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Tulisan ini mencoba mengungkap gambaran budaya politik etnis kontemporer yang dapat dicapai melalui pendekatan perilaku memilih dan kajian budaya etnis. Studi dilakukan pada etnis Sunda, kelompok etnis terbesar kedua di Indonesia yang memiliki dampak elektoral signifikan pada tingkat nasional tetapi tidak banyak literatur yang membahas budaya politiknya. Menggunakan metode gabungan kuantitatif berbasis survei dan kualitatif berbasis studi literatur, hasil penelitian menunjukkan bahwa penekanan pemilih Sunda terhadap pertimbangan faktor agama dan etnis dimaknai sebagai tuntutan etika dan keharmonisan nilai budaya ketimbang konservatisme agama. Pemilih Sunda menyukai kandidat yang mewakili nilai-nilai ideal kepemimpinan Sunda, seperti cerdas, ramah, santun, dan berwibawa. Gambaran tersebut sejalan dengan karakteristik dualitas budaya politik Sunda yang di satu sisi mengedepankan keharmonisan, taktik, dan penghormatan; sedangkan di sisi lainnya cenderung pasif dan menghindari cara konfrontatif.

The investigation of the graphene (GN) performance in improving mechanical properties of recycled polypropylene with crosslinkedpolyaniline (rPP-g-PANI) was prepared via ultrasound extrusion. The concentration of GN in the research was varied from 0.5 to 3 phr, while polyaniline (PANI) and dycumil peroxide(DCP) were fixed at 4 wt. % and 1 phr loading, respectively. The morphological structure of the nanocomposites was investigated using fill emission scanning electron microscopy (FESEM) and confirmed a good dispersion of PANI and GN on rPP matrix. The increasing loading of GN has promoted a slight improvement in tensile modulus and tensile strength at 1.5 and 2 phr of GN loadings, respectively. However elongation at break showed a decrease at all PANI loadings due to lack of interfacial addition between PANI/GN particles and the rPP matrix.

We have investigated the spatial self-phase modulation of palm oil containing silver nanoparticles (palm oil/Ag-NPs). The study carried out using continuous wave diode pumped solid state laser with wavelength of 405 nm and power of 50 mW. The strong spatial self-phase modulation patterns were observed that suggest the palm oil/Ag-NPs have a relatively large nonlinear refractive index. The obtained values of nonlinear refractive index were increased with the increase of volume fractions. The observed experimental patterns were also theoretically modeled which are in good agreement with experimental results.

This study is meant to examine the thesis quality of students of English Department at IAIN Samarinda. Through the descriptive-quantitative research, the thesis quality of students of English Department at IAIN Samarinda is reviewed from the aspects of language, structure, concepts understanding, theoretical framework, methodology, content, writing mechanism, and references used. This study also tries to figure out any factors that affect the thesis quality of English Department students. Fourteen English Department Students' thesis tested in 2013 are used as the main data. In addition, other data are obtained from respondents i.e. 19 students, and informants i.e. lecturers of English Department who are also their thesis advisors. The result shows that the average score of thesis written by 14 English Department students at IAIN Samarinda academic year of 2013 is 3.16 which is in the range of 2.61-3.40 scale, which is quite good quality. This quality is relevant with the informants' perceptions about the quality of thesis written by their students. Judging from some aspects, they assume that their students are able to write a good quality of thesis with an average score of 2.81 which is at a scale of 2.61-3.40. The quality is affected by internal factors and external factors. The most decisive internal factor is the respondents' low score of writing with appropriate and acceptable structure in English. This is the effect of respondents' lack of ability of composing adequate paragraphs in English. Meanwhile, the most concerning external factor is the quality of learning structure course and the professionalism of the informants in guiding the students to improve their writing ability in thesis writing. A bibliography is included.

The use of graph theory in the fields of chemistry, pharmacy, communication, maps, and aeronautics is significant. In order to study the properties of chemical compounds, the molecules of those compounds are modeled as graphs. Boiling point, enthalpy, π-electron energy, and molecular weight are a few examples of physical properties that are related to the geometric structure of the compound. Recently, the modified symmetric division deg (mSDD(G), in short) index is defined as the total of all adjacent vertices in pairs μv of the term ... . The purpose of this article is to demonstrate the usefulness of mSDD(G) index through the resolution of an interdisciplinary problem describing the structure of benzenoid hydrocarbons. With the help of linear regression models, we have studied the physicochemical properties of benzenoid hydrocarbons. Strong correlations were obtained, and the bounds for the same index were subsequently established. [ABSTRACT FROM AUTHOR]

In the field of cheminformatics, the amalgamation of graph theory, chemistry, along with technology facilitates the establishment of connections between the structural aswell as physiochemical attributes of organic compounds by employing certain valuable graph invariants including the corresponding molecular graph. In this work, we examine reverse topological indices, for instance, the reverse Zagreb index, the reverse arithmetic-geometric, the geometric-arithmetic, the reverse Nirmala indices for the bistar graphs B(n;m), the reverse sum-connectivity index, the reverse Sombor as well as the corona product of Km ο Kn'. [ABSTRACT FROM AUTHOR]

