Among the challenges in systematic inquiry into elder abuse and neglect (EAN) is the lack of standardized tool of measurement. Existing literature demonstrates diverse tools being used, with the Conflict Tactics Scale (CTS) and its versions being the most common. The Malaysian Elder Mistreatment Project (MAESTRO) utilized the Modified CTS developed and used by the National Study of Elder Abuse and Neglect in Ireland (NSEA-I). This article aimed to validate this Malay version of the modified CTS for use in the Malaysian context and by Malay-speaking populations across Southeast Asia while highlighting the various practical and methodological challenges encountered along the process. Data were collected from 1927 older respondents who lived in Kuala Pilah district. Preliminary data screening led to the dropping of 10 items due to 0 variance. Further four items were deleted during CFA due to low loading. The indicators of neglect factor were made into a composite factor due to high collinearity. The final scale had acceptable reliability and validity. This tool is likely to assist in assessing and detecting EAN more quickly and conveniently. It will also assist future researches of EAN in taking into account the issues that arise in the measurement of EAN.
Malaria is a major public health concern, and any tangible intervention during the pre-elimination phase can result in a significant reduction in infection rates. Recent studies have reported that antigens producing cross-protective immunity can play an important role as vaccines and halt malaria transmission in different endemic regions. In this study, we studied the genetic diversity, natural selection, and discovered novel conserved epitopes of a high molecular weight rhoptry protein 2 (RhopH2) in clinical samples of Plasmodium knowlesi and Plasmodium vivax cross-protective domains, which has been proven to produce cross-protective immunity in both species. We found low levels of nucleotide diversity (P. knowlesi; π ~ 0.0093, SNPs = 49 and P. vivax π ~ 0.0014, SNPs = 23) in P. knowlesi (n = 40) and P. vivax (n = 65) samples in the PkRhopH2 cross-protective domain. Strong purifying selection was observed for both species (P. knowlesi; dS - dN = 2.41, p < 0.009, P. vivax; dS - dN = 1.58, p < 0.050). In silico epitope prediction in P. knowlesi identified 10 potential epitopes, of which 7 epitopes were 100% conserved within clinical samples. Of these epitopes, an epitope with 10 amino acids (QNSKHFKKEK) was found to be fully conserved within all P. knowlesi and P. vivax clinical samples and 80%-90% conservation within simian malaria ortholog species, i.e., P. coatneyi and P. cynomolgi. Phylogenetic analysis of the PkRhopH2 cross-protective domain showed geographical clustering, and three subpopulations of P. knowlesi were identified of which two subpopulations originated from Sarawak, Malaysian Borneo, and one comprised only the laboratory lines from Peninsular Malaysia. This study suggests that RhopH2 could be an excellent target for cross-protective vaccine development with potential for outwitting strain as well as species-specific immunity. However, more detailed studies on genetic diversity using more clinical samples from both species as well as the functional role of antibodies specific to the novel conserved epitope identified in this study can be explored for protection against infection.
The cell-traversal protein for ookinetes and sporozoites (CelTOS), expressed on the surface of ookinetes and sporozoitesin Plasmodium species, is a promising malaria vaccine candidate. CelTOS is essential for parasite invasion into mosquito midgut and human hepatocytes, thereby contributing to malaria transmission and disease pathogenesis. This study explores the genetic diversity, polymorphisms, haplotypes, natural selection, phylogenetic analysis, and epitope prediction in the full-length Plasmodium knowlesi CelTOS gene in clinical samples from Sarawak, Malaysian Borneo, and long-term laboratory strains from Peninsular Malaysia and the Philippines. Our analysis revealed a high level of genetic variation in the PkCelTOS gene, with a nucleotide diversity of π ~ 0.021, which was skewed towards the 3' end of the gene. This level of diversity is double that observed in PfCelTOS and 20 times that observed in PvCelTOS from worldwide clinical samples. Tests of natural selection revealed evidence for positive selection within clinical samples. Phylogenetic analysis of the amino acid sequence of PkCelTOS revealed the presence of two distinct groups, although no geographical clustering was observed. Epitope prediction analysis identified two potential epitopes (96AQLKATA102 and 124TIKPPRIKED133) using the IEDB server and one epitope (125IKPPRIKED133) by Bcepred server on the C' terminal region of PkCelTOS protein. Both the servers predicted a common epitope region of nine amino acid length (IKPPRIKED) peptide, which can be studied in the future as a potential candidate for vaccine development. These findings shed light on the genetic diversity, polymorphism, haplotypes, and natural selection within PkCelTOS in clinical samples and provide insights about its future prospects as a potential candidate for P. knowlesi malaria vaccine development.
OBJECTIVES: To examine the association between elder abuse and poor sleep using a Malay validated version of Pittsburgh Sleep Quality Index (PSQI).
DESIGN: This study was divided into two phases. Phase I tested the construct validity and reliability of the Malay version of PSQI. Phase II was a population-based, cross-sectional study with a multi-stage cluster sampling method. Home-based interviews were conducted by trained personnel using a structured questionnaire, to determine exposure and outcome.
SETTING: Kuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia.
PARTICIPANTS: 1648 community-dwelling older Malaysians.
RESULTS: The Malay version of PSQI had significant test re-test reliability with intra-class correlation coefficients of 0.62. Confirmatory factor analyses revealed that one factor PSQI scale with three components (subjective sleep quality, sleep latency, and sleep disturbances) was most suitable. Cronbach's Alpha was 0.60 and composite reliability was 0.63. PSQI scores were highest among neglect (4.11), followed by physical (4.10), psychological (3.96) and financial abuse (3.60). There was a dose-response relationship between clustering of abuse and PSQI scores; 3.41, 3.50 and 3.84 for "no abuse", "1 type of abuse" and "2 types or more". Generalized linear models revealed six variables as significant determinants of sleep quality-abuse, co-morbidities, self-rated health, income, social support and gait speed. Among abuse subtypes, only neglect was significantly associated with poor sleep.
CONCLUSION: The Malay PSQI was valid and reliable. Abuse was significantly associated with poor sleep. As sleep is essential for health and is a good predictor for mortality among older adults, management of abuse victims should entail sleep assessment. Interventions or treatment modalities which focus on improving sleep quality among abuse victims should be designed.