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Abstract Background After two years of the COVID-19 pandemic, Malaysia began the transition to the endemic phase. students at higher education institutes are among those who were affected by the COVID-19 outbreak and deserve further attention. Hence, this study aimed to assess the knowledge, attitude, and practice (KAP) associated with COVID-19 among public university undergraduate students in Malaysia during the endemic phase. This study would be able to provide valuable insights that can enhance public health strategies, improve educational efforts, and prepare better for future health challenges. Methods An online cross-sectional study was conducted among undergraduate students at public universities in Malaysia. KAP towards COVID-19 were measured using a structured Malay and English version questionnaire consisting of (i) sociodemographic characteristics, (ii) knowledge of COVID-19 (10 items), attitudes associated with COVID-19 (five items) and practice on COVID-19 preventive measures (six items). Validity and reliability tests were conducted to assess the level of consistency of KAP content with Cronbach alpha values of 0.617, 0.616 and 0.722 for each section, respectively. Descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), Mann-Whitney test, Kruskal Wallis test and Pearson correlation were conducted. Results Around 73% of the respondents had good knowledge of COVID-19, 58.6% possessed positive attitudes, and 54.6% were classified as having good practices in COVID-19 prevention. There was no significant difference in knowledge scores among sociodemographic data. A significant difference in attitude scores was observed among race, zones of the public university and household incomes. Besides that, a significant difference in practice scores was also observed among gender, race and student accommodation. A weak positive and significant correlation existed between knowledge and practices (r = 0.220 and p = 0.001). Meanwhile, there was no correlation between knowledge and attitude (r = 0.039 and p = 0.517). Conclusion Undergraduate students from Malaysian public universities had good KAP associated with COVID-19. Still, appropriate health promotion activities are needed to provide the students with adequate knowledge, positive attitudes and good practice of COVID-19 prevention measures in the future.

Background: A fiber-rich diet lowers the risk of various diseases by increasing fecal bulk, shortening intestinal transit time, and stimulating intestinal flora. This study examines the association between knowledge, attitude, and practice (KAP) regarding dietary fiber intake and body mass index (BMI) among Dentistry and Software Engineering undergraduates. Methods: This cross-sectional study included 95 Dentistry and 92 Software Engineering students at the Universiti Kebangsaan Malaysia. The KAP questionnaire was analyzed for its reliability using Cronbach’s alpha and distributed through email. Results: Most respondents had normal weight. The Software Engineering students had a higher percentage of overweight and obese individuals than the Dentistry students. KAP measurements for both groups were moderate across all variables. No differences were found in attitude and practice levels between both groups. However, the Software Engineering students had higher knowledge of dietary fiber intake. KAP did not influence BMI in both groups. Factor analysis showed a high association between KAP on dietary fiber intake and BMI status among Software Engineering students compared to dentistry students. Conclusions: The level of KAP on dietary fiber intake is associated with BMI status among undergraduate students.

Abstract Background Cognitive frailty is a dual geriatric syndrome that is preventable with lifestyle changes. Lifestyle changes are influenced by literacy level. However, the association between limited health literacy (HL) and cognitive frailty (CF) is yet to be discovered. Objectives This study aims to determine the association between HL and CF among older adults. Methods Data was collected between April 2021 to March 2022 in this cross-sectional study. Citizens aged 60 years and older who can understand Malay and English were selected through purposive sampling from the AGELESS Trial screening sample frame. HLS-M-Q18 was administered to determine HL and CDR, and Fried’s Criteria were used to assess the CF status. Results A total of 757 participants were included in the analysis. 68.2% of the total participants had a limited HL level. The prevalence of CF among older adults with limited HL was 48.2% as compared to those with adequate HL (28.2%) (p

Visually impaired schoolchildren require classrooms tailored to their visual abilities and needs, as outlined in existing literature detailing optimal modifications, recommendations, and guidelines. The study aims to review existing literature on classroom modifications for visually impaired schoolchildren, outlining recommendations for creating ideal classrooms within mainstream physical settings. After initial screening, 712 publications (698 from databases and registers, and 14 from other methods) were identified for detailed review, of which 17 were ultimately eligible for inclusion. Through a systematic review of PubMed, Scopus, and Web of Science databases, along with additional sources up to February 2024, this research analyzed articles published from 1999 to 2024. A qualitative, thematic analysis was conducted on the included articles. Criteria included peer-reviewed journals, theses, and conference papers focusing on classroom settings for visually impaired schoolchildren aged 7 to 18. Key questions addressed are: 1) What classroom settings suit the needs of visually impaired schoolchildren? 2) What recommendations are tailored to visually impaired schoolchildren to create a conducive classroom environment? Analysis of 7 journal articles and 10 other publications revealed two main themes: optimizing classroom configuration and enhancing visual comfort. Articles primarily focused on suggestions for classroom layout, particularly furnishing arrangement (41%, n = 7) and enhancing lighting conditions (41% n = 7). However, concerns were raised about standard furniture designs and the need for tailored seating arrangements to meet the visual demands of visually impaired schoolchildren. Conclusion: This review provides valuable insights into creating optimal classroom settings for visually impaired schoolchildren, ensuring equal learning opportunities in a supportive environment tailored to their needs.

