GIS-Based Assessments of Neighborhood Food Environments and Chronic Conditions: An Overview of Methodologies.

The industrial revolution and urbanization fundamentally restructured populations' living circumstances, often with poor impacts on health. As an example, unhealthy food establishments may concentrate in some neighborhoods and, mediated by social and commercial drivers, increase local health risks. To understand the connections between neighborhood food environments and public health, researchers often use geographic information systems (GIS) and spatial statistics to analyze place-based evidence, but such tools require careful application and interpretation. In this article, we summarize the factors shaping neighborhood health in relation to local food environments and outline the use of GIS methodologies to assess associations between the two. We provide an overview of available data sources, analytical approaches, and their strengths and weaknesses. We postulate next steps in GIS integration with forecasting, prediction, and simulation measures to frame implications for local health policies. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Risk factors associated with household transmission of SARS-CoV-2 in Negeri Sembilan, Malaysia.

AIM: Households are a significant venue for the transmission of SARS-CoV-2. We conducted a study to characterise the transmission dynamics and identify risk factors for household transmission of SARS-CoV-2 in Negeri Sembilan, Malaysia. METHODS: This retrospective observational study included 185 families of paediatric COVID-19 cases from 1 February 2020 to 31 December 2020. We identified the index case for each household and gathered the socio-demographic, epidemiological investigation results and risk factors for household transmission from medical case records. The secondary attack rate was calculated, and logistic regression analyses were used to identify risk factors associated with secondary household transmission of SARS-CoV-2. RESULTS: Of the 848 household contacts, 466 acquired secondary infections, resulting in a secondary attack rate of 55%. The median age of the secondary cases was 12 years. Female household contacts and household contacts who slept in the same room with the index case were significantly associated with increased risk for COVID-19. Other independent risk factors associated with higher transmission risk in the household included an index case who was symptomatic, a household index case aged greater than 18 years and a male household index case. CONCLUSIONS: High rates of household transmission of COVID-19 were found, indicating households were a major setting of transmission of SARS-CoV-2. Our data provide insight into the risk factors for household transmission of SARS-CoV-2 in Malaysia.

Spirituality Needs in Chronic Pain Patients: A Cross-Sectional Study in a General Hospital in Malaysia.

Evidence-based practices that rely upon pain relieving medications and interventional strategies for symptom alleviation in chronic pain survivors have shown modest benefits. The recent emphasis of spiritual care as a new dimension of treatment strategy incorporated within the biopsychosocial model has inspired new hopes to mediate mental and physical health for illness coping. This study aimed to explore the factors associated with spirituality needs among chronic pain patients in a general hospital in Malaysia. An analytical cross-sectional study was conducted among 117 chronic pain patients in a general hospital in Malaysia. Clinical features and assessments were evaluated by an experienced pain physician and retrieved from patient medical records. An interviewer-administered questionnaire that consisted of items on socio-demographics, the validated 19-items spiritual needs questionnaire and the visual analog scale was utilized. Multivariate linear regression analysis was conducted to identify the factors associated with spiritual needs in chronic pain patients. Patients had higher actively giving score as compared to other spirituality need domains. Central neuropathic pain (ß = 1.691, p = 0.040) predicted existential. Renal problems (ß = 5.061, p = 0.019) highly predicted religiosity; followed by head pain (ß = 3.774, p = 0.036), central neuropathic pain (ß = 2.730, p = 0.022), heart problems (ß = 1.935, p = 0.041), income (ß = 0.001, p = 0.003), living arrangement (ß = - 3.045, p = 0.022), face (ß = - 3.223, p = 0.005) and abdominal (ß = - 4.745, p = 0.0001) pains. Predictors of inner peace include renal problems (ß = 3.752, p = 0.021), shoulder pain (ß = 1.436, p = 0.038) and pain duration (ß = - 0.012, p = 0.027). Predictors of actively giving were renal problems (ß = 3.803, p = 0.001), central neuropathic pain (ß = 1.448, p = 0.017), heart problems (ß = 1.004, p = 0.042), income (ß = 0.001, p = 0.0001), age (ß = - 0.046, p = 0.004) and abdominal pain (ß = - 2.617, p = 0.0001). Chronic pain patients had higher actively giving score compared to other spirituality needs. Their spirituality needs were significantly influenced by pain type, duration and site, co-existing medical conditions and socio-demographics.

