionnaire-related dengue studies conducted in Malaysia and evaluated their reliability and validity used in the questionnaires. An extensive literature search was conducted using various electronic databases, including PubMed, EMBASE, Medline, and ScienceDirect. Systematic reviews and meta-analysis (PRISMA) were selected as the preferred item reporting method. Out of 88 identified dengue-related, 57 published from 2000 to April 2020 met the inclusion criteria and were included. Based on the meta-analysis, a poor mean score was obtained for knowledge (49%), attitude (44%), and preventive practice (55%). The study showed that the level of knowledge on cardinal signs and modes of transmission for dengue virus were highest among health care workers, followed by students (international and local) and lastly community residents. In treatment-seeking behaviours, only half of the respondents (50.8%) would send their child to the nearest health clinics or hospitals when a child became restless or lethargic. The acceptance rate for dengue vaccine, bacteria (Wolbachia), as a vector for dengue control and self-test diagnostic kit for dengue showed considerably high (88.4%, 70%, and 44.8%, respectively). Health belief model (HBM) constructs, such as perceived barriers, perceived severity, perceived susceptibility, self-efficacy, and perceived benefit influence prevention practices. Lastly, only 23 articles (40.3%) had piloted or pretested the questionnaire before surveying, in which three reported Cronbach's alpha coefficient (0.70-0.90). A need for active participation of communities and healthcare personnel, promotion of awareness, and safe complementary medicines, as well as assessment of psychometric properties of questionnaire use in dengue surveys in Malaysia, in order for assessing dengue reliably and valid.
Driving fatigue is a serious issue for the transportation sector, decreasing the driver's performance and increasing accident risk. This study aims to investigate how fatigue mediates the relationship between the nature of work factors and driving performance. The approach included a review of the previous studies to select the dimensional items for the data collection instrument. A pilot test to identify potential modification to the questionnaire was conducted, then structural equation modelling (SEM) was performed on a stratified sample of 307 drivers, to test the suggested hypotheses. Based on the results, five hypotheses have indirect relationships, four of which have a significant effect. Besides, the results show that driving fatigue partially mediates the relationship between the work schedule and driving performance and fully mediates in the relationship between work activities and driving performance. The nature of work and human factors is the most common reason related to road accidents. Therefore, the emphasis on driving performance and fatigue factors would thereby lead to preventing fatal crashes and life loss.
Background: The central point of this study is team initiative, and we analyzed how the theoretical model of antecedents and consequents of personal initiative contribute to explaining the relationship between team initiative and its antecedents and consequents. Authentic leadership is proposed as the antecedent, and the consequent leads to two types of outcomes, one of which is related to employee well-being, and the other is related to performance. However, little is known about what occurs in this relationship once the focus shifts to the team level. From a team perspective, with the label team initiative, we propose a collective construct defined similarly to personal initiative. This study shows the relationship between team initiative and its two consequences, team work engagement and performance, which are measured in terms of team productivity by the leader. Methods: Our model was tested in a field study with 344 employees of 79 work teams belonging to 55 organizations. Results: The analysis of the results using SEM and a regression analysis supported our main hypotheses. Conclusions: The finding that initiative is related to performance establishes the importance of initiative at the team level. It also emphasizes its impact on employee well-being through team work engagement and suggests the importance of authentic leadership.
Since its inception in 1986, the contents of the National Health and Morbidity Survey (NHMS) have been periodically updated to support emerging health data needs for evidence-based policy and program development. In 2018, the healthcare demand questionnaire was redesigned to capture diverse and changing population demand for healthcare services and their utilization pattern. This paper describes the methods and processes undertaken in redesigning the questionnaire. We aim to highlight the systematic and inclusive approach, enabling all potential evidence users to be involved, indirectly encouraging research evidence uptake for policy and program planning. We applied a systematic approach of comprehensive literature search for national-level population survey instruments implemented globally and translated non-English tools to English. The development phases were iterative, conducted in parallel with active stakeholder engagements. Here, we detailed the processes in the planning and exploratory phase as well as a qualitative assessment of the questionnaire. We included instruments from 45 countries. The majority were from the Organisation for Economic Co-operation and Development (OECD) countries and focused on perceived health, health-related behavior, and healthcare use. Thirty-four stakeholders from 14 areas of expertise were involved. Stakeholders identified additional content areas required, such as chronic pain, alternative use of healthcare services (community pharmacy, home-visit, and private medical laboratory), family doctor, and informal caregiving. The questionnaire, redesigned based on existing literature with concordant involvement and iterative feedback from stakeholders, improved the choice of health topics through the identification of new topics and modification of existing questions to better meet future evidence needs on health problems, strategy, and program planning towards strengthening the nation's health systems.