Lifestyle intervention has proven effective in managing older adults' frailty and mild cognitive impairment issues. What remains unclear is how best to encourage lifestyle changes among older adults with frailty and Mild Cognitive Impairment (MCI). We conducted searches in electronic literature searches such as PubMed, Scopus, Cochrane Reviews, ProQuest, and grey resources to find articles published in English between January 2010 and October 2023. This review focused on research using a qualitative study design. We extracted data on publication year, location, the aim of the study, study population, involved intervention, barriers, motivations, and preferences reported in the articles. Out of 5226 retrieved, 253 articles were selected after the deletion of duplicates, title, abstract screening, and. We included fourteen articles for final analysis at the end of the review process. The two main themes generated from this review are intrinsic and extrinsic factors in motivations and barriers to lifestyle changes. The most reported motivators were the perceived benefits of lifestyle intervention and self-efficacy. Among the obstacles participants face are perceived adverse effects of intervention, lack of knowledge, existing impairment (physical or mental), and social support. Lifestyle change motivations and barriers among older adults mainly were intrinsic factors such as the perceived benefit of the intervention, self-efficacy, knowledge, familial commitment, and existing impairments. There is a need to empower older adults to overcome the barriers with support from healthcare professionals, the community, and the family.

Background The increasing prevalence and burden of chronic obstructive pulmonary disorder (COPD), the challenges in implementing pulmonary rehabilitation (PR) programs and the limited availability of alternatives and supportive programs to serve patients with COPD necessitate the development of pulmonary telerehabilitation (PTR) systems to provide patients with COPD with PR programs. Objective This study aimed to design and develop the ChestCare mobile Health app using user-centred design (UCD) approach. Thus, it provided PTR for patients with COPD, enhancing their self-management of symptoms and improving their compliance with PR programs. Methods In this mixed-methods sequential research, we deployed the UCD iterative design through the prototype app design and development sequence. The first phase was built based on the results of a previous needs assessment study and an analysis of related apps. This produced the initial mock-up, the foundation for the focus group discussions with physiotherapists and patients. Six physiotherapists with cardiorespiratory specialisation evaluated each app module and item of the latest mock-up using the content validity index (CVI) document. The I-CVI (S-CVI/Ave) and (S-CVI/UA) were computed. Qualitative and quantitative data were integrated, and decisions were made by comparing their results. Results The UCD iterative design through sequential MMR has generated four mock-up app versions. The latest version identified 13 modules through 150 items validated by six experts using a CVI document. The I-CVI calculation of 145 items was 1, while 0.83 for the remaining items, was within accepted values. The S-CVI scored 99.4, indicating an overall validity of the ChestCare app as a PTR system for patients with COPD. Conclusions The development and validation of the ChestCare app resulted from conducting UCD iterative design and sequential MMR, which identified 13 functionalities, including symptom assessment, tracking lung volume, functional capacity test, action plan, intervention program, COPD education, COPD community, monitoring and reminders.

Abstract Background Motoric cognitive risk (MCR) syndrome refers to a condition where both slow gait and memory complaints coexist, which heightens their vulnerability to developing dementia. Considering that the risk factors of MCR are elucidated from cross-sectional studies and also likely vary based on socioeconomic status, we conducted a community-based longitudinal study to determine the predictors of MCR among older adults in Malaysia. Methods Out of 1,249 older participants (aged 60 years and above) without MCR at baseline (Wave II of LRGS-TUA cohort study), 719 were successfully followed up after 3.5 years to identify predictors of subsequent MCR development. A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, psychosocial, functional status, and dietary intake. Anthropometric measurements, body composition, and physical performance were assessed. Univariate analyses were performed for each variable, followed by a hierarchical logistic regression analysis to identify the predictors of MCR that accounted for confounding effects between the studied factors. Results The incidence rate of MCR was 4.0 per 100 person-years. Smoking (Adjusted Odd Ratio (Adj OR) = 1.782; 95% Confidence Interval (CI):1.050–3.024), hypertension (Adj OR = 1.725; 95% CI:1.094–2.721), decreased verbal memory as assessed by the lower Rey Auditory Verbal Learning Test (RAVLT) (Adj OR = 1.891; 95% CI:1.103–3.243), and decreased functional status measured using instrumental activity of daily living (IADL) (Adj OR = 4.710; 95% CI:1.319–16.823), were predictors for MCR incidence. Conclusions Our study results provide an initial reference for future studies to formulate effective preventive management and intervention strategies to reduce the growing burden of adverse health outcomes, particularly among Asian older adults.

Background Technology advancement along with the increase in the older adults’ population leads to the creation of health applications. The combination of exercise, nutrition, and cognition should be studied carefully in improving older adults’ health. Objective The purpose of this study is to develop a health application, WeFit contains these three components and to determine its content validity, acceptability, and usability. Methodology This study is a design and development study involving three phases. The first phase is the need analysis involving a review on 16 mobile applications available in Google play and iTunes App store as well as a review of six articles for identifying the perception of older adults in using mobile applications. Second phase is mobile application development and content validity. The content validity was determined using the Content Validity Index for Individual Items (I-CVI). Phase 3 evaluated the acceptance of the WeFit mobile application among older adults and health practitioners. Results Phase 1 indicated that half of the applications reviewed (50.0%) had physical activity component and the other half (50.0%) had a cognitive component, and none on nutrition. No application is reported to have all three components. In Phase 2, WeFit health application containing the three components was developed where users can view exercise and food recommendations and play cognitive games. WeFit had an I-CVI value of 0.98. With respect to acceptability, majority of the study participants (93.3%) understood the WeFit's content and the graphics used were appropriate. The usability study found that the majority of the older adults were satisfied with the interface and content. All health practitioners (100%) agreed WeFit is easy to use and agreed that it can guide them in giving medical advices. Conclusion WeFit mobile app has been successfully developed, validated, and tested for acceptance among the older adults and health practitioners.