The traditional human-based visual quality inspection approach in agriculture is unreliable and uneven due to various variables, including human errors. In addition to the lengthy processing durations, the traditional method necessitates plant disease diagnostic experts. On the other hand, existing image processing approaches in agriculture produce low-quality output images despite having a faster computation time. As a result, a more comprehensive set of image processing algorithms was used to improve plant disease detection. This research aims to develop an efficient method for detecting leaf diseases using image processing techniques. In this work, identifying paddy diseases based on their leaves involved a number of image-processing stages, including image pre-processing, image segmentation, feature extraction, and eventually paddy leaf disease classification. The proposed work targeted the segmentation step, whereby an input image is segmented using the K-Means clustering with image scaling and colour conversion technique in the pre-processing stage. In addition, the Gray Level Co-occurrence Matrix technique (GLCM) is used to extract the features of the segmented images, which are used to compare the images for classification. The experiment is implemented in MATLAB software and PC hardware to process infected paddy leaf images. Results have shown that K-Means Clustering and GLCM are capable without using the hybrid algorithm on each image processing phase and are suitable for paddy disease detection. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine the influence of doping rare earth ion on strontium calcium aluminate (CaO-SrO-SiO2-Al2O3). Therefore, the authors have manufactured luminescent material consisting of 40CaO-5SrO-5SiO2-50Al2O3 doped with Dy3+. The compositions have been selected on the basis of chemical stability. Five pellets were prepared with different calcination temperatures and times, namely 400 and 600°C for 1 and 2 h, in order to shed light on their luminescence behaviour. X-ray diffraction, energy dispersive X-ray analysis and scanning electron microscopy elaborate and characterise the formation of small particle of photoluminescent material in the phosphor matrix host material. [ABSTRACT FROM AUTHOR]

Reza Zamiri1, Azmi Zakaria1,2, Mohd Shahril Husin1, Zaidan Abd Wahab1, Forough Kalaei Nazarpour3 1Department of Physics, Faculty of Science, 2Advanced Materials and Nanotechnology Laboratory, Institute of Advanced Technology, 3Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor, Malaysia Abstract: In the present work, we prepared silver nanoparticles by laser ablation of pure silver plate in ethanol and then irradiated the silver nanoparticles using a 532 nm Q-switched Nd:YAG pulsed laser. Transmission electron microscopic images of the sample after irradiation clearly showed formation of big structures, such as microrods and microbelts in ethanol. The obtained microbelts had a width of about 0.166 µm and a length of 1.472 µm. The reason for the formation of such a big structure is the tendency of the nanoparticles to aggregate in ethanol before irradiation, which causes fusion of the nanoparticles. Keywords: nanomaterial, laser ablation, nanoparticles

The pulsed laser thermal lens technique was used to study the thermal diffusivity of fluids containing copper nanoparticles (Cu-NPs) prepared by γ-irradiation method. The samples were prepared for the different concentrations of Cu precursor at 20.KGy dose. A Q-switched Nd-YAG pulsed laser of wavelength 532.nm was used as an excitation source and He-Ne laser was used as a probe beam in the present thermal lens experiment. It was found that the thermal diffusivity of the solution depends on the density of Cu-NPs.

The aim of the present study was to determine the influence of doping rare earth ion on strontium calcium aluminate (CaO-SrO-SiO2-Al2O3). Therefore, the authors have manufactured luminescent material consisting of 40CaO-5SrO-5SiO2-50Al2O3 doped with Dy3+. The compositions have been selected on the basis of chemical stability. Five pellets were prepared with different calcination temperatures and times, namely 400 and 600°C for 1 and 2 h, in order to shed light on their luminescence behaviour. X-ray diffraction, energy dispersive X-ray analysis and scanning electron microscopy elaborate and characterise the formation of small particle of photoluminescent material in the phosphor matrix host material. [ABSTRACT FROM AUTHOR]

