COVID-19 home remedy consumption and perceived effectiveness among adult population in Brunei Darussalam: a PLS-SEM approach.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 affects the respiratory system and causes severe acute respiratory infections. Several cultures have influenced the use of home remedies to ease mild symptoms of COVID-19 sometimes alongside conventional medicine. The aim of this study was to investigate the usage of COVID-19 home remedies among the adult population in Brunei. METHODS: The study design was a cross-sectional study using an online survey and distributed nationwide. The statistical analysis of the data included descriptive statistics describing the sociodemographic characteristics of the respondents, their experience with COVID-19 infection, consumption of general home remedies and COVID-19 home remedy, their practice of COVID-19 home remedy use, and their attitude towards the general use of home remedy. Sub-group analysis including Pearson's chi-square test and Fisher's exact test was computed for the variables in relation to the COVID-19 home remedy use and the perceived effectiveness of the types of home remedy. Multivariate analysis including Partial Least Squares Structural Equation Modelling (PLS-SEM) was applied to determine the correlations between the factors and outcomes measured. P-value less than 0.05 is considered statistically significant. RESULTS: There was a total of 864 eligible responses included in the study. The primary findings showed COVID-19 home remedy was used by 72.2% of the study participants. Most frequently used types of COVID-19 home remedy were cloves (37%), lemon (37%), and honey (23%). There was an infrequent usage of coconut (4.6%), eucalyptus oil (3.7%), habbatussauda (3.5%), traditional/ herbal cough syrup (2.4%), and turmeric (2.2%). The PLS-SEM demonstrated that 'Experience' appears to be a central endogenous variable that affects the decision on the use of COVID-19 home remedy. This relationship is mediated by 'Safety', 'Source', and 'Opinion' which have significant contributions to the outcome, accounting for 98.2% of the variance explained (R-square = 0.982). CONCLUSIONS: The outcome of this study establishes the baseline prevalence of COVID-19 home remedy consumption among Bruneian residents and compared the previous study on Brunei's general use of traditional medicine. The present findings could help nurses and other healthcare professionals in Brunei understand the practice of Bruneian adults on the consumption of home remedies for COVID-19.

Whole-of-Nation Moral Learning by Spiritual Hearts: A Case of Brunei's Transformation to tackle the COVID-19 Pandemic.

All nations are continuously learning how best to live with the COVID-19 pandemic. Utilizing organizational moral learning and Islamic spirituality perspectives, this paper proposes a learning framework called the whole-of-nation moral learning by spiritual hearts to understand the dynamics of learning and change in a nation tackling the pandemic. It proposes that to overcome the pandemic or any other crises, governance requires the combination of moral leadership and followership by spiritual hearts as agents for moral learning and change, supported by realigned and reconfigured systems for holistic growth. Brunei's journey in tackling the pandemic illustrates the framework.

Synergistic antioxidant activity of selected medicinal plants in Brunei Darussalam and its application in developing fortified pasta.

BACKGROUND: Developing functional foods by utilizing plants can often lead to compromised sensory properties. Thus this study investigates the combination of plants to produce synergistic effects and to incorporate these plant powders into a pasta formulation without affecting its sensory acceptance. Six common Brunei medicinal plants were evaluated for their in vitro antioxidant activity determined by 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity (IC50 ), ferric reducing antioxidant power (FRAP) assay and 2,2'-azino-bis(3-ethylbenziazoline-6-sulfonic acid) (ABTS) radical scavenging assay. Aqueous extracts of Amaranthus tricolor, Breynia androgyna, Manihot esculenta, Polygonum minus, Apium graveolens and Coriandrum sativum were prepared. RESULTS: Breynia androgyna had the highest FRAP value of 74.3 ± 5.33 mg g-1 ascorbic acid equivalents (AAE), with DPPH IC50 antioxidant activity of 70.3 ± 3.14 µg mL-1 and ABTS scavenging activity of 44.0 ± 2.80 mg g-1 AAE. This correlates well with the total flavonoid, flavonol and phenolic content (50.5 mg g-1 gallic acid equivalents (GAE), 50.6 mg g-1 GAE and 24.3 mg g-1 GAE, respectively). Plant species powders were combined in pairs and evaluated for their synergistic antioxidant properties. With potential synergistic plant mixtures, fortification of these mixtures into functional food can be developed to improve its overall antioxidant capacity. Based on the synergistic IC50 results of these mixtures, three fortified pastas were formulated by incorporating selected plant powder combinations of Amaranthus tricolor + P. minus, Apium graveolens + P. minus, and P. minus + B. androgyna into wheat pasta at 1:100 (w/w). CONCLUSION: Fortification of pasta with the plant powder blends resulted a significant increase in DPPH antioxidant activity, while successfully maintaining indistinguishable features from the control pasta, including minimal cooking loss, agreeable measure of cohesiveness, springiness and chewiness, with good overall sensory acceptability. © 2022 Society of Chemical Industry.

