Knowledge, compliance, and challenges in anti-malarial products usage: a systematic review of at-risk communities for zoonotic malaria.

BACKGROUND: Zoonotic malaria is a growing public health threat in the WHO Southeast Asia (SEA) and Western Pacific (WP) regions. Despite vector-control measures, the distribution of Macaque fascicularis and M. nemestrina, and Anopheles mosquitoes carrying non-human simian malaria parasites poses challenges to malaria elimination. The systematic review assesses the literature on knowledge and malaria-preventive practices in zoonotic malaria-affected areas across the WHO SEA and WP, aiming to identify challenges for malaria control. METHODS: Peer-reviewed articles published in English, Malay and Indonesian between January 2010 and December 2022 were searched in OVID Medline, Scopus, Web of Science, and Google Scholar. Studies of any design-excluding reviews, conference proceedings, and reports from all WHO SEA and WP countries vulnerable to zoonotic malaria-were included. Backwards-reference screening and thematic analysis were conducted. RESULTS: Among 4,174 initially searched articles, 22 peer-reviewed articles met the inclusion criteria. An additional seven articles were identified through backwards-reference screening, resulting in a total of 29 articles for this review. Half of these studies were conducted in Cambodia, Myanmar, Malaysia, and Thailand, mainly in forests and remote communities. The review highlighted inconsistencies in the operationalization of knowledge, and five major themes were identified related to knowledge: causation and transmission, symptoms, treatment, severity and complications, and malaria prevention. While participants generally had some understanding of malaria causation/transmission, minority and indigenous ethnic groups demonstrated limited knowledge and held misconceptions, such as attributing malaria to drinking dirty water. Preventive practices included traditional and non-traditional or modern methods-with a preference for traditional approaches to avoid mosquito bites. Challenges to malaria control included feasibility, cost, and access to healthcare services. CONCLUSION: This review provides insights into knowledge, local understandings, and preventive practices related to malaria in the WHO SEA and WP regions. The findings highlight the need for future research to explore the knowledge of at-risk communities regarding zoonotic malaria, their perceive threat of the disease and factors exposing them to zoonotic malaria. New strategies must be developed for zoonotic malaria programs tailored to local contexts, emphasizing the significance of community participation, health education, and socio-behavioural change initiatives. It is important to consider the interconnectedness of human health, environmental and non-human primates conservation. Socio-cultural nuances should also be carefully considered in the design and implementation of these programs to ensure their effect tailored to local contexts.

Barriers to Childhood Immunization in Rural and Remote Areas: A Qualitative Exploration From the Perspectives of Community Leaders in Sindh, Pakistan.

Despite overall improvements observed at the national level, there is a significant disparity in childhood vaccination coverage rates between urban and rural regions, particularly within tribal and remote areas in Pakistan. Our study aimed to explore the views of community/tribal leaders concerning barriers and their local solutions for improving vaccine uptake, with a specific focus on remote settings. An exploratory qualitative research study was conducted from July to September 2019 in Shikarpur, Sindh, Pakistan. We interviewed 11 community leaders, after developing a semi-structured interview guide based on the health belief model. Following validation, the collected data was transcribed and subsequently translated into the English language. A stepwise process of manual familiarization, coding, theme generation, and theme review using an inductive approach was followed. While most of the rural community leaders expressed a willingness to support vaccinations, numerous unexplored barriers were identified. These barriers included an unsustainable communication system heavily dependent on polio mobile teams, discourteous behavior of healthcare personnel, cultural restrictions that limited women's involvement, economic hardships, limited transportation options, insufficient collaboration with the education sector, poor knowledge among community leaders, and security concerns. Additionally, they proposed some innovative solutions of information dissemination methods through the Ottaque system, ethics-based training, subsidized transportation services or voucher system, and addressing security concerns in collaboration with community leaders. Our findings suggest policymakers take both community leaders and members for an inclusive policy-making process to redraft the special policy for these remote and rural areas.

Seeing malaria through the eyes of affected communities: using photovoice to document local knowledge on zoonotic malaria causation and prevention practices among rural communities exposed to Plasmodium knowlesi malaria in Northern Borneo Island.

