Understanding The Mimicker: Epidemiological Pattern and Determinant of Melioidosis Mortality in Negeri Sembilan, Malaysia.

BACKGROUND: Melioidosis, a tropical infectious disease caused by Burkholderia pseudomallei, is epidemic in most region in Southeast Asia with high case fatality. However, there is scanty information regarding the disease's epidemiological pattern, demographics, and underlying risk factors. METHOD: This 5-year retrospective study of 185 confirmed cases which were taken from the Negeri Sembilan Melioidosis Registry between 2018 and 2022. We aim to describe the incidence, mortality rate, case fatality, relationship with meteorology, and factors that influence mortality in this central region of Peninsular Malaysia. RESULTS: Incidence rate (IR) of melioidosis in Negeri Sembilan is varied at 1.9 to 5.1 with mean of 3.1 in 100,000 population per year. IR varied between districts in the state from zero to 22.01 in 100,000 population per year. Mortality rate were ranged from 0.17 to 0.74 cases with mean of 0.44 cases in 100,000 population per year. The case fatality rate of this state scattered from 8.70% to 16.67%. There were no significant linear associations between cases and deaths with monthly rainfall and humidity. The mean age of patients was 52.8 years, predominated with age around 41-60 years old. Males (77.8%) predominated, and the majority of cases were Malays (88.9%) and had exposed to soil related activities (74.6%). Mortality from melioidosis was more likely in Bumiputera and non-Malaysians (p<0.05). Patients who had at least one comorbidity were at a higher risk of death from melioidosis (p<0.05). Diabetes mellitus was found in 41.1% of all identified cases, making it a major underlying risk factor for both developing and dying from melioidosis (aOR:19.32, 95%CI:1.91-195.59, p<0.05). Hypertension and mortality status in melioidosis are also significantly correlated (aOR: 7.75, 95% CI: 2.26-26.61, p<0.05). CONCLUSION: The epidemiological patterns of cases reported from Negeri Sembilan are consistent for the most part from previous studies in other states in Malaysia and global with regard to its incidence, case fatality, demographic and predisposing chronic diseases. Diabetes mellitus and hypertension were significantly linked to increased mortality among all determinants.

Effectiveness of the Integrated Dengue Education and Learning (iDEAL) module in improving the knowledge, attitude, practice, environmental cleanliness index, and dengue index among schoolchildren: A randomised controlled trial protocol.

BACKGROUND: Dengue is a mosquito-borne disease caused by four distinct, closely related dengue viruses (DENV). Global dengue incidence has markedly increased in the past decades. The World Health Organization reported that cases increased from 505,430 in 2000 to 5.2 million in 2019. Similarly, the total dengue cases in Malaysia increased from 7,103 in 2000 to a peak of 130,101 in 2019. Knowledge, attitude, and practice (KAP) remain the most effective dengue prevention and control tools. Furthermore, school-based health education is key to enhancing knowledge and raising awareness of the seriousness of dengue among schoolchildren and transferring knowledge and practice from classrooms to homes. Thus, it is necessary to plan an integrated module for the primary prevention of dengue infection, specifically among schoolchildren. AIMS: The present study intends to develop, implement, and evaluate the effectiveness of a theory-based integrated dengue education and learning (iDEAL) module in improving the KAP, environmental cleanliness index, and dengue index among schoolchildren in Selangor and Kuala Lumpur. METHODS: This study is a single-blinded, cluster randomised controlled trial to be conducted from 1 September 2023 to 31 August 2025. The study will involve 20 primary and 20 secondary schools in Selangor and Kuala Lumpur. The 1600 participants will be randomly allocated to intervention and control groups based on selected clusters to avoid contamination. A cluster is a comparable school that fulfils the inclusion and exclusion criteria. The intervention group will receive the iDEAL module, while the control group will receive standard education. The iDEAL module will be developed following a systematic procedure and delivered in-person by trained researchers to the participants. The outcome will be measured using validated, self-administered questionnaires at baseline (T0), immediately (T1), one month (T2), and three months (T3) post-intervention to measure the intervention module effectiveness. The data will be analysed using IBM Statistical Package for Social Science (SPSS) version 28 and descriptive and inferential statistics. Within-group changes over time will be compared using one-way repeated measure analysis of variance for continuous and normally distributed variables. Within-group analysis of categorical data will use Cochran's Q test. The main effect and interaction between and within the intervention and control groups at T0, T1, T2, and T3 will be tested using the generalised linear mixed model (GLMM). Hypothetically, the KAP, environmental cleanliness index, and dengue index among the intervention group will be significantly improved compared to the control group. The hypothesis will be tested using a significance level with a p-value of 0.05 and a confidence interval of 95%. CONCLUSIONS: The study protocol outlines developing and testing an iDEAL module for schoolchildren in Selangor and Kuala Lumpur, with no socio-demographic differences expected. The intervention aims to improve KAP, environmental cleanliness index, and dengue index, potentially reducing dengue risk. Results could inform public health policies, emphasizing school-based interventions' importance in combating diseases like dengue.

