Predictors of elevated C-reactive protein among pre-treatment, newly diagnosed breast cancer patients: A cross-sectional study.

BACKGROUND & AIMS: Accumulating evidence showed that inflammation contributes markedly to cancer progression, with C-reactive protein (CRP) being one of the lengthily studied inflammation marker. For breast cancer (BCa), pre-treatment elevated CRP upon diagnosis was linked with increased mortality. This study aimed to identify factors predictive of elevated CRP in pre-treatment BCa population that can serve as potential therapeutic targets to reduce inflammation. METHODS: This is a cross-sectional study using multiple logistic regression to identify predictors of elevated CRP among pre-treatment, newly diagnosed BCa patients. Studied variables were socio-demographic and medical characteristics, anthropometric measurements [body weight, Body Mass Index, body fat percentage, fat mass/fat free mass ratio, muscle mass, visceral fat], biochemical parameters [albumin, hemoglobin, white blood cell (WBC), neutrophil, lymphocyte], energy-adjusted Dietary Inflammatory Index, handgrip strength (HGS), scored Patient Generated-Subjective Global Assessment, physical activity level and perceived stress scale (PSS). RESULTS: A total of 105 participants took part in this study. Significant predictors of elevated CRP were body fat percentage (OR 1.222; 95 % CI 1.099-1.358; p < 0.001), PSS (OR 1.120; 95 % CI 1.026-1.223; p = 0.011), low vs normal HGS (OR 41.928; 95 % CI 2.155-815.728; p = 0.014), albumin (OR 0.779; 95 % CI 0.632-0.960; p = 0.019), and WBC (OR 1.418; 95% CI 1.024-1.963; p = 0.036). CONCLUSION: Overall, predictors of elevated CRP in pre-treatment, newly diagnosed BCa population were body fat percentage, PSS, HGS category, albumin and WBC.

Effects of a Rapid Response Team on Patient Outcomes: A Systematic Review.

BACKGROUND: Despite the widespread adoption of the rapid response team (RRT) by many hospitals, questions remain regarding their effectiveness in improving several aspects of patient outcomes, such as hospital mortality, cardiopulmonary arrests, unplanned intensive care unit (ICU) admissions, and length of stay (LOS). OBJECTIVES: To conduct a systematic review to understand the rapid response team's (RRT) effect on patient outcomes. METHODS: A systematic search was conducted using PubMed, Cochrane, Embase, CINAHL, Web of Science, and two trial registers. The studies published up to May 6, 2022, from the inception date of the databases were included. Two researchers filtered the title, abstract and full text. The Version 2 of the Cochrane Risk of Bias tool and Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool were used separately for randomized and non-randomized controlled trials for quality appraisal. RESULTS: Sixty-one eligible studies were identified, four randomized controlled trials(RCTs), four non-randomized controlled trials, six interrupted time-series(ITS) design , and 47 pretest-posttest studies. A total of 52 studies reported hospital mortality, 51 studies reported cardiopulmonary arrests, 18 studies reported unplanned ICU admissions and ten studies reported LOS. CONCLUSION: This systematic review found the variation in context and the type of RRT interventions restricts direct comparisons. The evidence for improving several aspects of patient outcomes was inconsistent, with most studies demonstrating that RRT positively impacts patient outcomes.

Prevalence and factors associated with burnout among healthcare providers in Malaysia: a web-based cross-sectional study.