BACKGROUND: Many rural communities in Malaysian Borneo and Southeast Asia are at risk of Plasmodium knowlesi malaria. Multiple factors contribute to infection, however, a deep understanding of illness causation and prevention practices among at-risk communities remains limited. This study aims to document local knowledge on malaria causation and preventive practices of rural communities in Sabah, Malaysia, using photovoice-a participatory research method. METHODS: From January to June 2022, a photovoice study was conducted with rural communities in Matunggong subdistrict, Malaysia, to explore their experiences with and local knowledge of non-human primate malaria and prevention practices. The study included (1) an introductory phase in which participants were introduced to the photovoice method; (2) a documentation phase in which participants captured and narrated photos from their communities; (3) a discussion phase in which participants discussed photos and relevant topics through a series of three focus group discussions (FGDs) per village; and (4) a dissemination phase where selected photos were shared with key stakeholders through a photo exhibition. A purposively selected sample of 26 participants (adults > 18 years old, male, and female) from four villages participated in all phases of the study. The study activities were conducted in Sabah Malay dialect. Participants and the research team contributed to data review and analyses. RESULTS: Rural communities in Sabah, Malaysia possess local knowledge that attributes non-human primate malaria to natural factors related to the presence of mosquitoes that bite humans and which carry "kuman-malaria" or malaria parasite. Participants revealed various preventive practises ranging from traditional practises, including burning dried leaves and using plants that produce foul odours, to non-traditional approaches such as aerosols and mosquito repellents. By engaging with researchers and policymakers, the participants or termed as co-researchers in this study, showcased their ability to learn and appreciate new knowledge and perspectives and valued the opportunity to share their voices with policymakers. The study successfully fostered a balance of power dynamics between the co-researchers, research team members and policymakers. CONCLUSION: There were no misconceptions about malaria causation among study participants. The insights from study participants are relevant because of their living experience with the non-human malaria. It is critical to incorporate rural community perspectives in designing locally effective and feasible malaria interventions in rural Sabah, Malaysia. Future research can consider adapting the photovoice methodology for further research with the community toward building locally tailored-malaria strategies.

The public health response to a Plasmodium malariae outbreak in Penampang district, Sabah during a COVID-19 movement control order.

BACKGROUND: Since 2018, no indigenous human malaria cases has been reported in Malaysia. However, during the recent COVID-19 pandemic the World Health Organization is concerned that the pandemic might erode the success of malaria control as there are reports of increase malaria cases in resource limited countries. Little is known how the COVID-19 pandemic has impacted malaria in middle-income countries like Malaysia. Here the public health response to a Plasmodium malariae outbreak occurred in a village in Sabah state, Malaysia, during a COVID-19 movement control order is reported. METHODS: An outbreak was declared following the detection of P. malariae in July 2020 and active case detection for malaria was performed by collecting blood samples from residents residing within 2 km radius of Moyog village. Vector prevalence and the efficacy of residual insecticides were determined. Health awareness programmes were implemented to prevent future outbreaks. A survey was conducted among villagers to understand risk behaviour and beliefs concerning malaria. RESULTS: A total of 5254 blood samples collected from 19 villages. Among them, 19 P. malariae cases were identified, including the index case, which originated from a man who returned from Indonesia. His return from Indonesia and healthcare facilities visit coincided with the movement control order during COVID-19 pandemic when the healthcare facilities stretched its capacity and only serious cases were given priority. Despite the index case being a returnee from a malaria endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities. All cases were symptomatic and uncomplicated except for a pregnant woman with severe malaria. There were no deaths; all patients recovered following treatment with artemether-lumefantrine combination therapy. Anopheles balabacensis and Anopheles barbirostris were detected in ponds, puddles and riverbeds. The survey revealed that fishing and hunting during night, and self-treatment for mild symptoms contributed to the outbreak. Despite the index case being a returnee from a malaria-endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities. CONCLUSION: The outbreak occurred during a COVID-19 movement control order, which strained healthcare facilities, prioritizing only serious cases. Healthcare workers need to be more aware of the risk of malaria from individuals who return from malaria endemic areas. To achieve malaria elimination and prevention of disease reintroduction, new strategies that include multisectoral agencies and active community participation are essential for a more sustainable malaria control programme.

Disentangling the intersection of inequities with health and malaria exposure: key lessons from rural communities in Northern Borneo.