The fading popularity of a local ecological calendar from Brunei Darussalam, Borneo.

BACKGROUND: Local ecological calendars are ecocultural frameworks that link temporal and spatial scales, contributing to resilience and adaptive management of natural resources and landscapes. They also facilitate management, access and withdrawal of provisioning ecosystem services. In this article, we describe how the ecological calendar of the Kedayan people of Brunei Darussalam links skyscape and biodiversity with sociocultural aspirations to foster adaptive management of landscape, and provide an understanding of the transmission of calendric knowledge in the community. METHODS: In 2018, we collaborated with sixteen purposively sampled knowledge keepers from the Kedayan community of Brunei Darussalam to document the Kedayan local ecological calendar, and develop a calendrical pictogram. Using a structured questionnaire, we then interviewed 107 randomly selected community members, to understand the contemporary relevance and popularity of the Kedayan calendar, and the transmission of calendric knowledge in the community. RESULTS: Our findings reveal that very few respondents (n = 27, 25.3%) are aware of the existence of Kedayan ecological calendar; majority (n = 80, 74.7%) were not aware of its existence. There is no statistically significant correlation between consulting healers, knowledge on appropriate time requisite to consult healers, and awareness and self-professed knowledge of Kedayan calendar. Only 14 (13.1%) of the respondents reported to have received some form of calendric knowledge, while the majority (86.9%; n = 93) never received any calendric knowledge. Only a negligible 1.9% reported to have transmitted calendric knowledge to others indicating a breakdown in transmission of calendric knowledge. CONCLUSION: The calendric pictogram would help the community in revitalizing their calendar. However, the community will have to invest on enhancing transmission of calendric knowledge.

Knowledge Attitude and Practice of traditional and complementary / alternative medicines amongst End Stage Renal Disease patients in Brunei Darussalam.

OBJECTIVE: A limited study was found in regards to knowledge, attitudes, and practices (KAP) of traditional and complementary/alternative medicines (TCAM) amongst end-stage renal disease (ESRD) in South East Asian region including Brunei Darussalam. This study explored TCAM use amongst ESRD patients in Brunei Darussalam. METHODS: This was a cross-sectional study in a local Dialysis Centre using a bilingual self-structured questionnaire. Recruitment was done using systematic random sampling with certain inclusion criteria. All collected data were entered into Microsoft Excel 2016, and inferential statistics were carried out using R studio version 1.1.383. RESULTS: About 40.2% were TCAM users, and this was not predictable by any sociodemographic background. Nevertheless, compliance with conventional medicine (CM) was very high (94.1%). Users had a more positive disease perception, which was not affected by length on dialysis treatment or the presence of comorbidities. TCAM was perceived to be less effective and unsafe compared to CM, and patients agreed that its use should be monitored and notified. Health supplement (70.7%) was mainly used to improve general wellness (48.5%) or to relieve fatigue (42.4%), and most practices were influenced by family (43.9%). Only a minority of users (19.5%) reported side effects as majority (80.5%) consumed TCAM and CM separately. CONCLUSIONS: High TCAM practice showed that there are still needs that are not fulfilled. The health care professionals should always remain vigilant of its use and be attentive to attend to patients' needs.

Factors Associated with Participation in Stool Based Colorectal Screening in Brunei Darussalam.