Background Digital health has been widely used in delivering healthcare, presenting emerging opportunities to overcome barriers to effective obesity care. One strategy suggested for addressing obesity involves a hybrid weight management intervention that incorporates digital health. This scoping review aimed to map existing evidence regarding hybrid weight management intervention. Methods PubMed, Scopus, Cochrane Library, and the Web of Science electronic databases were searched for studies published between January 1, 2012 and May 16, 2023, with language restricted to English. The focus was on controlled trials in which a hybrid weight management intervention was used in the intervention among overweight or obese adults. The scoping review framework followed Arksey and O’Malley's guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISM-P). Results Full-text article review in the screening stage resulted in a total of 10 articles being included for narrative synthesis. Almost two-third of the articles originated from the United States (60%), followed by Europe and Australia, each accounting for 20%. The most common hybrid weight management intervention type was the combination of face-to-face and telehealth (i.e. phone call/text messaging) (40%), closely followed by a combination email intervention (30%) and mHealth apps intervention (30%). Most of the face-to-face dietary interventions were delivered as a group counseling (80%), while some were conducted as individual counseling (20%). Most studies observed a positive effect of the hybrid weight management intervention on body weight (weight lost 3.9–8.2 kg), body mass index (decreased 0.58 kg/m 2 ), waist circumference (decreased 2.25 cm), and physical activity level compared to standard care. Findings suggest a direct association between hybrid weight management interventions and weight loss. The weight loss ranged from 3.9 to 8.2 kg, with some evidence indicating a significant weight loss of 5% from baseline. There is a need to explore stakeholders’ telehealth perspective to optimize the delivery of hybrid weight management interventions, thereby maximizing greatest benefits for weight management.

Psychological issues are of significant concern in present-day society, as poor mental well-being results in depression and suicidal behavior. Understanding the current situation of psychological stress among secondary school students will help policy makers to formulate targeted measures to help them cope with stress, and at the same time evaluate the effectiveness of the existing policies to address the shortcomings and enhance the diversification of interventions. The main purpose of this review was to map the existing evidence on the prevalence and levels of psychological stress among adolescents in China, and to identify the associated risk factors. This review strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was performed spanning Web of Science, PubMed, and Scopus databases. Studies involving only humans and full text in English were selected. Selection was limited to samples from mainland China, Hong Kong, Macau, and Taiwan. Variables were extracted, exploring the factors that affected the mental wellness of Chinese middle school students. A final 15 articles and 1 report were included. The findings revealed psychological stress is prevalent among Chinese middle school population, with the degree of prevalence from low to severe stress levels. Three dimensions of psychological stress affecting Chinese secondary school students: school, family and lifestyle. Within the school, the factors included academic stress, peer relationships etc. Family-related factors were comprised of parent-child relationship, parents’ mental health status etc. Lastly, lifestyle-related factors included poor diet, sedentary and inactivity etc. Our findings suggest that policy makers should reduce the excessive emphasis on examination results and focus on the all-round development of students, and that schools should organize a variety of extra-curricular activities to reduce students’ stress. Parents should create a harmonious family atmosphere to minimize conflicts and maintain close communication with teachers.Systematic Review RegistrationOSF; https://doi.org/10.17605/OSF.IO/HEFCP.

Abstract BackgroundThe success of mobile apps in improving the lifestyle of patients with noncommunicable diseases through self-management interventions is contingent upon the emerging growth in this field. While users of mobile health (mHealth) apps continue to grow in number, little is known about the quality of available apps that provide self-management for common noncommunicable diseases such as diabetes, hypertension, and obesity. ObjectiveWe aimed to investigate the availability, characteristics, and quality of mHealth apps for common noncommunicable disease health management that included dietary aspects (based on the developer’s description), as well as their features for promoting health outcomes and self-monitoring. MethodsA systematic search of English-language apps on the Google Play Store (Google LLC) and Apple App Store (Apple Inc) was conducted between August 7, 2022, and September 13, 2022. The search terms used included weight managementobesitydiabeteshypertensioncardiovascular diseasesstrokediet ResultsOverall, 42 apps were identified. Diabetes-specific mHealth apps accounted for 7% (n=3) of the market, hypertension apps for 12% (n=5), and general noncommunicable disease management apps for 21% (n=9). About 38% (n=16) of the apps were for managing chronic diseases, while 74% (n=31) were for weight management. Self-management features such as weight tracking, BMI calculators, diet tracking, and fluid intake tracking were seen in 86% (n=36) of the apps. Most mHealth apps (n=37, 88%) did not indicate whether there was involvement of health professionals in app development. Additionally, none of the apps reported scientific evidence demonstrating their efficacy in managing health. The overall mean MARS score was 3.2 of 5, with a range of 2.0 to 4.1. Functionality was the best-rated category (mean score 3.9, SD 0.5), followed by aesthetics (mean score 3.2, SD 0.9), information (mean score 3.1, SD 0.7), and engagement (mean score 2.9, SD 0.6). ConclusionsThe quality of mHealth apps for managing chronic diseases was heterogeneous, with roughly half of them falling short of acceptable standards for both quality and content. The majority of apps contained scant information about scientific evidence and the developer’s history. To increase user confidence and accomplish desired health outcomes, mHealth apps should be optimized with the help of health care professionals. Future studies on mHealth content analysis should focus on other diseases as well.