BACKGROUND: The increasing incidence of Plasmodium knowlesi malaria poses a significant challenge to efforts to eliminate malaria from Malaysia. Macaque reservoirs, outdoors-biting mosquitoes, human activities, and agricultural work are key factors associated with the transmission of this zoonotic pathogen. However, gaps in knowledge regarding reasons that drive malaria persistence in rural Kudat, Sabah, Northern Borneo remain. This study was conducted to address this knowledge gap, to better understand the complexities of these entangled problems, and to initiate discussion regarding new countermeasures to address them. This study aims to highlight rural community members' perspectives regarding inequities to health relating to P. knowlesi malaria exposure. METHODS: From January to October 2022, a study using qualitative methods was conducted in four rural villages in Kudat district of Sabah, Malaysia. A total of nine in-depth interviews were conducted with community and faith leaders, after the completion of twelve focus group discussions with 26 photovoice participants. The interviews were conducted using the Sabah Malay dialect, audio-recorded, transcribed, and translated into English. The research team led the discussion and analysis, which was approved by participants through member checking at the community level. RESULTS: Participants identified disparity in health as a key issue affecting their health and livelihoods. Injustice in the social environment was also identified as a significant challenge, including the importance of listening to the voices of affected communities in disentangling the social and economic phenomena that can impact malaria control. Specific concerns included inadequate access to health-related resources and degradation of the environment. Participants recommended improving access to water and other necessities, increasing the availability of malaria control commodities in healthcare facilities, and developing sustainable programs to reduce socioeconomic disparities. CONCLUSION: Inequities to health emerged as a key concern for malaria control in rural Kudat, Sabah. A locally targeted malaria programme cantered on improving the social and economic disparities associated with health outcomes, could be a potential strategy for malaria prevention in such areas. Community-level perspectives gathered from this study can be used as a foundation for future discussions and dialogues among policymakers and community members for achieving greater transparency, improving social equity, and interoperability in addressing P. knowlesi malaria control.

Prevalence and predictors of vitamin D deficiency among adults with epilepsy: A cross-sectional study.

BACKGROUND: Vitamin D deficiency among adult people with epilepsy (PWE) is scarcely studied, despite its essential role in bone health and maintaining homeostasis. Several studies have studied the relationship between factors related to epilepsy and vitamin D metabolism. We aim to investigate this in our multi-ethnic society. METHODS: This was a single-center cross-sectional study. We recruited 159 participants diagnosed with epilepsy on antiseizure medications (ASMs). We included those aged 18 years and above, excluding patients with long-term medical conditions that would affect vitamin D metabolism. Sociodemographic data and details of epilepsy were collated. Venous sampling was performed to analyze the levels of albumin-corrected calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D3 [25(OH)D]. Serum 25(OH)D level is defined as deficient (<20 ng/ml), insufficient (20-29 ng/ml), and sufficient (≥30 ng/ml). RESULTS: The study reported that 73 (45.9%) participants had vitamin D deficiency, 38 (23.9%) had vitamin D insufficiency, and 48 (30.2%) patients had sufficient vitamin D levels. The predictors identified were PWE aged 18 to 44 years old (p = 0.001), female gender (OR 3.396, p = 0.002), and ethnicity (p < 0.001), specifically Malay and Chinese. However, no significant association was identified between types of ASMs, serum calcium, or the prevalence of vitamin D deficiency. CONCLUSION: Vitamin D deficiency among PWE is prevalent in our local population, suggesting that regular screening should be considered for those at risk. Early identification would allow intervention to reduce the risk of future complications.

Exploring barriers to and facilitators of malaria prevention practices: a photovoice study with rural communities at risk to Plasmodium knowlesi malaria in Sabah, Malaysia.

BACKGROUND: The control of Plasmodium knowlesi malaria remains challenging due to the presence of macaque monkeys and predominantly outdoor-biting Anopheles mosquitoes around human settlements. This study aims to explore the barriers and facilitators related to prevention of mosquito bites among rural communities living in Sabah, Malaysia using the participatory visual method, photovoice. METHODS: From January through June 2022, 26 participants were recruited from four villages in Kudat, Sabah, using purposive sampling. Participants were male and female villagers, aged > 18 years old. After photovoice training in the villages, participants documented facilitators of and barriers related to avoiding mosquito bites using their own smartphone cameras, and provided narratives for their photos. Twelve Focus Group Discussions (FGDs) sessions in three rounds were held to share and discuss the photos, and to address challenges to the avoidance of mosquito bites. All discussions were conducted in the Sabah Malay dialect, and were video and audio recorded, transcribed, and analyzed using reflexive thematic analysis. The Ideation Model, a meta-theoretical model of behaviour change, underpinned this study. RESULTS: The most common types of barriers identified by participants included (I) intrapersonal factors such as low perceived threat of malaria, (II) livelihood and lifestyle activities consisting of the local economy and socio-cultural activities, and (III) physical and social environment. The facilitators were categorized into (I) intrapersonal reasons, including having the opportunity to stay indoors, especially women who are housewives, (II) social support by the households, neaighbours and healthcare workers, and (III) support from healthcare services and malaria awareness program. Participants emphasized the importance of stakeholder's support in implementing feasible and affordable approaches to P. knowlesi malaria control. CONCLUSION: Results provided insights regarding the challenges to preventing P. knowlesi malaria in rural Kudat, Sabah. The participation of communities in research was valuable in expanding knowledge of local challenges and highlighting possible ways to overcome barriers. These findings may be used to improve strategies for zoonotic malaria control, which is critical for advancing social change and minimizing health disparities in malaria prevention.