Clinicians' Perceived Understanding of Biostatistical Results in the Medical Literature: A Cross-Sectional Study.

Background and objectives: The continuum of evidence-based medicine (EBM) depends solely on clinicians' commitment to keep current with the latest clinical information. Exploration on clinicians' understanding of biostatistical results in the medical literature is sparse to date. This study aimed to evaluate clinicians' perceived understanding of biostatistical results in the medical literature and the factors influencing them. Materials and Methods: A cross-sectional study was conducted among 201 clinicians at the Seberang Jaya Hospital, a cluster-lead research hospital in Northern Malaysia. A self-administered questionnaire that consisted of items on sociodemographics, validated items on clinicians' confidence level in interpreting statistical concepts, perceived understanding of biostatistics, and familiarity with different statistical methods were used. Descriptive, univariate, and multivariate analyses were conducted. Results: Perceived understanding of biostatistical results among clinicians in our sample was nearly 75%. In the final regression model, perceived understanding was significantly higher among clinicians who were able to interpret p-values with complete confidence (AOR = 3.0, 95% CI 1.1-8.1), clinicians who regularly encounter measures of central tendencies (AOR = 2.3, 95% CI 1.1-5.2), and clinicians who regularly encounter inferential statistics (AOR = 2.2, 95% CI 1.1-4.5) while appraising the medical literature. Conclusions: High perceived understanding was significantly associated with clinicians' confidence in interpreting statistical concepts and familiarity with different statistical methods. Our findings form a platform to understand clinicians' ability to appraise rigorous biostatistical results in the medical literature for the retrieval of evidence-based data to be used in routine clinical practice.

Factors Associated with Perceived Life Chaos among Post-Myocardial Infarction Survivors in a Malaysian Cardiac Care Facility.

Background and objectives: Survivors of chronic life-threatening conditions like myocardial infarction (MI) are often confronted with multiple physical and psychological stressors as a consequence of elevated demands of lifestyle adjustments and modifications. Such stressors, collectively known as "life chaos", cause disruption to one's lifestyle equilibrium of having organized, calm, and regular routines. The objective of the current study was to determine the level of life chaos and its associated correlates among post-myocardial infarction (post-MI) survivors in Malaysia. Materials and Methods: An analytical cross-sectional study was conducted among 242 post-MI survivors in a Malaysian cardiac health facility from July to September 2016. A self-administered questionnaire in Malay that consisted of items on socio-demographics, health attributes, validated OSLO-3 Social Support Scale (OSS-3), and the Modified Confusion, Hubbub, and Order Scale (CHAOS-6) was utilized in this study. Descriptive, bivariate, and multivariate analyses were conducted. Results: The sample constituted of 208 (86%) men and 34 (14%) women. The average age was 55 years (SD = 11), and the age ranged between 24 and 96 years. Overall, 128 (52.9%) of the total post-MI survivors had highly chaotic lives. In multivariate analysis, younger age, lower household income, perceived financial insecurity, poor health status, and multiple comorbidities were related to the high chaos score, and these associations were statistically significant (p < 0.05). Conclusions: Highly chaotic lifestyles were prevalent in post-MI survivors. Demographic, health attributes, and socio-economic factors were important correlates of life chaos.

Confirmatory Factor Analysis of the Malay Version of the Confusion, Hubbub and Order Scale (CHAOS-6) among Myocardial Infarction Survivors in a Malaysian Cardiac Healthcare Facility.

BACKGROUND: The six item Confusion, Hubbub and Order Scale (CHAOS-6) has been validated as a reliable tool to measure levels of household disorder. We aimed to investigate the goodness of fit and reliability of a new Malay version of the CHAOS-6. METHODS: The original English version of the CHAOS-6 underwent forward-backward translation into the Malay language. The finalised Malay version was administered to 105 myocardial infarction survivors in a Malaysian cardiac health facility. We performed confirmatory factor analyses (CFAs) using structural equation modelling. A path diagram and fit statistics were yielded to determine the Malay version's validity. Composite reliability was tested to determine the scale's reliability. RESULTS: All 105 myocardial infarction survivors participated in the study. The CFA yielded a six-item, one-factor model with excellent fit statistics. Composite reliability for the single factor CHAOS-6 was 0.65, confirming that the scale is reliable for Malay speakers. CONCLUSION: The Malay version of the CHAOS-6 was reliable and showed the best fit statistics for our study sample. We thus offer a simple, brief, validated, reliable and novel instrument to measure chaos, the Skala Kecelaruan, Keriuhan & Tertib Terubahsuai (CHAOS-6), for the Malaysian population.