INTRODUCTION: Colorectal cancers (CRC) continues to increase worldwide and is associated with significant morbidity and mortality. CRC can be prevented through early detection using several modalities. However, like any screening program participation remains suboptimal. This study assessed the factors associated with participation in a stool based CRC screening that was carried out as part of an Integrated Health Screening Survey for civil servants. MATERIALS AND METHODS: Civil servants who participated in a health survey (N=10,756, mean age 48.08 ± 5.26 years old) were studied. Demographic factors (gender, age groups, marital status, employment status, body mass index [BMI] categories, smoking status, personal and family history of cancers) were analyzed to assess for features associated with willingness to participate in this fecal immunohistochemistry test (FIT) screening for CRC. Comorbid conditions studied were cardiac disease, diabetes mellitus, dyslipidemia, hypertension and stroke. Multivariate analysis was performed to evaluate variables associated with participation in CRC screening programme. RESULTS: Of the invited 10,756 participants, 7,360 returned a stool specimen giving a participation rate of 68.4%. Those who participated were significantly older (60 years [77.8%], p0.05). Multivariate analyses showed that older age (45-49, 50-54, 55-59 and >60) and employment status (professional) remained significant factors associated with participation in a stool based CRC screening. CONCLUSIONS: Our study showed that older age and professional employment status were significantly associated with willingness to participate in a stool based CRC screening.

Practice of Postpartum Warming Among Mothers in Brunei.

Introduction: Postpartum warming is widely practiced among women in Asian countries despite unsubstantiated health claims. This study aimed to identify sources of knowledge and explore the practices of postpartum warming among mothers in Brunei. Methods: A cross-sectional study using a self-administered questionnaire was conducted on 124 mothers who had experience in postpartum warming. Results: Coal was commonly used for heat. Main source of knowledge came from family members. Older women had significantly lower intention to perform the practice in future pregnancies. Women who lived in nuclear families practiced it to a significantly higher frequency compared with those living in extended families. Discussion: Women still practice warming to adhere with family expectations and traditions although noticeable changes have been observed as society modernizes. It still poses a risk of carbon monoxide poisoning and fire hazard from burning coal. Future studies should focus on health and safety aspects to provide evidence on the actual health benefits and ameliorate risk factors.

A comparative account of the traditional healing practices of healers and non-healers in the Kiudang area of Brunei Darussalam.

ETHNOPHARMACOLOGICAL RELEVANCE: In this study, we compare the traditional medicinal knowledge and associated spiritual practices of healers with that of non-healers, to understand the relevance of healers in contemporary times. Given that Brunei Darussalam is well-known for its forest cover, the study also aims to understand the number of species collected from the forests, compared to those from human influenced habitats. MATERIALS AND METHODS: A total of six specialist healers from Belait, Tutong, Dusun and Iban communities, and seven non-healers who had personal experience in self-medication using medicinal plants participated in the study. We identified the specialist healers through purposive sampling, on the basis of their reputation in the locality, while the non-healers were those experienced in self-medication, recommended by the healers. Informants were interviewed at their residences, followed by collection trips to the plant habitats. We classified the total recorded ailments into 15 disease categories. We then compared the medicinal uses cited by healers to those mentioned by non-healers, as well as with prior published records from Brunei Darussalam. We also compare the habitats of species cited by both healers and non-healers to understand the dependency of the local pharmacopoeia on forests and human-influenced habitats. RESULTS: Our study records 175 medicinal plants belonging to 85 families, the majority of which (92) were exotic to Borneo. There were 110 species collected from disturbed, human influenced habitats such as roadsides, agricultural fields, secondary and degraded forests, and homestead lands, while 58 species were collected from the forests surrounding Kiudang. Majority of the plants used by both healers and non-healers were collected from human-influenced habitats, indicating that the local pharmacopoeia could be a disturbance one. Most of the medicinal plants recorded in this study were used to treat chronic, but non-life threatening conditions. Ailments affecting the digestive system were the most targeted group with 67 species used. All medicinal uses with more than one citation were recorded from healers. Medicinal uses cited by healers also had greater correspondence with prior published reports from Brunei Darussalam. Healers believe that combining medicinal plants can produce a synergistic effect. Our study found that traditional knowledge related to healing practices is mostly transmitted vertically from parents to children. We also show that a ritual gift (pikaras) and invocations characteristic of the beliefs of the healers play an important role in facilitating healing. CONCLUSION: Our study adds further evidence to prior studies that the medicinal plants and healing practices in the Kiudang region could be considered as disturbance pharmacopoeia. Healers with their knowledge on both therapeutic and spiritual aspects of healing continue to play an important role in local healthcare.