A systematic review of asymptomatic Plasmodium knowlesi infection: an emerging challenge involving an emerging infectious disease.

BACKGROUND: In the last decade Plasmodium knowlesi has been detected in humans throughout South East Asia. The highest risk groups for this infection are males, adults and those performing forest-related work. Furthermore, asymptomatic cases of P. knowlesi malaria have been reported including among women and children. METHODS: Pubmed, Scopus and the Web of Science databases for literature describing asymptomatic P. knowlesi malaria published between 2010 and 2020 were searched. A systematic literature review was conducted to identify studies reporting the prevalence and incidence of laboratory confirmed asymptomatic P. knowlesi cases in humans, their clinical and demographic characteristics, and methods used to diagnose these cases. RESULTS: By analysing over 102 papers, thirteen were eligible for this review. Asymptomatic P. knowlesi infections have been detected in 0.03%-4.0% of the population depending on region, and infections have been described in children as young as 2 years old. Various different diagnostic methods were used to detect P. knowlesi cases and there were differing definitions of asymptomatic cases in these studies. The literature indicates that regionally-differing immune-related mechanisms may play a part on the prevalence of asymptomatic P. knowlesi. CONCLUSION: Differing epidemiological characteristics of asymptomatic P. knowlesi malaria in different regions reinforces the need to further investigate disease transmission mechanics. Effective public health responses to changes in P. knowlesi epidemiology require proactive intervention and multisectoral collaboration.

Children's exposure to air pollution in a natural gas industrial area and their risk of hospital admission for respiratory diseases.

The rapid expansion of the natural gas industry to meet the global demand have raised environmental health concerns. Few studies have found that areas with natural gas industrial activity have poor air quality. However, the negative health impacts of ambient air pollution in a natural gas industrial area remain unclear. This study aimed to explore the relationship between short-term exposure to air pollution and hospital admissions for respiratory diseases among children in a natural gas industrial area in Bintulu, Malaysia. Daily hospital admissions for respiratory diseases among children were collected from a hospital in Bintulu from 2010 to 2019. Data on six air pollutants (PM10, PM2.5, SO2, NO2, O3, and CO) in the study area were obtained from the Department of Environment Malaysia. Quasi-Poisson time series regressions with distributed lag non-linear models (DLNM) were applied to explore the associations between ambient air pollution and childhood hospitalisations for respiratory diseases. Stratification analyses were performed by gender and age group to identify the vulnerable populations. A 10 µg/m3 increased PM2.5 and SO2 was associated with hospital admissions for respiratory diseases among children with the greatest relative risk of RR 1.089 (95% CI 1.001-1.183) at cumulative lag 0-2 days and RR 1.229 (95% CI 1.073-1.409) at cumulative lag 0-6 days, respectively. There was no significant association between short-term exposure of PM10, NO2, CO, and O3 with childhood respiratory hospitalisation. The association between PM2.5 and SO2 exposure and hospital admissions for childhood respiratory diseases in the two pollutants model remained statistically significant. There were stronger associations in younger children aged 0-4 years and girls. This study reveals that short-term exposure to SO2 was associated with a higher risk of respiratory hospitalisations among children in Bintulu than PM2.5. Better air quality control is necessary for children's health living in the natural gas industrial area.

The prevalence and clinical significance of Presymptomatic COVID-19 patients: how we can be one step ahead in mitigating a deadly pandemic.

BACKGROUND: Presymptomatic COVID-19 patients have been identified as a major stumbling block in efforts to break the chain of transmission. Studies on temporal dynamics of its shedding suggests it peaks 1-2 days prior to any symptom onset. Therefore, a large proportion of patients are actively spreading the disease unknowingly whilst undetected. However, lengthy lockdowns and isolation leads to a host of socioeconomic issues and are impractical. Conversely, there exists no study describing this group and their clinical significance despite their key role in disease transmission. METHODS: As a result, we devised a retrospective study to look at the prevalence of presymptomatic patients with COVID-19 from data sourced via our medical records office. Subsequently, we identify early indicators of infection through demographic information, biochemical and radiological abnormalities which would allow early diagnosis and isolation. In addition, we will look into the clinical significance of this group and their outcome; if it differs from asymptomatic or symptomatic patients. Descriptive statistics were used in addition to tabulating the variables and corresponding values for reference. Variables are compared between the presymptomatic group and others via Chi-square testing and Fisher's exact test, accepting a p value of < 0.05 as significant. RESULTS: Our analysis shows a higher proportion of presymptomatic patients with atypical symptoms like chest pain while symptomatic patients commonly present with respiratory symptoms like cough and shortness of breath. Besides that, there were more females presenting as presymptomatic patients compared to males (p = 0.019) and these group of patients were likely to receive treatment (p < 0.001). Otherwise, we were not able to identify other statistically significant markers suggesting a patient is presymptomatic. CONCLUSION: As we have little means of identifying these silent spreaders, it highlights further the importance of general measures implemented to stop COVID-19 transmission like social distancing, face mask, and widespread testing.