Perceived Stress among Malaysian Railway Workers.

BACKGROUND: Stress is a common work-related problem worldwide. Railway workers are predominantly stressed due to their rigid protocols and limited rest opportunities. This study aimed to determine the level of, and factors associated with, stress among railway workers in Malaysia. METHODS: A cross-sectional study was conducted among all 729 railway workers employed at Keretapi Tanah Melayu Berhad (KTMB) in eight states in Malaysia via a postal survey. The self-administered questionnaire consisted of socio-demographic characteristics and the validated Malay version of Perceived Stress Scale-10 (PSS-10). Response rate was 70.4% (513/729). RESULTS: Mean (SD) age of workers was 41.4 (10.7), with the majority aged 30 years or older (79.3%). Mean (SD) perceived stress was 18.8 (4.3). In multiple linear regression analysis, the significant predictors of high stress were high school versus tertiary education (ß = 0.10, 95% CI 0.11, 1.73, P = 0.027) and being a white collar worker versus blue collar (ß = 0.113, 95% CI 0.10, 1.74, P = 0.010). CONCLUSIONS: Education level and type of work were significantly associated with perceived stress among railway workers in this study.

Job satisfaction and turnover intention among Iraqi doctors--a descriptive cross-sectional multicentre study.

BACKGROUND: During the last two decades, the Iraqi human resources for health was exposed to an unprecedented turnover of trained and experienced medical professionals. This study aimed to explore prominent factors affecting turnover intentions among Iraqi doctors. METHODS: A descriptive cross-sectional multicentre study was carried out among 576 doctors across 20 hospitals in Iraq using multistage sampling technique. Participants completed a self-administered questionnaire, which included socio-demographic information, work characteristics, the 10-item Warr-Cook-Wall job satisfaction scale, and one question on turnover intention. Descriptive and bivariate and multiple logistic regression analyses were conducted to identify significant factors affecting turnover intentions. RESULTS: More than one half of Iraqi doctors (55.2%) were actively seeking alternative employment. Factors associated with turnover intentions among doctors were low job satisfaction score (odds ratio (OR) = 0.97; 95% confidence interval (CI): 0.95, 0.99), aged 40 years old or less (OR = 2.9; 95% CI: 1.74, 4.75), being male (OR = 4.2; 95% CI: 2.54, 7.03), being single (OR = 5.0; 95% CI: 2.61, 9.75), being threatened (OR = 3.5; 95% CI: 1.80, 6.69), internally displaced (OR = 3.1; 95% CI: 1.43, 6.57), having a perception of unsafe medical practice (OR = 4.1; 95% CI: 1.86, 9.21), working more than 40 h per week, (OR = 2.3; 95% CI: 1.27, 4.03), disagreement with the way manager handles staff (OR = 2.2; 95% CI: 1.19, 4.03), being non-specialist, (OR = 3.9, 95% CI: 2.08, 7.13), and being employed in the government sector only (OR = 2.0; 95% CI: 1.09, 3.82). CONCLUSION: The high-turnover intention among Iraqi doctors is significantly associated with working and security conditions. An urgent and effective strategy is required to prevent doctors' exodus.

Patient satisfaction in Malaysia's busiest outpatient medical care.

