Cancer incidence and mortality in Brunei Darussalam, 2011 to 2020.

This study presents the trends of age-standardised incidence and mortality rates of common cancers in Brunei Darussalam from 2011 to 2020. All cancer cases diagnosed among Brunei Darussalam citizens and permanent residents in the period 2011 to 2020 were included in the study. De-identified data were provided by the CanReg5 based BDCR, Ministry of Health Brunei Darussalam. The annual age-standardised incidence and mortality rates per 100,000 persons were standardised by the direct method using the World Health Organization (WHO) world standard population distribution. Joinpoint regression analyses were used to study the incidence and mortality trends of cancer in Brunei Darussalam over the 2011-2020 period. Trends were expressed as average annual percent change (AAPC) over 2011 to 2020, or annual percent change (APC) for a given time period. There were a total of 6,495 new cancer cases diagnosed and 3,359 death cases recorded from 2011 to 2020, in Brunei Darussalam. The five common cancers for males were colorectal, lung and bronchus, prostate, liver, and non-Hodgkin lymphoma. Among females, the five most common cancers were breast, colorectal, lung and bronchus, corpus uteri and cervix uteri. The five leading cancer deaths for males were lung and bronchus, colorectal, liver, prostate, and stomach, while for females, the five leading cancer deaths were breast, lung and bronchus, colorectal, ovary, and cervix uteri. There was a significant increase in the incidence trend of corpus uteri (AAPC[Formula: see text]) and a significant decline in the incidence trend for cervical cancer (AAPC[Formula: see text]) from 2011 to 2020. There was a significant increase in the mortality trend of female breast cancer from 2011 to 2015 (APC[Formula: see text]), but the trend significantly declined from 2015 to 2020 (APC[Formula: see text]). We also found a significant decrease in mortality trends for stomach cancer (AAPC[Formula: see text]) from 2011 to 2020 for both genders combined. The burden of common cancers is expected to continue to grow with ageing population, effective public health interventions targeting high burden cancers and high-risk groups, and control of modifiable risk factors will continue to be the essential approaches in reducing cancer burden.

The application of chemometrics in metals source of identification in Brunei Bay surface sediment.

Brunei Bay is a unique ecosystem which offers a vast biodiversity. This study was carried out to define the source of metals in the surface sediment of Brunei Bay to ensure the bay's health. The secondary data were analysed using chemometrics analysis to verify the possible factors that influence metals distribution in Brunei Bay sediment. Samples were collected several times during 2013 to 2014 using Ponar grab at 16 stations within the bay. Samples were then dried, pre-treated, digested and analysed using Inductively Coupled Plasma Mass Spectrometry (ICPMS) in the laboratory. Overall, the mean concentration of metal, sediment pH and clay fraction were significantly changed during different sampling periods, as the changes were presumed affected by seasonal changes. The Pearson correlation has pointed that metals were dominantly derived by natural input; however, the total organic carbon was proven to be derived by anthropogenic sources. Moreover, the principal component analysis has verified that the distribution of metals in the bay's sediment was dominantly influenced by natural processes. However, the utilization and manipulation of marine resources are slightly affecting the bay's ecosystem which may deteriorate the ecosystem health soon.

End-stage kidney disease in Brunei Darussalam (2011-2020).