Seroprevalence of Hepatitis B Virus Infection and Its Associated Factors Among Blood Donors in Yemen.

BACKGROUND: In limited-resource countries, the prevalence of hepatitis B virus (HBV) infection can be measured using data taken from blood donors. This study aimed to determine the HBV infection seroprevalence and its associated factors among blood donors in Sana'a Governorate, Yemen. METHODS: A cross-sectional study was conducted on 500 people who donated blood at hospitals located in Sana'a between August and October 2016. The volunteers were aged 18-65 years old and were recruited using convenience sampling. A set of questionnaires was administered through face-to-face interviews. Blood samples from each donor were tested for hepatitis B surface antigens using enzyme-linked immunosorbent assay. RESULTS: The overall seroprevalence of HBV infection in the blood donors was 2.6%. Participants with a history of dental treatment had 7.80 higher odds (95% confidence interval [CI]: 2.26, 26.71; P = 0.002) for HBV infection. Respectively, blood donors who had history of malaria infection or cupping therapy had 7.48 (95% CI: 1.75, 31.82; P = 0.010) and 7.32 (95% CI: 1.72, 30.83; P = 0.010) greater odds of HBV infection. CONCLUSION: The seroprevalence of HBV infection in Sana'a is lower than in other governorates in Yemen. Stakeholders could focus on a history of dental procedure, malaria infection and cupping treatment when strategising about HBV infection prevention and control among blood donors.

Detection of Leptospira kmetyi at recreational areas in Peninsular Malaysia.

Humans can be infected by pathogenic Leptospira through contact with infected animals or contaminated environments. Recreational exposure has been associated with human leptospirosis; however, there is a lack of information on the distribution of Leptospira spp. in recreational areas. Thus, we conducted this study to detect and describe the distributions of Leptospira spp. and to determine the prevalence of pathogenic leptospires at recreational areas in Peninsular Malaysia. Soil and water samples were randomly collected from 33 recreational areas in Peninsular Malaysia from December 2018 to April 2019. Each culture was examined under dark-field microscopy prior to genus confirmation by polymerase chain reaction using primers for the 16S rRNA gene. A total of 390 water and soil samples were collected, and 131 cultures were positive for Leptospira under dark-field microscope examination. Leptospira was identified in most of the recreational areas sampled, and at least one pathogenic Leptospira species was isolated from 17 recreational areas. The prevalence of saprophytic, intermediate, and pathogenic Leptospira spp. was 19.7%, 5.6%, and 8.2%, respectively. The dominant pathogenic species found in the samples was Leptospira kmetyi. This study provides important data on the distribution and prevalence of Leptospira spp. from soil and water, as well as the dominant pathogenic species, at recreational areas in Peninsular Malaysia. Therefore, preventive measures should be taken to ensure the safety of visitors.

Risk of concentrations of major air pollutants on the prevalence of cardiovascular and respiratory diseases in urbanized area of Kuala Lumpur, Malaysia.

Rapid urbanisation in Malaysian cities poses risks to the health of residents. This study aims to estimate the relative risk (RR) of major air pollutants on cardiovascular and respiratory hospitalisations in Kuala Lumpur. Daily hospitalisations due to cardiovascular and respiratory diseases from 2010 to 2014 were obtained from the Hospital Canselor Tuanku Muhriz (HCTM). The trace gases, PM10 and weather variables were obtained from the Department of Environment (DOE) Malaysia in consistent with the hospitalisation data. The RR was estimated using a Generalised Additive Model (GAM) based on Poisson regression. A "lag" concept was used where the analysis was segregated into risks of immediate exposure (lag 0) until exposure after 5 days (lag 5). The results showed that the gases could pose significant risks towards cardiovascular and respiratory hospitalisations. However, the RR value of PM10 was not significant in this study. Immediate effects on cardiovascular hospitalisations were observed for NO2 and O3 but no immediate effect was found on respiratory hospitalisations. Delayed effects on cardiovascular and respiratory hospitalisations were found with SO2 and NO2. The highest RR value was observed at lag 4 for respiratory admissions with SO2 (RR = 1.123, 95% CI = 1.045-1.207), followed by NO2 at lag 5 for cardiovascular admissions (RR = 1.025, 95% CI = 1.005-1.046). For the multi-pollutant model, NO2 at lag 5 showed the highest risks towards cardiovascular hospitalisations after controlling for O3 8 h mean lag 1 (RR = 1.026, 95% CI = 1.006-1.047), while SO2 at lag 4 showed highest risks towards respiratory hospitalisations after controlling for NO2 lag 3 (RR = 1.132, 95% CI = 1.053-1.216). This study indicated that exposure to trace gases in Kuala Lumpur could lead to both immediate and delayed effects on cardiovascular and respiratory hospitalisations.