Creating a universal and supportive learning environment is essential for the holistic education development of visually impaired school children. However, inadequate infrastructure, limited access to specialized tools, and a shortage of skilled teachers may contribute to lower self-confidence and academic performance. This underscores the necessity for specific guidelines and recommendations to address an optimal classroom setting that is tailored to their visual needs. In this paper, a scoping review protocol is introduced, utilizing the framework proposed by Arksey and O'Malley (2005), to address the following research questions: 1) Is there any established standard classroom setting for visually impaired school children? 2) What recommendations or specific guidelines exist regarding the physical measurement, layout, lighting, contrast, and appropriate position for visually impaired school children? The scoping review explored four electronic databases: PubMed, Scopus Emerald Insight, and Web of Sciences. The outcomes from the scoping review will offer conceptual elucidation, synthesize existing theoretical and empirical understandings, and propose the optimal classroom settings tailored to the visual needs of visually impaired schoolchildren. This paper introduces the a-priori study protocol, which outlines the planned methodology for conducting the scoping review in detail. This protocol has been officially registered with the Open Science Framework (OSF) at the following link: http://osf.io/z2sdt.

Introduction: Cardiorespiratory fitness has an inverse relationship with cognitive impairment and frailty in older adults. Direct assessment of maximal oxygen consumption (VO2 max) is the gold standard to assess cardiorespiratory fitness. However, it is costly and requires a laboratory setting. Therefore, VO2 max estimation among older adults with cognitive frailty (CF) will allow the assessment of aerobic capacity, which is commonly overlooked due to the complexity of the test. Aim: This study aims to determine the use of one of three physical performance tests (2-minute step, 2-minute walk, and 1-minute sit to stand) to effectively estimate cardiorespiratory fitness among older adults with CF. Methods: In this cross-sectional study, community-dwelling individuals aged 60 years old and above in Klang Valley were screened for CF. The participants performed three physical performance tests (2-minute walk, 2-minute step, and 1-minute sit to stand) followed by treadmill-based maximal exercise testing on another day. Results: A total of 32 older adults with cognitive frailty (mean age; SD: 67.1;4.7 years) participated in this study. Nearly half of them had hypertension (43.5 %), hypercholesterolemia (43.5 %), and multimorbidity (47.8 %). Among the endurance tests performed, only the 2-minute walk test independently predicted VO2 max by sex-specific with men (R2 = 0.58, p = 0.03) and women (R2 = 0.34, p = 0.01). The 2-minute walk test had good agreement with VO2 max (ICC = 0.77, 95 % CI: −3.1–2.4). Conclusion: The 2-minute walk test is a valid tool for estimating cardiorespiratory fitness among older adults with CF. However, it should be further tested across a larger population.

Objective This scoping review aimed to identify the design and usability testing of a telerehabilitation (TR) system, and its characteristics and functionalities that are best-suited for rehabilitating adults with chronic diseases. Methods Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O’Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members. Results A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the “input-process-output” framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users’ needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively. Conclusion This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified “input-process-output” framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the “moderated-unmoderated” model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.

Introduction: Studies have shown that exercise increases angiogenesis and perfusion in the hippocampus, activates neurogenesis in the dentate gyrus and increases synaptic plasticity, as well as increases the complexity and number of dendritic spines, all of which promote memory function and protect against cognitive decline. Flavonoids are gaining attention as antioxidants in health promotion due to their rich phenolic content, particularly for their modulating role in the treatment of neurodegenerative diseases. Despite this, there has been no comprehensive review of cognitive improvement supplemented with flavonoid and prescribed with exercise or a combination of the two interventions has been conducted. The purpose of this review is to determine whether a combined intervention produces better results when given together than when given separately.Methods: Relevant articles assessing the effect of physical exercise, flavonoid or in combination on cognitive related biomarkers and neurobehavioral assessments within the timeline of January 2011 until June 2023 were searched using three databases; PubMed, PROQUEST and SCOPUS.Results: A total of 705 articles were retrieved and screened, resulting in 108 studies which are in line with the objective of the current study were included in the analysis.Discussion: The selected studies have shown significant desired effect on the chosen biomarkers and neurobehavioral assessments.Systematic Review Registration: identifier: [CRD42021271001].

Background: In Malaysia, the increasing prevalence of physical inactivity is alarming. The effects of adopting a sedentary lifestyle have led to health problems such as coronary heart disease and type II diabetes mellitus, as well as increased mortality rates. Young adults, including tahfiz students, tend to be physically inactive due to much time spent sitting during lectures or studying. Therefore, an active lifestyle must be encouraged. This study aims to identify the factors that influence tahfiz students to exercise. Methods: Data from 12 male and 19 female students were collected through in-depth interviews, which were recorded and transcribed into text then subjected to thematic analysis. Results: Results show that the main motivations to exercise were body health and fitness, self-appearance, and sense of togetherness. The main themes for barriers were aversion to exercise time and commitment. In general, respondents preferred a moderate, 10–30 minute group sessions for 3–5 times per week. Conclusions: This study revealed five themes for motivations (body health and fitness, psychological wellbeing, appearance, physical support, and enforcement), and six themes for barriers to exercise (aversion to exercise, time, commitment, discomfort, no motivation, and the environment). These factors could be considered in exercise module development to improve students’ engagement.