Theory-Based Intervention Module on Occupational Safety and Health (TRIMOSH) in improving knowledge, attitude, and practice among food industry workers: Study protocol for a randomised controlled trial.

INTRODUCTION: The significant contribution of the food and beverage industry to Malaysia's Gross Domestic Product is projected to increase in the upcoming years. With the industry's expansion, the demand for workers on food premises would also continuously increase. The food industry workers are exposed to risks arising from physical, chemical, biological, ergonomic, and psychosocial hazards while performing their duties. Thus, it is essential for these workers to be equipped with proper knowledge, attitude, and practices (KAP) in safety and health. AIMS: This study aims to develop and evaluate the effectiveness of the safety and health programme TRIMOSH (Theory-Based Intervention Module on Occupational Safety and Health) in improving the knowledge, attitude, and practice among food industry workers. METHODS: TRIMOSH intervention study is a two-arm randomised, single-blinded, controlled, parallel trial that will be conducted among food industry workers in Selangor, Malaysia. In a partnership with Food Handler Training Schools in Selangor, 10 pairs of Food Handler Training Schools with 12 participants per group (n = 240) will be recruited for balanced randomisation intervention and control conditions. Furthermore, data collection of all participants was conducted at four time points: baseline (T0), immediately (T1), one month (T2), and three months (T3) post-intervention. Generalised Linear Mixed Model (GLMM) will be conducted to determine the effects of intervention within and between study groups. Subsequently, the primary outcomes increase the knowledge, attitude, and practice (KAP) of safety and health at food premises. Clinical Trial Registry registration was approved by the ClinicalTrials.gov committee on October 2022 with the ClinicalTrials.gov Identifier: NCT05571995. This study has also been approved by the Ethics Committee for Research Involving Human Subjects of Universiti Putra Malaysia (JKEUPM-2022-346). All participants are required to provide consent prior to participation. CONCLUSIONS: The characteristics of the respondents are expected to show no difference between the groups. It is hypothesised that TRIMOSH is effective in improving the knowledge, attitude, and practices of food industry workers in Selangor. The results will be reported and presented in international peer-reviewed journals, conferences, and other platforms. In addition, the TRIMOSH programme will be offered at the national level by the relevant authorities for the benefit of food industry workers.

Prevalence of recent occupational injury and its associated factors among food industry workers in Selangor.

INTRODUCTION: Malaysia's gross domestic product is heavily influenced by the food and beverage sector and the contribution of the industry to the national economy is expected to increase in the coming years. Thus, the need for employees in the food industry will continue to rise as this sector grows. Nevertheless, employees in the food industry are exposed to various occupational hazards that can lead to occupational injuries, mainly related to kitchen work. Given the increasing number of employees in the food industry and the rising trend of occupational injuries, this study was conducted to determine the prevalence of recent occupational injuries and their associated factors and predictors among food industry workers. METHODS: This cross-sectional study was conducted in 2023 among food industry workers in Selangor, Malaysia. The respondents were sampled using a multistage random sampling method. Data were collected via online self-administered questionnaires and analysed using descriptive statistics and logistic regression models in the SPSS software, version 25. RESULTS: A total of 250 responses were received from 342 samples, with an overall response rate of 73.0%. The prevalence of recent occupational injuries among food industry workers was 44.8%. Statistically, significant associations were present between occupational injuries and alcohol consumption (p = 0.001), poor knowledge (p = 0.031), poor compliance (p = 0.021), poor safety management (p = 0.021), poor safety training (p = 0.002), poor safety culture (p = 0.003), physical exposure (p < 0.001), and ergonomic exposure (p = 0.009). The predictors for recent occupational injuries among food industry workers were Malay (adjusted Odds Ratio; aOR = 2.60, p = 0.027, 95% Confidence Interval; CI = 1.116, 6.035), alcohol consumption (aOR = 5.31, p = 0.001, 95% CI = 2.042, 13.779), poor knowledge (aOR = 1.98, p = 0.032, 95% CI = 1.059, 3.691), poor safety culture (aOR = 2.44, p = 0.002, 95% CI = 1.372, 4.342), and exposure to physical hazards (aOR = 8.88, p < 0.001, 95% CI = 3.031, 26.014). CONCLUSION: This study has found a high prevalence of occupational injuries among food industry workers, thereby highlighting the importance of addressing alcohol consumption, improving worker knowledge, enhancing work safety culture, and better control measures on exposure to physical hazards, especially among Malay workers. By prioritising these factors, employers can create safer work environments and minimise the risk of occupational injuries.

Systematic Review of Brain-Eating Amoeba: A Decade Update.