Klebsiella pneumoniae is an opportunistic pathogen that is responsible for causing nosocomial and community-acquired infections. Despite its common presence in soil and aquatic environments, the virulence potential of K. pneumoniae isolates of environmental origin is largely unknown. Hence, in this study, K. pneumoniae isolated from the estuarine waters and sediments of the Matang mangrove estuary were screened for potential virulence characteristics: antibiotic susceptibility, morphotype on Congo red agar, biofilm formation, presence of exopolysaccharide and capsule, possession of virulence genes (fimH, magA, ugE, wabG and rmpA) and their genomic fingerprints. A total of 55 strains of K. pneumoniae were isolated from both human-distributed sites (located along Sangga Besar River) and control sites (located along Selinsing River) where less human activity was observed, indicated that K. pneumoniae is ubiquitous in the environment. However, the detection of potentially virulent strains at the downstream of Kuala Sepetang village has suggested an anthropogenic contamination source. In conclusion, the findings from this study indicate that the Matang mangrove estuary could harbor potentially pathogenic K. pneumoniae with risk to public health. More studies are required to compare the environmental K. pneumoniae strains with the community-acquired K. pneumoniae strains.
Frontline healthcare providers are exposed to indirect trauma through dealing with traumatized patients. This puts them at risk of vicarious traumatization. In response to the COVID-19 pandemic, this study seeks to establish the psychometric properties of the Malay version of the Vicarious Traumatization Questionnaire among healthcare providers. A cross-sectional study was conducted. The translated Malay version of the Vicarious Traumatization Questionnaire was completed by 352 healthcare providers in Kelantan, Malaysia. The data was entered using IBM SPSS Statistics version 26.0 (SPSS Inc., Chicago, IL, USA, 2019), and descriptive analysis was performed. The psychometric properties of the scale were assessed in two phases. The Rasch model to assess the validity and reliability was performed using Winsteps version 3.72.3. The confirmatory factor analysis using the structural equation modeling was performed using AMOS version 23.0. The Rasch analysis showed that the 38 items, in two constructs, had high item reliability and item separation at 0.97 and item separation at 5.36, respectively, while good person reliability and person separation were at 0.95 and 4.58, respectively. The correlations of all persons and items are greater than 0.20. There are no misfitting or overfitting items in the outfit MNSQ. There are four items that are challenging in answering the scale. The final model of the confirmatory factor analysis shows two constructs with 38 items demonstrating acceptable factor loadings, domain to domain correlation, and best fit (Chi-squared/degree of freedom = 4.73; Tucker-Lewis index = 0.94; comparative fit index = 0.94; and root mean square error of approximation = 0.10). Composite reliability and average variance extracted of the domains were higher than 0.7 and 0.5, respectively. The Vicarious Traumatization Questionnaire tested among healthcare providers has been shown to valid and reliable to assess vicarious traumatization.
Healthcare workers (HCW) are exposed to health-related anxiety in times of pandemic as they are considered to have a high risk of being infected whilst being the vital workforce to manage the outbreak. This study determined the factors that influence health anxiety and its extent in correlations with perceived risk, knowledge, attitude, and practice of HCW. A cross-sectional online survey was conducted on a total of 709 HCW from both public and private healthcare facilities who completed a set of questionnaires on sociodemographic data, knowledge, attitude, and practice of HCW on COVID-19, and health anxiety traits assessed using the short version Health Anxiety Inventory (HAI). Multiple linear regression (adjusted R2 = 0.06) revealed respondents with higher perceived risk for COVID-19 significantly predicted higher HAI scores (beta 1.281, p < 0.001, 95%, CI: 0.64, 1.92), and those with a higher cautious attitude towards COVID-19 significantly predicted higher HAI scores (beta 0.686, p < 0.001, 95%CI: 0.35, 1.02). Healthcare workers' perceived risk and cautious attitude towards COVID-19 might be potentially influenced by management of the sources and approaches to the dissemination of information of the pandemic. The implementation of certain measures that minimize the infection risk and its related anxiety is important to preserve both their physical and psychological wellbeing.
Our aim was to examine perceived occupational turnover intentions among medical students and the associated factors. A cross-sectional study using a Web-based survey was conducted. A total of 2922 completed responses were received (response rate 55.7%). A total of 58.4% (95% CI 56.6-60.2) reported high turnover intention (score of 7-15). The odds of higher total turnover score among the fifth-year students was nearly four times that of first-year students (OR = 3.88, 95% CI 2.62-5.73). Perception of the medical profession as not being of high social status and reputation significantly influenced high turnover intention scores (OR = 2.26, 95% CI 1.90-2.68). All three dimensions of the multidimensional scale of perceived social support (MSPSS) significantly predict turnover intention. Lower scores in the support from Significant Other (OR = 1.47, 95% CI 1.17-1.84), Family (OR = 1.47, 95% CI 1.18-1.83) and Friend (OR = 1.42, 95% CI 1.14-1.77) subscales were associated with higher turnover intention. Low score in the Brief Resilience Scale (BRS) was also associated with higher turnover intention (OR = 1.44, 95% CI 1.17-1.77). The findings shed light on the importance of changing public attitudes towards respecting the medical profession and improving the implementation of policies to protect the well-being of people in the medical profession.