Background: Chronic diseases are known to detrimentally impact an individual's quality of life (QOL) and well-being. Therefore, this study aims to evaluate the QOL and overall well-being among both healthy individuals and those with diverse primary diagnoses., Methods: This is a cross-sectional study and data collection took place from May 2022 to May 2023. Information regarding healthy participants was gathered from healthcare workers without any comorbidities. Data for non-healthy participants were collected from individuals diagnosed with various conditions across four specialist clinics: nephrology, oncology, psychiatry, and cardiology. All participants completed the Significant Quality of Life Measures (SigQOLM), a comprehensive assessment tool consisting of 69 items that evaluate 18 domains of QOL and well-being., Results: The study included a total of 452 participants, with 284 (62.8%) classified as healthy. Among the non-healthy participants, 41 (9.1%) had end-stage renal diseases (ESRD), 48 (10.6%) were diagnosed with cancer, 40 (8.8%) had depressive disorder, and the remaining had heart disease (8.6%). Statistical analysis revealed significant differences (p < 0.001) between healthy and non-healthy participants in both overall SigQOLM scores and across all 18 domains of SigQOLM., Conclusion: Generally, healthy participants also experienced excellent QOL and well-being. However, disparities in both QOL and overall well-being were evident among patients with various diagnoses. These findings provide valuable insights for medical practitioners and policy makers by enabling them to tailor interventions to enhance the QOL and well-being of their patients., Competing Interests: Declarations. Ethics approval and consent to participate: This study received ethics approval and obtained prior written consent from research participants. Only individuals who had given their written informed consent would be eligible for participation in the study. Ethical approval for this study was granted by the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia under the registration number of NMRR ID-21-01979-XDL (IIR). All the authors of this paper have confirmed that this study has adhered to the relevant guidelines and regulations pertaining to the reporting of experiments on humans and/or the use of human tissue samples. Consent for publication: We have obtained the formal approval for publication of this article from the Director-General of the Ministry of Health, Malaysia. Therefore, we thank the Director-General of Health of the Ministry of Health, Malaysia for his kind permission to publish these findings. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Evidence of the waning immunity of coronavirus disease 2019 (COVID-19) primary vaccination, and immune evasion by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants has led to the rollout of booster vaccination in many countries. Assessing the effectiveness of booster vaccination against severe COVID-19 outcomes is crucial during the transition to endemicity., Methodology: We conducted a population-based, matched case-control study in Malaysia to estimate the marginal vaccine effectiveness (mVE) of homologous and heterologous BNT162b2 and CoronaVac booster vaccination against COVID-19 related intensive care unit (ICU) admission and death in Delta-predominant and Omicron-predominant periods., Results: Receipt of a booster vaccination - either homologous or heterologous for CoronaVac, and homologous for BNT162b2 - demonstrated mVE estimates of at least 70% against ICU admission and at least 80% against death, compared to BNT162b2 primary vaccination, in both periods. Overall, the mVE estimates were 10-20 percentage points lower in the Omicron-predominant period than in the Delta-predominant period., Conclusions: Our study reaffirms that the administration of booster vaccination increases protection against severe COVID-19 outcomes for BNT162b2 and CoronaVac primary vaccination recipients., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2025 Masliyana Husin, Peter Seah Keng Tok, Jing Lian Suah, Boon Hwa Tng, Thevesh Thevananthan, Kalaiarasu M Peariasamy, Sheamini Sivasampu.)

Objectives: Health-Significant Quality of Life Measure (Health-SigQOLM) provides a generic and dynamic assessment of Health-related quality of life (HRQOL). This study aims to assess the HRQOL among healthy and non-healthy participants with varying chronic diseases., Results: Comparisons between healthy and non-healthy participants revealed statistically significant differences (p < 0.001) in the mean overall HRQOL score as well as across all its nine domains. Therefore, the Health-SigQOLM, along with its nine domains, is demonstrated to have adequate sensitivity in distinguishing between healthy and non-healthy study participants. This had supported the evidence that the Health-SigQOLM is a reliable and valid scale for measuring both generic and dynamic HRQOL., Competing Interests: Declarations. Ethics approval and consent to participate: All respondents have provided written informed consent to participate in this study. Ethical approval for this study was granted by the Medical Research and Ethics Committee (MREC), Malaysia. The ethical approval number for this study is NMRR ID-21-01979-XDL (IIR). The study adhered to the Declaration of Helsinki. Confidentiality was ensured and maintained throughout the process. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background/Objectives: The HRQ-6D is a newly developed instrument to measure Health-related quality of life (HRQOL) and EQ-5D is the gold standard for measuring HRQOL. This study aims to test the concurrent validity between EQ-5D and HRQ-6D measures among patients with different primary diagnoses. Methods : This cross-sectional study uses two HRQOL measurement instruments, EQ-5D-3L and HRQ-6D. Data collection was performed between January 2023 and May 2023. All the necessary data for this study were collected from actual patients who presented with any one of the four different types of primary diagnoses: heart disease, cancer, depressive disorders, and end-stage renal disease (ESRD). They were recruited from the four specialist clinics that cater to the treatment of each of the four different types of primary diagnoses in a tertiary hospital. Results : There were 149 patients who participated in the study wherein 40 (26.8%) of them were ESRD patients, 39 (26.2%) of them were cancer patients, 38 (25.5%) of them were mentally depressed, and the remaining were patients with heart diseases. The domains in HRQ-6D, except for the perception of future health, are significantly associated with domains in EQ-5D-3L after having controlled for patients' primary diagnoses (i.e., p < 0.001). The HRQ-6D replaces the domain "Usual activities" with "Physical energy," and the association between these two domains is significant ( p < 0.001). The correlation between the overall HRQ-6D and EQ-VAS scores is also significant (coefficient = 0.445, p < 0.001). Conclusions : The HRQ-6D is demonstrated to have concurrent validity with EQ-5D. Therefore, clinicians and researchers can use HRQ-6D to measure patient outcomes for interventional and observational studies. (Total word count = 265 words).