INTRODUCTION: Primary amoebic meningoencephalitis (PAM) is a rare but lethal infection of the brain caused by a eukaryote called Naegleria fowleri (N. fowleri). The aim of this review is to consolidate the recently published case reports of N. fowleri infection by describing its epidemiology and clinical features with the goal of ultimately disseminating this information to healthcare personnel. METHODS: A comprehensive literature search was carried out using PubMed, Web of Science, Scopus, and OVID databases until 31 December 2022 by two independent reviewers. All studies from the year 2013 were extracted, and quality assessments were carried out meticulously prior to their inclusion in the final analysis. RESULTS: A total of 21 studies were selected for qualitative analyses out of the 461 studies extracted. The cases were distributed globally, and 72.7% of the cases succumbed to mortality. The youngest case was an 11-day-old boy, while the eldest was a 75-year-old. Significant exposure to freshwater either from recreational activities or from a habit of irrigating the nostrils preceded onset. The symptoms at early presentation included fever, headache, and vomiting, while late sequalae showed neurological manifestation. An accurate diagnosis remains a challenge, as the symptoms mimic bacterial meningitis. Confirmatory tests include the direct visualisation of the amoeba or the use of the polymerase chain reaction method. CONCLUSIONS: N. fowleri infection is rare but leads to PAM. Its occurrence is worldwide with a significant risk of fatality. The suggested probable case definition based on the findings is the acute onset of fever, headache, and vomiting with meningeal symptoms following exposure to freshwater within the previous 14 days. Continuous health promotion and health education activities for the public can help to improve knowledge and awareness prior to engagement in freshwater activities.

Digitalisation Medical Records: Improving Efficiency and Reducing Burnout in Healthcare.

(1) Background: electronic medical record (EMR) systems remain a significant priority for the improvement of healthcare services. However, their implementation may have resulted in a burden on healthcare workers (HCWs). This study aimed to determine the prevalence of burnout symptoms among HCWs who use EMRs at their workplace, as well as burnout-associated factors. (2) Methods: an analytical cross-sectional study was conducted at six public health clinics equipped with an electronic medical record system. The respondents were from a heterogeneity of job descriptions. Consent was obtained before enrolment into the study. A questionnaire was distributed through an online platform. Ethical approval was secured. (3) Results: a total of 161 respondents were included in the final analysis, accounting for a 90.0% response rate. The prevalence of burnout symptoms was 10.7% (n = 17). Three significant predictors were obtained in the final model: experiencing ineffective screen layouts and navigation systems, experiencing physical or verbal abuse by patients, and having a poor relationship with colleagues. (4) Conclusions: the prevalence of burnout symptoms among healthcare workers working with electronic medical record systems was low. Despite several limitations and barriers to implementation, a paradigm shift is needed to equip all health sectors with electronic medical record systems to improve healthcare service delivery. Continuous technical support and financial resources are important to ensure a smooth transition and integration.

Perceived Risk for Dengue Infection Mediates the Relationship between Attitude and Practice for Dengue Prevention: A Study in Seremban, Malaysia.

Dengue remains a public health concern due to limited curative treatment and safe vaccine availability. Prevention by individual is utmost necessary but its practice is still lacking. Perceived risk to disease has been reported to exert a good effect on health behaviour change. However, limited evidence showed its relationship towards attitude and practice for dengue prevention. Hence, we aim to measure the mediating effect of dengue risk perception in the relationship between dengue attitude and dengue prevention practice. A cross-sectional study was conducted from April 2021 to November 2021 in a district of Seremban using a pre-validated questionnaire. Informed consent was obtained from the respondents prior to inclusion in the study. The study was approved by the ethical research committee. A total of 347 respondents took part in the survey, but only 341 data points were included in the final analysis. The majority of the respondents were female (63.0%), of Malay ethnicity (86.8%), married (55.4%), and currently employed (71.0%). The pooled confirmatory factor analysis result demonstrated an RMSEA value of 0.038 (<0.08), CFI value of 0.969 (>0.90), TLI value of 0.9565 (>0.90), and ChiSq/df = 1.479 (<3.0). All the hypotheses for direct effect yielded a significant and positive relationship. Bootstrapping analysis to test for mediation revealed a partial mediation effect as both indirect and direct effects are significant. Risk perception is a mediator variable between attitude and dengue prevention practice. Therefore, our recommendation is to increase health awareness activity that helps to improve individual's risk perception through active health promotion and a health educational campaign that inculcates dengue risk messages. Ultimately, this effort can enhance good health prevention behaviour.

The role of electronic medical records in improving health care quality: A quasi-experimental study.

The Teleprimary Care-Oral Health Clinical Information System (TPC-OHCIS) is an updated electronic medical record (EMR) that has been applied in Malaysian primary healthcare. Recognizing the level of patient satisfaction following EMR implementation is crucial for assessing the performance of health care services. Hence, the main objective of this study was to compare the level of patient satisfaction between EMR-based clinics and paper-based clinics. The study was a quasi-experimental design that used a control group and was conducted among patients in 14 public primary healthcare facilities in the Seremban district of Malaysia from May 10, to June 30, 2021. Patient satisfaction was assessed using the validated Short-Form Patient Satisfaction Questionnaire, which consisted of 7 subscales. All data were analyzed using the IBM Statistical Package for Social Sciences version 21. A total of 321 patients consented to participate in this study, and 48.9% of them were from EMR clinics. The mean score for the communication subscale was the highest at 4.08 and 3.96 at EMR-adopted clinics and paper-based record clinics. There were significant differences in general satisfaction and communication subscales, with higher patient satisfaction found in clinics using EMR. With the utilization of EMR, patient satisfaction and communication in delivering healthcare services have improved.