Socialising over fruits and vegetables: the biocultural importance of an open-air market in Bandar Seri Begawan, Brunei Darussalam.

BACKGROUND: Earth's biocultural diversity comprising biological, cultural and linguistic diversities is being eroded quickly. Our ability to recognise and appreciate what is remaining is crucial for its survival. However, not all forms of diversity are appreciated equally and a growing trend in plant blindness indicates that humans ignore plants in the environment. In this context, open-air markets emerge as cultural spaces that bring people closer to each other, as well as with local biodiversity represented by fruits, vegetables and medicinal plants. METHODS: We conducted a cross-sectional survey with 160 people visiting Tamu Kianggeh of Bandar Seri Begawan, Brunei Darussalam. We randomly interviewed every fifth adult visitor (> 18 years) leaving the market on Fridays and Sundays continuously for a month, using a structured questionnaire. The questionnaire had 18 questions related to demographic particulars, reasons for visiting the market, vendor preference, social networking and visits to open-air markets and supermarkets. RESULTS AND DISCUSSION: People visit the market for the diversity of vegetables/fruits; local fruits and vegetables; socialising; cheap prices; ability to bargain; freshness of the products; convenience; medicinal plants; snacks; leisure etc. The ethnic diversity represented at the market comprised chiefly of Malay, Kedayan, Iban, Dusun, Tutong, Chinese communities and foreigners. Majority of the respondents chose 'availability of a wide range of fruits and vegetables' as the primary reason for the visit, followed by 'availability of local fruits and vegetables'. Tamu Kianggeh sold larger number of fruits and vegetables (104 taxa, 26 natives, 2 endemics) compared to the nearest supermarket (85 taxa, 14 natives and 1 endemic). A significant number of respondents also reported that they had made friends at the market. CONCLUSION: Tamu Kianggeh is a meeting ground for ethnic and biological diversities, a property that makes them important centres of biocultural diversity at the local level. Open-air markets such as Tamu Kianggeh bring people closer to a diverse range of vegetables and fruits. They also bring people closer to each other by serving as platforms for socialising. We propose that strategies developed to counter plant blindness should also consider the potential of open-air markets.

Colorectal Cancer in Brunei Darussalam: An Overview and Rationale for National Screening Programme.

Colorectal cancer (CRC) is the third most common cancer worldwide after lung and breast cancers, and ranks second in terms of cancer mortality globally. Brunei Darussalam reports high incidence of CRC in the Southeast Asian region and has no formal national screening programme for CRC. Screening for CRC in Brunei Darussalam is offered in an opportunistic fashion for individuals with average or above average risks for CRC, that is, the individual has a positive family history of CRC or neoplasms and is more than 50 years old. Opportunistic screening is widely practiced but this is not standardised. The Ministry of Health in Brunei Darussalam is currently in the process of implementing a CRC screening programme as part of a larger national health screening based on the increasing incidence of non-communicable diseases (NCDs). This review article assesses the situation of CRC in Brunei Darussalam from the 1980s to present day, including incidence of CRC in different age groups, ethnicities and genders; relevant non-modifiable and modifiable risk factors of CRC in Brunei Darussalam setting; and common CRC screening techniques used in Brunei Darussalam as well as other Asia-Pacific countries. The review also discusses the merits of a national CRC screening programme. With the increasing incidence of CRC worldwide and in Brunei Darussalam, national screening for CRC in Brunei Darussalam is an important strategy to lower morbidity and mortality rates. A review of the progress and outcome of the national screening programme will be available a few years after rollout.

Self- Reported Personal and Family History of Cancers in Brunei Darussalam: Result of an Integrated Health Survey.