BACKGROUND: This study aimed to assess the determinants of burnout among healthcare providers in the primary care setting. METHODS: A web-based cross-sectional study was conducted among 1280 healthcare providers aged 18 years and older from 30 primary care clinics in Selangor, Malaysia. In this study, the Copenhagen Burnout Inventory was used to assess burnout. The results were analyzed using multiple logistic regression. RESULTS: The prevalence of personal burnout was 41.7%, followed by work-related burnout (32.2%) and client-related burnout (14.5%). The determinants for personal burnout in this study were younger age, being a doctor, higher COVID-19 exposure risk, do not know where to seek help, inability to handle stress, poorer sleep quality score, higher total COVID-19 fear score, higher total stress score, and lower total BRS score. The determinants of work-related burnout were younger age, being a doctor, longer years of working, higher COVID-19 exposure risk, do not know where to seek help, lower altruistic score, poorer sleep quality score, higher total stress score, and lower total brief resilience score (BRS) score. The determinants of client-related burnout were doctor, single/divorced, more than one attachment site, and higher satisfaction toward the infection control, inability to handle stress, higher total depression score, and lower total BRS score. CONCLUSION: Every fourth out of ten suffered from personal burnout, one-third from work-related burnout, and one-seventh from client-related burnout among healthcare providers during the COVID-19 pandemic. Healthcare systems must take care of healthcare workers' physical and emotional depletion, reducing the risk of burnout.

Efficacy and Tolerability of a Sunscreen Containing Licochalcone a and L-Carnitine as an Adjunct to Retinoids in the Management of Acne and Post-Acne Pigmentation Among Malaysian Patients.

Purpose: We aim to evaluate the effectiveness and tolerability of a sunscreen formulation containing licochalcone A (LicA) and L-carnitine (LC) as an adjuvant to adapalene in the management of acne and post-acne pigmentation (PAH). Patients and Methods: A randomized, double-blind, active comparator-controlled trial of 51 patients aged 18 years or older with a clinical diagnosis of mild-to-moderate acne vulgaris was conducted at the Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia. The efficacy and tolerability of once-daily adapalene 1.0% were assessed during the 2-week run-in period. Subsequently, patients were randomized to receive either an add-on investigational LicA-containing sunscreen or niacinamide-containing comparator sunscreen every 4 hourly during daytime for 4 weeks. Patients were followed up at Weeks 2 and 4 to assess for improvement in acne severity, PAH, calorimetric parameters and cutaneous tolerability. Results: Two weeks of adapalene usage significantly improved acne severity; however, up to 52% of patients experienced dryness, burning and stinging. Adding LicA-containing or comparator sunscreens was associated with further improvement in acne severity, PAH and calorimetric parameters at the study endpoint. No significant differences in the cutaneous tolerability profiles were observed between treatment groups. Notably, significantly fewer patients receiving LicA-containing sunscreen developed scaliness at Week 4 compared with those in the comparator group. In addition, more patients receiving LicA-containing sunscreen reported less dryness, burning and stinging reactions than the comparator group. Importantly, more patients receiving LicA-containing sunscreen agreed that their treatment led to excellent improvement than the comparator group; of note, one patient reported that their condition worsened with the receipt of the comparator product. Conclusion: The concurrent use of LicA-containing sunscreen with adapalene may improve the cutaneous tolerance to adapalene among Malaysian patients.

Level of fear towards COVID-19 and its determinants among healthcare providers in Malaysia: A cross-sectional study.

Introduction: Malaysia is one of the hardest-hit countries by COVID-19 in Asia. The rapidly rising number of cases had sparked fear among healthcare providers. This study aimed to assess the determinants of fear towards COVID-19 among healthcare providers in primary care settings. Method: This online-based cross-sectional study was conducted among 1280 healthcare providers aged ≥18 years from 30 primary care clinics in the state of Selangor, Malaysia. The Fear of COVID-19 Scale was used to assess the level of fear, and the results were analysed using multiple linear regression. Results: The mean age of the respondents was 36 years, and the mean working experience was 11 years. The majority of the respondents were women (82.4%) and Malays (82.3%). The factors that were significantly correlated with higher levels of fear were underlying chronic disease (ß=1.12, P=0.002, 95% confidence interval [CI]=0.08, 3.15), concern about mortality from COVID-19 (ß=3.3, P<0.001, 95% CI=0.19, 7.22), higher risk of exposure (ß=0.8, P<0.001, 95% CI=0.14, 5.91), concern for self at work (ß=2.8, P=0.002, 95% CI=0.08, 3.10) and work as a nurse (ß=3.6, P<0.001, 95% CI=0.30, 7.52), medical laboratory worker (ß=3.0, P<0.001, 95% CI=0.12, 4.27) and healthcare assistant (ß=3.9, P<0.001, 95% CI=0.17, 5.73). The level of fear was inversely correlated with a higher work-related stress management score (ß=-0.9, P<0.001, 95% CI=-0.14, -5.07) and a higher sleep quality score (ß=-1.8, P<0.001, 95% CI=-0.28, -10.41). Conclusion: Family physicians should be vigilant and identify healthcare providers at risk of developing COVID-19-related fear to initiate early mental health intervention.