INTRODUCTION: The Brunei Dialysis and Transplant Registry (BDTR) recorded data on patients with end-stage kidney disease (ESKD) from 2011 to 2020, mainly for planning of services and benchmarking of standards. We report the trends of epidemiologic and performance parameters, compare performances between modalities of Kidney Replacement Therapy and evaluate the survival of ESKD patients over the 10-year period. MATERIALS AND METHODS: Three groups of data were analysed from the BDTR over the 10-year period. Epidemiological data, blood parameters and dialysis are key performance indicators. RESULTS: There are increments in prevalence and incidence of treated ESKD patients in Brunei over 10 years, especially with haemodialysis (HD). The projected prevalence and incidence showed an anticipated annual increase of 42.2 per million population (pmp) and 9.9 pmp respectively. Diabetes mellitus (DM) (79%) was the main cause of ESKD. HD (86%), peritoneal dialysis (PD) (9%) and transplant (5%) were the main modalities of kidney replacement therapy in 2020. Cumulative results over the decade showed significant improvements in serum phosphate, peritonitis rates and HD blood flow rates. PD patients have better survival rates, lower systolic blood pressure and better adequacy. PD survival (patient survival of 91%, 73% and 56% at 1, 3 and 5 years respectively) was superior to HD survival (86% and 64% at 1 and 2 years, respectively), but patient demographics (age and DM status) were different. The 2020 dataset showed satisfactory anaemia management but mineral bone disease management was sub-optimal. Seventy percent of prevalent HD patients had arteriovenous fistula access. Thirty-two percent and fifty-two percent of HD and PD patients, respectively, achieved target dialysis adequacy. Peritonitis rate was 0.3 episodes per patient year. CONCLUSION: Brunei has a high incidence and prevalence of treated ESKD in the last decade, especially DM-related ESKD. This study has identified many specific areas to be targeted for improvements and provided evidence for further proliferation of PD and transplant preference policy.

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.

Thalassemia in Asia 2021 Thalassemia in Brunei Darussalam.

Acknowledging and understanding the extent of thalassemia and hemoglobinopathy issues in a country is crucial for the benefit of implementing a national preventive and control program to reduce its prevalence. In order to obtain reliable prevalence data, the gene frequencies of the thalassemias and other hemoglobinopathies should be investigated. Molecular studies on thalassemia have yet to be done for Brunei's population. It was estimated that carriers of thalassemia or hemoglobinopathies in Brunei is approximately 5.0% or less of the overall population. There are about 200 current cases of thalassemia and other hemoglobinopathies including adults and children reported across all four districts of Brunei. Blood parameter analysis, microscopy, hemoglobin (Hb) electrophoresis and high performance liquid chromatography (HPLC) are the most common methods of investigation in aiding diagnosis in the hospital laboratory. Genotyping analysis conducted in an overseas laboratory has been employed to confirm some diagnosis. Compiled data from 2009-2017 at the Hematology Laboratory of the Raja Isteri Pengiran Anak Saleha Hospital, Jalan Putera Al-Muhtadee Billah, Bandar Seri Begawan, Brunei Darussalam, showed that the most reported diagnoses are α-thalassemia (α-thal) trait, ß-thalassemia (ß-thal) trait, heterozygous Hb E (HBB: c.79G>A)/ß-thal, ß-thal major (ß-TM) and ß-thal intermedia (ß-TI). The data reported indicate the importance of establishing a thalassemia registry with relevant data on patients and patient outcomes as a tool for monitoring and improving patient care.

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.

Survival of colorectal cancer patients in Brunei Darussalam: comparison between 2002-09 and 2010-17.

BACKGROUND: Colorectal cancer (CRC) is a major cause of cancer-related mortality worldwide. It is the second leading cause of cancer death in men and women in Brunei Darussalam in 2017, posing a major burden on society. METHODS: This retrospective cohort study (n = 1035 patients diagnosed with CRC in Brunei Darussalam from 1st January 2002 until 31st December 2017) aims to compare the overall survival rates of CRC patients (2002-2017), to compare survival rates between two study periods (2002-2009 and 2010-2017) and to identify prognostic factors of CRC. Kaplan-Meier estimator and log-rank tests were performed to analyse the overall survival rates of CRC patients. Multiple Cox regression was performed to determine the prognostic factors of CRC with adjusted hazard ratios (Adj. HRs) reported. RESULTS: The 1-, 3- and 5-year survival rates of CRC patients are 78.6, 62.5, and 56.0% respectively from 2002 to 2017. The 1-, 3-, and 5-year survival rates of CRC patients for 2002-2009 are 82.2, 69.6, and 64.7%; 77.0, 59.1, and 51.3% for 2010-2017 respectively. A significant difference in CRC patients' survival rate was observed between the two study periods, age groups, ethnic groups, cancer stages, and sites of cancer (p < 0.05). The Adjusted Hazard Ratios (Adj. HRs) were significantly higher in the 2010-17 period (Adj. HR = 1.78, p < 0.001), older age group ( ≥ 60 years) (Adj. HR = 1.93, p = 0.005), distant cancer (Adj. HR = 4.69, p < 0.010), tumor at transverse colon and splenic flexure of colon (Adj. HR = 2.44, p = 0.009), and lower in the Chinese(Adj. HR = 0.63, p = 0.003). CONCLUSION: This study highlights the lower survival rates of CRC patients in 2010-2017, Malays, older patients, distant cancer, and tumors located at the latter half of the proximal colon (transverse colon), and predominantly LCRC (splenic flexure, descending colon, sigmoid colon, overlapping lesion colon and colon (NOS), as well as the rectosigmoid junction and rectum (NOS)). Age, ethnicity, cancer stage, and tumor location are significant prognostic factors for CRC. These findings underscore the importance of public health policies and programmes to enhance awareness on CRC from screening to developing strategies for early detection and management, to reduce CRC-associated mortality.