Background: Malaysia has the highest prevalence of obesity among Southeast Asian countries, and the current number is expected to increase further. In particular, the rate of obesity is reportedly increasing among females and young adults in Malaysia. Modern lifestyle habits, which include night eating and poor sleep quality, have been shown to increase the risk of obesity and high body fat. This study aims to determine the link between female university students’ body composition and their night eating habits and sleep quality. Methods: Body composition was measured using a Bioelectrical Impedance Analysis (BIA) analyzer. Night eating syndrome and sleeping pattern and quality were determined using the Night Eating Questionnaire (NEQ) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Results: A total of 112 female students participated in this study, the majority (66.1%) of whom were categorized as having normal weight. Their body fat percentages (28.0 ± 6.1) were found to be lower than the standard value for Asian women. Most of the subjects were categorized as having normal night eating (93.8%) and poor sleep (76.8%) patterns. The correlation analysis results indicated significant relationships between sleep quality and night eating habit and body weight. Furthermore, analysis using binary logistic regression showed a protective relationship between muscle mass and sleeping habit. Conclusions: This study showed that the majority of the university students had poor sleep quality. This is an alarming finding. Therefore, further investigations on factors related to poor sleep quality among young adults are required.

IntroductionAging is associated with physiological changes in multiple systems in the body and may impact the transportation choices of older adults. In this study, we examine the associations between biopsychosocial factors and the transportation choices of Malaysian older adults.MethodsOne hundred and nineteen (119) older adults, aged 60 and above, living in Klang Valley, Malaysia were recruited for this cross-sectional study. Participants were interviewed face-to-face to obtain sociodemographic data, health status (whether there were and, if yes, the number of comorbidities), outdoor mobility and transportation patterns, Instrumental Activity Daily Living (IADL) status and cognitive function. Participants’ physical performance (dominant handgrip strength, 10-m walk, and timed up and go tests), hearing threshold (pure tone audiometry), and vision function (visual acuity, contrast sensitivity) were measured. Transportation patterns of older adults were categorized into three groups, that is, flexible (using public transport and/or private vehicles), using only private vehicles and restricted (relying on others or walking).ResultsFurther information is needed to enable such older adults as older women, those with comorbidities and poorer functional status to access transportation, especially to meet their health care needs.DiscussionThe majority (51%) of participants were in the ‘using only private vehicles’ group, followed by the ‘flexibles’ (25%) and the ‘restricted’ (24%). Factors significantly associated with the restricted transportation group were: (a) being female (AdjOR 15.39, 95% CI 0.86–23.39, p

Introduction: Cardiovascular health contributes significantly to the incidence of cognitive impairment. Prior to conducting exercise-related intervention, it is crucial to explore cardiovascular health blood parameters that have been commonly used as guidance for the purpose of monitoring. Information on the effectiveness of exercise on cardiovascular-related biomarkers is lacking, especially among older adults with cognitive frailty. Therefore, we aimed to review existing evidence on cardiovascular-related blood parameters and their changes following exercise intervention among older adults with cognitive frailty.Methods: A systematic search was conducted on PubMed, Cochrane, and Scopus databases. Related studies involving only human and full text in either English or Malay language were selected. Types of impairment were limited to cognitive impairment, frailty, and cognitive frailty. Studies were restricted to randomized controlled trial and clinical trial design studies. For charting purposes, all variables were extracted and tabulated. Trends in types of parameters studied were explored.Results: A total of 607 articles were screened, and the final 16 were included in this review. Four cardiovascular-related blood parameter categories were extracted: inflammatory, glucose homeostasis, lipid profile, and hemostatic biomarkers. The common parameters monitored were IGF-1 and HbA1c, glucose, and insulin sensitivity in some studies. Out of the nine studies on inflammatory biomarkers, exercise interventions showed a reduction in pro-inflammatory markers, namely, IL-6, TNF-α, IL-15, leptin, and C-reactive protein and an increase in anti-inflammatory markers, namely, IFN-γ and IL-10. Similarly, in all eight studies, glucose homeostasis-related biomarkers had improved with exercise intervention. The lipid profile was tested in five studies, with four studies showing improvements with exercise intervention via a decrease in total cholesterol, triglycerides, and low-density lipoprotein and an increase in high-density lipoprotein. A decrease in pro-inflammatory biomarkers and an increase in anti-inflammatory biomarkers were demonstrated with multicomponent exercise, including aerobic exercise in six studies and aerobic exercise on its own in the remaining two studies. Meanwhile, four out of six studies that yielded improvements in glucose homeostasis biomarkers involved only aerobic exercise and the remaining two studies involved multicomponent with aerobic exercise.Conclusion: The most consistent blood parameters studied were glucose homeostasis and inflammatory biomarkers. These parameters have been shown to improve with multicomponent exercise programs, particularly with the inclusion of aerobic exercise.

Background: Non-pharmacological management of hypertension includes weight loss, alcohol and sodium restriction, regular exercise, and relaxation. In people with overweight hypertension, systolic blood pressure (SBP) and diastolic blood pressure (DBP) can be decreased via exercise and weight loss together. Breathing exercises are one method of relaxing.Objectives: The aim of this scoping review is to map the information that is currently available about the advantages of breathing exercises in decreasing blood pressure in hypertension patients.Methods: This scoping review adheres to Arksey and O’Malley’s framework, which entails identifying review questions, seeking pertinent evidence, choosing pertinent studies, mapping data, and discussing, concluding, and reporting the findings. The PRISMA flowchart is used to show how the evidence search process works.Results: As a result, 339 articles in total were retrieved from the three databases. 20 papers total were included in this review after screening. In 14 of the 20 investigations, participants with stage 1 and stage 2 essential hypertension, two with pre-hypertension, and four with Isolated Systolic Hypertension (ISH) were studied. The respondents’ ages ranged from 18 to 75. The systolic blood pressure declined by 4–54.22 mmHg, while the diastolic blood pressure dropped by 3–17 mmHg.Conclusion: Slow breathing can be used as an alternate, non-pharmacological therapy for hypertension individuals to reduce blood pressure.Systematic Review Registration: (https://osf.io/ta9u6/).