Background/Objectives: This study aims to compare the health-related quality of life (HRQOL) between healthcare providers without chronic diseases and participants with chronic diseases presenting with one of the four different primary diagnoses on the health-related quality of life with six domains (HRQ-6D) scale. Methods: This is a cross-sectional study to compare the HRQOL between healthcare providers without chronic diseases and participants with chronic diseases. Data collection was performed from May 2022 to May 2023. Data for the comparison group were taken from healthcare providers without chronic diseases, and for the participant group with chronic diseases, the data were collected from actual patients with one of four types of primary diagnoses who were recruited from specialist cardiology, oncology, psychiatry, and nephrology clinics. All the participants of this study filled in the HRQ-6D. Results: There were 238 (58.6%) healthcare providers without chronic diseases who participated in this study, as well as 41 (10.1%) patients with end-stage renal disease (ESRD), 48 (11.8%) patients with cancer, and 40 (9.9%) patients who were depressed, and the remaining patients had heart disease. The means (SD) of HRQ-6D scores among healthcare providers without chronic diseases for pain, physical strength, emotion, mobility, self-care, perception of future health, and overall HRQ-6D score were 75.3% (19.8), 74.5% (21.1), 85.6% (18.4%), 93.0% (12.3), 91.6% (13.9), 74.2% (23.3), and 82.4% (13.6), respectively. In comparisons between healthcare providers without chronic diseases and participants with chronic diseases, all mean differences of the overall HRQ-6D score and its domains and dimensions were statistically significant ( p < 0.001). Conclusions: The overall score of the HRQ-6D, as well as its domains and dimensions are sensitive in detecting the study participants with chronic diseases from among those without chronic diseases. Therefore, the HRQ-6D is a reliable and valid scale to measure HRQOL. Future studies may use this scale for interventional, observational, and cost-effectiveness studies.

Objective: The "Health" element is one of the elements in Significant Quality of Life Measure (SigQOLM) that measures quality of life and well-being of people. This study aims to evaluate the Health element (Health-SigQOLM) as a generic and dynamic scale to measure health-related quality of life (HRQOL) with a broader spectrum of coverage. This study used a secondary data that developed SigQOLM. Only the "Health" element with 33 items is used for analysis., Results: The construct of Health-SigQOLM has a minimum factor loading of 0.425 with excellent model fit. The health status among healthcare workers is significantly associated with the Health-SigQOLM (p < 0.001). The Health-SigQOLM score can clearly distinguish between healthy people and those who have been afflicted with some diseases but have never been hospitalized due to disease progression or other associated complications (p = 0.002). The Health-SigQOLM is a generic and dynamic tool for assessing various aspects of health-related quality of life., (© 2024. The Author(s).)

There is currently limited data on the effectiveness of COVID-19 vaccines for children aged 6-11 years in Malaysia. This study aims to determine vaccine effectiveness (VE) against COVID-19-related hospitalization after receipt of one- and two-doses of BNT162b2 mRNA (Comirnaty-Pfizer/BioNTech) vaccine over a duration of almost 1 year in the predominantly Omicron period of BA.4/BA.5 and X.B.B sub lineages. This study linked administrative databases between May 2022 and March 2023 to evaluate real-world vaccine effectiveness (VE) for the BNT162b2 mRNA (Comirnaty-Pfizer/BioNTech) vaccine against COVID-19-related hospitalization in the Omicron pre-dominant period with BA.4/BA.5 and X.B.B sub lineages. During the Omicron-predominant period, the cumulative hospitalization rate was almost two times higher for unvaccinated children (9.6 per million population) compared to vaccinated children (6 per million population). The estimated VE against COVID-19 hospitalization for one dose of BNT162b2 was 27% (95% CI - 1%, 47%) and 38% (95% CI 27%, 48%) for two doses. The estimated VE against hospitalization remained stable when stratified by time. VE for the first 90 days was estimated to be 45% (95% CI 33, 55%), followed by 47% (95% CI 34, 56%) between 90 and 180 days, and 36% (95% CI 22, 45%) between 180 and 360 days. Recent infection within 6 months does not appear to modify the impact of vaccination on the risk of hospitalization, subject to the caveat of potential underestimation. In our pediatric population, BNT162b2 provided moderate-non-diminishing protection against COVID-19 hospitalization over almost 1 year of Omicron predominance., (© 2024. The Author(s).)