INTRODUCTION: Cancers remain an important cause of mortality and morbidity, and overall incidence of cancers continues to increase worldwide with some cancers increasing while others decreasing. Understanding the epidemiology of cancer burden is important for health care planning. Most studies to date have reported incidence based on cancer registry. This aim of this study is to report the incidence of self-reported personal and family history of cancers. MATERIALS AND METHODS: Data on cancers were extracted from an anonymized database of a survey (Integrated Health Screening Survey) for civil servants conducted between 2008 and 2013 (N=21,437, mean age 40.61 ± 9.46 years old, men 45.1%). RESULTS: The overall incidence of self-reported cancers was 11.2%; personal and family histories were 0.6% and 9.4% respectively (1.2% did not state if cancers were either personal or family history). Commonly self-reported personal history of cancers were cancer of the breast, cervix and colorectal and for self-reported family history were cancers of the gastrointestinal tract, pulmonary, breast, head/neck and gynecological system. Common associations were with first degree relatives (single parent affected 50.8%, both parents affected 1.8%, siblings affected 21.9% and parents and siblings affected 3.1%). Involvement of grandparents accounted for 13.4%. The numbers affected ranged from one to three family members. For self-reported personal history of cancers, older age and gender were significant on univariate analysis and remained on multivariate analyses (p<0.05). For self-reported family history of cancers, older age, gender, professionals employment and smoking status were significant on univariate analysis but only older age, gender, race and professional employments remained significant factors on multivariate analyses (p<0.05). CONCLUSIONS: Our study showed that more than one in nine of participants reported personal or family histories of cancers, and certain characteristics were predictive of self-reporting history of cancers. Associations of cancers were mainly with first degree relatives.

When the seeds sprout, the hornbills hatch: understanding the traditional ecological knowledge of the Ibans of Brunei Darussalam on hornbills.

BACKGROUND: Hornbills are known to play an important role in rainforests as agents of seed dispersal. Decades of scientific research has led to a vital body of knowledge on hornbill taxonomy, ecology, distribution, and conservation status. However, the traditional ecological knowledge (TEK) that local people possess on hornbills has largely been underexplored. In 2018, we collaborated with the Iban people of Temburong, Brunei Darussalam, to study their TEK on hornbills. METHOD: We collaborated with the members of the Iban community from four longhouses and four villages in Temburong, Brunei Darussalam. Our study adopts a qualitative approach; we used detailed semi-directive interviews and brief semi-structured interviews to gather data. The semi-directive interviews documented the TEK related to Hornbills in detail while the brief semi-structured interviews assessed the current status of TEK in the age group of 18-40 years. RESULTS: The results show that the Iban ethnotaxonomy recognises seven folk species of hornbills, with Asian Black Hornbill (Anthracoceros malayanus) and Oriental Pied Hornbill (Anthracoceros albirostris) considered as a single folk species. The Iban TEK on diet and reproductive behaviour of hornbills complement existing scientific records, with the Iban TEK providing additional locale-specific information on the dietary preferences, abundance and conservation threats. However, the average Iban member has lost much of this TEK, and it is the subsistence hunters and agriculturists who have conserved it. CONCLUSION: There is an urgent need for encouraging transmission of knowledge from the hunters and agriculturists to others through ecotourism and conservation ventures. Our study adds further support to the understanding that the TEK of local communities is an important source of locale-specific knowledge on species of high conservation value such as hornbills.

Knowledge and attitude towards mental illness among primary healthcare nurses in Brunei: A cross-sectional study.

BACKGROUND: Mental Health problems are one of the leading disabilities worldwide. Individuals seeking help for their mental illness expect nurses to be cognisant of their needs without prejudice and discrimination. Existing evidences suggest a growing number of patient referral from primary healthcare to psychiatric consultations. This study aimed to explore primary healthcare nurses' knowledge and attitude towards mental illness and people with mentally illness. METHODS: A cross-sectional study using the Mental Health Problem Perception and the Community Attitudes to Mental Illness questionnaires. Descriptive and multivariate regression using maximum likelihood procedures were applied. RESULTS: Regression analysis showed significantly high correlation between knowledge and authotarianism (ß = 0.775, p = 0.007) and moderate inverse correlation with social restrictiveness (ß = -0.517, p < 0.001). However, no significant correlation with benevolence (ß = -0.057, p = 0.181) was detected. Nurses with higher educational level were significantly associated with authotarianism attitude. CONCLUSIONS: This is the first study examining knowledge and attitude of primary healthcare nurses in Brunei. The relationship between the study variables as well as demographic factors, in comparison to other countries, were discussed. Overall, negative attitude among nurses is still a challenging issue; therefore, developing re-education initiatives and increase contact time, especially for healthcare front liners with negative attitudes regardless of education level, to favour change of attitude, is important to foster holistic care to people with mental illness and promote mental health in the population.