Background: The process of memorizing various reading materials enhances the brain capacity to process, store, and assemble memories and increases the intelligence quotient (IQ) level. However, the connection between the memorization of Quran and the enhancement of memory level is not fully understood. Hence, a cross-sectional study was conducted to examine the correlation between Quran memorization and the IQ level among Muslim adolescents from selected Islamic schools in Selangor, Malaysia. Methods: The Wechsler Abbreviated Scale of Intelligence was used to measure the student’s IQ level, whereas Digit Span and Rey Auditory Verbal Learning Test were used to evaluate the memory level. Questionnaires were distributed for demographic data collection and the Quran memorization level. Results: The full-scale results for all the four sub-tests revealed that the studied tahfiz students had a low average level of IQ, with a mean of 88.06 ± 15.80. For the short-term verbal memory, the majority (n = 36, 56.3%) were in the normal category, whereby for long-term verbal memory, the majority (n = 20, 31.3%) were below normal. The results showed that the IQ level was non-significant (p = 0.059) but moderately correlated (r = 0.391) with the level of Quran memorization. The coefficient of determination or effect size calculation showed that Quran memorization shared 15.29% of the variability in the IQ level. Multiple linear regression analysis revealed that only the working memory is significant to predict the IQ. Provided that other influencing factors are constant, an increase of one unit in the working memory was predicted to increase 5.55 units of IQ. Conclusions: In conclusion, the level of Quran memorization was not significantly correlated with the IQ and memory status of Muslim adolescents from the selected Islamic schools in Selangor, Malaysia.

Objectives: Listening to or memorizing the Quran has been suggested to affect the psychosocial health and well-being of Muslims. Muslims who memorized Quran have a higher quality of life (QoL) and lower anxiety and stress. Hence, this systematic review was conducted to evaluate the studies that assessed the effect of listening to, reciting, or memorizing the Quran on physical and mental health.Methods: This review was performed on articles published from the inception and April 2021. Databases including ProQuest, PubMed and Web of Science were searched on 19 April 2021. Keywords such as “Quran”, “al- Quran,” “al- Kareem,” “Holy Quran,” “memori,” “Tahfiz,” “Huffaz,” “listening” and “reciting” were used for databases searching. The risk of bias was assessed using Cochrane risk of bias tool and Joanna Briggs Institute (JBI). Only 20 articles were included in data synthesis out of a total of 230.Results: The findings revealed that listening to, reciting or memorizing the Quran had a favorable effect on depression, anxiety, physiologic parameters, quality of life, quality of sleep and intelligence quotient.Conclusion: The current evidence suggests that, listening to, reciting or memorizing the Quran may be useful as an intervention to improve physical and mental health.

Objectives This scoping review aims to identify the level of willingness, the existing barriers, and motivators among older adults in using mobile applications to monitor and manage their health conditions. The secondary aim of this paper is to categorise these willingness, barriers and motivators using the Theoretical Domains Framework (TDF).Design Scoping review.Data source PubMed, Embase, CINAHL, Cochrane Library, Google Scholar and Science Direct (January 2009–December 2020).Study selection Studies that describe older adults’ perspectives with regard to their willingness, barriers or motivators towards the use of mobile applications in monitoring and managing their health condition were included.Data extraction Titles and abstracts were initially screened by two reviewers. Articles agreed by both reviewers were proceeded to full-text screening. One reviewer extracted the data, which were verified by a second reviewer. Findings were further classified according to the 14 TDF domains by two researchers.Results Six studies were included in the final scoping review. Barriers to adopting mobile applications for health-related interventions among older adults were the most common topic identified in the included studies. Barriers included being unaware of the existence of mobile health applications, lack of technological skills, lack of perceived ability and time, absence of professional involvements, and violation of trust and privacy. With regard to willingness, older adults are willing to use mobile applications if the apps incorporated features from a trusted source and have valid credentials. Motivators included continuous improvements of mobile applications’ design interface and personalised features tailored to older adults’ needs.Conclusions With the constant research for more diversified technology, the development of mobile applications to help older adults to manage and monitor health is seen as feasible, but barriers have to be addressed. The most prominent barriers linked to TDF domains were: (1) technological skills, (2) belief about consequences, and (3) memory, attention and decision process. Future interventions should use behaviour change techniques that target these three TDF domains in order to improve the ability to engage older adults with mobile technology.

Introduction The decreasing level of physical activity among female undergraduates is worrying as it is associated with the increased risk of non-communicable diseases. Thus, this study aimed to identify the motivations, barriers and preferences towards exercise among female undergraduates in Malaysia. Methods A non-probability purposive sampling was used for the recruitment process. The inclusion criteria of the participants were registered female undergraduates and aged between 18–30 years old. A semi-structured in-depth interview was used to collect topic-related information from the participants and signed consents were obtained prior to the interview. The interview questions were on respondents’ understanding of exercise, motivation and barriers to exercise, and exercise preferences. The recruitment process was conducted until the data was saturated. All interviews were audio recorded and manually transcribed verbatim. NVivo 11 was used to conduct the inductive analysis of the data to develop themes for motivation and barriers to exercise. For exercise preferences, four predetermined themes were used. Findings A total of 26 respondents participated in this study. Eight themes were found for motivation to exercise, with the most common themes being maintaining or improving appearance, health benefits and togetherness. For barriers of exercising, five themes were found, and the most common ones were disliking exercise and no motivation. For exercise preferences, most respondents preferred a structured exercise program with flexibility in terms of when and where the exercise could be conducted. Light or moderate intensity exercise for 10–30 minutes with a frequency of 1–2 times a week was desired the most among the respondents. Conclusion In conclusion, personal and environmental factors play important roles in motivating or hampering female undergraduates to exercise, and a structured program was the preferred mode of exercise of these respondents. A new exercise module was designed based on this needs assessment with a 70% acceptance rate among the participants. These findings can help the future development of more exercise modules tailored to female university students.