Quality of life (QOL) should ideally be determined by a broader spectrum of measurable parameters. This study aims to develop and validate a study instrument that is designed to determine a holistic measure of health and non-health aspects of QOL, and it is called the 'Significant Quality of Life Measure' (SigQOLM). This study involves five phases which aim to (i) explore and understand the subject matter content, (ii) develop a questionnaire, (iii) assess its content validity and face validity, (iv) conduct a pilot study, and lastly (v) perform a field-test by using the questionnaire. For the field-testing phase, a cross-sectional study was conducted which elicited responses from healthcare workers via a self-administered survey for all the SigQOLM items. Based on the results, the overall framework of the SigQOLM consists of four elements, 18 domains with 69 items. The element of "Health" is measured by nine domains, while "Relationships", "Functional activities, and "Survival" are measured by three domains respectively. The SigQOLM has been developed successfully and then validated with a high level of reliability, validity, and overall model fit. Therefore, the SigQOLM will provide researchers and policymakers another viable option to elicit a more comprehensive outcome measure of QOL which shall then enable them to implement specific interventions for improving the QOL of all the people, both healthy or otherwise., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Introduction: Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is beneficial in acute ischaemic stroke (AIS). We aim to compare the realworld clinical outcomes and service efficiency of IVT in Malaysian primary stroke centres (PSCs) versus acute stroke ready hospitals (ASRHs)., Materials and Methods: We conducted a multi-centre cohort study involving 5 PSCs and 7 ASRHs in Malaysia. Through review of medical records of AIS patients who received IVT from 01 January 2014 to 30 June 2021, real-world data was extracted for analysis. Univariate and multivariate regression models were employed to evaluate the role of PSCs versus ASRHs in post-IVT outcomes and complications. Statistical significance was set at p<0.05., Results: A total of 313 multi-ethnic Asians, namely 231 from PSCs and 82 from ASRHs, were included. Both groups were comparable in baseline demographic, clinical, and stroke characteristics. The efficiency of IVT delivery (door-toneedle time), functional outcomes (mRS at 3 months post- IVT), and rates of adverse events (intracranial haemorrhages and mortality) following IVT were comparable between the 2 groups. Notably, 46.8% and 48.8% of patients in PSCs and ASRHs group respectively (p=0.752) achieved favourable functional outcome (mRS≤1 at 3 months post-IVT). Regression analyses demonstrated that post-IVT functional outcomes and adverse events were independent of the role of PSCs or ASRHs., Conclusion: Our study provides real-world evidence which suggests that IVT can be equally safe, effective, and efficiently delivered in ASRHs. This may encourage the establishment of more ASRHs to extend the benefits of IVT to a greater proportion of stroke populations and enhance the regional stroke care.

Aims: To evaluate the effectiveness of the Enhanced Primary Healthcare (EnPHC) interventions on process of care and intermediate clinical outcomes among type 2 diabetes patients., Methods: This was a quasi-experimental controlled study conducted in 20 intervention and 20 control public primary care clinics in Malaysia from November 2016 to June 2019. Type 2 diabetes patients aged 30 years and above were selected via systematic random sampling. Outcomes include process of care and intermediate clinical outcomes. Difference-in-differences analyses was conducted., Results: We reviewed 12,017 medical records of patients with type 2 diabetes. Seven process of care measures improved: HbA1c tests (odds ratio (OR) 3.31, 95% CI 2.13, 5.13); lipid test (OR 4.59, 95% CI 2.64, 7.97), LDL (OR 4.33, 95% CI 2.16, 8.70), and urine albumin (OR 1.99, 95% CI 1.12, 3.55) tests; BMI measured (OR 15.80, 95% CI 4.78, 52.24); cardiovascular risk assessment (OR 174.65, 95% CI 16.84, 1810.80); and exercise counselling (OR 1.18, 95% CI 1.04, 1.33). We found no statistically significant changes in intermediate clinical outcomes (i.e. HbA1c, LDL, HDL and BP control)., Conclusions: EnPHC interventions was successful in enhancing the quality of care, in terms of process of care, by changing healthcare providers behaviour., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Health-related quality of life (HRQOL) is one of the most important outcome measures to be assessed by medical research. This study aims to develop and validate an instrument called the "health-related quality of life with six domains" (HRQ-6D), which aims to measure an individual's health-related quality of life within a 24 h period of time. This is a questionnaire development study involving five phases, which are (i) to explore the subject matter content for gaining a better understanding of the topic, (ii) to develop the questionnaire, (iii) to assess both its content validity and face validity, (iv) to conduct a pilot study, and finally, (v) to undertake a field testing of the questionnaire. For the field-testing phase, a cross-sectional study involving a self-administered survey for HRQ-6D items was conducted among healthcare workers with various health conditions. Exploratory factor analysis was initially applied to construct the major dimensions of the HRQ-6D. Confirmatory factor analysis was subsequently applied to evaluate the model fit of the overall framework of the HRQ-6D. The clinical utility of this HRQ-6D was also assessed via its association with actual clinical evidence. A total of 406 respondents participated in the survey. Six domains were identified from the analysis, namely "pain", "physical strength", "emotion", "self-care", "mobility", and "perception of future health" comprising two items in each domain. Each domain was reported to have a minimum value of Cronbach's alpha of 0.731, and the model fit for the overall framework of the HRQ-6D was also found to be excellent. Exploratory factor analysis was undertaken for the 12 items of the HRQ-6D. All the domains can be categorized into three major dimensions, namely "health", "body function", and "future perception", with a minimum value for their factor loadings of at least 0.507. A notable finding was that the HRQ-6D was significantly associated with an individual's existing comorbidities and current status of health ( p < 0.05). This study successfully validated the HRQ-6D, and we found it to possess both excellent levels of reliability and validity and a satisfactory degree of model fit; it was also significantly associated with actual clinical evidence.