A self-management app to improve asthma control in adults with limited health literacy: a mixed-method feasibility study.

BACKGROUND: Digital technology tailored for those with limited health literacy has the potential to reduce health inequalities. Although mobile apps can support self-management in chronic diseases, there is little evidence that this approach applies to people with limited health literacy. We aimed to determine the acceptability of a self-management app in adults living with asthma and have limited health literacy and the feasibility of delivering the intervention and assessing outcomes. METHODS: We recruited eligible adults from the Klang Asthma Cohort registry in primary care for a 3-month mixed-method study plus a 2-month extended observation. We collected baseline data on socio-demography, health literacy and asthma control level. The outcomes of the intervention were assessed at 1- and 3-month: i) adoption (app download and usage), ii) adherence (app usage), iii) retention (app usage in the observation period), iv) health outcomes (e.g., severe asthma attacks) and v) process outcomes (e.g., ownership and use of action plans). At 1-month, participants were purposively sampled for in-depth interviews, which were audio-recorded, transcribed verbatim, and analysed deductively. RESULTS: We recruited 48 participants; 35 participants (23 Female; median age = 43 years; median HLS score = 28) completed the 3 months study. Of these, 14 participants (10 Female; median age = 48 years; median HLS score = 28) provided interviews. Thirty-seven (77%) participants adopted the app (downloaded and used it in the first month of the study). The main factor reported as influencing adoption was the ease of using the app. A total of 950 app usage were captured during the 3-month feasibility study. App usage increased gradually, peaking at month 2 (355 total log-ins) accounting for 78% of users. In month 5, 51.4% of the participants used the app at least once. The main factors influencing continued use included adherence features (e.g., prompts and reminders), familiarity with app function and support from family members. CONCLUSIONS: An asthma self-management app intervention was acceptable for adults with limited health literacy and it was feasible to collect the desired outcomes at different time points during the study. A future trial is warranted to estimate the clinical and cost-effectiveness of the intervention and to explore implementation strategies.

Stop and Play Digital Health Education Intervention for Reducing Excessive Screen Time Among Preschoolers From Low Socioeconomic Families: Cluster Randomized Controlled Trial.