[Telerehabilitation: from the virtual world to reality-Medicine in the twenty-first century : Video-assisted treatment in times of COVID-19]. / Telerehabilitation: von der virtuellen Welt zur Realität ­ Medizin im 21. Jahrhundert : Videogestützte Therapie in Zeiten von COVID-19.

Neurological diseases are the most common cause of disability worldwide. In addition to physical limitations, they often lead to cognitive deficits that make active participation in professional and social life difficult. Due to physical and cognitive deficits, it is often difficult for neurological patients to gain access to specialized knowledge or to receive specialized treatment and is associated with greatly increased effort. Neurological diseases account for 11.6% of global disability-adjusted life years (DALYs, a measure for quantifying disease burden) and 16.5% of deaths, and remain the leading cause of DALYs and the second leading cause of death worldwide. Neurorehabilitation encompasses the goal of reintegrating patients with neurological dysfunctions into everyday life. The ongoing situation in the context of the COVID-19 pandemic poses new challenges for the healthcare system. Social distancing and quarantine have deprived many people with neurological disorders of access to routine medical care. The corona pandemic is a catalyst for the widespread use of telemedicine in the field of neurology and neurorehabilitation. Projects such as the Brunei project of the Nordwest Krankenhaus Frankfurt as well as an MS clinic in Canada show that highly specialized medicine and neurorehabilitation can be delivered to remote areas or in the living room of patients or any doctor's office. Telemedical, telerehabilitative and teletherapeutic applications offer the opportunity to supplement and optimize existing care structures and with modern technology to make a new and contemporary interpretation of old-fashioned medical and therapeutic home visits.

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.

Work-family conflict, health status and job satisfaction among nurses.

OBJECTIVE: Research studies have demonstrated that nurses face difficulty balancing family roles and responsibilities with work. This study aimed to explore the relationship between work-family conflict and health status and job satisfaction among nurses. METHODS: This was a cross-sectional study of 426 nurses working in high-dependency and general settings in a large referral hospital in Brunei Darussalam. RESULTS: Work-family conflict inversely affects health status and job satisfaction for nurses working in high-dependency and general settings. However, general nurses experienced higher work-family conflict albeit better job satisfaction and health status compared to high-dependency nurses. Older, single and non-smoker nurses reported higher job satisfaction. CONCLUSION: This study further informs healthcare and nursing administrators and policymakers, who should foster effective strategies and interventions to support the balance of nurses' work and family life.

Analysis of SARS-CoV-2 Transmission in Different Settings, Brunei.

We report the transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across different settings in Brunei. An initial cluster of SARS-CoV-2 cases arose from 19 persons who had attended the Tablighi Jama'at gathering in Malaysia, resulting in 52 locally transmitted cases. The highest nonprimary attack rates (14.8%) were observed from a subsequent religious gathering in Brunei and in households of attendees (10.6%). Household attack rates from symptomatic case-patients were higher (14.4%) than from asymptomatic (4.4%) or presymptomatic (6.1%) case-patients. Workplace and social settings had attack rates of <1%. Our analyses highlight that transmission of SARS-CoV-2 varies depending on environmental, behavioral, and host factors. We identify red flags for potential superspreading events, specifically densely populated gatherings with prolonged exposure in enclosed settings, persons with recent travel history to areas with active SARS-CoV-2 infections, and group behaviors. We propose differentiated testing strategies to account for differing transmission risk.