Introduction: COVID-19 vaccines have been highly effective in reducing morbidity and mortality during the pandemic. While primary series vaccination rates are generally high in Southeast Asian (SEA) countries, various factors have limited the rollout and impact of booster doses., Areas Covered: We reviewed 79 studies in the International Vaccine Access Center (IVAC) VIEW-hub platform on vaccine effectiveness (VE) after primary immunizations with two-dose schedules. VE data were reported for SARS-CoV-2 infection, COVID-19-related hospitalizations and deaths, and stratified across variants of concern, age, study design and prior SARS-CoV-2 infection for mRNA vaccines (BNT162b2, mRNA-1273, and combinations of both), vector vaccines (AstraZeneca, AZD1222 [ChAdOx1 nCoV-19] 'Vaxzevria'), and inactivated virus vaccines (CoronaVac)., Expert Opinion: The most-studied COVID-19 vaccines provide consistently high (>90%) protection against serious clinical outcomes like hospitalizations and deaths, regardless of variant. Additionally, this protection appears equivalent for mRNA vaccines and vector vaccines like AZD1222, as supported by our analysis of Asian and relevant international data, and by insights from SEA experts. Given the continued impact of COVID-19 hospitalizations and deaths on health-care systems worldwide, encouraging vaccination strategies that reduce this burden is more relevant than attempting to prevent broader but milder infections with specific variants, including Omicron.

Competing Interests: All authors declare no conflict of interest.

Importance: Evidence for the timing of booster vaccination after completion of BNT162b2 and CoronaVac primary vaccination is crucial to guide policy recommendations., Objective: To compare the odds of symptomatic SARS-CoV-2 infection and COVID-19-related outcomes after heterologous and homologous boosting of CoronaVac at 3-month intervals and homologous boosting of BNT162b2 at 6-month intervals, with BNT162b2 primary series (2 doses) as the reference group., Design, Setting, and Participants: This population-based retrospective cohort study used national data for Malaysia. Participants included all individuals aged 18 years and older who received a complete primary series of CoronaVac or BNT162b2 vaccine and were eligible for a booster dose between November 21, 2021, and December 28, 2021. Data were analyzed from November 21, 2021, to January 7, 2022., Exposures: Receipt of a booster vs no booster and categorized into primary series BNT162b2 (2 doses of BNT162b2), primary series CoronaVac (2 doses of CoronaVac), 3 doses of BNT162b2, primary series CoronaVac plus a BNT162b2 booster, and 3 doses of CoronaVac., Main Outcomes and Measures: The primary outcome was symptomatic SARS-CoV-2 infection. The secondary outcomes were COVID-19-related intensive care unit admission and death. All outcomes were observed from the day an individual was considered fully boosted (≥14 days after booster dose)., Results: Our cohort included 13 840 240 individuals (mean [SD] age, 39.9 [15.5] years; 7 040 298 [50.9%] men; 4 451 180 individuals [32.2%] with ≥1 comorbidities), of whom 5 081 641 individuals (36.7%) had received a booster dose. Using the primary series BNT162b2 recipients as reference, the adjusted odds against symptomatic SAR-CoV-2 infection were lower for individuals who received the primary series CoronaVac plus a BNT162b2 (adjusted odds ratio [aOR], 0.06 [95% CI, 0.05-0.06]), 3 doses of CoronaVac (aOR, 0.08 [95% CI, 0.06-0.10]), or 3 doses of BNT162b2 (aOR, 0.01 [95% CI, 0.00-0.01]). Receipt of heterologous booster (primary series of CoronaVac plus a BNT162b2 booster) was associated with lower odds of SARS-CoV-2 infection (aOR, 0.17 [95% CI, 0.17-0.18]) compared with homologous booster (3 doses of CoronaVac) for individuals aged 60 years and older (aOR, 0.19 [95% CI, 0.19-0.20])., Conclusions and Relevance: In this cohort study, for individuals who received the CoronaVac primary series and a booster dose of BNT162b2 or CoronaVac at 3 months, the observed odds of symptomatic SARS-CoV-2 infection were similar to individuals who received the BNT162b2 primary series plus a third dose of BNT162b2 at 6 months. Heterologous booster is recommended for individuals aged 60 years or older who received the CoronaVac primary series, given the lower observed odds against symptomatic SARS-CoV-2 infection among those who received a BNT1612b2 booster.