BACKGROUND: High prevalence of excessive screen time among preschool children is attributable to certain parental factors such as lack of knowledge, false perception about screen time, and inadequate skills. Lack of strategies to implement screen time guidelines, in addition to multiple commitments that may hinder parents from face-to-face interventions, demands the need to develop a technology-based parent-friendly screen time reduction intervention. OBJECTIVE: This study aims to develop, implement, and evaluate the effectiveness of Stop and Play, a digital parental health education intervention to reduce excessive screen time among preschoolers from low socioeconomic families in Malaysia. METHODS: A single-blind, 2-arm cluster randomized controlled trial was conducted among 360 mother-child dyads attending government preschools in the Petaling district, who were randomly allocated into the intervention and waitlist control groups between March 2021 and December 2021. This 4-week intervention, developed using whiteboard animation videos, infographics, and a problem-solving session, was delivered via WhatsApp (WhatsApp Inc). Primary outcome was the child's screen time, whereas secondary outcomes included mother's screen time knowledge, perception about the influence of screen time on the child's well-being, self-efficacy to reduce the child's screen time and increase physical activity, mother's screen time, and presence of screen device in the child's bedroom. Validated self-administered questionnaires were administered at baseline, immediately after the intervention, and 3 months after the intervention. The intervention's effectiveness was evaluated using generalized linear mixed models. RESULTS: A total of 352 dyads completed the study, giving an attrition rate of 2.2% (8/360). At 3 months after the intervention, the intervention group showed significantly reduced child's screen time compared with the control group (ß=-202.29, 95% CI -224.48 to -180.10; P<.001). Parental outcome scores also improved in the intervention group as compared with that in the control group. Mother's knowledge significantly increased (ß=6.88, 95% CI 6.11-7.65; P<.001), whereas perception about the influence of screen time on the child's well-being reduced (ß=-.86, 95% CI -0.98 to -0.73; P<.001). There was also an increase in the mother's self-efficacy to reduce screen time (ß=1.59, 95% CI 1.48-1.70; P<.001) and increase physical activity (ß=.07, 95% CI 0.06-0.09; P<.001), along with reduction in mother's screen time (ß=-70.43, 95% CI -91.51 to -49.35; P<.001). CONCLUSIONS: The Stop and Play intervention was effective in reducing screen time among preschool children from low socioeconomic families, while improving the associated parental factors. Therefore, integration into primary health care and preschool education programs is recommended. Mediation analysis is suggested to investigate the extent to which secondary outcomes are attributable to the child's screen time, and long follow-up could evaluate the sustainability of this digital intervention. TRIAL REGISTRATION: Thai Clinical Trial Registry (TCTR) TCTR20201010002; https://tinyurl.com/5frpma4b.

Effectiveness of video self-instruction training on cardiopulmonary resuscitation retention of knowledge and skills among nurses in north-western Nigeria.

Background: Adaptable cardiopulmonary resuscitation/basic life support (CPR/BLS) training are required to reduce cardiac arrest mortality globally, especially among nurses. Thus, this study aims to compared CPR knowledge and skills retention level between instructor-led (control group) and video self-instruction training (intervention group) among nurses in northwestern Nigeria. Methods: A two-arm randomized controlled trial study using double blinding method was conducted with 150 nurses from two referral hospitals. Stratified simple random method was used to choose eligible nurses. For video self-instruction training (intervention group), participants learnt the CPR training via computer in a simulation lab for 7 days, in their own available time whereas for instructor-led training (control group), a 1-day program was conducted by AHA certified instructors. A generalized estimated equation model was used for statistical analysis. Results: Generalized Estimated Equation showed that there were no significant differences between the intervention group (p = 0.055) and control group (p = 0.121) for both CPR knowledge and skills levels respectively, whereas higher probability of having good knowledge and skills in a post-test, one month and three-month follow-up compared to baseline respectively, adjusted with covariates (p < 0.05). Participants had a lower probability of having good skills at 6-month follow-up compared to baseline, adjusted with covariates (p = 0.003). Conclusion: This study showed no significant differences between the two training methods, hence video self-instruction training is suggested can train more nurses in a less cost-effective manner to maximize resource utilization and quality nursing care. It is suggested to be used to improve knowledge and skills among nurses to ensure cardiac arrest patients receive excellent resuscitation care.

Interactions of genetic and macronutrient intake with abdominal obesity among middle-aged vegetarians in Malaysia.

