Prevalence, characteristics, and predictors of healthcare workers with COVID-19 infection in an urban district in Malaysia.

Introduction: healthcare workers (HCWs) are at high risk of acquiring COVID-19 occupational transmission and subsequently, exposing patients and others. This study aimed to determine the prevalence and examine the characteristics and predictors of HCWs with COVID-19 infection in a Malaysian district. Methods: this is a cross-sectional study of HCWs working at Cheras District Health Office, with COVID-19 infection from 1st January to 31st October 2021. Data was obtained from the Occupational Safety and Health Unit which included variables of basic sociodemography, type of disease acquisition; healthcare-acquired (HA) or community-acquired (CA), and management outcome. Data was analysed descriptively and cases with type of disease acquisition were compared using logistic regression. Results: the prevalence of HCWs with COVID-19 was 17.4%. Majority aged 30-39, female gender and Malay ethnicity (51.7%, 60% and 91.7% respectively). Main comorbidities included hypertension (3.3%), diabetes mellitus (3.3%), both hypertension and diabetes mellitus (2.5%) and obesity (4.2%). Smokers, pregnant mothers and non-immunized made up only small proportions (4.2%, 4.2%, and 4% respectively). Paramedics were the most infected proportion (68.4%). About one third of cases managed COVID-19 patients directly (37.5%). Similar proportion had HA infection (29.2%). Smaller proportion (12.8%) needed hospitalization. The early source of infection was HA (January-April). Later, the trend shifted towards CA (May-October). Male gender (OR 3.22, 95% CI = 1.43 - 7.29, p<0.05), smoker (OR 10.84, 95% CI = 1.17 - 100.77, p<0.05), and those who manage COVID-19 cases were more likely to acquire occupational COVID-19 infection (OR 2.28, 95% CI = 1.02 - 5.09, p<0.05). Conclusion: continuous occupational infectious disease control measures is necessary to reduce the disease burden. Future research on HCWs with COVID-19 infection with larger scale is recommended to determine the final model for predictors of infection.

Non-operative management of solid organ injuries in a middle-income country, how does it stack up?

INTRODUCTION: The first trauma surgery unit in Malaysia was established in 2011. After 10 years, we examine our experience in the management, and outcomes of blunt liver, spleen, and kidney injuries. METHODS: This is a cross-sectional study of patients with blunt liver, spleen, and kidney injuries in a level 1 trauma centre in Malaysia between January 2018 to June 2021. Patients' characteristics, new injury severity score, organ-specific AAST injury score, type of primary management (operative management [OM], non-operative management [NOM]), causes of failed NOM, management of failed NOM, and outcome of treatment were recorded and analysed. RESULTS: Among 448 patients, 83.9% were male and in the working-age range of 15-64 years old (93.5%). Road traffic crashes made up 92.0% of blunt trauma resulting in 65.5% of isolated organ injuries and 34.5% combined injuries. An overwhelming 84.2% of the patients had major trauma (NISS>15). Three hundred and thirty-four patients (74.6%) underwent initial non-operative management. Patients in the OM group showed lower mean GCS scores (p = 0.022) and higher NISS scores (p < 0.001). High-grade liver and kidney injuries were mostly treated with NOM (p < 0.001). In contradistinction, patients with high-grade spleen injuries had more OM performed (p < 0.001). NOM had been successful in 325 patients (97.3%) with 9 failures. Underlying causes for NOM failure were hemodynamic instability due to secondary bleeding and infectious complications. Overall mortality was 11.2%, which was significantly higher in the OM group (23.7%) than in the NOM group (6.9%). CONCLUSION: This study represents one of the largest single centre experiences on the blunt liver, spleen, and kidney injuries in Malaysia and South-East Asia. With good selection and adequate resources, non-operative management of blunt liver, spleen, and kidney injuries is a safe and effective therapeutic approach with a high success rate of 97.3%, avoiding the morbidity of unnecessary laparotomies.

Seroepidemiological Studies on Japanese Encephalitis: A Systematic Review.