Abstract Background Poverty at old age is associated with poor dietary habit, nutritional status and higher rates of chronic diseases and psychosocial problems. However, there is limited information about this matter according to urban and rural settings. The aim of this study was to identify dietary, nutritional, physical and cognitive factors associated with poor socioeconomic status (SES) among older adults according to urban and rural settings in Malaysia. Methods An analysis was conducted among 2237 older adults who participated in a longitudinal study on aging (LRGS TUA). This study involved four states in Malaysia, with 49.4% from urban areas. Respondents were divided into three categories of SES based on percentile, stratified according to urban and rural settings. SES was measured using household income. Results The prevalence of low SES was higher among older adults in the rural area (50.6%) as compared to the urban area (49.4%). Factors associated with low SES among older adults in an urban setting were low dietary fibre intake (Adj OR:0.91),longer time for the Timed up and Go Test (Adj OR:1.09), greater disability (Adj OR:1.02), less frequent practice of caloric restriction (Adj OR:1.65), lower cognitive processing speed score (Adj OR:0.94) and lower protein intake (Adj OR:0.94). Whilst, among respondents from rural area, the factors associated with low SES were lack of dietary fibre intake (Adj OR:0.79), lower calf circumference (Adj OR: 0.91), lesser fresh fruits intake (Adj OR:0.91), greater disability (Adj OR:1.02) and having lower score in instrumental activities of daily living (Adj OR: 0.92). Conclusion Lower SES ismore prevalent in rural areas. Poor dietary intake, lower fitness and disability were common factors associated with low in SES, regardless of settings. Factors associated with low SES identifiedin both the urban and rural areas in our study may be useful inplanning strategies to combat low SES and its related problems among older adults.

Abstract Background Motoric cognitive risk (MCR) syndrome is characterized by slow gait and memory complaints that could be used to predict an increased risk of dementia. This study aims to determine the MCR syndrome and its risk factors among low-income (B40) older adults in Malaysia. Methods Data from TUA cohort study involving 1366 older adults (aged 60 years and above) categorized as low-income were analysed, for risk of MCR syndrome based on defined criteria. Chi-square analysis and independent t test were employed to examine differences in socioeconomic, demographic, chronic diseases and lifestyle factors between MCR and non-MCR groups. Risk factors of MCR syndrome were determined using hierarchical logistic regression. Results A total of 3.4% of participants fulfilled the criteria of MCR syndrome. Majority of them were female (74.5%, p = 0.001), single/widow/widower/divorced (55.3%, p = 0.002), living in rural area (72.3%, p = 0.011), older age (72.74 ± 7.08 year old, p

Research has proven that aerobic exercise improves glucose homeostasis among patients with type 2 diabetes mellitus (T2DM). Elastic resistance (tube or band) is suggested as a good alternative for home-based strength training among older adults including those with T2DM due to its low cost, simplicity, portability, and versatility. This study aimed to measure the effects of 16-week home-based progressive resistance training (PRT), using a resistance tube on glucose homeostasis and cardiovascular risk factors among older adults with T2DM. A total of 70 participants aged 61.68 (5.50) years with T2DM were assigned to the intervention ( n = 35) and control ( n = 35) groups in this quasi-experimental trial. The intervention group underwent 16 weeks of home-based PRT using a resistance tube. Significant improvements in HbA1c (−1.34% point, p < 0.001), fasting blood glucose (−1.30 mmol/L, p < 0.001), and systolic blood pressure (−1.42 mmHg, p < 0.05) were observed after 16 weeks of intervention. However, no significant changes were observed in lipid profile, diastolic blood pressure, resting heart rate, and ankle–brachial index. The finding suggests that 16 weeks of home-based PRT using a resistance tube has the potential to improve glycemic control and reduce systolic blood pressure among older adults with T2DM and caused no adverse events.

Aim : The goal is to explore available evidence and provide greater clarity to what is described as psychosocial intervention to improve cognitive function among older population with MCI as well as identifying areas for future research. Methods : An electronic literature search of PubMed, Cochrane, Ebscohost, Medline, Scopus, and gray resource was conducted to find articles published in English language between 2010 and September 2020. This review focused on research undertaken using randomized clinical trials study design. We extracted information regarding the publication date, geographical location, study setting, intervention mechanism, type of cognitive measurement used, and outcome of the studies. References of this literature were also reviewed to ensure comprehensive search. Result : Out of 240 potential records found, a total of 27 articles were identified following the first round of screening and deletion of duplicates. Full-text article reviews and analysis in the second round of screening narrowed the selection down to four articles. Another three relevant articles obtained from references were also included making a total of seven articles in the final analysis. Findings : Psychosocial intervention strategies for improvement of cognitive function, done in various setting all over the globe, covered a range of approaches including art therapy, visual art therapy, therapeutic writing therapy, reminiscence activity, and cognitive behavioral approach. Most were conducted in weekly basis within 1-to-2-hour duration of session. Cognitive function of older adult in psychosocial intervention group was significantly improved in two studies. Three studies showed no significant improvement at all in the cognitive function, and another one reported success in improving cognitive function over time in the intervention group than in control group. One study did not describe the interaction effect. Different types of cognitive measurement also were used to quantify different domains of cognitive function in the reviewed studies. Conclusion : The idea of using psychosocial intervention for improving cognitive function has begun to increasingly accepted recently. Findings from the limited studies are encouraging, although the outcome of the cognitive function was mixed. Large-scale and longer duration of psychosocial intervention with bigger sample size is warranted for future studies.