BACKGROUND AND OBJECTIVES: Evidence for gene-diet interactions is lacking among individuals with specific dietary practices including vegetarians. This study aimed to determine the interactions of rs174547 in the fatty acid desaturase 1 (FADS1) gene with macronutrient such as carbohydrate (particularly fibre), protein and fat intakes on abdominal obesity among middle-aged Malaysian vegetarians of Chinese and Indian ethnicity. METHODS AND STUDY DESIGN: The present cross-sectional study was conducted among 163 vegetarians in Kuala Lumpur and Selangor, Malaysia. Dietary intakes of vegetarians were assessed by using a food frequency questionnaire. Waist circumference of vegetarians was measured by using a Lufkin tape W606PM. Genotypes of the rs174547 of vegetarians were determined by using Agena® MassARRAY. A multiple logistic regression model was used to determine the interactions of the rs174547 with macronutrient on abdominal obesity. RESULTS: About 1 in 2 vegetarians (51.5%) had abdominal obesity. Individuals with CT and TT genotype at T3 intake of carbohydrates, protein, fat and fibre as well as individuals with TT genotype at T2 intake of carbohydrates and protein had higher odds of abdominal obesity (pinteration <0.05). The gene-diet interaction remained significant for fibre intake (OR: 4.71, 95% CI: 1.25-17.74, pinteraction=0.022) among vegetarians with TT genotype at T2 intake of fibre after adjusting for age and sex and considering the effects of ethnicity and food groups. CONCLUSIONS: The rs174547 significantly interacted with fibre intake on abdominal obesity. A specific dietary fibre recommendation based on genetics is needed among Chinese and Indian middle-aged vegetarians.

Spatial Accessibility of Primary Care in the Dual Public-Private Health System in Rural Areas, Malaysia.

Disparities in access to health services in rural areas represent a global health issue. Various external factors contribute to these disparities and each root requires specific remedial action to alleviate the issue. This study elucidates an approach to assessing the spatial accessibility of primary care, considering Malaysia's dual public-private system specifically in rural areas, and identifies its associated ecological factors. Spatial accessibility was calculated using the Enhance 2-Step Floating Catchment Area (E2SFCA) method, modified as per local context. Data were secondary sourced from Population and Housing Census data and administrative datasets pertaining to health facilities and road network. The spatial pattern of the E2SFCA scores were depicted using Hot spot Analysis. Hierarchical multiple linear regression and geographical weight regression were performed to identify factors that affect E2SFCA scores. Hot spot areas revolved near the urban agglomeration, largely contributed by the private sector. Distance to urban areas, road density, population density dependency ratios and ethnic composition were among the associated factors. Accurate conceptualization and comprehensive assessment of accessibility are crucial for evidence-based decision making by the policymakers and health authorities in identifying areas that need attention for a more specific and localized planning and development.

Completers Versus Dropouts of A Parent Training Programme and Child Behaviour Improvement In Malaysia

@#Introduction: There is a strong body of evidence advocating parent training programmes in the management of behavioral problems in children. In these programmes, attrition is a major challenge. We aimed to examine the sociodemographic and clinical profiles, parental motivation, and pre-intervention severity of children’s behavioural problems as rated by mothers who completed (PC) and mothers who dropped out (PD) of a parent training programme. We also aimed to determine whether there was any change in their children’s behaviour scores before and after intervention. We hypothesized that parent and child sociodemographic and clinical profiles, parental motivation, and pre-intervention severity of children’s behavioural problems would be different between PC and PD, and that children of PC would experience significant improvements in their behaviour. Methods: Data from a randomised controlled trial (RCT) involving 35 mothers and children aged 6–12 years old with behavioural problems who were enrolled in a parent training programme were examined. Child behaviour was measured using the Strength and Difficulties Questionnaire. Results: No significant differences were found between PC and PD in terms of the sociodemographic and clinical profiles, parental motivation, and pre- or post-intervention child behaviour. After programme completion, PC (n=27) reported improvements in all the behaviour subscales; total difficulties (p<0.001), emotional problem (p=0.004), conduct problem (p=0.001), hyperactivity symptoms (p<0.001), peer problems (p=0.036), and prosocial behaviour (p=0.001). Conclusion: The parent training programme produces significant child behaviour improvements in mothers who complete the programme. Nonetheless, the study has some limitations which restrict the generalizability of these findings.