This study aimed to explore factors associated with patient satisfaction of outpatient medical care in Malaysia. A cross-sectional exit survey was conducted among 340 outpatients aged between 13 and 80 years after successful clinical consultations and treatment acquirements using convenience sampling at the outpatient medical care of Tengku Ampuan Rahimah Hospital (HTAR), Malaysia, being the country's busiest medical outpatient facility. A survey that consisted of sociodemography, socioeconomic, and health characteristics and the validated Short-Form Patient Satisfaction Questionnaire (PSQ-18) scale were used. Patient satisfaction was the highest in terms of service factors or tangible priorities, particularly "technical quality" and "accessibility and convenience," but satisfaction was low in terms of service orientation of doctors, particularly the "time spent with doctor," "interpersonal manners," and "communication" during consultations. Gender, income level, and purpose of visit to the clinic were important correlates of patient satisfaction. Effort to improve service orientation among doctors through periodical professional development programs at hospital and national level is essential to boost the country's health service satisfaction.

How Socio-economic Inequalities Cluster People with Diabetes in Malaysia: Geographic Evaluation of Area Disparities Using a Non-parameterized Unsupervised Learning Method.

Accurate assessments of epidemiological associations between health outcomes and routinely observed proximal and distal determinants of health are fundamental for the execution of effective public health interventions and policies. Methods to couple big public health data with modern statistical techniques offer greater granularity for describing and understanding data quality, disease distributions, and potential predictive connections between population-level indicators with areal-based health outcomes. This study applied clustering techniques to explore patterns of diabetes burden correlated with local socio-economic inequalities in Malaysia, with a goal of better understanding the factors influencing the collation of these clusters. Through multi-modal secondary data sources, district-wise diabetes crude rates from 271,553 individuals with diabetes sampled from 914 primary care clinics throughout Malaysia were computed. Unsupervised machine learning methods using hierarchical clustering to a set of 144 administrative districts was applied. Differences in characteristics of the areas were evaluated using multivariate non-parametric test statistics. Five statistically significant clusters were identified, each reflecting different levels of diabetes burden at the local level, each with contrasting patterns observed under the influence of population-level characteristics. The hierarchical clustering analysis that grouped local diabetes areas with varying socio-economic, demographic, and geographic characteristics offer opportunities to local public health to implement targeted interventions in an attempt to control the local diabetes burden.

Setting research priorities for global pandemic preparedness: An international consensus and comparison with ChatGPT's output.

Background: In this priority-setting exercise, we sought to identify leading research priorities needed for strengthening future pandemic preparedness and response across countries. Methods: The International Society of Global Health (ISoGH) used the Child Health and Nutrition Research Initiative (CHNRI) method to identify research priorities for future pandemic preparedness. Eighty experts in global health, translational and clinical research identified 163 research ideas, of which 42 experts then scored based on five pre-defined criteria. We calculated intermediate criterion-specific scores and overall research priority scores from the mean of individual scores for each research idea. We used a bootstrap (n = 1000) to compute the 95% confidence intervals. Results: Key priorities included strengthening health systems, rapid vaccine and treatment production, improving international cooperation, and enhancing surveillance efficiency. Other priorities included learning from the coronavirus disease 2019 (COVID-19) pandemic, managing supply chains, identifying planning gaps, and promoting equitable interventions. We compared this CHNRI-based outcome with the 14 research priorities generated and ranked by ChatGPT, encountering both striking similarities and clear differences. Conclusions: Priority setting processes based on human crowdsourcing - such as the CHNRI method - and the output provided by ChatGPT are both valuable, as they complement and strengthen each other. The priorities identified by ChatGPT were more grounded in theory, while those identified by CHNRI were guided by recent practical experiences. Addressing these priorities, along with improvements in health planning, equitable community-based interventions, and the capacity of primary health care, is vital for better pandemic preparedness and response in many settings.

Exploration of risk taking behaviors and perceived susceptibility of colorectal cancer among Malaysian adults: a community based cross-sectional study.