Background: Over the years, global salt intake has increased and has resulted in the escalation of cardiovascular diseases and hypertension. The lack of knowledge, as well as poor attitude and practice, are the main reasons that have led to high salt intake. Therefore, this study aims to evaluate the knowledge, attitude and practice (KAP) towards salt intake and health among non-academic staff of the Faculty of Health Sciences (FSK), Universiti Kebangsaan Malaysia (UKM). Methodology: This cross-sectional study was conducted among the non-academic staff of the Faculty of Health Sciences (FSK), Universiti Kebangsaan Malaysia (UKM). The respondents were recruited using stratified random sampling technique with an informed consent. A validated questionnaire to test the knowledge, attitude and practice (KAP) towards salt intake and health by the Ministry of Health Malaysia was converted into a Google form and the link was emailed to 118 participants. A total of 33 responses were obtained for evaluation. The significant values were set as P < 0.05. Results: It was observed that female participants had better attitudes towards salt intake and health compared to males (p = 0.044). Also, individuals with higher education levels had better attitudes towards salt intake and health, compared to those with lower education levels (p=0.009). However, knowledge and practice of salt intake and health bore no significant results when considering gender, education level and age. Discussion and Conclusion: Overall, this study has identified sociodemographic characteristics as contributing factors towards individuals’ attitude on salt intake and health. This may provide a crucial foundation in the development of cost-effective healthcare programs to widen knowledge, create awareness and promote a healthy lifestyle by reducing salt intake and further reduce the prevalence of non-communicable diseases.

Background: Time management is one of the factors that may influence students’ academic performance in university. A cross-sectional study was carried out to evaluate the role of motivation camp programme towards time management among first-year undergraduate students of the Biomedical Science Programme, Universiti Kebangsaan Malaysia (UKM) by using a questionnaire. Methods: A total of 32 students was categorized into group 1 and group 2 (n=16 per group), with group 1 is students who did not attend the motivational camp and group2 participated in the camp. Their academic performance in terms of Grade Point Average (GPA) was evaluated in semester 1 and 2 of the 2017/2018 session. A correlation test between total study hours and GPA in both semesters showed a weak correlation for group1 and group2. Independent T-test was also carried out to compare time management and GPA. Results: There is no significant difference between group1 and group2 in time planning; however, there is a significant difference (p

Exaggerated cardiovascular reactivity to and delayed recovery from stress increase the risk of cardiovascular diseases in the future. While exercise training has been shown to attenuate stress-induced cardiovascular reactivity and enhance recovery from stress, the effects with acute exercise are less characterized. The aim of this scoping review was to explore the range and characteristics of published evidence regarding acute exercise on cardiovascular reactivity and stress recovery. The secondary objective was to highlight research gaps and implications for future research. A total of 36 articles met the review inclusion/exclusion criteria, involving 1200 participants from various age groups, fitness and health status. Blood pressure (BP) reactivity was the most measured outcome, followed by heart rate (HR) reactivity, and to some extent, heart rate variability. Overall, acute exercise particularly of the moderate-intensity aerobic type effectively reduced stress-induced BP reactivity in the general population. The effects on HR reactivity and cardiovascular recovery were inconclusive. Further research would be recommended to establish if other forms of exercise intensity or type are equally beneficial to lower exaggerated cardiovascular responses to stress. Despite methodological differences and limitations, the available evidence supports the therapeutic potential of acute exercise in addressing the ill effects of stress on cardiovascular health.

Introduction The world’s older population continues to grow at an unprecedented rate. An ageing population poses a great challenge to our healthcare system that requires new tool to tackle the complexity of health services as well as the increasing expenses. Mobile health applications (mHealth app) is seen to have the potential to address these challenges, alleviating burdens on the healthcare system and enhance the quality of life for older adults. Despite the numerous benefits of mHealth apps, relatively little is known about whether older adults perceive that these apps confer such benefits. Their perspectives towards the use of mobile applications for health-related purposes have also been little studied. Therefore, in this paper, we outline our scoping review protocol to systematically review literature specific to older adults’ willingness, perceived barriers and motivators towards the use of mobile applications to monitor and manage their health.Methods and analysis Arksey and O’Malley’s scoping review methodology framework will guide the conduct of this scoping review. The search strategy will involve electronic databases including PubMed, Excerpta Medica Database, Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Google Scholar and ScienceDirect, in addition to grey literature sources and hand-searching of reference lists. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Data will be charted and sorted through an iterative process by the research team. The extracted data will undergo a descriptive analysis and simple quantitative analysis will be conducted using descriptive statistics. Engagement with relevant stakeholders will be carried out to gain more insights into our data from different perspectives.Ethics and dissemination Since the data used are from publicly available sources, this study does not require ethical approval. Results will be disseminated through academic journals, conferences and seminars. We anticipate that our findings will aid technology developers and health professionals working in the area of ageing and rehabilitation.