Valuable components of bambangan fruit (Mangifera pajang) and its co-products: A review.

Fruits are important food commodities that can be consumed either raw or processed and are valued for their taste, nutrients, and healthy compounds. Mangifera pajang Kosterm (bambangan) is an underutilized fruit found in Malaysia (Sabah and Sarawak), Brunei, and Indonesia (Kalimantan). It is highly fibrous and juicy with an aromatic flavour and strong smell. In recent years, bambangan fruit has been gaining more attention due to its high fibre, carotenoid content, antioxidant properties, phytochemicals, and medicinal usages. Therefore, the production, trade, and consumption of bambangan fruit could be increased significantly, both domestically and internationally, because of its nutritional value. The identification and quantification of bioactive compounds in bambangan fruit has led to considerable interest among scientists. Bambangan fruit and its waste, especially its seeds and peels, are considered cheap sources of valuable food and are considered nutraceutical ingredients that could be used to prevent various diseases. The use of bambangan fruit waste co-products for the production of bioactive components is an important step towards sustainable development. This is an updated report on the nutritional composition and health-promoting phytochemicals of bambangan fruit and its co-products that explores their potential utilization. This review reveals that bambangan fruit and its co-products could be used as ingredients of dietary fibre powder or could be incorporated into food products (biscuits and macaroni) to enhance their nutraceutical properties.

The process of internationalization of the nursing and midwifery curriculum: A qualitative study.

BACKGROUND: There is an abundance of literature on internationalization of curricula. However, research on how a curriculum is internationalized to accommodate non-mobile students studying in their home countries is limited. OBJECTIVE: To describe the process undertaken by curriculum developers in internationalizing the Brunei nursing and midwifery curriculum through curriculum design. DESIGN: A descriptive qualitative research design. SETTING: A nursing and midwifery higher education institution in Brunei. PARTICIPANTS: Seventeen nurse/midwife academics. METHODS: Semi-structured interviews were conducted with 17 curriculum developers. Data were analyzed using thematic analysis. RESULTS: Four themes emerged: expectations of an internationalized curriculum; formation of a committee; benchmarking and setting standards; and designing the curriculum for internationalization. CONCLUSIONS: This study has implications for the development of an internationally-oriented curriculum that takes into account the cultural context of a specific country. The findings highlight the need to involve students in curriculum design, a practice that is not common in Brunei.

Village midwives and their changing roles in Brunei Darussalam: A qualitative study.

BACKGROUND: There are lay midwives worldwide, interchangeably and universally called traditional birth attendants or traditional midwives by organisations such as the World Health Organization and the International Confederation of Midwives. AIM: This study aimed to explore the history of lay midwives (village midwives) in Brunei, describe the evolution from their previous to current roles and determine if they are still needed by women today. METHODS: This qualitative, descriptive study included in-depth, semi-structured interviews with eight women who had received care from village midwives. Data analysis was based on the principles underpinning thematic analysis and used a constant comparative method. FINDINGS: Village midwives have been popular in Brunei since the 1900s, with their major role being to assist women with childbirth. However, since the 1960s, their roles and practices have changed to focus on pre-conception, antenatal, postnatal and women's general healthcare. Traditional practices were influenced by religion, culture and the social context of and within Brunei. DISCUSSION: The major changes in village midwives' roles and practices resulted from the enforcement of the Brunei Midwives' Act in 1956. Village midwives' traditional practices became juxtaposed with modern complementary alternative medicine practices, and they began charging a fee for their services. CONCLUSION: Brunei village midwives are trusted by women, and their practices may still be widely accepted in Brunei. Further research is necessary to confirm their existence, determine the detailed scope and appropriateness of their practices and verify the feasibility of them working together with healthcare professionals.

Role of occupational health in managing non-communicable diseases in Brunei Darussalam.