BACKGROUND: Perceived susceptibility to an illness has been shown to affect Health-risk behavior. The objective of the present study was to determine the risk taking behaviors and the demographic predictors of perceived susceptibility to colorectal cancer in a population-based sample. METHODS: A cross-sectional study was carried out among 305 Malaysian adults in six major districts, selected from urban, semi-urban, and rural settings in one state in Malaysia. A self-administered questionnaire was used in this study. It was comprised of socio-demographics, risk-taking behaviors, and validated domains of the Health Belief Model (HBM). RESULTS: The mean (± SD) age of the respondents was 34.5 (± 9.6) and the majority (59.0%) of them were 30 years or older. Almost 20.7% of the respondents felt they were susceptible to colorectal cancer. Self-reported perceived susceptibility mirrored unsatisfactory screening behaviors owing to the lack of doctors' recommendation, ignorance of screening modalities, procrastination, and the perception that screening was unnecessary. Factors significantly associated with perceived susceptibility to colorectal cancer were gender (OR = 1.8, 95% CI 1.0-3.3), age (OR = 2. 2, 95% CI 1.2-4.0), ethnicity (OR = 0. 3, 95% CI 0.2-0.6), family history of colorectal cancer (OR = 3. 2, 95% CI 1.4-7.4) and alcohol intake (OR = 3.9, 95% CI 2.1-7.5). CONCLUSION: The present study revealed that screening behavior among respondents was unsatisfactory. Hence, awareness of the importance of screening to prevent colorectal cancers is imperative.

Emotional burnout, perceived sources of job stress, professional fulfillment, and engagement among medical residents in Malaysia.

This study was the first to explore factors associated with emotional burnout (EB) among medical residents in Malaysia. A cross-sectional study was conducted in a universal sample of 205 medical residents in a Malaysian general hospital. The self-administered questionnaire used consisted of questions on sociodemographics and work characteristics, sources of job stress, professional fulfillment, engagement, and EB. EB was measured using the emotional exhaustion subscale, the Maslach Burnout Inventory (MBI). Mean (±SD) age of the respondents was 26.5 (±1.6). The most common source of job stress was "fear of making mistakes." Most of the participants were dissatisfied with the increase of residentship period from one year to two years. A high level of EB was reported by 36.6% of the respondents. In multivariate analysis, the most important correlates of EB were sources of job stress, professional fulfillment, and engagement. A high prevalence of EB was found among medical residents. Sociodemographic characteristics, performance pressure, and satisfaction with policies were significantly associated with EB. Although this study was limited by its cross-sectional design, its findings posit a sufficient foundation to relevant authorities to construct, amend, and amalgamate existing and future policies. Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life-the poetry of the common place, of the common man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their grief.SirWilliam Osler, Aphorisms from the Student Life (Aequanimitas, 1952).

Adverse health effects and unhealthy behaviors among medical students using Facebook.

Little is known about the relationships between adverse health effects and unhealthy behaviors among medical students using Facebook. The aim of this study was to determine the associations between adverse health effects and unhealthy behaviors with Facebook use. A cross-sectional study was conducted in a private university in Malaysia among 316 medical students. A self-administered questionnaire was used. It included questions on sociodemographics, pattern of Facebook use, social relationship, unhealthy behaviors, and health effects. Mean age was 20.5 (±2.7) years. All students had a Facebook account. The average daily Facebook surfing hours were 2.5 (±1.7). Significant associations were found between average hours of Facebook surfing and the following factors: isolation from family members and community, refusing to answer calls, musculoskeletal pain, headache, and eye irritation (P < 0.005). The average hours spent on Facebook were significantly associated with holding urination and defecation while online, surfing Facebook until midnight, and postponing, forgetting, or skipping meals (P < 0.005). The average hours spent on Facebook were associated with adverse health effects and unhealthy behaviors among medical students, as well as social isolation from the family and community.

Factors affecting dengue fever knowledge, attitudes and practices among selected urban, semi-urban and rural communities in Malaysia.

Dengue fever is a major public health problem in Malaysia. This study aimed to assess factors affecting knowledge, attitudes, and practices regarding dengue fever among a selected population in Malaysia. A descriptive, community-based, cross sectional study was conducted with 300 participants from three different geographical settings in urban, semi-urban, and rural areas within the states of Selangor and Kuala Lumpur. The questionnaire included questions on demographic data, knowledge, attitudes, and practices regarding dengue fever. Mean age of respondents was 34.4 (+/- 5.7) years, and the age ranged from 18 to 65 years. The majority of respondents were married (54.7%), Malays (72.7%) and heard about dengue fever (89.7%). Television was the common source of information about dengue fever (97.0%). Participants answered 4 out of 15 items of knowledge incorrectly. There was no significant association between knowledge score and socio-demographic factors. About one-fifth of the respondents (24%) believed that immediate treatment is not necessary for dengue fever, and the majority of them were not afraid of the disease (96.0%). Attitudes toward dengue fever were significantly associated with the level of education and employment status (p < 0.05). Practice was associated significantly with age, marital status, and geographic area (p < 0.05) and knowledge on dengue fever (p = 0.030). There is a need to increase health promotion activities through campaigns and social mobilization to increase knowledge regarding dengue fever. This would help to mold positive attitudes and cultivate better preventive practices among the public to eliminate dengue in the country.