Probable causes and risk factors for positive SARS-CoV-2 test in recovered patients: Evidence from Brunei Darussalam.

Case reports of patients with coronavirus disease-2019 (COVID-19) who have been discharged and subsequently report positive reverse transcription-polymerase chain reaction again (hereafter referred as "re-positive") do not fully describe the magnitude and significance of this issue. To determine the re-positive rate (proportion) and review probable causes and outcomes, we conduct a retrospective study of all 119 discharged patients in Brunei Darussalam up till April 23. Patients who were discharged are required to self-isolate at home for 14 days and undergo nasopharyngeal specimen collection postdischarge. Discharged patients found to be re-positive were readmitted. We reviewed the clinical and epidemiological records of all discharged patients and apply log-binomial models to obtain risk ratios for re-positive status. One in five recovered patients subsequently test positive again for severe acute respiratory syndrome coronavirus 2-this risk is more than six times higher in persons aged 60 years and above. The average Ct value of re-positive patients was lower predischarge compared with their readmission Ct value. Out of 111 close contacts tested, none were found to be positive as a result of exposure to a re-positive patient. Our findings support prolonged but intermittent viral shedding as the probable cause for this phenomenon. We did not observe infectivity potential in these patients.

Post-fire carbon dynamics in the tropical peat swamp forests of Brunei reveal long-term elevated CH4 flux.

Tropical peatlands hold about 15%-19% of the global peat carbon (C) pool of which 77% is stored in the peat swamp forests (PSFs) of Southeast Asia. Nonetheless, these PSFs have been drained, exploited for timber and land for agriculture, leading to frequent fires in the region. The physico-chemical characteristics of peat, as well as the hydrology of PSFs are affected after a fire, during which the ecosystem can act as a C source for decades, as C emissions to the atmosphere exceed photosynthesis. In this work, we studied the longer-term impact of fires on C cycling in tropical PSFs, hence we quantified the magnitude and patterns of C loss (CO2 , CH4 and dissolved organic carbon) and soil-water quality characteristics in an intact and a degraded burnt PSF in Brunei Darussalam affected by seven fires over the last 40 years. We used natural tracers such as 14 C to investigate the age and sources of C contributing to ecosystem respiration (Reco ) and CH4 , while we continuously monitored soil temperature and water table (WT) level from June 2017 to January 2019. Our results showed a major difference in the physico-chemical parameters, which in turn affected C dynamics, especially CH4 . Methane effluxes were higher in fire-affected areas (7.8 ± 2.2 mg CH4  m-2  hr-1 ) compared to the intact PSF (4.0 ± 2.0 mg CH4  m-2  hr-1 ) due to prolonged higher WT and more optimal methanogenesis conditions. On the other hand, we did not find significant differences in Reco between burnt (432 ± 83 mg CO2  m-2  hr-1 ) and intact PSF (359 ± 76 mg CO2  m-2  hr-1 ). Radiocarbon analysis showed overall no significant difference between intact and burnt PSF with a modern signature for both CO2 and CH4 fluxes implying a microbial preference for the more labile C fraction in the peat matrix.

Identification of culturable petroleum-degrading bacteria and fungi from petroleum-contaminated sites in Brunei Darussalam.

Microbes that can be cultured and degrade petroleum are of particular interest for biotechnology such as bioremediation. This study aims to isolate and identify culturable petroleum-degrading bacteria and fungi from Brunei Darussalam, which has not previously been explored. A total of eight bacterial and nine fungal isolates that could degrade petroleum were obtained from petroleum-contaminated water or soil samples. DNA barcoding using 16S rRNA gene sequence identified five different bacterial genera which were Bacillus, Enterobacter, Micrococcus, Pseudoaltermonas and Pseudomonas. DNA barcoding using rRNA-ITS gene sequence identified nine different fungal taxa which were Aspergillus, Cladosporium, Exophiala, Flavodon, Hypocreales, Nectriaceae, Penicillium, Peniophora and Trichoderma. Biolog provided additional support to the identification of some isolates. This study is the first to report these unique microbes from Brunei Darussalam, which are of ecological and biotechnological value.