Objectives: Japanese encephalitis (JE) is one of the major mosquito-borne infectious diseases in the Western Pacific region, accounting for 20%-30% of mortality cases. The JE virus (JEV) seroprevalence fluctuations indicate that continuous research is important for prevention and control activities. By mapping JEV seroprevalence by age stratification, the population profile for immunity and susceptibility can be identified to aid in vaccination program planning. Thus, this study aimed to determine the trend of age-specific JEV seroprevalence. Methods: We conducted a systematic review of all studies conducted on JEV seroprevalence between 2010 and 2019. The two search engines used were PubMed and Web of Science. Eligible criteria were set, and articles were screened according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. Three investigators cross-checked all articles assigned. Data were extracted into an Excel sheet, and results were tabulated in tables and graphs accordingly. Results: Four studies from four countries (Taiwan, Sri Lanka, South Korea, and India) met the eligibility criteria. The papers showed an increasing trend of JEV seropositivity in all countries as their populations reach older age cohorts. Nonetheless, there were slight downtrend notches seen among young adults in Taiwan and India before increasing after reaching more mature ages. South Korea has the highest seroprevalence rate (97.8%-98.3%) among the compared countries. This is most likely because it was the earliest to introduce the JEV vaccine in 1967, which was later made mandatory in the early 1980s, while India has the lowest seroprevalence rate (12.9%-18.1%). Among the old vaccination-naïve population, seropositivity is commonly derived from natural infection. Conclusions: Decreases in reported JE cases are mainly due to immunization. As JEV is expected to remain in nature and the zoonotic chains, the risk of infection will persist. Hence, it is important to apply JEV vaccination protocols in national immunization programs, prioritizing young children.

Effectiveness of Colorectal Cancer Screening Promotion Using E-Media Decision Aids: A Systematic Review and Meta-Analysis.

Colorectal cancer (CRC)-screening reduces mortality, yet remains underutilized. The use of electronic media (e-media) decision aids improves saliency and fosters informed decision-making. This systematic review aimed to determine the effectiveness of CRC-screening promotion, using e-media decision aids in primary healthcare (PHC) settings. Three databases (MEDLINE, Web of Science, and the Cochrane Library) were searched for eligible studies. Studies that evaluated e-media decision aids compared to usual care or other conditions were selected. Quality was assessed by using Cochrane tools. Their effectiveness was measured by CRC-screening completion rates, and meta-analysis was conducted to calculate the pooled estimates. Ten studies involving 9393 patients were included in this review. Follow-up durations spanned 3-24 months. The two types of decision-aid interventions used were videos and interactive multimedia programs, with durations of 6-15 min. Data from nine feasible studies with low or some risk of bias were synthesized for meta-analysis. A random-effects model revealed that CRC-screening promotion using e-media decision aids were almost twice as likely to have screening completion than their comparisons (OR 1.62, 95% CI: 1.03-2.62, p < 0.05). CRC-screening promotion through e-media has great potential for increasing screening participation in PHC settings. Thus, its development should be prioritized, and it should be integrated into existing programs.

The Prevalence and Risk Factors of Hypertension among the Urban Population in Southeast Asian Countries: A Systematic Review and Meta-Analysis.

The trend of global prevalence for hypertension has been dramatically increasing for the past two decades in Southeast Asian countries. A systematic review aiming to assess the prevalence of hypertension and its risk factors among the urban population in Southeast Asian countries was conducted. We performed database searches of PubMed and Web of Science and performed meta-analysis to determine the pooled prevalence estimate. The overall pooled prevalence estimate of hypertension for Southeast Asian urban population was 33.82%. Among this, 33.98% of hypertension was reported in the community and 32.45% among adolescents in school. The common risk factors that we found were male, ethnicity, education and socioeconomic level, body mass index, waist circumference, smoking, and dyslipidaemia. The review indicates an urgent need for primary and secondary prevention activities. Therefore, a multisectoral and intersectoral approach and collaboration should be undertaken to improve the overall health outcomes of all populations in all Southeast Asian countries.