Social and psychological factors affecting eating habits among university students in a Malaysian medical school: a cross-sectional study.

BACKGROUND: Eating habits have been a major concern among university students as a determinant of health status. The aim of this study was to assess the pattern of eating habits and its associated social and psychological factors among medical students. METHODS: A cross sectional study was conducted among 132 medical students of pre-clinical phase at a Malaysian university. A self-administered questionnaire was used which included questions on socio-demography, anthropometry, eating habits and psychosocial factors. RESULTS: Mean (± SD) age of the respondents was 22.7 (± 2.4) years and (the age) ranged from 18 to 30 years. More than half had regular meals and breakfast (57.6% &, 56.1% respectively). Majority (73.5%) consumed fruits less than three times per week, 51.5% had fried food twice or more a week and 59.8% drank water less than 2 liters daily. Eating habits score was significantly low among younger students (18-22 years), smokers, alcohol drinkers and those who did not exercise. (p<0.05). Four psychological factors out of six, were significantly associated with eating habits (p<0.05). In multivariate analysis, age and 'eating because of feeling happy' were significantly associated with eating habits score (p<0.05). CONCLUSION: Most of the students in this study had healthy eating habits. Social and psychological factors were important determinants of eating habits among medical students.

Spatial Dynamics and Multiscale Regression Modelling of Population Level Indicators for COVID-19 Spread in Malaysia.

As COVID-19 dispersion occurs at different levels of gradients across geographies, the application of spatiotemporal science via computational methods can provide valuable insights to direct available resources and targeted interventions for transmission control. This ecological-correlation study evaluates the spatial dispersion of COVID-19 and its temporal relationships with crucial demographic and socioeconomic determinants in Malaysia, utilizing secondary data sources from public domains. By aggregating 51,476 real-time active COVID-19 case-data between 22 January 2021 and 4 February 2021 to district-level administrative units, the incidence, global and local Moran indexes were calculated. Spatial autoregressive models (SAR) complemented with geographical weighted regression (GWR) analyses were executed to determine potential demographic and socioeconomic indicators for COVID-19 spread in Malaysia. Highest active case counts were based in the Central, Southern and parts of East Malaysia regions of Malaysia. Countrywide global Moran index was 0.431 (p = 0.001), indicated a positive spatial autocorrelation of high standards within districts. The local Moran index identified spatial clusters of the main high-high patterns in the Central and Southern regions, and the main low-low clusters in the East Coast and East Malaysia regions. The GWR model, the best fit model, affirmed that COVID-19 spread in Malaysia was likely to be caused by population density (ß coefficient weights = 0.269), followed by average household income per capita (ß coefficient weights = 0.254) and GINI coefficient (ß coefficient weights = 0.207). The current study concluded that the spread of COVID-19 was concentrated mostly in the Central and Southern regions of Malaysia. Population's average household income per capita, GINI coefficient and population density were important indicators likely to cause the spread amongst communities.

Prevalence of Workplace Bullying and Its Associated Factors among Workers in a Malaysian Public University Hospital: A Cross-Sectional Study.