Determinants of Premarital Sexual Behavior Among the Late Adolescents in Pahang, Malaysia

@#Introduction: Premarital sexual behaviour remains an important sexual and reproductive health issue among adolescents in Malaysia. It is also a prohibited act and considered sinful among the Muslims community. This study aimed to identify the determinants of premarital sexual behaviour among the late adolescents age group in Pahang, Malaysia. Methods: An observational study was conducted among eligible late adolescents, which were recruited using probability sampling method. Only those aged 18 to19 years old, and previously attended the public secondary schools in Malaysia were included, with non-Malaysian, married and those who were absent during the data collection day were excluded. Data was collected using a valid and reliable set of questionnaires measuring the personal (demographic profile, knowledge and attitude), behavioural (premarital sexual behaviour and high-risk activities) and environmental (subjective norms and perceived parental communication) factors. Multiple logistic regression analysis was conducted to identify the determinants of premarital sexual behaviour. Results: A total of 390 adolescents aged 18 and 19 years old participated in this study, with 82.3% of respondents reported never had premarital sexual behaviour. Multiple logistic regression showed that the male and engagement in high-risk activities had higher odds in premarital sexual behaviour respectively (AOR =11.649, 95% CI: 3.615,37.536, p <0.001; AOR=19.224, 95% CI: 7.820,47.262, p <0.001). Conclusion: Male gender and engagement in high-risk activities remained important risk factors towards the ongoing concern related to premarital sexual behaviour among adolescents in Malaysia. Failure to address this issue should be explored and improve accordingly.

Association between dietary inflammatory index and body fat percentage among newly diagnosed breast cancer patients.

BACKGROUND: Obesity, particularly excessive body fat, is an established risk factor and substantial prognostic determinant in breast cancer. Recent studies suggested that diet-related inflammation plays a key role in obesity. This study aimed to determine the association between energy-adjusted dietary inflammatory index (E-DII) and body composition, particularly body fat percentage, among patients with newly diagnosed breast cancer. MATERIALS AND METHODS: This cross-sectional study was conducted on 124 breast cancer outpatients within the first year of diagnosis and yet to commence oncological treatment. Body composition parameters [body weight, body mass index (BMI), body fat percentage, fat mass over fat-free mass ratio (FM/FFM), muscle mass, and visceral fat] were obtained using a bioelectrical impedance analyzer. Body fat percentage was categorized into two groups which were normal (<35%) and high (≥35%). The E-DII was calculated from the validated 165-items Food Frequency Questionnaire (FFQ) and categorized into three groups or tertiles. Multiple logistic regression analysis was used to determine the association between the E-DII and body fat percentage. RESULTS: Mean body weight, body fat percentage, FM/FFM, and visceral fat increased as E-DII increased from the lowest tertile (T1) to the most pro-inflammatory tertile (T3) (p for trend <0.05). E-DII was positively associated with body fat percentage (OR 2.952; 95% CI 1.154-7.556; p = 0.024) and remained significant after adjustment for cancer stage, age, physical activity, ethnicity, smoking history, and presence of comorbidities. Compared to T1, participants in T3 had a significantly lower consumption of fiber, vitamin A, beta-carotene, vitamin C, iron, thiamine, riboflavin, niacin, vitamin B6, folic acid, zinc, magnesium, and selenium, but a higher intake of total fat, saturated fat, and monounsaturated fatty acids. CONCLUSIONS: A higher E-DII was associated with increased body fat percentage, suggesting the potential of advocating anti-inflammatory diet to combat obesity among newly diagnosed breast cancer patients.

E-DII was significantly and positively associated with high body fat percentage, particularly among pre-menopausal breast cancer patients.Participants in the highest E-DII tertile group had significantly higher body weight, body fat percentage, FM/FFM, and visceral fat than those in the lowest E-DII tertile group.Those in the highest E-DII tertile group were more likely to consume a higher intake of total fat, saturated fat, and monounsaturated fatty acids, but lower fiber, vitamin A, beta-carotene, vitamin C, iron, thiamine, riboflavin, niacin, vitamin B6, folic acid, zinc, magnesium, and selenium compared to the lowest E-DII tertile group.