Objectives: In this study, we aimed to investigate vaccine effectiveness (VE) against SARS-CoV-2 infections among adolescents aged 12 to 17 years in Malaysia and examine potential VE differences after full vaccination., Methods: We consolidated data on COVID-19 testing, vaccination, and outcomes for all public school-going adolescents in Malaysia from September 1, 2021, to December 31, 2021, and estimated the VE against SARS-CoV-2 infections during this period. Cases were defined as positive tests, either by reverse transcriptase- PCR (RT-PCR) or rapid antigen (RTK-Ag) testing, while controls were negative tests. Secondarily, we restricted the analysis to all tests performed in December 2021 and compared VE by month of full vaccination., Results: A total of 175,880 eligible tests (53.4% or 93,995 RT-PCR tests) were included. After full vaccination with BNT162b2, VE against SARS-CoV-2 infections was 65.7% (95% confidence interval [CI] 64.4, 66.9) over the study period. When restricted to tests in December 2021, VEs for those fully vaccinated in September 2021, October 2021, and November 2021 were comparable (60.6% [95% CI 23.7, 81.5], 56.9% [95% CI 51.1, 62.0], and 65.7% [95% CI 59.8, 70.7] respectively)., Conclusions: Among adolescents, full vaccination with BNT162b2 offered considerable protection against SARS-CoV-2 infections over at least three months without substantial evidence of waning., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: We aimed to investigate and compare waning vaccine effectiveness (VE) against COVID-19 infection, COVID-19 related ICU admission, and COVID-19-related death for BNT162b2 and CoronaVac vaccines., Methods: We consolidated national data on COVID-19 vaccination and outcomes, and used cases from September 1 st -30 th , 2021 to compare VE between the 'early' (fully vaccinated in April-June 2021) and 'late' (July-August 2021) groups. We estimated VE against COVID-19 infection with a negative binomial regression and VE against ICU admission and death among confirmed COVID-19 cases with a logistic regression., Results: For BNT162b2, VE against COVID-19 infections declined from 90.8% (95% CI 89.4, 92.1) in the 'late' group to 79.3% (95% CI 76.1, 82.1) in the 'early' group. VE for BNT162b2 against ICU admission and death were stable. For CoronaVac, VE waned against COVID-19 infections from 74.5% (95% CI 70.6, 78.0) to 30.4% (95% CI 18.8, 40.3). Effectiveness against ICU admission waned from 56.0% (95% CI 51.2, 60.2) to 28.7% (95% CI 12.2, 42.1). CoronaVac's effectiveness against death remained stable., Conclusion: VE against COVID-19 infection waned after 3-5 months of full vaccination for both BNT162b2 and CoronaVac vaccines in Malaysia. For CoronaVac, protection against ICU admission also declined., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries., Objective: The aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics., Methods: A cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic., Results: In total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states; other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97)., Conclusions: Our findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service., (©Sock Wen Ng, Wen Yea Hwong, Masliyana Husin, Norazida Ab Rahman, Nazrila Hairizan Nasir, Kawselyah Juval, Sheamini Sivasampu. Originally published in JMIR Formative Research (https://formative.jmir.org), 09.05.2022.)

The COVID-19 pandemic has accelerated implementation of telemedicine in healthcare facilities for delivery of care. Healthcare providers' acceptance of the telemedicine services is important for successful implementation of this new system. A questionnaire based on the Technology Acceptance Model (TAM) has been used to measure user acceptance of telemedicine service. The aim of this study was to translate and validate the English version of the questionnaire into Malay, to extend the availability and utilization of this questionnaire in Malaysia. A forward and backward translation of the questionnaire was conducted to produce the TAM in the Malay version (Malay-TAM). Panel experts assessed content validity. Internal consistency reliability was determined using Cronbach's alpha. Confirmatory factor analysis based on structural equation modelling was performed to validate the factor structure. The questionnaire was then tested on and completed by 149 healthcare workers from several public health clinics across Malaysia. The Malay-TAM demonstrated good reliability with Cronbach's alphas ranging from 0.823 to 0.912. Factor analysis showed good convergent validity but relatively poor discriminant validity. All five constructs were retained to preserve content validity. The findings suggest that the Malay-TAM can serve as a reliable and valid instrument to measure acceptance to telemedicine., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Masliyana Husin et al.)

Malaysia rolled out a diverse portfolio of predominantly three COVID-19 vaccines (AZD1222, BNT162b2, and CoronaVac) beginning 24 February 2021. We evaluated vaccine effectiveness with two methods, covering 1 April to 15 September 2021: (1) the screening method for COVID-19 (SARS-CoV-2) infection and symptomatic COVID-19; and (2) a retrospective cohort of confirmed COVID-19 cases for COVID-19 related ICU admission and death using logistic regression. The screening method estimated partial vaccination to be 48.8% effective (95% CI: 46.8, 50.7) against COVID-19 infection and 33.5% effective (95% CI: 31.6, 35.5) against symptomatic COVID-19. Full vaccination is estimated at 87.8% effective (95% CI: 85.8, 89.7) against COVID-19 infection and 85.4% effective (95% CI: 83.4, 87.3) against symptomatic COVID-19. Among the cohort of confirmed COVID-19 cases, partial vaccination with any of the three vaccines is estimated at 31.3% effective (95% CI: 28.5, 34.1) in preventing ICU admission, and 45.1% effective (95% CI: 42.6, 47.5) in preventing death. Full vaccination with any of the three vaccines is estimated at 79.1% effective (95% CI: 77.7, 80.4) in preventing ICU admission and 86.7% effective (95% CI: 85.7, 87.6) in preventing deaths. Our findings suggest that full vaccination with any of the three predominant vaccines (AZD1222, BNT162b2, and CoronaVac) in Malaysia has been highly effective in preventing COVID-19 infection, symptomatic COVID-19, COVID-19-related ICU admission, and death.