From the High Arctic to the Equator: Do Soil Metagenomes Differ According to Our Expectations?

Comparing the functional gene composition of soils at opposite extremes of environmental gradients may allow testing of hypotheses about community and ecosystem function. Here, we were interested in comparing how tropical microbial ecosystems differ from those of polar climates. We sampled several sites in the equatorial rainforest of Malaysia and Brunei, and the high Arctic of Svalbard, Canada, and Greenland, comparing the composition and the functional attributes of soil biota between the two extremes of latitude, using shotgun metagenomic Illumina HiSeq2000 sequencing. Based upon "classical" views of how tropical and higher latitude ecosystems differ, we made a series of predictions as to how various gene function categories would differ in relative abundance between tropical and polar environments. Results showed that in some respects our predictions were correct: the polar samples had higher relative abundance of dormancy related genes, and lower relative abundance of genes associated with respiration, and with metabolism of aromatic compounds. The network complexity of the Arctic was also lower than the tropics. However, in various other respects, the pattern was not as predicted; there were no differences in relative abundance of stress response genes or in genes associated with secondary metabolism. Conversely, CRISPR genes, phage-related genes, and virulence disease and defense genes, were unexpectedly more abundant in the Arctic, suggesting more intense biotic interaction. Also, eukaryote diversity and bacterial diversity were higher in the Arctic of Svalbard compared to tropical Brunei, which is consistent with what may expected from amplicon studies in terms of the higher pH of the Svalbard soil. Our results in some respects confirm expectations of how tropical versus polar nature may differ, and in other respects challenge them.

Health help-seeking by men in Brunei Darussalam: masculinities and 'doing' male identities across the life course.

Using data collected through semi-structured interviews and focus group discussions with 37 adult men living in Brunei Darussalam, this paper explores how masculinities and expectations about male roles across the life course influence men's perceptions, of and attitudes towards health and health help-seeking behaviour. Bruneian men gave accounts that consistently spoke of a series of masculine roles and associated attributes and behaviours, which mapped across the life course. Men described health and the steps that they had taken to protect their health in terms of responsibilities associated with being a breadwinner, provider of support for parents, role model and leader of the family. Whilst adherence to Bruneian norms about masculinity could obstruct men's engagement with health help-seeking, we also found that men mobilised their understanding of Bruneian masculinity such that it provided culturally legitimate way of engaging in health help-seeking. We conclude by considering implications for further development of conceptualisations of masculinities, particularly responding to the call to consider Connell's theory of 'hegemonic masculinity' in the context of the Global South. We also consider the implications of the findings of this research for policy and practice in provision of health promotion and services in Brunei.

Early Adolescent Patterns of Alcohol and Tobacco Use in Eight Association of South-East Asian Nations (ASEAN) Member States.

BACKGROUND: Though alcohol and tobacco are the most commonly used substances among adolescents, little is known about the patterning of early adolescent substance use in Association of South-East Asian Nations (ASEAN) member states. OBJECTIVES: This study examined past month patterns of substances use and its gender difference among adolescents. METHODS: Cross-sectional samples among adolescents aged 13-16 years who completed the Global School-based Student Health Survey (GSHS) from eight ASEAN countries were included in the analysis (n = 40,212). RESULTS: Prevalence of past month any tobacco use was relatively high in Brunei, Indonesia, Malaysia, Thailand, and the Philippines (11-15%), but prevalence of dual cigarette and other forms of tobacco use was about 2-5% in the five countries. Past month alcohol consumption prevalence was also high in Thailand, Viet Nam, and the Philippines (16-24%), compared to the rest countries (1.4-8.2%). Moreover, prevalence of the concurrent alcohol and tobacco use was higher in Thailand and the Philippines (7 and 10%, respectively), particularly in boys (13 and 15%, respectively). Conclusions/importance: Almost 30-40% of the boys and 10-20% of girls in Malaysia, Philippines, Thailand, and Viet Nam are engaged in at least one of the two risk behaviors, and the concurrent alcohol and tobacco use was also relatively high among boys in those countries (5-15%). This study may provide some valuable insights on alcohol and tobacco policy in the region and requires to begin prevention and treatment programs in ASEAN member states.