A study on exposure to cyanide among a community living near a gold mine in Malaysia.

Cyanidation in gold extraction has detrimental impacts on the ecosystem and the population in surrounding areas. The research described in this article aimed to assess the health effects of environmental exposure to cyanide in a community near a gold mining area in Malaysia. A total of 255 members of the exposed community and 117 members of the control community answered questionnaires on their exposure to a gold mine and health outcomes. Urine samples were collected for biomarker assessment (i.e., urinary thiocyanate). The authors found that the mean level of urinary thiocyanate was significantly higher among the exposed community (0.30 ± 0.26 mg/dL) than the control community (0.24 ± 0.23 mg/dL) (p = .0021). The exposed community had a significantly higher prevalence of headaches (prevalence odds ratio [pOR] = 2.6, p = .001), dizziness (pOR = 3.7, p < .001), skin irritation (pOR = 2.1, p = .040), and eye irritation (pOR = 5.1, p = .004). No association occurred between dietary exposure and urinary biomarkers. Smokers living near a gold mine had a higher urinary thiocyanate level (0.56 mg/dL) than smokers in the control community (0.49 mg/dL).

Individual evaluation of fatigue at work to enhance the safety performance in the construction industry: A systematic review.

The construction industry is recognized as one of the most hazardous industries globally due to the dynamic on site activities and labour-intensive characteristics. The construction tasks are physically and cognitively demanding therefore the construction workers are prone to work fatigue which compromises safety performance. The evaluation of fit for duty, or fitness for work (FFW) aims to determine if workers are at risk of adverse impacts of ill-health, injury or accidents. This systematic review aimed to critically summarize up-to-date measures and evaluation tools that were employed to monitor work fitness or fatigue specifically among construction workers. Adhering with the PRISMA protocol, three databases were searched from the inception to 2022, with a total combination of 37 keywords, concluding to the selection of 20 relevant articles. The Mixed Method Appraisal Tool (MMAT) was used as the guide for the study appraisal. A total of 20 articles were reviewed, published from 2008-2022. Majority of the studies employed experimental design. The review identified the subjective evaluation scales and objective measurement tool. The subjective self-response questionnaires can be categorized into single dimension or multidimension covering both physical and mental fitness; whereas the objective measurement tool can be categorized into physiological metrics, physical and cognitive performance measure. The available scientific evidence has raised the relevant issues for on-site practicality and potentially guide the formulation of evidence-based guidelines for the FFW assessment in the construction industry.

Projecting non-communicable diseases attributable to air pollution in the climate change era: a systematic review.

OBJECTIVES: Climate change is a major global issue with significant consequences, including effects on air quality and human well-being. This review investigated the projection of non-communicable diseases (NCDs) attributable to air pollution under different climate change scenarios. DESIGN: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. A population-exposure-outcome framework was established. Population referred to the general global population of all ages, the exposure of interest was air pollution and its projection, and the outcome was the occurrence of NCDs attributable to air pollution and burden of disease (BoD) based on the health indices of mortality, morbidity, disability-adjusted life years, years of life lost and years lived with disability. DATA SOURCES: The Web of Science, Ovid MEDLINE and EBSCOhost databases were searched for articles published from 2005 to 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The eligible articles were evaluated using the modified scale of a checklist for assessing the quality of ecological studies. DATA EXTRACTION AND SYNTHESIS: Two reviewers searched, screened and selected the included studies independently using standardised methods. The risk of bias was assessed using the modified scale of a checklist for ecological studies. The results were summarised based on the projection of the BoD of NCDs attributable to air pollution. RESULTS: This review included 11 studies from various countries. Most studies specifically investigated various air pollutants, specifically particulate matter <2.5 µm (PM2.5), nitrogen oxides and ozone. The studies used coupled-air quality and climate modelling approaches, and mainly projected health effects using the concentration-response function model. The NCDs attributable to air pollution included cardiovascular disease (CVD), respiratory disease, stroke, ischaemic heart disease, coronary heart disease and lower respiratory infections. Notably, the BoD of NCDs attributable to air pollution was projected to decrease in a scenario that promotes reduced air pollution, carbon emissions and land use and sustainable socioeconomics. Contrastingly, the BoD of NCDs was projected to increase in a scenario involving increasing population numbers, social deprivation and an ageing population. CONCLUSION: The included studies widely reported increased premature mortality, CVD and respiratory disease attributable to PM2.5. Future NCD projection studies should consider emission and population changes in projecting the BoD of NCDs attributable to air pollution in the climate change era. PROSPERO REGISTRATION NUMBER: CRD42023435288.