Super-refractory status epilepticus (SRSE) is a neurocritical emergency, associated with significant morbidity and mortality. The precise pathophysiology is still not completely understood. The likelihood of spontaneous seizure termination reduces with time, and it is of paramount importance to abort status in order to prevent permanent long-term neurological sequelae and death. A few neuroprotective strategies, such as general anaesthesia, steroids, ketogenic diet and hypothermia, have been used to treat SRSE, however, the clinical outcome remains inconclusive. We herein present two cases of SRSE, which were successfully treated with electroconvulsive therapy (ECT) after failing all pharmacological measures.

Aim: The purpose of this paper is to describe the recruitment strategies, the response rates and the reasons for non-response of Malaysian public and private primary care doctors in an international survey on the quality, cost and equity in primary care., Background: Low research participation by primary care doctors, especially those working in the private sector, is a challenge to quality benchmarking., Methods: Primary care doctors were sampled through multi-stage sampling. The first stage-sampling unit was the primary care clinics, which were randomly sampled from five states in Malaysia to reflect their proportions in two strata - sector (public/private) and location (urban/rural). Strategies through endorsement, personalised invitation, face-to-face interview and non-monetary incentives were used to recruit public and private doctors. Data collection was carried out by fieldworkers through structured questionnaires., Findings: A total of 221 public and 239 private doctors participated in the study. Among the public doctors, 99.5% response rates were obtained. Among the private doctors, a 32.8% response rate was obtained. Totally, 30% of private clinics were uncontactable by telephone, and when these were excluded, the overall response rate is 46.8%. The response rate of the private clinics across the states ranges from 31.5% to 34.0%. A total of 167 answered the non-respondent questionnaire. Among the non-respondents, 77.4 % were male and 22.6% female (P = 0.011). There were 33.6% of doctors older than 65 years (P = 0.003) and 15.9% were from the state of Sarawak (P = 0.016) when compared to non-respondents. Reason for non-participation included being too busy (51.8%), not interested (32.9%), not having enough patients (9.1%) and did not find it beneficial (7.9%). Our study demonstrated the feasibility of obtaining favourable response rate in a survey involving doctors from public and private primary care settings.

Aim: This paper describes the study protocol, which aims to evaluate the effectiveness of a multifaceted intervention package called 'Enhanced Primary Healthcare' (EnPHC) on the process of care and intermediate clinical outcomes among patients with Type 2 diabetes mellitus (T2DM) and hypertension. Other outcome measures include patients' experience and healthcare providers' job satisfaction., Background: In 2014, almost two-thirds of Malaysia's adult population aged 18 years or older had T2DM, hypertension or hypercholesterolaemia. An analysis of health system performance from 2016 to 2018 revealed that the control and management of diabetes and hypertension in Malaysia was suboptimal with almost half of the patients not diagnosed and just one-quarter of patients with diabetes appropriately treated. EnPHC framework aims to improve diagnosis and effective management of T2DM, hypertension or hypercholesterolaemia and their risk factors by increasing prevention, optimising management and improving surveillance of diagnosed patients., Methods: This is a quasi-experimental controlled study which involves 20 intervention and 20 control clinics in two different states in Malaysia, namely Johor and Selangor. The clinics in the two states were matched and randomly allocated to 'intervention' and 'control' arms. The EnPHC framework targets different levels from community to primary healthcare clinics and integrated referral networks.Data are collected via a retrospective chart review (RCR), patient exit survey, healthcare provider survey and an intervention checklist. The data collected are entered into tablet computers which have installed in them an offline survey application. Interrupted time series and difference-in-differences (DiD) analyses will be conducted to report outcomes.

Introduction: Adequate control of hypertension is a global challenge and is the key to reduce cardiovascular disease risk factors. This study evaluates management of hypertensive patients in primary care clinics in Malaysia., Methods: A cross-sectional analysis of 13 784 medical records from 20 selected public primary care clinics in Malaysia was performed for patients aged ≥30 years old who were diagnosed with hypertension and had at least one visit between 1st November 2016 and 30th June 2019. Multivariable logistic regression adjusted for complex survey design was used to determine the association between process of care and blood pressure (BP) control among the hypertensive patients., Results: Approximately 50% of hypertensive patients were obese, 38.4% of age ≥65 years old, 71.2% had at least one comorbidity and approximately one-third were on antihypertensive monotherapy. Approximately two-third of the hypertensive patients with diabetic proteinuria were prescribed with the appropriate choice of antihypertensive agents. Approximately half of the patients received at least 70% of the target indicated care and 42.8% had adequately controlled BP. After adjusting for covariates, patients who received counseling on exercise were positively associated with adequate BP control. Conversely, patients who were prescribed with two or more antihypertensive agents were negatively associated with good BP control., Conclusions: These findings indicated that BP control was suboptimal and deficient in the process of care with consequent gaps in guidelines and actual clinical practices. This warrants a re-evaluation of the current strategies and approaches to improve the quality of hypertension management and ultimately to improve outcome., Competing Interests: The authors have declared that no competing interests exist.