Negotiated ethical responsibility: Bruneian nurses' ethical concerns in nursing practice.

BACKGROUND: There has been wide interest shown in the manner in which ethical dimensions in nursing practice are approached and addressed. As a result, a number of ethical decision-making models have been developed to tackle these problems. However, this study argued that the ethical dimensions of nursing practice are still not clearly understood and responded to in Brunei. RESEARCH AIM: To explore how Bruneian nurses define ethical concerns they meet in everyday practice in the medical surgical wards of three Brunei hospitals. RESEARCH DESIGN: A qualitative study was employed. Interviews were conducted with 28 practising and administrative nurses of three hospitals. Interview data were analysed via a constant comparative method. ETHICAL CONSIDERATION: The study's protocol was reviewed and approved by the Ethical Committee of the School of Health in Social Science at the University of Edinburgh and the Medical Health Research Ethics Committee of the Ministry of Health, Brunei. FINDINGS: The nurses described three ethical dimensions in their practice, namely: 'nurse at work' which illustrates the ethical dimensions within the work environment; 'nurse and doctor' which elucidates the ethical dimensions in the nurse and doctor relationship; and 'nurse and patient' which further examines ethical aspects in patient care. Nurses responded to the ethical dimensions in the ward setting with the aim of avoiding the conflict and maintaining ward harmony. DISCUSSION: The data provide new insights into how nurses respond to ethical dimension in the ward settings where it puts strong emphasis on the nurses' understanding of responsibility placed upon them as professional nurses. CONCLUSION: With these findings, it is recommended that further support is needed for nurses to be aware of the ethical dimension in their practice and to respond to ethical concerns accordingly.

Strategies used to cope with stress by emergency and critical care nurses.

BACKGROUND:: developing coping strategies to use in stressful situations is an essential nursing skill. Prolonged and constant stress is harmful to nurses' health and leads to organisational inefficiency, high staff turnover and decreased job satisfaction. AIM:: to identify nurses' stress coping strategies and determine the relationship between coping strategies and sociodemographic factors. METHOD:: a descriptive cross-sectional study using a self-administered questionnaire was undertaken at an emergency department and critical care units at the largest referral hospital in Brunei. RESULTS:: problem-solving and positive reappraisal were the predominant positive coping strategies identified. Those working in medical intensive care employed escape-avoidance behaviours more frequently. Married participants exhibited higher levels of confrontative coping behaviours. CONCLUSION:: to the authors' knowledge, this is the first study to examine job-stress coping strategies among nurses in Brunei. The authors examined the different strategies and the poor health outcomes associated with using negative coping styles. Future stress management interventions should target staff who employ negative coping strategies to promote positive strategies, enabling them to provide better quality care.

Optimization of a reduced volume PCR amplification for PowerPlex® Fusion kit using FTA™ cards and generation of population genetic data for Brunei population.

The commercial PowerPlex® Fusion kit is an autosomal STR multiplex kit that has high discrimination power and is more informative in forensic, paternity, and relationship-testing cases. Key features of this multiplex system are the possibility to direct amplify FTA™ card punches as well as non-FTA cards and commonly used swabs; optimised inhibitor tolerance and high sensitivity generating full profiles from amount as little as 100 pg of human DNA. This study focused on the optimization of performance variables such as FTA™ punch sizes, reduced reaction volumes, and FTA™ purification reagent aiming to increase the analytical sensitivity, decrease the sample consumption, and cost effectiveness. LOD and LOQ values demonstrated high sensitivity of the PowerPlex® Fusion system. In addition, population databases of Brunei Malay and Chinese from the Brunei Darussalam were established, and parameters of forensic importance were calculated. Overall, the forensic parameters indicated an enhanced utility of the PowerPlex® Fusion kit for forensic evidence analysis and paternity testing in Brunei Malay and Chinese populations.