A qualitative exploration and a Fuzzy Delphi validation of high-risk scaffolding tasks and fatigue-related safety behavioural deviation among scaffolders.

Background: Most construction mishaps were caused by scaffolding incidents despite implementing various safety measures, and the association with human factors like fatigue has been widely reported. This study aims to identify all high-risk task sequences involved during the erection of the most commonly used scaffold; the deviation from the standard protocol led to a substandard fatigue state, followed by content validation using the Fuzzy Delphi Method. Methods: Qualitative exploration was conducted via focal group discussions (FGDs) involving 30 certified experts. The findings generated from FGDs were further validated by utilising the Fuzzy Delphi Method (FDM) by consulting 19 experts with extensive practical experience and leadership roles in scaffolding safety. Results: The FGDs identified a total of 7 constructs and 50 items for task sequences involved in the tubular scaffold erection, namely construct Instruction (3 items), Preparation (3 items), Foundation (10 items), First Lift (8 items), Working Platform (7 items), Guardrails (5 items) and Second Lift (14 items). In the FDM validation process, the experts' consensus for each construct was fulfilled with a threshold value (d) ≤ 0.2; thus, all constructs were accepted. Experts' consensus for all items achieved an expert agreement of 75 % and above. Items ranking was conducted using average fuzzy numbers. The highest average fuzzy number documented was 0.8, while the lowest was 0.588. None of the items with the lowest ranking was discarded as all items perfectly fulfilled the second prerequisite and obtained excellent experts' agreement. Conclusions: The tool generated will help guide the development of a protocol for scaffolding safety management.

Exploring community participation in vectorborne disease control in Southeast Asia: a scoping review protocol.

INTRODUCTION: Vector borne diseases (VBDs) present significant public health challenges in Southeast Asia (SEA), and the increasing number of cases threatens vulnerable communities. Inadequate vector control and management have been linked to the spread of VBDs. To address these issues, community participation has been proposed as a promising approach to enhance health programmes and control of VBDs. This article outlines a protocol for a scoping review of the published literature on community-participation approaches to control VBDs in the SEA region. The primary research question is 'How does community participation complement the control of VBDs in SEA?' This review aims to provide an overview of various approaches and identify barriers and facilitators to effective implementation. METHODS AND ANALYSIS: The research questions will guide the scoping review. In stage 1, peer-reviewed publications from PubMed, Web of Science and Scopus will be searched using predefined search terms related to community-based approaches and VBDs in the SEA region, English, Indonesian and Malay published between 2012 and 2022. In stage 2, the references from relevant articles will be screened for eligibility. In stage 3, eligible articles will be charted in Microsoft Excel to facilitate the review process, and studies will be characterised based on the investigated diseases; this review will also highlight the methodological context of these studies. In stage 4, a thematic analysis will be conducted to derive meaningful findings from the dataset relevant to the research inquiry, followed by writing the results in stage 5. This scoping review aims to be the first to explore community participation in VBD control in the SEA population, providing valuable insights for future research and stakeholders involved in disease control. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval because the methodology synthesises information from available articles. This review is planned for dissemination in academic journals, conference presentations and shared with stakeholders as part of knowledge sharing among those involved in VBD control.

Electroencephalography as a tool for assessing delirium in hospitalized patients: A single-center tertiary hospital experience.