BACKGROUND AND PURPOSE: Workplace bullying has been regarded as a serious phenomenon, particularly in health-care settings, due to its tendency to predispose health workers to serious psychological repercussions, job dissatisfaction, and turnover. Such consequences are costly to health systems and disruptive to the continuity of patient care. While global bullying literature in health settings grows, evidence on the magnitude of the problem from a Malaysian perspective is scarce. This study aimed to determine the prevalence of workplace bullying and its associated factors among health workers in a Malaysian public university hospital. METHODS: This cross-sectional study was conducted from October to December 2019 among 178 hospital workers at the Hospital Canselor Tuanku Muhriz in Kuala Lumpur, Malaysia. The study utilized a self-administered questionnaire that consisted of items on sociodemographics, work characteristics, sources of bullying, and the validated Malay version of the 23-item Negative Acts Questionnaire - revised to determine the prevalence of bullying. Descriptive and inferential statistics were analyzed using SPSS 22.0. Statistical significance was set at P<0.05. RESULTS: The prevalence of workplace bullying in this sample was 11.2%. Superiors or supervisors from other departments and colleagues were the main perpetrators. In the multivariate model, working for 10 years or less (aOR 4, 95% CI 1.3-12.3; P=0.014) and not being involved in patient care (aOR 5, 95% CI 2.5-10; P<0.001) were statistically significant attributes associated with workplace bullying. CONCLUSION: Workplace bullying in the current study was strongly associated with occupational characteristics, particularly length of service and service orientation of the workers. Hospital directors and managers could undertake preventive measures to identify groups vulnerable to bullying and subsequently craft appropriate coping strategies and mentoring programs to curb bullying.

Influence of Population Density for COVID-19 Spread in Malaysia: An Ecological Study.

The rapid transmission of highly contagious infectious diseases within communities can yield potential hotspots or clusters across geographies. For COVID-19, the impact of population density on transmission models demonstrates mixed findings. This study aims to determine the correlations between population density, clusters, and COVID-19 incidence across districts and regions in Malaysia. This countrywide ecological study was conducted between 22 January 2021 and 4 February 2021 involving 51,476 active COVID-19 cases during Malaysia's third wave of the pandemic, prior to the reimplementation of lockdowns. Population data from multiple sources was aggregated and spatial analytics were performed to visualize distributional choropleths of COVID-19 cases in relation to population density. Hierarchical cluster analysis was used to synthesize dendrograms to demarcate potential clusters against population density. Region-wise correlations and simple linear regression models were deduced to observe the strength of the correlations and the propagation effects of COVID-19 infections relative to population density. Distributional heats in choropleths and cluster analysis showed that districts with a high number of inhabitants and a high population density had a greater number of cases in proportion to the population in that area. The Central region had the strongest correlation between COVID-19 cases and population density (r = 0.912; 95% CI 0.911, 0.913; p < 0.001). The propagation effect and the spread of disease was greater in urbanized districts or cities. Population density is an important factor for the spread of COVID-19 in Malaysia.

Mapping the Scientific Landscape of Diabetes Research in Malaysia (2000-2018): A Systematic Scientometrics Study.

The escalated burden of diabetes on the population's health has catalyzed rigorous scientific research to produce appropriate evidence for treatment and control. Malaysia suffers from the leading diabetes epidemic within the Western Pacific region. It is crucial to map the scientific landscape of diabetes research for the country to identify trends in productivity and determine whether research efforts are directed toward the needs-gaps priority for evidence synthesis that could be used for the drafting of policies and guidelines. This systematic scientometrics study was conducted to map the scientific research output (trends and distribution, citation frequency, keywords link visualization, and thematic cluster conceptualization) related to diabetes between 2000-2018 in Malaysia. Using three international databases (PubMed, EMBASE, Scopus) and one local database (MyCite), scientific publication records related to diabetes in Malaysia between 2000 and 2018 were retrieved and analyzed using quantitative and qualitative methodologies. Microsoft Excel 2016, EndNote X9.2, BibExcel 2016, GraphPad Prism 8.0.1, VOS viewer software 1.6.13, and R software version 1.3.959 were used to analyze the trend and contents of diabetes publications. A total of 2094 publication records that accounted for 35,497 citations were analyzed. Kuala Lumpur was the most scientifically productive state in Malaysia, contributing 754 papers. Medical Journal of Malaysia had the highest number of publications. The inflection point of the Malaysian diabetes research output was in 2013, with most publications being non-collaborative research works. Most publications originated from academia, especially from local public universities. The overall publication productivity of diabetes research in Malaysia was conceptualized into eleven thematic clusters, with clinical and animal studies being the most prevalent themes. The diabetes literature in Malaysia has grown steadily over the past 19 years. However, the cumulative evidence remains inadequate and is insufficiently powered to guide policymaking and the control of diabetes. It does not yet seem feasible to direct the diabetes epidemic curve to a plateau for the Malaysian population based on Malaysian diabetes publications.