Like most ASEAN countries, Brunei faces an epidemic of non-communicable diseases. To deal with the complexity of NCDs prevention, all perspectives--be it social, familial or occupational--need to be considered. In Brunei Darussalam, occupational health services (OHS) offered by its Ministry of Health, among others, provide screening and management of NCDs at various points of service. The OHS does not only issue fitness to work certificates, but is a significant partner in co-managing patients' health conditions, with the advantage of further management at the workplace. Holistic approach of NCD management in the occupational setting is strengthened with both employer and employee education and participation, targeting several approaches including risk management and advocating healthy lifestyles as part of a healthy workplace programme.

Renal replacement therapy in Brunei Darussalam: comparing standards with international renal registries.

BACKGROUND AND AIM: Brunei Darussalam is a small South East Asian country with a high prevalence and incidence of end stage kidney disease (ESRD). This study aims to compare key performance indicators recorded in the Brunei Dialysis and Transplant Registry and department records against international practice. Registries from the USA (USRDS), UK (UK Renal Registry), Australasia (ANZDATA), Europe (ERA-EDTA Registry) and Malaysia (MDTR) were used for comparisons. METHODS AND RESULTS: Haemodialysis (83%) and renal transplantation (6%) were the most and least favoured modality of renal replacement therapy in Brunei. Diabetes mellitus as a cause of ESRD (57%) was high in Brunei but on par with other South East Asian countries. Dialysis death rates (11%) and living-related transplant survival rates (5 year graft and patient survival 91% and 96% respectively) were favourable compared with other registries. Anaemia and mineral bone disease management were similar to Malaysia but slightly inferior to the others, but generally in keeping with KDOQI and KDIGO targets. Haemodialysis adequacy (48% achieving urea reduction ratio of >65%) was relatively poorer due to poor dialysis flow rates and low fistula usage (71%). Peritoneal dialysis peritonitis (24.5 patient-month/episode) and adequacy (78% achieving kt/v of 1.7) were in keeping with ISPD targets and international registries' results. CONCLUSION: Brunei has achieved reasonable and commendable standards in many areas pertaining to the renal services. This report has identified several key areas for developments but this is to be expected for a service making its first foray into international benchmarked practice.

Prevalence and predictive factors for complementary and alternative medicine use in Brunei Darussalam.

INTRODUCTION: Complementary and alternative medicine (CAM) use is common among patients with chronic disorders. CAM use is also reported to be common among the general population. This cross-sectional study assessed the prevalence, types of ingested CAM use and the factors predictive of their use in Brunei Darussalam. METHODS: 568 visitors (male 41.4 percent, mean age 40.2+/-15.1 years) to the medical wards were randomly approached and invited to participate in this study. Demographical data (gender, age and racial groups), comorbidities, smoking history, use of prescribed medications and psychosomatic symptoms of depression (anxiety, backache, depression, headache and insomnia) and CAM use were collected. RESULTS: Overall, 21.1 percent had used CAM in the last 12 months, comprising traditional remedies (35.8 percent), vitamins/minerals supplements (19.2 percent), non-vitamins/non-minerals supplements (30 percent) and herbal remedies (3.3 percent). 11.7 percent were unsure of the CAM they had taken. On univariate analysis, older age (40 years and above) and presence of psychosomatic symptoms of depression, particularly backaches, depression, headache and insomnia, were predictive for CAM use. On multivariate analysis, only the presence of any psychosomatic symptoms of depression remained significant for CAM use (odds ratio 1.7, 95 percent confidence interval 1.1-2.6). Among those using prescribed medications, 21.9 percent were also using CAM. 21 percent of subjects without any comorbidities reported using CAM. There was no report of any adverse events. CONCLUSION: CAM use is not uncommon. One-fifth of our subjects have used CAM within the past 12 months, even in those who do not have any comorbidity. Presence of any psychosomatic symptom of depression was predictive for CAM use. Most importantly, a proportion of the users were not even sure of what they had taken.

Mebendazole retention enema for severe Trichuris trichiura (whipworm) infection: a case report.

The authors report a case of massive Trichuris trichiura infection, resulting in severe anaemia and congestive cardiac failure in a 9-year-old Iban boy, who was resistant to the usual oral anthelmintic treatment, but promptly responded to mebendazole retention enema. This patient also had an associated Entamoeba histolytica infection.