Background: Delirium is a prevalent yet underdiagnosed disorder characterized by acute cognitive impairment. Various screening tools are available, including the Confusion Assessment Method (CAM) and 4 A's test (4AT). However, the results of these assessments may vary among raters. Therefore, we investigated the objective use of electroencephalography (EEG) in delirium and its clinical associations and predictive value. Method: This cross-sectional observational study was conducted at Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan, Malaysia, from April 2021 to April 2023. This study included patients aged ≥18 years with a preliminary diagnosis of delirium. Demographic and clinical data were collected along with EEG recordings evaluated by certified neurologists to classify abnormalities and compare the associated factors between patients with delirium with or without EEG abnormalities. Results: One hundred and twenty patients were recruited, with 80.0% displaying EEG abnormalities, mostly generalized slowing (moderate to severe) and primarily generalized slowing (mild to severe), and were characterized by theta activity. Age was significantly associated with EEG abnormalities, with patients aged 75 and older demonstrating the highest incidence (88.2%). The CAM scores were strongly correlated with EEG abnormalities (r = 0.639, P < 0.001) and was a predictor of EEG abnormalities (P < 0.012), indicating that EEG can complement clinical assessments for delirium. The Richmond Agitation and Sedation Scale (RASS) scores (r = -0.452, P < 0.001) and Barthel index (BI) (r = -0.582, P < 0.001) were negatively correlated with EEG abnormalities. Additionally, a longer hospitalization duration was associated with EEG abnormalities (r = 0.250, P = 0.006) and emerged as a predictor of such changes (P = 0.030). Conclusion: EEG abnormalities are prevalent in patients with delirium, particularly in elderly patients. CAM scores and the duration of hospitalization are valuable predictors of EEG abnormalities. EEG can be an objective tool for enhancing delirium diagnosis and prognosis, thereby facilitating timely interventions.

Why was the study done? Confusion is frequently observed among patients presenting with various medical issues. There are several tests available to assist in assessment of these patients to see if the symptoms present constitute delirium. However, there may be occasions where identifying delirium is difficult despite the tools available. Electroencephalography (EEG) may be another option to assist medical personnel in diagnosing delirium. In this study, we examine the use of EEG in identification of delirium and its clinical associations. What did the researchers do? Our team studied the use of EEG in patients admitted for various medical issues with symptoms suggestive of delirium over a 2-year period. We collected relevant clinical data and performed EEG for each participant. What did the researchers find? A total of 120 participants were involved in the study. We observe abnormal EEG findings in 80% of patients with the majority showing generalized slowing. The factors associated with EEG abnormalities are advancing age, positive Confusion Assessment Method (CAM), and duration of hospitalization. What do the findings mean? As the service is not widely available, it would not be practical to substitute existing clinical assessment tools with EEG. However, we cannot discount the importance of identifying delirium due to its association with poor clinical outcomes. Therefore, for centers that may perform EEG, it may be used as an adjunct in diagnosing delirium should any doubts arise.

Environmental and Occupational Factors Associated with Leptospirosis: A Systematic Review.

Background: Leptospirosis is a neglected emerging zoonotic disease with a profound public health impact worldwide with higher burden of disease in resource-poor countries. The environmental and occupational exposures contribute to human and animal transmission, but the interaction was less explored. A deeper understanding of the critical environmental and occupational drivers in different contexts will provide useful information for disease control and prevention measures. Objective: This review aimed to summarize the potential environmental and occupational risk factors associated with leptospirosis infection. Methods: Four databases (Scopus, Web of Science, Ovid MEDLINE, EBSCOhost) were searched for articles published from 2012 to 2021. Eligible articles were assessed using a checklist for assessing the quality of the studies. The quality of the articles was assessed based on the laboratory diagnosis approach and statistical analysis method. Results: A total of 32 studies were included in this systematic review. Water-related risk factors such as natural water as the primary water source (AOR 1.8-18.28), water-related recreational activities (AOR 2.36-10.45), flood exposure (AOR 1.54-6.04), contact with mud (AOR 1.57-4.58) and stagnant water (AOR 2.79-6.42) were associated with increased risk of leptospirosis. Infrastructural deficiencies such as un-plastered house walls and thatched houses presented a higher risk (AOR 2.71-5.17). Living in low-lying areas (AOR 1.58-3.74), on clay loam soil (OR 2.72), agricultural land (OR 2.09), and near rubber tree plantations (AOR 11.65) is associated with higher risk of leptospirosis. Contact with rats (AOR 1.4-3.5), livestock (AOR 1.3-10.4), and pigs (AOR 1.54-7.9) is associated with an increased risk of leptospirosis. Outdoor workers (AOR 1.95-3.95) and slaughterhouse workers (AOR 5.1-7.5) have higher risk of leptospirosis. Conclusion: The environmental and occupational components related to water, infrastructure, landscape, agriculture, and exposed animals play an essential role in leptospirosis transmission. The magnitude of those risk factors differs with geographical region, climate factor, urbanization and population growth, and the country's socioeconomic status.