Factors predicting health-related quality of life of the Malaysian B40 school-aged children living in urban-poor flats in the central region of Malaysia.

BACKGROUND AND OBJECTIVES: Health-related quality of life (HRQoL) is a multidimensional concept that indicated an individual's holistic health, whereby the urban-poor community are susceptible to low HRQoL due to their high vulnerability. This study aimed to determine factors that predicted the HRQoL among the urban-poor school-aged children. METHODS AND STUDY DESIGN: This is a cross-sectional study and a total of 408 primary school-aged children (male: 72.3%; female: 27.7%), with a mean age of 9.68±1.48 years, were recruited from 10 urban-poor flats through cluster sampling at the central region of Malaysia. Their anthropometry, nutrition knowledge, attitude and practice, physical activity, dietary practices, and HRQoL were assessed. RESULTS: A quarter (24.5%) of the urban-poor children were either overweight or obese in the present study. The HRQoL total score among the urban-poor children was 65.0±18.5. The result of multiple linear regression analysis shown that higher nutrition attitude (B=0.34, p=0.001) and practices (B=0.39, p=0.001), higher physical activity (B=3.73, p=0.004), higher lunch intake (B=1.35, p<0.001), lower supper intake (B=-1.35, p<0.001), and lower fast-food intake (B=-1.61, -1.17, p<0.001) are the significant predictors of better HRQoL among the urban-poor children (R2=0.32, F(8,399)=23.72, p<0.001). CONCLUSIONS: Future studies should focus on these predictors to formulate interventions that could enhance the HRQoL among the Malaysian urban-poor children.

An exploratory study on the handwritten allographic features of multi-ethnic population with different educational backgrounds.

Ethnicity, native and/or foreign language knowledge, as well as the learned writing systems potentially influence the development of an individual's handwriting. The unique education system consisting of National schools, Chinese-medium vernacular schools, Tamil-medium vernacular schools, and Islamic religious schools in Malaysia may have established specific characteristic handwritten allographic features that deserve investigation within the intelligence context. This study was aimed to explore handwritten allographic features of handwriting samples from 120 subjects (30 writers from four different educational backgrounds mentioned above). Characteristic features which could be attributed to the study groups were statistically analyzed and identified. In this study, thirteen allographic features, including letters "A", "B", "D", "H", "p", "T", "t", "w", "X" and "x", were found to be discriminative. Such information could serve to indicate the primary education system undergone by a writer; enabling the comparison of different handwriting profiles and allowing characterization of writers to a specific group of people.

COVID-19 Inpatient Deaths and Brought-in-Dead Cases in Malaysia.

Coronavirus disease 2019 (COVID-19) deaths can occur in hospitals or otherwise. In Malaysia, COVID-19 deaths occurring outside of the hospital and subsequently brought to the hospital are known as brought-in-dead (BID) cases. To date, the characteristics of BID COVID-19 cases in Malaysia are not clear. The objectives of this study are 2-fold: to explore the characteristics of 29,155 mortality cases in Malaysia and determine the factors associated with the high probability of BID, using the multilevel logistic regression model. Data on COVID-19 mortality cases from the entire country between March 17, 2020 and November 3, 2021 were retrieved from a national open data source. Of the 29,155 COVID-19 mortality cases, 5,903 (20.2%) were BID. A higher probability of BID (p < 0.05) was seen among individuals aged between 18 and 59 years, non-Malaysians, had no comorbidities, did not receive COVID-19 vaccination, and the interval between the date of death and diagnosis. A high prevalence of BID is an alarming public health issue, as this may signal health system failure at one or several levels and, hence, need urgent attention from relevant stakeholders. Based on the findings of this study, increasing the intensity of the vaccination campaign, addressing any issues faced by noncitizens about to COVID-19 management in- and out-of-hospital, increasing the awareness of signs and symptoms of worsening COVID-19 and, hence, the significance of self-monitoring, and determining the potential gaps in the health system may contribute to their increased risk of deaths.

Systematic review on factors associated with self-perceived burden among cancer patients.

INTRODUCTION: Cancer is the leading cause of death in the world. There was a high prevalence of high self-perceived burden (SPB) among cancer patients and this could bring adverse consequences to the physical and mental health of cancer patients, which can lead to suicide if not treated well. This review aims to determine the prevalence of SPB among cancer patients and its risk factors. METHODS: Published journals before September 2021, from five databases (PubMed, ScienceDirect, Springer, Cochrane, and CNKI) were retrieved according to the keywords. The keywords used included cancer patients, terminally ill patients, cancer, SPB, self-perceived burden, self-burden, self-perceived, factor, predictor, associated factor, determinants, risk factor, prognostic factor, covariate, independent variable, and variable. The quality of the inclusion and exclusion criteria was independently reviewed by three researchers. RESULTS: Out of 12,712 articles, there are 22 studies met the eligibility criteria. The prevalence of SPB among cancer patients ranged from 73.2 to 100% in Malaysia, China, and Canada. Most of them had moderate SPB. Out of the reported factors, age, gender, marital status, ethnicity, residence, educational level, occupational status, family income, primary caregiver, payment methods, disease-related factors, psychological factors, and physical factors were mostly reported across the studies. CONCLUSIONS: In conclusion, SPB prevalence is high in cancer patients. Therefore, hospitals, non-governmental organizations, relevant policymakers, and communities can provide special programs for high-risk groups to provide psychological guidance or design corresponding interventions to reduce the SPB level of patients and improve the quality of life.

Effectiveness of Triple Benefit Health Education Intervention on Knowledge, Attitude and Food Security towards Malnutrition among Adolescent Girls in Borno State, Nigeria.

Knowledge and attitude are essential components of food security as malnutrition remains a critical public health concern among adolescents. The study evaluates the effectiveness of a Triple Benefit Health Education Intervention on knowledge, attitude and food security towards malnutrition among adolescent girls. This was a cluster randomized controlled trial among 417 randomly selected adolescent girls aged 10 to 19 years old in Maiduguri, Borno state, Nigeria from October 2019 to March 2020. About 208 respondents were assigned to experimental while 209 to control group, respectively, using an opaque sealed envelope. A structured questionnaire using KoBo Collect Toolbox was used for the collection of data at baseline, three and six-months post intervention while the data collected were analyzed using generalized estimating equation (GEE). The outcome of the baseline shows no statistically significant difference in sociodemographic characteristics, knowledge, attitude and food security between experimental and control groups. The study reveals a statistically significant difference between experimental and control groups for knowledge (p < 0.001; p < 0.001), attitude (p < 0.001; p < 0.001) and food security (p = 0.026; p = 0.001) at three and six-months post intervention, respectively. The triple benefit health education intervention package employed in this study can serve as an intervention tool to combat malnutrition among adolescent girls in Nigeria at large.

Risk factors for early TB treatment interruption among newly diagnosed patients in Malaysia.

TB treatment interruption has resulted in delayed sputum conversion, drug resistance, and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction. To date, there are limited studies investigating the physico-social risk factors for early treatment interruptions. This prospective multicenter cohort study aimed to investigate the risk factors for early treatment interruption among new pulmonary tuberculosis (TB) smear-positive patients in Selangor, Malaysia. A total of 439 participants were recruited from 39 public treatment centres, 2018-2019. Multivariate Cox proportional hazard analyses were performed to analyse the risk factors for early treatment interruption. Of 439 participants, 104 (23.7%) had early treatment interruption, with 67.3% of early treatment interruption occurring in the first month of treatment. Being a current smoker and having a history of hospitalization, internalized stigma, low TB symptoms score, and waiting time spent at Directly Observed Treatment, Short-course centre were risk factors for early treatment interruption. An appropriate treatment adherence strategy is suggested to prioritize the high-risk group with high early treatment interruption. Efforts to quit smoking cessation programs and to promote stigma reduction interventions are crucial to reduce the probability of early treatment interruption.